The recto colonic neoplasm diagnosis

The rectocolonic neoplasm diagnosis is made by the following diagnostic procedures:

• rigid rectoscopy
• flexible rectosigmoidoscopy
• colonoscopy
• irigography
• hemoccult test

Rigid rectoscopy requires a rigid metallic rectoscope and allows the examination of approx. 20-25 cm of the rectosigmoid. The device is not expensive, the technique is easy and it allows the diagnosis of rectal cancer. In addition to the anal examination and anoscopy (which diagnose the pathology of the anal channel and rectal ampoule), it may correctly evaluate the distal region of digestive tube.

Flexible rectosigmoidoscopy uses the flexible sigmoidoscope for the diagnosis. It allows the exact evaluation of the left colon (most often up to the splenic angle of colon), where 70-80% of colon neoplasms are only two enemas and the discomfort of the patient is not very high.

Barium enema evidences the colon by retrograde fulgilling of colon with barium. The double contrast technique is useful. It does not allow biopsy from suspect lesions and it does not allow therapeutic measures. The technique is the most widespread method of colon evaluation, but gas a diagnostic sensibility clearly inferior to the colonoscopy.

In the future it is anticipated the using of CT spiral (virtual colonoscopy) to reconstruct the colon and to diagnose the neoplasia or big polyps). Also in some dedicated centers, the abdominal ultrasound examination and especially hydrosonography may sometimes diagnose the colon neoplasm. Echoendoscopy allows the evaluation of the extension in layers of the neoplasm.

The Hemoccult test allows the determination of occult hemorrhages in the stool. It is rather a screening test, in general population; it helps to discover suspect persons that will be afterwards examinated endoscopically. The Hemoccult test is recommended every year, generally after 50 years of age. The Hemoccult test II, more modern, does not require special preparation and has a superior sensibility.

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The predisposing causes for the colon neoplasm

The predisposing causes for the colon neoplasm are:

• colocrectal polyps
• familial colic polyposis
• inflammatory bowel disease
• familial predisposition
• Lynch syndrome

Colorectal polyps represent a frequent situation in the gastroenterological practice, almost 10% of people 50 years - old and up to 30% of people over 70 years present colonic polyps. These polyps may be adenomatous (adenoma) and hyperplastic.


Adenomatous polyps (real polyps) are of many histological types: tubular, tubulo - villous and villous. The villous polyps have the most increased potential of malignity. The hyperplasic (inflammatory) polyps have no malignant potential.
The evolution of polyps towards malignity seems to be linked to genetic factors (familial), metabolic factors (the co- carcinogen effect of billiary acids) and alimentary factors (the negative effect of lack of vegetables and fibers). The bigger the polyps are (generally over 2 cm diameters), the more numerous and the more severe dysplasia is found at biopsy, the highest is their malignant potential. Starting from these data concerning the relationship polyp - neoplasia, searching polyps by colonoscopy and the endoscopic polypectomia has become a necessity, because it is the best prophylaxis of rectocolic neoplasia.

Familial colic polyposis represents a pathological situation with a genetic character, defined by the presence of more than 100 polyps in the rectum and colon, appearing before the age of 30 years. The genetic transmission is autosomal - dominant and the evolution of polyps to cancer is the rule. Therefore, it becomes a necessoty to check - out actively the transmission is autosomal - dominant and the evolution of polyps to cancer is the rule. Therefore, it becomes a necessity to check - out actively the transmission in the affected families and the most precociously total colectomy, before the malignization.

Inflammatory bowel diseases with prolonged evolution increase the risc of colon neoplasm. This risk is of approx. 10% after 25 years of evolution in ulcero - hemorrhagic rectocolitis (becoming significant after more than 10 years of evolution). The risk is smaller in Chron's disease with prolonged evolution.

Familial predisposition represents an increased risk for the descendants of a family with colon cancer (the frequency of cancer is 2-3 times bigger in first - degree relatives).

The Lynch syndrome or the hereditary nonpolypoidal colorectal cancer (without the intermediate state of polyp and with important hereditary involvement) is characterized by presence in more members of a family, the apparition of cancer at young age and frequently associates other neoplasms (the most eften ovary and endometer).

The Amsterdam criteria for diagnosis of Lynch syndrome are at least 3 members of a family with diagnosis of colonic carcinoma, one of which must be a first-degree relative, in a generation; the transmission be done at two succesive generations and at least one of the casees to be diagnosed before 50 years.

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Esophagus Neoplasm Treatment and Evolution

It represent 15% of digestive cancers. Histological, most of them are epidermoid carcinomas.
It is more frequently met in men (men/ female ratio=3/1), the average age of apparition being 60-65 years.

Some definite etiologic factors (causes) are:

• cigarette smoking
• excess alcohol intake
• alimentary factors : proteic deficiency, low intake of vitamins A, B, C, nitrosamine excess, lack of zinc and molybdenum.
• other conditions: excessively hot liquids intake (tea), ion radiations exposure, infectious agents(Papiloma-virus), genetic factors.

There are also a series of pathological states predisposing to the onset of esophageal cancer:

• ENT cancers
• Barrett’s esophagus
• mega esophagus
• esophageal diverticula’s
• postcaustic stenosis
• peptic stenosis
• Plummer-Vilson syndrome(esophageal iron deficiency dysphagia)

There are aspects that are more pathological:

• they most frequently occur in the lower third (over 50%) and only 20% in the upper third
• macroscopically, the most frequent form is ulcero - vegetant
• microscopically, 90% are epidermoid(squamous) carcinomas. Other rare forms are adenocarcinoma, or very rarely, sarcoma, lymphoma, melanoma.

There are a series of clinic symptoms described, unfortunately they present only in phases when surgical treatment is surpassed: dysphagia, regurgitations, thoracic pains, weight loss, dysphonia.

The diagnosis is mainly endoscopic, with endoscopic biopsies; contrast radiographs may also be useful. Echoendoscopy is useful for the preoperatory staging, CT-scan as well.

Evolution of  esophageal cancer is rapid, with poor prognosis and 5 years-survival of only 5%.

Complications that might appear can worsen the prognosis: eg aspiration pneumonia, eso-bronchic fistula, perforations, hemorrhages.

The treatment has more possibilities:

1. Surgical- the best treatment, perform an esophagectomy with minimum 5 cm above the superior pole of the lesion.
2. Radiation therapy - is a palliation method.
3. Chemotherapy – using Bleomycine,Cisplatine,5-fluorouracil.
4. Endoscopic:

• the mucosal endoscopic resection, mucosectomia – in incipient forms;
• photocoagulation using laser or autofluorescence – also in incipient cancers;
• edoscopic prosthesis – is a palliation method, used to increase life quality and treatment of dysphagia (in advanced cancers).
• endoscopic dilatation has the same purpose, but shorter-term effects.
• rechanneling of esophageal lumen with laser

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