Summary
The records of 1258 patients with ulcerative colitis who were seen at the Cleveland Clinic in the years 1950 through 1963 were reviewed. Twenty-four cases of carcinoma of the colon were found, an approximate overall incidence of 1.9%. Of these 24 patients, 15 died of the carcinoma; 1 patient died of an unrelated condition, and 8 patients are living and well.
Carcinoma was found to occur in patients with ulcerative colitis at an age earlier than that at which colonic malignant lesions develop in persons without colitis. The mean age of diagnosis of colonic carcinoma was 40.7 years. The mean interval between the onset of colitis and the time of diagnosis of colonic carcinoma was 18.3 years. Ten of the 24 patients had multiple carcinomas, including 3 with multifocal lesions of carcinoma in situ. Of 29 separate carcinomas found, 14 were in the rectosigmoid. The most frequent symptoms of neoplasm simulated those of an exacerbation of the colitis, and included diarrhea, abdominal pain, rectal bleeding, and weight loss. The unreliability of roentgenographic diagnosis of colonic carcinoma in association with colitis was re-emphasized by our study, as 6 of 13 potentially diagnosable lesions were missed. Carcinoma of the colon arising in patients with long-standing ulcerative colitis is a serious hazard, but is not so frequent as has been suspected. However, the physician who treats the patient with ulcerative colitis should be wary of new symptoms and should manage them vigorously with appropriate diagnostic and therapeutic procedures. In this manner, carcinoma may be detected early, and survival rates may be improved.
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A portion of this paper was presented at the fall meeting of the American College of Physicians, Los Angeles, Calif., Oct. 9, 1964.
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Diaz, R.J., Farmer, R.G. & Brown, C.H. Carcinoma of the colon and ulcerative colitis. Digest Dis Sci 10, 643–656 (1965). https://doi.org/10.1007/BF02237639
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DOI: https://doi.org/10.1007/BF02237639