HOW CAN OUTLOOK IN ALIMENTARY TRACT CANCER BE IMPROVED

Consistent early recognition of cancer of the large bowel is the only manner in which the present accomplishment can be achieved and improved. In patients who are good operative risks, near total or total colectomy should find wider acceptance among surgeons. In such patients, the operation can be performed with risks not out of line with the mortality of segmental resection for colon cancer (approximately 5 per cent). The disparity in accomplishment in Dukes' class A and C lesions is striking. Our experience indicates that second look procedures can salvage a number of patients in the class C (17 per cent). Our experience suggests the need for annual re-examination of all patients having undergone prior excision of cancer of the colon. A new cancerous lesion of the colon was observed in three patients thirteen to eighteen years after the initial operation. Clinicians need to regard the remaining colonic mucosa of patients with cancer of the colon as potential bearers of new cancer. Some prophylaxis is provided against recurrent colonic cancer in patients undergoing primary near total colectomy for the initial cancerous lesion. The experience of our Cancer Detection Center suggests definitely that when annual proctoscopic examination in all patients of forty-five years or more finds wide acceptance, the mortality from rectal cancer may begin to exhibit features of the decline in mortality attending wide application of the Papanicolaou test for cervical cancer. Although convincing histologic evidence is wanting of transformation of benign adenomatous polyps into invasive cancer, surgical elimination of such benign lesions in patients observed in our Cancer Detection Center was followed by a striking reduction in the anticipated occurrence of rectal cancer (72 per cent), followed in turn by a lesser need for radical operative procedures. Consistent early recognition of cancer of the colon awaits development, refinement, and wider application of more precise roentgeno-graphic technics. © 1967.