Multiple malignant tumors of the colon and rectum

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Abstract
THIS REPORT is based on the records of 641 patients who underwent operations for malignancy of the colon and rectum at the Municipal Postgraduate School of Surgery in Buenos Aires, and private clinics, from 1952 to 1963. Multipte involvement of the gastrointestinal tract by malignancy is not uncommon, and the colon and rectum are the most frequent sites of this coincidental phenomenon. Primary multiple malignancy occurs synchronously when two or more neoplasms originate simultaneously. When there is a long interval between the appearance of the multiple lesions, they are said to be metachronous or asynchronous. Billroth I0 was the first to report cases of multiple carcinomas, and it was Czerny 16 who removed double carcinomas of the colon successfully for the first time. Billroth established three criteria to identify these independent tumors: 1) They must be characterized by different histologic structure so that it can be determined definitely that the lesions are of different origin; 2) Each neoplasm must develop from its parent epithelium; and 3) Each lesion must metastasize independently. The strictness of these criteria pi:obably was responsible for a low incidence 4 which, in all likelihood, is false because two cancers with the same histologic features may occur independently of each other. The criteria laid down by Warren and Gates3S are more logical. They require that each * Read by title at the joint meeting of the American Proctologic Society and the Section of Proctology of the Royal Society of Medicine, Philadelphia, Pennsylvania, May 9 to 14, 1964.

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