The Chance of Cancer and Lymphatic Metastasis in Small Colon Tumors Discovered on X-ray Examination

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Abstract
The discovery of a radio-graphic shadow of a tumor of the colon more than 25 cm. from the anal margin and 1.0 cm. or more in diameter following barium enema examination presents the patient with a risk of death from cancer greater than the risk of removal by abdominal operation, unless this risk has been increased because of the patient''s age or poor condition. In 941 cleared specimens of cancers of the colon and rectum statistically significant relationships were demonstrated between the size of the cancers and the incidence of lymph node metastasis. In cancers of the colon more than 25 cm. from the anal margin, lymph node metastasis did not occur in any of the 11 cancers less than 1.5 cm. in diameter. However, in the next higher diameter range, 1.5 to 1.9 cm., two of 11 cancers did have metastases. In the colon and rectum together lymph node metastasis did not occur in any of the 16 cancers less than 1.5 cm. in diameter, but in the 1.5 to 1.9 cm. range, five of 23 cancers did have metastases. Because of the danger of metastasis, resection should be done in most cases in small cancers of the colon, or rectum irrespective of their size. However if the cancer is limited to the head of a pedunculated polyp with a well-defined pedicle, local excision may be preferable in some cases, especially in lesions of the rectum.