Adenocarcinoma of the Large Bowel

Pathological features of 656 consecutive large bowel adenocarcinomas resected at the Middlesex Hospital in the 10-year period 1951-61 have been studied, comparing right and left colon and rectum. A change in sex distribution from a majority of females in right colon cases to a small male majority in rectal cases was found. High grade and colloid tumours were more frequent in the right colon than elsewhere in the large bowel. The proportion of patients with advanced tumours was also higher in the right colon. Adenomatous polyps were found in 24·5% of resected specimens and 31 of these (19%) had more than one carcinoma. The overall corrected 5 year survival rate was 50·7% for those with right colon tumours, 66·9% for those with growths of the left colon and 56·7% for those with tumours in the rectum. The effect of Dukes stage and of histological grade on prognosis was similar in colon and rectum. Females fared better than males at all sites and had a lower operative mortality. The effect of extent of local spread on survival in Stage B cases was studied. An increasing operative mortality and a steady worsening of prognosis with increased local spread was found.