Carcinoma of the colon secondary to chronic ulcerative colitis

Summary

In Case I there was no evidence of carcinoma in the cecum and ascending colon at the time of the first hospitalization and ileostomy. Subsequent developments illustrate the necessity of frequent X-ray studies in such cases. When warning symptoms appear, such as an increase in pain, change from tenesmus to steady dull pain, increased bleeding or massive hemorrhage, obstruction, cachexia or marked anemia, malignancy should be suspected.

In Case II attention was called to the malignant change by massive hemorrhages and X-ray evidence of a proliferative lesion in the transverse colon. The second adenocarcinoma developing in the sigmoid, and the malignant polyp in the cecum found at the time of colectomy, demonstrate the value of colectomy. This case also demonstrates the importance of repeated proctoscopic and X-ray studies of patients having chronic ulcerative colitis. If multiple polyps are found, serious consideration should be given to immediate colectomy.

The ages of the two patients reported were 32 and 43 years. These ages are in accord with recorded evidence that carcinoma develops earlier in patients with chronic ulcerative colitis than in patients without colitis. The presence of three separate carcinomas in the second case, one of which was known to be a malignant polyp, suggests that the carcinoma in this case developed from polyps rather than pseudopolyps.