Neoplasia distal to the splenic flexure in patients with proximal colon cancer☆,☆☆,★,★★

https://doi.org/10.1016/S0016-5107(96)70125-6Get rights and content

Abstract

Background: Current American Cancer Society recommendations are that persons aged 50 years or older undergo screening flexible sigmoidoscopy every 3 to 5 years. In clinical practice, persons with adenomas at sigmoidoscopy are generally referred for full colonoscopy. However, cancers proximal to the splenic flexure may not be accompanied by neoplasia distal to the splenic flexure. Methods: In order to estimate how often screening flexible sigmoidoscopy would be negative in persons with proximal cancer, we retrospectively reviewed 2053 consecutive colorectal cancer cases diagnosed from 1988 to 1994. Seven hundred ninety-nine (38.9%) had tumors proximal to the splenic flexure. We selected 358 study cases based on full colonoscopy performed and the colonoscopy reports available. Results: Colonoscopy demonstrated distal adenomas in 77 cases (21.5%): 29 (8.1%) had hyperplastic polyps only, 4 (1.1%) had synchronous cancer, and 248 (69.3%) had no distal polyps. In this population, 77.4% of patients with proximal colon cancer had no distal neoplasia. We estimate that 30% of all patients with colorectal cancer would have a negative screening flexible sigmoidoscopy. Conclusions: Prospective evaluation of colonoscopic findings in persons with proximal cancers is needed. Ongoing evaluation of colonoscopy as a general screening test is appropriate. (Gastrointest Endosc 1996;44:109-11.)

Section snippets

METHODS

Cases were identified at nine central Indiana Hospitals (one university hospital and eight community hospitals) over the interval 1988 to 1994. Using a tumor registry at each hospital, all colorectal cancer cases during the interval 1988 to 1994 were identified. Proximal colon cancer was defined as proven adenocarcinoma proximal to, but not including, the splenic flexure.

Data acquisition was through complete medical record review by gastroenterology fellows. The inclusion criteria for the study

RESULTS

A total of 2053 cases of colorectal cancer were identified and complete medical records reviewed. Of these cases, 799 (38.9%) were located proximal to the splenic flexure.

Three hundred twelve cases were excluded because colonoscopy was never performed (diagnosis made by barium enema, CT scan, or at the time of surgery). One hundred twenty-three cases were excluded because colonoscopy was performed outside the hospital and the report was not available. There were 6 cases of failure to “clear”

DISCUSSION

This study represents the largest reported collection of patients with proximal colon cancer in which the findings of colonoscopy distal to the tumor have been described (Table 2). We found that less than one quarter of proximal colon cancers were accompanied by distal colonic neoplasms. This result is similar to that in previous reports (Table 2).

Flexible sigmoidoscopy reaches the splenic flexure in 16% of cases and usually reaches the sigmoid descending junction.5 Thus in general, neoplasia

References (22)

  • HB Chodash et al.

    Are rectosigmoid polyps a sensitive marker for proximal colon cancers?

    Gastrointest Endosc

    (1990)

    • Cited by (0)

    ☆

    From the Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.

    ☆☆

    This work was funded in part by an Endoscopic Research Award from the American Society for Gastrointestinal Endoscopy

    ★

    Reprint requests: Douglas K. Rex, MD, Indiana University Hospital, 550 North University, UH 2300, Indianapolis, IN 46202.

    ★★

    37/1/71780

    View full text
    Copyright © 1996 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.