Dissemination of cancer of the colon and rectum

Abstract

Summary Dissemination of cancer of the colon and rectum occurs through (1) local invasion, (2) lymphatic extension, (3) vascular extension, and (4) implantation or seeding. Following combined abdominoperineal resection for carcinoma of the rectum in 103 patients, perineal recurrences were observed in seven. In only two, however, were the recurrences due to implantation. Both of these had multiple recurrences. The first patient permitted removal of the initial recurrence but refused surgical removal of the second. The other patient had all three perineal recurrences removed and is clinically free of malignant disease three and one half years after the initial operation. Methods to control cancer dissemination, in addition to the usual surgical procedures have been discussed. These included the adjuvant use of systemic anticancer drugs, local irrigation of wounds with anticancer chemicals and ligation of the bowel above and below the lesion.