Cancer Res Treat.  2008 Jun;40(2):71-74.

Clinical Characteristics of Multiple Primary Colorectal Cancers

• Yoon JW
• Lee SH
• Ahn BK
• Baek SU

Abstract

PURPOSE: Although multiple primary colorectal cancer has been recognized as a significant clinical entity, its clinical and pathological features and its prognosis are still controversial. The purpose of this study was to clarify clinical and pathological features of multiple primary colorectal cancer.
MATERIALS AND METHODS
Among 1669 patients who underwent surgery for primary colorectal cancer from January 1997 to June 2005, 26 patients (1.6%) with multiple primary colorectal cancer were identified. We reviewed clinical characteristics including diagnostic interval, lesions, operating methods, and TNM stage, and we defined the index lesion as the most advanced lesion among the synchronous lesions. For the purposes of the study, the colon and rectum were classified into three segments. The right-side colon included the appendix, cecum, ascending colon, hepatic flexure, and transverse colon, and the left-side colon included the splenic flexure, descending colon, and sigmoid colon.
RESULTS
Of the 26 patients with multiple primary colorectal cancers, nineteen patients were male and seven patients were female, with a mean age of 61.5 years. Nineteen patients had synchronous colorectal cancers and seven patients had metachronous colorectal cancers. In the metachronous cases, the mean diagnosticinterval was 36.8 months. The site of the first lesion in metachronous colorectal cancers was the right colon in five cases (71.4%) and the left colon in two cases (28.6%), and the site of the second lesion was the rectum in six cases (55.5%), the right colon in three cases (33.3%), and the left colon in one case. The TNM stage of the second lesions in the metachronous colorectal cancers was stage II in four cases (57.1%), stage III in one case (14.3%), and stage IV in one case (14.3%). For the synchronous colorectal cancers, the operation methods were single-segment resection combined with endoscopic mucosal resection in five cases (26.3%), single-segment resection alone in six cases, two-segment resection in six cases, and total colectomy in two cases.
CONCLUSION
In metachronous colorectal cancers, the secondary lesions were later-stage cancer. Therefore, careful postoperative follow-up is necessary for patients who have undergone surgery for colorectal cancers. Further study of therapeutic modalities is important for synchronous colorectal cancers.

Keyword

Colorectal neoplasms; Multiple primary cancers; Synchronous; Metachronous

MeSH Terms

Appendix
Cecum
Colectomy
Colon
Colon, Ascending
Colon, Descending
Colon, Sigmoid
Colon, Transverse
Colorectal Neoplasms
Female
Follow-Up Studies
Humans
Male
Prognosis
Rectum

Reference

1. Welch JP. Multiple colorectal tumors. An appraisal of natural history and therapeutic options. Am J Surg. 1981; 142:274–280. PMID: 7258541.

2. Cunliffe WJ, Hasleton PS, Tweedle DE, Schofield PF. Incidence of synchronous and metachronous colorectal carcinoma. Br J Surg. 1984; 71:941–943. PMID: 6498470.

3. Takeuchi H, Toda T, Nagasaki S, Kawano T, Minamisono Y, Maehara Y, et al. Synchronous multiple colorectal adenocarcinoma. J Surg Oncol. 1997; 64:304–307. PMID: 9142187.

4. Chen HS, Sheen-Chen SM. Synchronous and "early" metachronous colorectal adenocarcinoma. Dis Colon Rectum. 2000; 43:1093–1099. PMID: 10950007.

5. Ueno M, Muto T, Oya M, Ota H, Azekura K, Yamaguchi T. Multiple primary cancer: an experience at the Cancer Institute Hospital with special reference to colorectal cancer. Int J Clin Oncol. 2003; 8:162–167. PMID: 12851840.

6. Wang HZ, Huang XF, Wang Y, Ji JF, Gu J. Clinical features, diagnosis, treatment and prognosis of multiple primary colorectal carcinoma. World J Gastroenterol. 2004; 15:2136–2139. PMID: 15237453.

7. Papadopoulos V, Michalopoulos A, Basdanis G, Papapolychroniadis K, Paramythiotis D, Fotiadis P, et al. Synchronous and metachronous colorectal carcinoma. Tech Coloproctol. 2004; 8:S97–S100. PMID: 15655657.

8. Oya M, Takahashi S, Okuyama T, Yamaguchi M, Ueda Y. Synchronous colorectal carcinoma: clinico-pathological features and prognosis. Jpn J Clin Oncol. 2003; 33:38–43. PMID: 12604723.

9. Moertel CG, Bargen JA, Dockerty MB. Multiple carcinoma of the large intestine: a review of the literature and a study of 261 cases. Gastroenterology. 1958; 34:85–98. PMID: 13501357.

10. Evers BM, Mullins RJ, Matthews TH, Broghamer WL, Polk HC Jr. Multiple adenocarcinoma of the colon and rectum. An analysis of incidence and current trends. Dis Colon Rectum. 1988; 31:518–522. PMID: 3391060.

11. Arai T, Sawabe M, Takubo K, Kanazawa K, Esaki Y. Multiple colorectal cancers in the elderly: a retrospective study of both surgical and autopsy cases. J Gastroenterol. 2001; 36:748–752. PMID: 11757746.

12. Rennert G, Robinson E, Rennert HS, Neugut AI. Clinical characteristics of metachronous colorectal tumors. Int J Cancer. 1955; 60:743–747. PMID: 7896438.

13. Kim YJ, Kim NK, Lee KY, Sohn SK, Min JS. Clinicopathologic characteristics of multiple primary colorectal cancer. J Korean Soc Coloproctol. 2002; 18:343–348.

14. Finan PJ, Ritchie JK, Hawley PR. Synchronous and 'early' metachronous carcinoma of the colon and rectum. Br J Surg. 1987; 74:945–947. PMID: 3664228.

15. Kaibara N, Kimura O, Nishidoi H, Miyano Y, Koga S. Intraoperative colonoscopy for the diagnosis of multiple cancers of the large intestine. Jpn J Surg. 1982; 12:117–121. PMID: 7109357.

16. Barillari P, Ramacciato G, De Angelis P, Gozzo P, Indinnimeo M, Valabrega S, et al. Effect of preoperative colonoscopy on the incidence of synchronous and metachronous neoplasms. Acta Chir Scand. 1990; 156:163–166. PMID: 2330795.

17. Johnson CD, Hara AK, Reed JE. Computed tomographic colonoscopy (Virtual colonoscopy): a new method for detecting colorectal neoplasms. Endoscopy. 1997; 29:454–461. PMID: 9342563.

18. Heald RJ, Bussey HJ. Clinical experiences at St. Mark's Hospital with multiple synchronous cancers of the colon and rectum. Dis Colon Rectum. 1975; 18:6–10. PMID: 1126258.

19. Passman MA, Pommier RF, Vetto JT. Synchronous colon primaries have the same prognosis as solitary colon cancers. Dis Colon Rectum. 1996; 39:329–334. PMID: 8603557.

20. Kimura T, Iwagaki H, Fuchimoto S, Hizuta A, Orita K. Synchronous colorectal carcinoma. Hepatogastroenterology. 1994; 41:409–412. PMID: 7851846.

21. Pagana TJ, Ledesma EJ, Mittelman A, Nava HR. The use of colonoscopy in the study of synchronous colorectal neoplasms. Cancer. 1984; 53:356–359. PMID: 6690019.

22. Tate JJ, Rawlinson J, Royle GT, Brunton FJ, Taylor I. Pre-operative or postoperative colonic examination for synchronous lesions in colorectal cancer. Br J Surg. 1988; 75:1016–1018. PMID: 3219527.

23. Arenas RB, Fichera A, Mhoon D, Michelassi F. Incidence and therapeutic implications of synchronous colonic pathology in colorectal adenocarcinoma. Surgery. 1997; 122:706–710. PMID: 9347846.

24. Masubuchi S, Konishi F, Togashi K, Okamoto T, Senba S, Shitoh K, et al. The significance of microsatellite instability in predicting the development of metachronous multiple colorectal carcinomas in patients with nonfamilial colorectal carcinoma. Cancer. 1999; 85:1917–1924. PMID: 10223230.

25. Ericson K, Halvarsson B, Nagel J, Rambech E, Planck M, Piotrowska Z, et al. Defective mismatch-repair in patients with multiple primary tumours including colorectal cancer. Eur J Cancer. 2003; 39:240–248. PMID: 12509957.