CA: A Cancer Journal for Clinicians, Vol 17, 268-277, Copyright
© 1967 by American Cancer Society
The Barium Enema in Checkups of Patients with Cancer of the Colon
Indications and How Often?
Robert D. Moreton M.D.1
1 Assistant Director and Professor of Radiology, The University of Texas M. D. Anderson Hospital and Tumor Institute, Houston, Texas.
Multiple carcinomas of the colon and rectum are not actually rare and investigation has revealed that the incidence is greater than would be expected on the basis of chance alone. Many so-called recurrent carcinomas are probably new and independent lesions.
Some individuals apparently have tissues that predispose to the development of cancer. It seems that an individual who has had one malignant tumor of the colon is more likely to develop a second lesion than a patient who has never had cancer of the colon.
Discovery of one primary carcinoma in the colon should lead to a complete examination of the colon using a method whereby any additional tumors, either benign or malignant, can be detected. If this cannot be done preoperatively because of possibility of obstruction, it should be performed postoperatively as soon as safely possible because tumors may have been missed even on careful palpation of the colon by the surgeon during the operative procedure.
All patients who have had resection of the colon for carcinoma should be followed with thorough colon examinations probably for the rest of their useful lives so that any new lesions can be detected before onset of symptoms, if possible, and certainly before extension through the bowel.
The initial examination should be done from three to six months following surgery and these radiographs will represent the normal postoperative colon, serving as comparison in future examinations.
Any questionable area should be reexamined in order to rule out an artifact or spasm which might simulate a recurrence or new lesion.
Subsequent radiographs should be carefully compared with previous films in order to detect any change at the site of anastomosis or evidence of new growth not present previously.
In the case of a questionable change in the bowel lumen, follow-up examinations should be done at one-to two-month intervals until the exact situation is determined.
If there are no changes in the subsequent examinations the colon should be examined, preferably at six-month intervals, but at least annually throughout the active life of the patient.
Cases have been presented illustrating the value of such a regimen.
Recurrence of symptoms should not be considered as unquestionable evidence of recurrence of the lesion because a new or independent growth may be present, even in the region of the anastomotic site of a previously removed cancer. The prognosis of new lesions is far better than that of recurrent malignant tumors.
