A Paper on THE TREATMENT OF CANCER OF THE RECTUM WITH RADIUM
Authors: C. Gordon-Watson
Journal: BMJ (1930)

RADICAL sur1-ger-for cancer involves some mutilation of, the humnan bodyv.TheT -appeal ''which radium male!s to- both surgeon anid patient is the hope of a cure without disfigureiment.in the case of the tongue, the larynx, the breast, this appeal is outstanding.Much has been accom-iplishedi to substantiate tile claiml s of radiumu versul s surgery in these situationis, thlouighl they are not yet so firlmlly establishledl as to he uniassailable.Ifradium treatmient of rectal cancer can be raised to the sam1ie level, anid if it can supplant radical surgery, it.must be able to cure the disease without a permanent colostomy anid to leave a rectumii which can funietion.lThis ideal, tlough possible in certain instanices, as I have shown, is a lonig way off.Nevertheless it i os ne to hie aimed at, and justifies inteinsive research.It is generally recognized thlat the pi-esenit itmethods of radical surgery Tfor cancer of the rectum in its early stages cure a high V)ercelltage of cases, but they involve tlhe stignia of c olostoimyv.SPREAD OF CANCER OF THE RECTUM.Thle recent work of Dr. Cuthbert Dukes' oni the spread of cancer of the ectum suggests that it is not niecessary to excise the rectulmi completely and establish a peirmanent colostomyly for aneaily carcinomia whichhas not penetrated the r-ectal wall.Dr. Dukes has shown on histological evidence, based oni a hundred consecutive specimens of excise(d rec(t t1nls, that lymphatic invasion does not occur until the growth has penetrated through the longittudinial coat.anid, further, that the line of spread is in the miiain to the retrarectal space anid upwards along the superior haemorrhoidals.So far as this series of cases cani be relied oni to represent the average, the lines of lateral and down'ard(l spr-ead along the middle and inferior haemorrhlioidals ai'e negligible.These observations, if confirmed in a fulrtler series of cases, are of the uitmost importaniee, an(I hiave an important bearing on tr eatment either by irradiation or by radical surgery.LOCAL RESECTION FOR EAARLY CARCINOMA.If the gr owth can be removed freely by somiie form of local resection aiId the rectal passage maintained, this methiod imay be justified on histological grounds, wi-hetlher or imot a temi-ipor1ary colostomY is reequired.The view, whichi hos held ground for twenty years or so, th1at, hiow- ever earlv tme carciniloma, coiiiplete rem1o-val of the rectum111 and l)eli'rectal lymphatics is essential, must be recon- siderled, and the metlhods of tlhirty years ago may l)erhaps be reinitroduced.Actingf on these views, I have treated the last thiree cases of quite early mobile carcinoma of the ectum by local resection, onie witlhouit a colostonyv anid two with a teml)or'ary colostoim-y.Time alone will show wi-hethelr this procedure, based oii histological evidence, is jwis4ified by ultimiate i'esults.It may e menltionie(d here, h1oNwever, that the ricsults of Hfar'iisonl Cripps over twenty years atgo, and Cu'ey Tl't umllcir in m-iiore reecent veal's, show tilat eiid-ie' ilts of op)erations, less radical than now usually considered nec essary, are remarkably good.C(an radium treatmient of an early carciniomiia comiipete withi a local resection which aimiis at avoiding a lperranent colostomy?These three cases could have been dealt witl quite easily and thoroughly by interstitial irradiationi.Two of them were amenable to vaginal irradiation and the other to posteuiior barrage after resection of the coccyx.That * Ro'ad in opcfning a dlisecussion in the Section of Suirgery at Anntuzl MIectiiag of the British Medical Association, Winnipeg, 1930.these were not so treated, in spite of some succes-,eS in