A Lecture ON CARCINOMA OF THE COLON: Delivered at the Medical Graduates' College and Polyclinic.
Authors: V. Z. Cope
Journal: BMJ (1912)

THE large bowel, in marked contrast to the small intestine, is very prone to malignant change; the irritation caused by the bowel contents, which progress slowly and may be hard in consistency, is probably accountable for this, thoughg some other reason must be sought for the frequent incidence of cancer in the caecal region, where the contents arc fluid.In tthe latter position however, bacterial action *is at its maximum, and this may be of significance as a predisposing factor to cancer.I am not concerned here with carcinoma of the rectum, bbut with those cancers affecting the bowel from the caccuim or caput coli to the recto-sigmoidal junction, situated opposite thle third piece of the sacrum.The subject is imiiportant, both on account of the frequency of the .conditionand because recent advanlcs in diagnostic methods and treatment have greatly im-lproved our chances of dealing radically with the disease.That it is com- paratively fr3quent may be judged from thle fact that out -of over four thousand general surgical cases admitted to tlle wards of St. Mary's Hospital during the past two year-s, twenty were cases of cancer of the colon-apropor Lion of about one in two hundred.Some parts of the colon are miiore frequiently attacked than others.Taking the distribution of 100 cases, at least 36 would be situated in the sigmoid (iliac and pelvic) colon, and about 25 in the caccum.The transverse colon andsplenicflexure, the hepatic flexure, ancl the ascending and descending colon are accountable for tlle rest in about tlhat order of frequency.Certainly the ascending and descending portions are tlhe least often affected.Statistics vary considerably, and can only be obtained approximately.Of 20 cases which I have had cognizance of at St.Mary's dluring the last two years, 11 occurred in the iliac and pelv ic colon, 3 in the splenic flexure, 2 at the hepatic filexure, 2 in the caecum, and 1 each in the descending and transverse portions of the colon.Tllemicrosopic anatomy in practically all cases is that of a colulmnar-celled carcinoma, wlhich arises fromii tlle -glands of Lieberkiihn.Wide variations exist in tlle re- action of the connective tissue to the invading cancer cells.In those instances where there is slight resistance to its advance a tumour forms by the extension of the growth both along and round the bowel.This form is prone to degenerative and ulcerative changes.In other cases the cancer is strenuously resisted by the formation of connective tissue, wliich contracts and strangles the advancinig cancerous cells.This progress is comparable to the slow advance of an atrophic scirrbhus of the breast, withl tlle important difference that the breast complaint may not cause any marked inconvenience for years, whilst tlle bowel lesion tonds to obstruct the lumen exactly in proportion to the natural attempts at cure.The lymphatics and blood vessels course round the bowel walI in a circular fashion, so that a ring of involved tissue, is soon formed.*We can, therefore, recognize two main clinical types-the first with tumour formation growing fairly rapidly; the second with no tumour to be felt, but causing a lard, malignant ring, which -constricts the bowel.This ring