Cancer de novo should be recoginized to be one of the most common pathways of colorectal cancer development, as well as cancer arising from adenoma. Cancer de novo arises frequently in the form of depressed or flat lesion rather than protuberant lesion and advances rapidly. This type of cancer should be found out at the early stage and treated. Therefore, the examinations focused on polypoid lesions alone are not sufficient, even though performed carefully. It should be emphasized that the careful observations of small depressed or flat lesions are also required for precise diagnosis and treatment of colorectal cancers and leading to prophylaxis of advanced cancers.

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Present status of the radiographic diagnosis of eraly colorectal cancer was discussed in relation to (1) comparison of radiographic and endoscopic diagnosis, based on 157 foci of early cancer obtained at the Cancer Institute Hospital between 1973 and 1985, and (2) the assessment of its diagnostic criteria, based on 2722 foci including adenoma, early cancer and advanced cancer experienced between 1973 and 1987. (1) There was a considerable number of early cancer which endoscopic as well as radiographic detection. The radiographic diagnosis missed almost twice as many early cancers as endoscopic diagnosis. It was considered that both examinations should be done as much as possible for detection of early cancer and that the radiographic examination should be preceded by endoscopy in order to reduce radiology-missed lesion to minimum in such circumstances. (2) Following the previous diagnostic criteria, the majority of sessile lesions (91.0%) without surface depression, measuring 10 mme level could be diagnosed as early cancer in the radiographic diagnosis. However, in the present report which included the new data in the last 6 years the possibility of early cancer with the same morphology fell to 43.3%. This fact svggested that the diagnostic criteria of pathology for adenoma and intramucosal cancer should be ressessed to avoid the inconsistency, of pathologic-radiologic correlation.

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Two hundred and ninety three early colon cancers were diagnosed colonoscopically in the past 7 years. Early cancers were divided into two according to the shape ; constricted and non-constricted. Constricted early cancers were 83% of m cancer while they were 46% of sm cancer. Constricted cancers were frequent in the sigmoid colon, and non-constricted ones were frequent at the rectum and the right colon.
It has been considered that most of early cancers of the colon are polypoid in shape. However, recent development of the diagnostic ability of colonoscopy has revealed that non-polypoid (flat, depressed) early cancers are not so rare, and they are important precursor of advanced cancers.

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Factures of colorectal early carcinoma were historically reviewed. From histological examination of surgically resected specimens it was found that early carcinoma was present in larger adenomas, the larger the adenoma the higher the chance of having carcinoma. After introduction of colonoscopic polypectomy a large number of smaller adenomas were collected for histological examination which had shown that the largest number of early carcinomas belonged to the medium size (1-2cm) and even adenoma under 1cm in diameter had malignant potential around 5%. It became also clear that adenomas with short stalk or broad base had much higher malignant potential than adenomas with long stalk.
Moreover, recent colonoscopy discovered small flat adenomas under 1cm in diameter which contained focal carcinoma quite frequently, and even II c or IIc+IIa type of early carcinomas were found to exist in the large bowel.
Features of colorectal early carcinoma are variable from polypoid to non-polypoid, even flat lesions, however, true frequency of each lesions is still to be investigated.

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Since Jan. 1982, 231 cases of early carcinoma of the colon were experienced in our hospital. The relationship between their properties and their operational methods and results was analysed. 1. The 231 cases consist of 140 mucosal and 98 submucosal carcinoma. 2. The techniques for the resection were fiberscopic polypectomy in 113 cases, intestinal resection in 96 cases and local resection in 29 cases. The local resection comprises 6 cases of colotomy, 22 cases of transanal and one case of transsacral resection. 3. Secondary resection of the colon was performed in 19 cases, the main reason of which is invasion into the resected margin in 12 cases. 4. Fiberscopic polypectomy was selected on judgement to qe benign in 94 cases, to clarify invasion in 113 cases and on judgement to be confined to the mucosa in 5 cases. Resection of the colon was performed in such cases as difficult in fiberscopic polypectomy in 18 cases, diagnosed as submucosal ca. in 13 cases and diagnosed as progressed ca. in 29 cases. 5. Morhologically, elevated lesions as Isp and Ip tended to be polypectomized and flat or concaved lesion as IIa+IIc were prone to be colectomized. 6. As for the diameter, they were polypectomized when they were less than 2 cm and prone to be colectomized or locally resected when they were over 2cm. 7. As for the invasion, they were polypectomized when they were less than sm2 and were liable to be colectomized when they were over the level. 8. Polypectomy is applied irrelevant to the location of the cancer and the situation is the same with colectomy while transperianal excision is limited to cancer in the rectum. 9. Concerning histological differentiation, well differentiated ca. and moderately differentiated ca. were liable to be coloectomized. 10. Between cancer with adenoma and cancer de novo, there was no difference in the method of resection. 11. As to lymphovascular invasion, cases with lyo and vo were frequency polypectomized and the cases with ly+ and v+ were frequently colectomized. 12. There were 3 cases of lymph node metastasis in which the tumor is large, Rb in location and ly+. 13. There were no case of local rerurrence and 2 cases of hepatic metastasis.

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Treatment of early colorectal carcinoma has to satisfy the following three principles ;
1)a therapeutic plan by which an approximately 100% 5-year survival rate can be expected,
2)use of the least invasive approach to obtain this result, 3) careful post-treatment follow-up. Most cases of cancer in adenoma are treated by endoscopic polypectomy. However, in cases of flat adenoma or broad-based adenoma, local resection should be considered.
Early carcinoma confined to the submucosal layer is mostly treated by local excision, but cases showing lymphatic invasion or moderately or poorly differentiated carcinoma should be treated by segmental resection combined with regional lymph node dissection. In cases of early carcinoma of the rectum, resection can be done either a trans-sphincteric or trans-sacral approach.

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W e have carried out surgical operations for early rectal cancer and anal cancer over a 21-year period, from 1967 to 1987.
1. The 90 cases treated comprised 37 cases of m cancer and 53 cases of sm cancer.
2. Macroscopically the m cancer cases were mostly Type I cancer, whereas sm cancers were Type II a + II c, being II a in more than half of all cases.
3. Among the m cancer cases 35 were treated by local excision and 2 by radical surgery. For sm cancer cases, 29 were treated by local excision and 24 by radical surgery. Among them, metastasis to the lymphnodes was seen as n1 in 1 case of sm cancer treated by radical surgery.
4. In sm cancer, ly (+) was found in 15 cases out of the 29 treated by local excision, and 6 received further radical surgery ; no residual cancer was noted with findings of no, ly(-).
5. As for the prognosis of surgically treated sm cancer, 2 patients died due to hepatic metastasis after the first radical operation. However, all the renaining patients are currently alive and healthy.

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The aim of this study was to clarify the influence of cellular DNA content on survival. Far this pupose, DNA was measured in paraffin-embedded materials from 236 cases of colorectal cancer by flow cytometry (FCM). A single-cell suspension was made from each paraffin-embedded specimen according to Schuttes method, and then stained with P. I. using Vindelcvs' method. The DNA histogram was obtained using an FACS IV flow cytometer. The DNA index was calculated by dividing the channel number of the second peak by that of TIL as an internal standard. There was no correlation between DNA ploidy pattern and conventional histopathologic features, for example age, sex, location, size, Borrman classification, histology, invasion, and abdominal dissemination. However, there was a close correlation between DNA ploidy pattern and lymph node metastasis, liver metastasis, and Dukes' stage. In cases showing Dukes' stage C, the survival of patients with aneuploid patterns was significantly shorter than that of patients with diploidy. The survival of patients with aneuploid patterns was not reflected by the degree of DNA content. Analysis of the DNA ploidy pattern thus appears to be an important method for evaluation of prognosis, as well as conventional histopathologic fetures.

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We measured the serum levels of the N-terminal peptide of type III procollagen (P-III-P) in patients with Crohn's disease and ulcerative colitis in order to clarify the differences in collagen metabolism between the two diseases.
The mean level of serum P-III-P in Crohn's disease at remission was 16.5ng/ml, which was significantly higher than that in Crohn's disease at the active stage and that in ulcera-tive colitis. In the sera of patients with Crohn's disease who had received hyperalimentation alone without oral intake or drugs, the P-III-P levels increased gradually after the beginning of treatment and remained high for 3 months after induction of remission. However, in the sera of patients with Crohn's disease who had received prednisolone in addition to hyperalimentation, no elevation in the levels of P-III-P was observed. In the sera of patients with ulcerative colitis, most of whom had received prednisolone, the P-III-P levels showed no significant difference between the active stage and remission.
The present results suggest that additional prednisolone therapy may prevent excessive collagen production in patients with Crohn's disease at the early remission stage and that some differences in collagen metabolism may exist between this disease and ulcerative colitis.

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Thirty-four patients with rectal cancer were divided into two groups. Group R: 15 patients who received 42.6 Gy Co-irradiation for 5 weeks, prior to surgery. Group C: 19 patients to received 4 injections of peplomycin 10 mg and 5-bromodeoxyuridine (BUdR) 500 mg together with 42.6 Gy of irradiation. Histological investigation of the microscopic extension of tumor cells into the extramural tissue of the rectum was performed for these two groups using Ohoshi-Shimosato's classification. Results: Extreme effects of irradiation (over Grad IIb) were observed 4 cases (26.7 %) in Group R and 11 cases (57.9 %) in Group C. There was a significant difference (p<0.05) between the two groups. The histopathological effects of radiation were much more marked in Group C than in Group R.

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Fecal occult blood screening was performed by the EIA method in 1, 366 cases, of which 331 (24.4%) were identified as positive for fecal occult blood. This figure was high in comparison with other immunological tests in our experience. These positive subjects were requested to undego more detailed examination of the colon and rectum. Colorectal disease was discovered by detailed examination involving procedures such as berium enema or colono fiberscopy. No disease was found in those subjects with a hemoglobin concentration of below 60ng/ml. Thirty-two adenomas were found among in these positive patients. However, there was no relation between hemoglobin concentration in feces and the number of dis-covered the polyps.
The sensitivity of the EIA method for screening of fecal occult blood in cases of colorectal cancer is relatively high in comparison with other methods. We therefore recommend the use of this method in combination with the Guajak method.

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From 1978 to 1987, the authors have experienced 50 lesions of the villous tumor in 38 cases. Firstly, the surface structure of the tumor was observed by the magnifying endoscope and stereoscopic microscope. The evidence of carcinoma and its localization were investigated histologically in order to study the growth pattern of the villous tumor. Secondary in order to study the histogenesis of villous adenoma, and to analyze the malignant potentiality of this tumor, the S-phase cell were labelled by the ex vivo autoradiogram by perfusing the resected specimien with oxygenated perfluorochemicals supplemented with tritium thymidine. Results are as follows :(1)Ex vivo labelling method revealed the uniform diffuse distribution of S-phase cells in villous adenoma, in comparison to the tubular adenoma approximetely same size which showed compartmentalization.(2)Villous adenoma showed strong tendency to grow in both lateral and upward directions.(3)The labelling index of villous adenoma was greater than that of tubular adenoma and was smaller than that of adenocarcinoma.(4)Result of ex vivo autoradiogram suggest the malignant potentiality of this tumor developing multi focal carcinoma. When focal cancers develope in the deep crypt, it is rather difficult to identify the lesion from the surface.

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A case of chronic intestinal pseudo-obstruction secondary to hypothyroidism is re-ported.
A 75-year-old woman, who had undergone thyroid surgery about 30 years previously, gradually developed severe constipation and abdominal distension in 1980. Laparotomy was performed in July 1984 at another hospital, because of suspected bowel obstruction, but severe abdominal distension continued postoperatively. The patient was admitted in September 1985 again complaining of marked abdominal distension. Plain X-ray film showed marked dilatation of the colon, but barium enema revealed no obstruction. Thyroid function tests indicated primary hypothyroidism. Anorectal reflex, complinance, and colonic mobility response to neostigmine and prostaglandin indicated a diagnosis of intestinal pseudo-obstruction secondary to hypothyroidism. A rectal tube was inserted for decompression of the dilated colon, and intravenous hyperalimentation was applied. Thyroxine was administered for the hypothyroidism. As the level of serum thyroid hormone became elevated to a normal value, the abdominal distension was resolved and the patient was discharged after three months. Only five cases of intestinal pseudo-obstruction secondary to hypothyroidism have been reported in Japan up to October 1987.

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A 38-year-old man presented with a chief complaint of bloody stool. The patient's older brother had contracted rectal cancer with colon polyposis. Barium enema was performed, revealing non-clustered polyposis of the colon and the case was diagnosed as adenomatosis coli. As the patient was operating a bean curd-manufacturing business, his high frequency of postoperative defecation was extremely inconvenient from the viewpoint of his profession and sanitation, and hence a total of 3 operations and 34 endoscopic polypectomies were conducted with the aim of maximum retention of anorcctal function. Fifteen years after sugey, as the age of 53 years, his present defecation function is satisfactory, the patient is healthy and able to conduct his normal business, Close observation of the residual colon is being performed and there are no polyps at present.
Several problems exist in the treatment of adenomatosis coli, and radical therapy cannot be performed easily. The rate of cancer advance, site of onset and social backgro-und factors recessitake careful oservation and selection of an optimal mode of surgery for individual cases.

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A 37-year-old man, who had undergone subtotal colectomy with ileo-rectal anastomosis for ulcerative colitis, was admitted to our department for treatment of rectal cancer. Upon colonoscopic examination, we located the rectal stenosis and sampled several mucosal specimens, which showed moderately differentiated adenocarcinoma and signet ring cell carcinoma acco-mpanied by dysplasia. The lesion was too advanced to allow tumor resection and a loop-ileostomy was constructed. Despite radio-, chemo- and immunotherapies, the patient died seven months after surgery. It is concluded that careful long-term follow-up is indispensable for patients who have undergone illeo-rectal anastomosis for ulcerative colitis.

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A 60 year-old man was admitted to our department because of melena and general malaise. A barium enema study and colonoscopic examination revealed multiple small polyps of a variety of sizes and mucosal hemorrhage in. the large intestine.
The biopsy specimens obtained by colonscopy disclosed malignant lymphoma. Chemo-therapy was given immediately after establishment of the diagnosis, and the melena improved.
During the hospital course he developed sepsis and died 5 weeks after the initiation of VEMP treatment.
This case is considered to be compatible with multiple lymphomatous polyposis of the gastrointestinal tract, which was proposed by Cornes 1961 and occurs only rarely.
A detailed discussion and literature review are also given.

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The clinicopathological features of hepatic metastasis of colorectal cancer were investi-gated.
The subjects were 267 patients with colorectal cancer who underwent surgery between 1975 and 1985. Among these patients, hepatic metastasis was found during surgery in 29 and after surgery in 13, totaling 42 (15.8%).
In relation to sex, the percentage of hepatic metastasis was 19.2% among males and 12.4% among femals, showing a predominance in male patients. With regard to age, such metastasis was most freruent among male patients in their 60s and among female patients in their 50s. The tumor was located in the colon in 16.2 % of patients and in the rectum in 14.8 %, showing no particular difference between the two sites. There were no biased patterns in relation to the histologic type or the maximum diameter of the tumor. The depth of wall invasion was judged to be ss(a1), or severer in all hepatic metastasis cases. Lymphatic invasion was positive in 18.7% of patients and negativg in 8.9%, while venous invasion was positive in 21.4 % and negative in 10.1 %. Lymph node'metastasis was positive in 21.2% and negative in 8.3%. The percentave of hepatic metastasis was significantly higher in positive cases than in negative cases with regard to all the above parameters.
Thus, hepatic metaseasis was found to be closely related to the depth of wall invasion and vascular invasion.

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