The Polyp-Cancer Sequence in the Large Bowel
The Polyp-Cancer Sequence in the Large Bowel
复制标题
大肠息肉癌序列
DOI：
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发表时间：
1974
期刊：
影响因子：
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通讯作者：
B. Morson
中科院分区：
文献类型：
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作者：
B. Morson
结肠癌和直肠癌是最常见类型的恶性疾病之一，这一点尚未得到充分认识。死亡率统计数据告诉我们，在英格兰和威尔士的一般人群中，它是仅次于肺癌的第二大死亡原因（Registrar-General 1972），但当考虑到其相对高得多的治愈率时，肺癌和肠癌的发病率可能非常相似。最近来自美国的数据表明，大肠癌正在变得越来越常见，现在在总人口中的发病率高于除皮肤癌之外的任何其他癌症（Silverberg & Holleb 1973）。因此，结肠癌和直肠癌是一个重要的公共卫生问题。众所周知，癌前状态的识别是癌症预防的基础。目前，孤立性息肉、家族性息肉病和溃疡性结肠炎是已知易患大肠癌的病症。大多数结肠癌和直肠癌从孤立的腺瘤性息肉和绒毛状腺瘤演变而来的概念有时被称为息肉癌序列。医学科学家在任何时候都应该知道他试图回答什么问题，这是至关重要的：只有找到相关问题的答案，我们才能取得进步。假设已经有大量证据支持息肉-癌的顺序（Morson &布塞1970），以下问题需要详细回答：（1）是否所有腺瘤性息肉和绒毛状腺瘤都不可避免地变成癌？(2)所有的结肠和直肠癌都是从既存的腺瘤性息肉和绒毛状腺瘤演变而来的吗？(3)息肉癌序列的演变需要多长时间？(4)如果某些癌症不是由预先存在的息肉引起的，那么组织发生的替代机制是什么？在这个地址方面的形态学的息肉癌序列将被描述，连同一些最近的统计数据，从圣马可医院的恶性潜力孤立腺瘤性息肉和绒毛状腺瘤。其他证据也将提出，这给一些想法的生活史的息肉癌序列。
It is not sufficiently appreciated that cancer of the colon and rectum is one of the commonest types of malignant disease. Mortality statistics tell us that it is second only to lung cancer as a cause of death in the general population of England and Wales (Registrar-General 1972) but when its relatively much higher cure rate is taken into consideration then the incidence rates of lung and bowel cancer may be very similar. Recent figures from the United States have shown that large bowel cancer is becoming commoner and now has a higher incidence in the total population than any other cancer except that of the skin (Silverberg & Holleb 1973). Cancer of the colon and rectum is therefore an important public health problem. It is well recognized that the identification of precancerous conditions is the basis of cancer prevention. At the present time isolated polyps, familial polyposis and ulcerative colitis are the conditions which are known to predispose to cancer of the large bowel. The concept that most cancers of the colon and rectum evolve from isolated adenomatous polyps and villous adenomas is sometimes known as the polyp-cancer sequence. It is essential that the medical scientist should at all times be aware of what questions he is trying to answer: only by finding answers to relevant questions shall we make progress. Granted that a substantial body of evidence in support of the polyp-cancer sequence is already available (Morson & Bussey 1970) the following questions require to be answered in detail: (1) Do all adenomatous polyps and villous adenomas inevitably become cancerous? (2) Do all cancers of the colon and rectum evolve from pre-existing adenomatous polyps and villous adenomas? (3) How long does it take for the polyp-cancer sequence to evolve? (4) If some cancers do not arise from pre-existing polyps what is the alternative mechanism of histogenesis ? In this Address aspects of the morphology of the polyp-cancer sequence will be described, together with some recent statistics from St Mark's Hospital about the malignant potential of isolated adenomatous polyps and villous adenomas. Other evidence will also be presented which gives some idea of the life history of the polyp-cancer sequence.