EARLY DETECTION OF NONPOLYPOID CANCERS IN THE RECTAL REMNANT IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS GARDNERS-SYNDROME

Background. Invasive cancer occurs in the rectal remnant of patients w ith familial adenomatous polyposis (FAP). Methods. A long term surveil lance proctoscopy program was performed on 25 patients with an establi shed diagnosis of FAP or Gardner's syndrome. Results. The surveillance revealed small nonpolypoid cancer of the rectal remnant in two patien ts. One cancer, which measured 5 mm, was restricted to the mucosa, whe reas the other, measuring 10 mm at its greatest dimension had invaded the submucosa. On proctoscopy, both the lesions were characterized by a reddish depression, surrounded by marginal elevations. Both of these cancers were composed of well differentiated adenocarcinoma without a ny adenomatous component. Conclusions. The authors' experience suggest s that nonpolypoid cancers do exist in FAP/Gardner's syndrome and that careful follow-up seems necessary in patients with a diagnosis, espec ially in consideration of the possible development of nonpolypoid lesi ons.