• Uncommon in large bowel; most occur in the rectum
• Lesions < 2 cm in diameter usually are asymptomatic, behave benignly, and can be managed by local excision
• Larger tumors arising in the colon (mainly the right side) or rectum cause local symptoms, often metastasize, and require standard cancer resection
• Carcinoid syndrome appears in fewer than 5% of patients with metastatic carcinoid of the large bowel
• Derived from cells that are capable of synthesizing a wide variety of hormones
• 60% of rectal carcinoids present as asymptomatic submucosal nodules measuring < 2 cm in diameter
• Rare; account for < 0.5% of all colorectal malignancies
• The documentation of widespread dissemination of lymphoma in most cases underscores the concept that lymphoma of the GI tract is a systemic disease in which tumor cells are present in other organ sites
• Extremely rare: account for < 0.1% of all large bowel malignancies
• Most common histologic subtype is leiomyosarcoma
• Most significant prognostic indicator is tumor grade
• Carcinoids of the colon are uncommon (2% of GI carcinoids) and most of them occur in the rectum (15% of GI carcinoids)
• Lymphomas are the most common noncarcinomatous malignant tumors of the large bowel; primary non-Hodgkin colonic lymphoma account for 10% of GI lymphomas
• Sarcomas represent < 1% of colonic tumors, with peak incidence in sixth decade of life
• History and physical exam
• Colonoscopy with biopsy
• Staging studies: Chest film, abdominal CT scan, liver function tests
• For lymphoma: Bone marrow biopsy
• Because this disease is highly responsive to chemotherapy and radiation, surgery is not always the primary mode of therapy
• Usually, for localized, low-grade colorectal lymphomas, radiation is considered first-line therapy
• Intermediate- and high-grade lymphomas, chemotherapy combined with radiation therapy should be the primary treatment
• Rectal carcinoid: Transanal local excision suffices for definitive therapy because small tumors rarely metastasize
• Lymphoma: Surgery has been primarily for diagnostic and staging purposes and for the management of treatment-related complications (ie, perforation or bleeding).
• Sarcoma: If tumors are clinically localized at initial presentation, a radical en bloc excision should be performed to obtain a margin of ...
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