Flat-Type Early Colorectal Cancer Preferentially Develops in Right-Sided Colon in Older Patients

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Flat-type colorectal cancer is frequently reported in Japan and Europe, but its clinical features remain obscure. Thus, we investigated the clinical features of flat-type early colorectal cancer with respect to tumor location and patient age and compared them with those of polypoid-type early and advanced cancer.


Between January 1999 and June 2001, total colonoscopy was performed in 6,178 patients (mean age, 61 years; 4,290 males and 1,888 females). Of these patients, 402 patients with 429 colorectal cancers were found: 202 at advanced stage (invading beyond muscularis propria) and 227 at early stage (carcinomain situor invading within submucosa). Early-stage cancer was classified into two macroscopic subgroups: flat-type and polypoid-type.


Out of 227 early cancers, 44 were flat type and 183 were polypoid. Flat-type early cancer was more frequently located in the right colon (57 percent, 25/44) than polypoid-type cancer (19 percent, 35/183;P< 0.001). Adenomatous component in flat-type early cancer was less frequent than in polypoid-type cancer (23 percentvs. 92 percent,P< 0.001). The proportion of right-sided colon in flat-type early cancer increased with age (33 percent in patients ≤59 years, 50 percent in patients between 60 and 69 years, and 72 percent in patients ≥70 years), whereas polypoid-type early cancer showed minimal change (16 percent, 18 percent, and 25 percent, respectively). An increase in the proportion of right-sided colon with age was also found in advanced cancer (20 percent, 38 percent, and 52 percent, respectively).


The incidence of flat-type early cancer in right-sided colon increased with age, similar to the pattern of advanced cancer. This suggests that flat-type early cancer may be a precursor of advanced cancer in the right colon, especially in older people.

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