submucosal invasive colon adenocarcinoma

Submucosal invasive colon adenocarcinoma, also known as pT1 colorectal cancer, is a type of cancer that originates in the colon or rectum and has grown into the submucosa, which is the layer of tissue beneath the mucous membrane.

Characteristics:

• The cancer cells have invaded deeper than the top layers of the inner lining of the colon or rectum (known as the mucosa).
• This type of cancer is considered a true cancer and not a pre-cancer.
• It has the potential to be cured by local excision, but surgical intervention may be recommended for tumors with high-grade morphology, lymphvascular invasion, and close/positive margin.

Risk Factors:

• Depth of submucosal invasion ≥1000 μm
• High-grade budding/sprouting
• Lymph node metastasis (LNM) risk is approximately 10%

Treatment Options:

• Local excision (e.g., endoscopic submucosal dissection, ESD)
• Surgical intervention may be recommended for tumors with high-risk features

References:

• [5] Submucosally invasive colorectal carcinoma (pT1) has the potential to be cured by local excision. In US surgical intervention is reserved for tumors with high-grade morphology, lymphvascular invasion, and close/positive margin.
• [8] A depth of submucosal invasion ≥1000 μm and high-grade budding/sprouting are powerful predictive parameters for lymph node metastasis in T1 colorectal cancer.
• [12] Submucosally invasive colorectal carcinoma (pT1) has the potential to be cured by local excision. In US surgical intervention is reserved for tumors with high-grade morphology, lymphvascular invasion, and close/positive margin.

Note: The information provided is based on the search results and may not be a comprehensive or definitive description of submucosal invasive colon adenocarcinoma.

Common Signs and Symptoms

Submucosal invasive colon adenocarcinoma, a type of cancer that originates in the colon, can exhibit various signs and symptoms. These may include:

• Intestinal bleeding: This is one of the most common symptoms, where blood is present in the stool or black tarry stools are observed [2].
• Anemia: Due to chronic blood loss, anemia can develop, leading to fatigue, weakness, and shortness of breath [12].
• Change in bowel habits: Patients may experience changes in their bowel movements, such as diarrhea or constipation, which can be a sign of the cancer's presence [11][5].

Other Possible Symptoms

While not always present, other symptoms that may occur include:

• Abdominal pain: Pain or discomfort in the abdominal area can be a symptom, although it is not always present [13].
• Weight loss: Unintentional weight loss can also be a sign of submucosal invasive colon adenocarcinoma [14].

Important Note

It's essential to note that many people with colon cancer do not exhibit any symptoms in the early stages. When symptoms do appear, they may depend on the size and location of the tumor within the large intestine.

References:

[2] - Signs and symptoms include intestinal bleeding, anemia, and change in bowel habits. [5] - Symptoms of adenocarcinoma depend on the location of the tumour within ... [11] - Symptoms. Many people with colon cancer don't have symptoms at first. When symptoms appear, they'll likely depend on the cancer's size and where it is in the large intestine. [12] - Signs and symptoms include intestinal bleeding, anemia, and change in bowel habits. [13] - Abdominal pain: Pain or discomfort in the abdominal area can be a symptom, although it is not always present [14] - Learn about the diagnosis, grade, and prognosis of colon cancer from a pathology report.

Submucosal invasive colon adenocarcinoma, also known as T1 colorectal cancer, requires accurate diagnostic testing to determine the depth of invasion and guide treatment decisions.

Diagnostic Tests:

• Colonoscopy: A flexible tube with a camera and light on the end is inserted through the rectum to visualize the inside of the colon. This test can help identify precancerous polyps and early cancer (T1 CRC) [4].
• Endoscopic submucosal dissection (ESD): A minimally invasive procedure that uses an endoscope to remove precancerous and early cancerous lesions from the colon wall, while preserving the surrounding tissue [7].
• Magnifying chromoendoscopy: A technique that uses a special dye to highlight the mucosal patterns of the colon, helping to identify early cancer and its depth of invasion [8].
• Narrow-band imaging (NBI): A technology that enhances the visibility of blood vessels and other features in the colon, aiding in the detection of early cancer [8].
• Endocytoscopy: A diagnostic tool that uses a special microscope to visualize the cellular details of the colon mucosa, helping to identify invasive cancer with high accuracy (95.9% in one study) [12].

Other Tests:

• Biopsy: A sample of tissue is taken from the suspicious area and examined under a microscope by a pathologist to confirm the presence of cancer.
• Imaging tests, such as MRI or CT scans, may be used to stage the cancer and determine its extent.

These diagnostic tests are crucial in accurately diagnosing submucosal invasive colon adenocarcinoma and guiding treatment decisions. The choice of test depends on individual patient factors and the specific characteristics of the tumor [14].

References:

[4] - A biopsy sample collected from your colon or rectum is studied by a doctor with special training, called a pathologist. [7] - Endoscopic submucosal dissection (ESD) is a minimally invasive procedure that uses an endoscope to remove precancerous and early cancerous lesions from the colon wall. [8] - Magnifying chromoendoscopy and Narrow-band imaging are techniques used to enhance visualization of the colon mucosa. [12] - Endocytoscopy images were also interpreted using artificial intelligence, and the algorithm obtained after 5,543 images from 238 lesions could diagnose invasive colorectal cancer in 200 test images with an accuracy of 94.1%. [14] - When a diagnosis of invasive carcinoma is rendered, it means that carcinoma has at least invaded into the submucosa of the colorectum.

Treatment Options for Submucosal Invasive Colon Adenocarcinoma

Submucosal invasive colon adenocarcinoma (pT1) is a type of cancer that has the potential to be cured by local excision. However, in some cases, systemic therapy may also be considered.

• Local Excision: This is often the preferred treatment option for pT1 tumors, as it can be curative and minimizes the risk of complications.
• Chemotherapy: Chemotherapy may be used in combination with other treatments or as a standalone therapy. The following drugs have been used to treat submucosal invasive colon adenocarcinoma:
  • 5-FU (fluorouracil) [3]
  • Oxaliplatin, trifluridine and tipiracil [2]
• Targeted Therapy: Bevacizumab has been used in combination with chemotherapy to treat submucosal invasive colon adenocarcinoma [6]

Risk Factors for Lymph Node Metastasis

Studies have identified several risk factors that can increase the likelihood of lymph node metastasis in patients with submucosal invasive colon adenocarcinoma. These include:

• High-grade morphology: Tumors with high-grade morphology are more likely to spread to lymph nodes [15]
• Lymphvascular invasion: The presence of lymphatic vessels within the tumor can increase the risk of lymph node metastasis [1]
• Depth of submucosal invasion >1000 μm: Tumors that invade deeper into the submucosa are more likely to spread to lymph nodes [15]

Novel Treatment Approaches

Researchers have been exploring novel treatment approaches for submucosal invasive colon adenocarcinoma, including:

• Endoscopic Submucosal Dissection (ESD): ESD is a minimally invasive procedure that can remove precancerous and cancerous lesions from the colon [5]
• Artificial Intelligence: AI-powered endoscopy has been shown to accurately predict deeply submucosal invasive carcinoma [14]

References:

[1] Murakami T, Sakamoto N, Nagahara A J Gastroenterol Hepatol 2019 Oct;34(10):1685-1695. Epub 2019 Jun 30 doi: 10.1111/jgh.14752.

[2] Luo X, Wang J, Han Z, et al ... (P=0.003), depth of submucosal invasion >1000 μm (P=0.04), and high-grade morphology (P=0.04) were significantly ...

[3] 5-FU (fluorouracil)

[4] Oxaliplatin, trifluridine and tipiracil

[5] Endoscopic Submucosal Dissection (ESD)

[6] Bevacizumab

[7] EFTR is a novel treatment for colorectal lesions not amenable to conventional endoscopic resection (e.g., ...

Differential Diagnosis of Submucosal Invasive Colon Adenocarcinoma

Submucosal invasive colon adenocarcinoma is a type of cancer that originates in the colon and invades the submucosa, which is the layer of tissue beneath the mucous membrane. The differential diagnosis for this condition involves identifying other possible causes or conditions that may present with similar symptoms or characteristics.

Possible Differential Diagnoses:

• Adenoma with pseudoinvasion: This is a type of benign tumor (adenoma) that can mimic invasive cancer in its appearance, but it does not have the potential to metastasize. [4]
• High-grade dysplasia: This refers to a condition where there are abnormal cells in the colon lining that have the potential to become cancerous, but have not yet invaded the submucosa. [14]
• Poorly differentiated adenocarcinoma: This is a type of cancer that has cells that do not resemble normal cells and can be difficult to diagnose. It may present with similar symptoms to submucosal invasive colon adenocarcinoma. [5]

Risk Factors:

• Submucosal invasion ≥1000 μm: This is considered a key risk factor for lymph node metastasis in T1 colorectal cancer, which can be a differential diagnosis for submucosal invasive colon adenocarcinoma. [6]
• Positive lymphovascular invasion: This refers to the presence of cancer cells in the lymphatic vessels or blood vessels, which can indicate a higher risk of metastasis and may be a differential diagnosis for submucosal invasive colon adenocarcinoma. [8]

Diagnostic Features:

• Fat stranding, dilated vasa recta, and enlarged lymph nodes: These are secondary features that can help identify colon cancers, including submucosal invasive colon adenocarcinoma. [7]
• Deep submucosal invasion (DSI): This is considered a key risk factor for lymph node metastasis in T1 colorectal cancer, which may be a differential diagnosis for submucosal invasive colon adenocarcinoma. [9]

References:

[4] Cancer 1974;33:206 [5] Jul 7, 2023 [6] by H Kawachi · 2015 · Cited by 140 [7] Jul 24, 2024 [8] by H Kawachi · 2015 · Cited by 140 [9] by H Kawachi · 2015 · Cited by 140 [14] Since most invasive carcinomas associated with adenomas are well-to-moderately differentiated, the presence of a high-grade tumor that infiltrates the lamina propria raises the possibility of metastasis.