Flat early cancers of the large intestine.

From January 1976 to December 1987, 37 early colorectal cancers of the flat type were treated. Thirty-four of them (91.9%) were not accompanied by adenoma, and were thought to have arisen de novo. There is indeed a de novo route of cancer development in the human large intestine, and cancers de novo merely show polypoid growth. Flat type cancers arising de novo tend to reach deeper layers at an earlier stage than polypoid-type carcinomas in adenoma. Of those with a diameter of less than 10 mm, only 40% stayed in the mucosa. Consequently, advanced cancers cannot be prevented by snare polypectomy alone. More attention should be directed to the discovery of small, flat, nonpolypoid cancers.