Nilsson E, Bolin S, Sjödahl R
Acta Chir Scand. 1982;148(7):617-22.
During the period 1971-1975 284 patients were treated for adenocarcinoma of the colon or rectum; 52% were aged 70 years or more, and 37% had incurable disease at the time of diagnosis. When staged according to Dukes' classification, tumours of the right colon (coecum and ascending colon) were more advanced than those in other parts of the colon and rectum (p less than 0.05). In retrospect, local symptoms from colon and rectum were present in 95% of the patients, whereas 49% had symptoms and signs possibly indicating malignant disease. Local and/or general symptoms of more than six months' duration were noted for 38%. Only 3 patients were asymptomatic at the time of diagnosis. Evidence of at least one risk factor for colorectal cancer was obtained in 11%. Those admitted as emergencies (34%) showed a significantly higher incidence of incurable disease than those admitted electively (p less than 0.01). In 22% of all patients an abdominal mass could be palpated and in 32% a tumour was found on rectal exploration. X-ray examination of the colon was performed on 218 patients, with apparently normal findings in 30. However, in 18 of the latter 30 new scrutiny aroused suspicion of tumour in the large bowel. Before admission only 45 patients had undergone rectosigmoidoscopy. Doctor's delay exceeded 5 months for 45 patients (16%); these tumours did not differ from those of other patients with respect to Dukes' classification.
在1971年至1975年期间，284例患者接受了结肠癌或直肠癌治疗；52%的患者年龄在70岁及以上，37%的患者在诊断时患有无法治愈的疾病。根据杜克氏分类法进行分期时，右半结肠（盲肠和升结肠）的肿瘤比结肠和直肠其他部位的肿瘤更晚期（p<0.05）。回顾发现，95%的患者有结肠和直肠的局部症状，而49%的患者有可能提示恶性疾病的症状和体征。38%的患者有持续超过6个月的局部和/或全身症状。只有3例患者在诊断时无症状。11%的患者有至少一项结直肠癌危险因素的证据。因急症入院的患者（34%）显示出无法治愈疾病的发生率显著高于择期入院的患者（p<0.01）。在所有患者中，22%可触及腹部肿块，32%在直肠检查时发现肿瘤。对218例患者进行了结肠X线检查，其中30例结果明显正常。然而，在这30例中的18例中，再次仔细检查引起了对大肠肿瘤的怀疑。入院前只有45例患者接受了直肠乙状结肠镜检查。45例患者（16%）医生延误超过5个月；这些肿瘤在杜克氏分类方面与其他患者的肿瘤并无差异。
