Læknablaðið - 15.02.2001, Blaðsíða 15

FRÆÐIGREINAR / RISTILKRABBAMEIN
Ristilkrabbamein áíslandi 1955-1989
Meinafræðileg athugun
Lárus Jónasson1,
Jónas
HaUgrímsson',
Ásgeir Theodórs2,
Þorvaldur
Jónsson3,
Jónas Magnússon',
Jón Gunnlaugur
Jónasson1
'Rannsóknastofa Háskólans í
meinafræði,
2meltingarsjúkdómadeild St.
Jósefsspítala Hafnarfirði,
skurðdeildir Landspítala
3Fossvogi og 4Hringbraut.
Fyrirspurnir, bréfaskipti: Jón
Gunnlaugur Jónasson
Rannsóknastofu Háskólans í
meinafræði, Landspítala
Hringbraut, Pósthólf 1465,
121 Reykjavík. Sími: 560 1922;
bréfasími: 560 1904; netfang:
jongj@landspitali.is
Lykilorð: ristilkrabbamein,
œxlisflokkun, staðsetning,
þroskunargráða, faraldsfrœði.
Ágrip
Markmið: í þessari rannsókn var markmiðið að
kanna ýmsa meinafræðilega þætti ristilkrabbameina á
íslandi á 35 ára tímabili frá 1955-1989 og þær
breytingar sem orðið hafa á þessum þáttum á
tímabilinu.
Efniviður og aðfcrðir: Upplýsingar fengust frá
Krabbameinsskrá Krabbameinsfélags Islands um alla
þá er greindust með krabbamein í ristli á rann-
sóknartímabilinu. Öll vefjasvör og krufningaskýrslur
voru yfirfarin. Öll vefjasýni voru endurskoðuð og
meinin endurmetin með tilliti til vefjagerðar,
staðsetningar í ristli, þroskunargráðu æxlanna og
Dukes flokkunar auk þess sem aldursstaðlað nýgengi
var reiknað eftir endurskoðun greininga. Illkynja æxli
í sepum eru með í rannsókninni. Rannsóknar-
tímabilinu var skipt í sjö fimm ára tímabil og breyt-
ingar meinafræðilegra þátta á tímabilunum kannaðar.
Niðurstöður: Alls voru eftir endurmat æxlanna
1205 æxli sem uppfylltu skilmerki þess að teljast
ristilkrabbamein, 572 í körlum og 633 í konum.
Nýgengi jókst á rannsóknartímabilinu hjá körlum úr
8,2 í 21,5/105 og hjá konum úr 7,9 í 15,8/10\ Unnið var
meinafræðilega úr 1109 æxlum. Hefðbundin kirtla-
krabbamein (adenocarcinoma NOS) voru 90,1%
æxlanna en næst algengasta vefjagerðin var slím-
krabbamein (mucinous carcinoma). Flest æxlin voru
staðsett íbugaristli (sigmoid colon) (38,6%) en næst á
eftir voru botnristill (coecum) (19,1%) og risristill
(ascending colon) (14,5%). Staðsetningar æxlanna
breyttust ekki á rannsóknartímabilinu. Slímkrabba-
mein og signethringsfrumukrabbamein (signet ring
carcinoma) voru tíðari í hægri hluta ristils. Dukes
flokkun æxlanna sýndi að 9,1% voru á stigi A, 32,1%
á stigi B, 24,6% á stigi C og 22,7% á stigi D, en 11,5%
reyndist ekki unnt að ákvarða. Lítilsháttar aukning
varð á hlutfalli æxla á stigi A á síðari hluta tímabilsins
ENGLISH SUMMARY
Jónasson L, Hallgrímsson J, Theodórs Á, Jónsson Þ,
Magnússon J, Jónasson JG
Carcinoma of the colon in lceland 1955-1989. A
study on pathology
Læknablaöiö 2001; 87: 111-7
Objective: The objective of this study was to investigate
various pathological parameters of colon carcinoma in
lceland in the 35 year time period from 1955-1989, and
changes in these parameters during the study period.
Material and methods: Information on all patients
diagnosed with colon carcinoma in the study period was
obtained from the lcelandic Cancer Registry. All pathology
reports and autopsy reports were checked. All pathology
samples were reviewed and the tumours reevaluated,
reclassified, tumour location determined, the tumours
graded and Dukes staged and age standardized incidence
was calculated according to revised diagnosis. Cancers in
polyps are included in the study. The study period was
separated into seven five year periods and changes in
pathological parameters investigated according to time
periods.
Results: After reevaluation of the tumours 1205 fulfilled
the criteria for the diagnosis of colon carcinoma, 572 in
men and 633 in women. The incidence increased in the
study period for men from 8.2 to 21.5/105 and for women
from 7.9 to 15.8/105. The pathological parameters were
determined for 1109 tumours. Adenocarcinoma NOS was
the most common diagnosis or 90.1 % of the tumours and
mucinous carcinomas came second. Most of the tumours
were located in the sigmoid colon (38.6%), 19.1 % in the
coecum and 14.5% in the ascending colon. No significant
observed changes occurred in tumour location in the study
period. The mucinous histological type and signet ring
tumour type were more common in the right colon. In
Dukes staging of the tumours 9.1 % were in stage A,
32.1 % in stage B, 24.6% in stage C and 22.7% in stage D,
whereas 11.5% proved indeterminate. A minimal trend to
increase in Dukes A tumours was observed in the latter
half of the study period, overall no significant changes in
Dukes classification could be pinpointed in the time
period. Most of the tumours were of intermediate tumour
grade or 70.1 %, but 16.5% were well differentiated and
13.4% were poorly differentiated. A much higher
percentage of poorly differentiated tumours were present
in the right colon in comparison to the left colon. A poorer
differentiation of the tumours went hand in hand with
worse Dukes stage of tumours.
Conclusions: We conclude that: 1. the incidence of colon
carcinoma has much increased during the study period for
both sexes, 2. observed changes in studied pathological
parameters over the study period were minimal. Of interest
is the minimal change in Dukes stages of colon cancer in
the study period.
Key words: colon carcinoma, histological typing, location,
tumour differentiation, epidemiology.
Correspondence: Jón Gunnlaugur Jónasson. E-mail
jongj@landspitali.is
Læknablaðið 2001/87 111