The value of CT in malignant colonic tumors.

Fifty-five patients with malignant colonic tumors were reviewed, and the CT findings were analyzed, as well as two cases of carcinoid tumors of the terminal ileum. There is increased incidence of recurrence in patients under 60 years of age, and 22% of local recurrences occurred 5 years or later after "curative" surgery. A local recurrence alone was found in 44% of patients, distant metastases alone in 10%, and concomitant local recurrence and distant spread in 46%. Three-quarters of the locally recurrent masses were infiltrative and one-quarter were non-infiltrative. The important infiltrative elements included bone erosion, and 45% of those with bladder infiltration had distant metastases. The finding of hydronephrosis was associated with the presence of a local recurrence mass in all instances, and half of these cases had regional lymphadenopathy with local infiltration. Furthermore, 60% of patients demonstrating hydronephrosis had distant metastases. The most commonly involved organs in distant metastatic spread were the liver and lungs There was a higher incidence of lymphadenopathy associated with pulmonary metastases than with hepatic deposits, which could possibly indicate different routes of spread. CT was found to be particularly helpful in detecting clinically occult recurrent disease. In clinically apparent disease, CT was able to assess the extent of the disease process and it also played a role in the practical therapeutic management of patients.