Big Juicy Colons

Since the name of this blog is bigjuicycolon.com, I figured we may as well start with colon cancer. That and diverticulitis are the usual reasons colons get removed. Not the entire colon, mind you, just the affected part. It may look like the surgeon took more than he needed to, but surgeons have to be mindful of the vascular supply to the remaining colon. Everything that has the same vascular supply as the affected part has to be removed, or it will become gangrenous, and that will require another surgery.

colon cancer

colon cancer

Ever since Katie Couric’s husband Jay died of colon cancer at age 42, colon cancer has been pretty much out of the closet.  Colon cancer is one of the commonest cancers in this country, after lung and breast. Most colon cancers look pretty much like this. 

The surgeon needs to know that the margin is adequate. That’s why fresh colon resections come to pathology so that the pathologist can open them and measure how far the tumor is from the ends of the specimen. Especially when there is more than one tumor, which can happen. Here’s a colon with three!

colon w 3 cancers

And one of them is right in the margin.

Some specimens are pretty striking. Patients who use certain kinds of laxatives for years get this dark brown coloration of the mucosa, called melanosis. Notice that the small bowel, the polyps, and the cancer are not colored. That’s because they grow fast and don’t have enough time to get discolored.

colon with melanosis, a cancer, and polyps

colon with melanosis, a cancer, and polyps

Colon cancers nearly always start from polyps, also called adenomas. Here is an example of an adenoma.

colon polyp

colon polyp

Ever wonder what pathologists see when they look through the microscope? This slide shows the microscopic appearance of normal colon mucosa, or lining.

normal colon mucosa

normal colon mucosa

This slide shows cancer arising in an adenoma. Adenoma on the left, cancer on the right.

adenoma-carcinoma spectrum

adenoma-carcinoma spectrum

This is cancer too.

colon cancer micro

colon cancer micro

What do you think? Grossed out? I did warn you, you know. Me, I find this stuff fascinating.

Guess I wouldn’t be a pathologist if I didn’t.

Now, what do you want to see next?

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