In the management of anal cancer, local disease failure is a major clinical problem requiring early detection followed by radical surgery, often accompanied by plastic reconstruction. By implication, these factors favour the centralization of treatment for this uncommon cancer to a multidisciplinary oncology team.

Although there is no statistically significant survival benefit in the whole series, there is a survival benefit for the subset of patients considered by the surgeon to have undergone a curative operation. We recommend that this form of adjuvant therapy should be offered to all patients with locally advanced rectal cancer who are to undergo radical surgery.

Two hundred and twenty-three patients with colorectal carcinoma were treated consecutively at the University Hospital of South Manchester from May 1976 to January 1981. Twenty-four patients (10.7 per cent) were found to have more than one colorectal carcinoma. In 18 patients this was recognized either immediately or within 6 months of the initial diagnosis--synchronous carcinoma. In the other six cases a second carcinoma was found at a later time--metachronous carcinoma. The incidence of synchronous, and consequently the combined incidence of synchronous and metachronous carcinoma, was higher than previously documented. The anatomical distribution of the multiple carcinomas and the sex incidence in these patients was similar to that seen in patients with a single carcinoma of the large bowel. A high association of adenomatous polypi with multiple large bowel carcinomas was observed. The possibility of more extensive colonic resection in the younger patient with a favourable carcinoma is discussed.

A series of 20 cases of radiation bowel disease (RBD) was studied qualitatively and the arterial changes were studied quantitatively. A control series of 45 cases was studied. In the control cases there were positive correlations between the medial thickness of all vessels studied and the diastolic blood pressure as well as the incidence of intimal fibrosis in both intramural and extramural arteries. The medial thickness in all the arteries in cases of RBD was significantly higher than in the controls. This was probably due to the large number of fibrin thrombi which increased the vascular resistance. The degree of intimal fibrosis of the intramural arteries and arterioles was significantly greater than in the controls. Similarly the incidence of intimal fibrosis in all arterioles and intramural arteries was greater than the control group. The degree of intimal fibrosis was related to the dose of radiation received. The effect of radiation was an on-going process since the percentage of arterioles with intimal fibrosis increased with the time after radiotherapy. Blood pressure and age played no part in these correlations in RBD. The most consistently observed qualitative changes in RBD were in the arteries, arterioles and to a lesser extent the veins. These showed fibrin thrombi, fibrinoid necrosis, subendothelial oedema and fibrin. Various stages of healing were seen in the vessels. We believe that the blood vessels are the main site of injury in RBD and that the endothelial cell is the initial target for radiation damage.

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