1

结肠癌的基本信息

结肠癌治疗效果好,肠道局限性病变通常可以治愈。外科手术是主要的治疗手段,约50%的术后病人能够痊愈。而术后复发是一个重要问题,常最终导致患者死亡。

发病率与死亡率

注:据估计,2013年美国结肠癌新发病例数和死亡病例数约为:[1]

新发病例数:102,480例(仅结肠癌)。

死亡病例数:50,830(结肠癌和直肠癌)。

胃肠道间质瘤亦可发生于结肠。(更多信息请参见PDQ总结 胃肠道间质瘤的治疗​。)

解剖

下消化系统解剖。

危险因素

结直肠癌高发人群包括有遗传病家族史的群体,占所有结直肠癌患者的10%-15%。相关遗传性疾病包括:

家族性息肉病。

遗传性非息肉病性结肠癌(HNPCC)或Lynch综合征I型与II型。

溃疡性结肠炎或克罗恩结肠炎病史[2][3]

其他增加结直肠癌患病风险的常见情况包括:

结直肠癌或腺瘤病史。

一级亲属中有结直肠癌或腺瘤病史。

卵巢癌、子宫内膜癌或乳腺癌病史[4][5]

这些高危人群仅占全体结直肠癌患者的23%,因此,仅限于此类高危人群的早期癌症筛查将会遗漏大部分结直肠癌患者[6]。(更多信息请参见PDQ总结: 结直肠癌的筛查结直肠癌的预防。)

筛查

由于结肠癌具有发病率高、明确的高危人群、原发病变生长缓慢、早期患者预后佳、相对简单准确的筛查方式等特点,推荐所有50岁以上成年人进行常规结肠癌筛查,尤其是具有一级家属结直肠癌病史的人群。(更多信息请参见PDQ总结: 结直肠癌的筛查。)

预后因素

结肠癌患者的预后与以下因素明确相关:

肿瘤对肠壁的浸润程度。

是否累及淋巴结。

是否有远处转移。

这三项特征构成了所有结肠癌分期系统的基础。

其他预后因素包括:

肠梗阻和肠穿孔提示预后不良[7]

治疗前血清癌胚抗原(CEA)水平高提示预后不良[8]

结肠癌的回顾性研究还评价了一些其他预后相关标记物,例如染色体18q的等位基因缺失、胸苷酸合成酶的表达等,但多数未经前瞻性研究确认[9][10][11][12][13][14][15][16][17][18]。一项基于人群调查的研究显示,在 607例小于50岁的结直肠癌患者中,与HNPCC相关的微卫星不稳定与良好预后相关,但与分期无关[19]。据报道,当按肿瘤分期分层后,HNPCC患者预后均优于散发性结直肠癌患者。但由于回顾性研究的内在特点以及可能存在的选择性偏倚,导致难以解读这些研究结果[20]

治疗意见取决于医生、患者,以及疾病分期等因素,但与病人年龄无关[21][22][23]

辅助治疗后不同人种的总生存率存在差异,但无病生存率无差异,提示合并症可能与不同人种的生存结果相关[24]

随访

结肠癌治疗后,定期随访可以帮助早发现、早治疗复发病变[25][26][27][28]。 但由于具有局限、潜在可治愈性转移灶的患者比例较低,定期监测降低复发性结肠癌患者死亡率的效果有限。至今尚无大型随机临床试验证明术后标准化随访计划的有效性[29][30][31][32][33]

CEA是结肠癌患者治疗中频繁使用到的一种血清糖蛋白。相关综述显示:[34]

CEA筛查结直肠癌的价值有限,假阳性和假阴性报道均很多。

术后CEA检测应仅限于准备行肝转移或肺转移切除手术的患者。

不推荐常规使用CEA监测治疗反应。

由于随访意义不明确,数据质量不佳,因此最佳的随访方案和随访频率并未确定[31][32][33]。CEA免疫闪烁显像[35]和正电子发射断层扫描(PET)[36]等新型监测手段尚处于临床评估阶段。

相关总结

其他与结肠癌相关的PDQ总结请参见:

结直肠癌的预防​

结直肠癌的筛查​

结直肠癌遗传学​

罕见儿童肿瘤的治疗(儿童结肠癌)

参考文献

1. American Cancer Society.: Cancer Facts and Figures 2013. Atlanta, Ga: American Cancer Society, 2013. Available online . Last accessed January 10, 2014.

2. Thorson AG, Knezetic JA, Lynch HT: A century of progress in hereditary nonpolyposis colorectal cancer (Lynch syndrome). Dis Colon Rectum 42 (1): 1-9, 1999.[PUBMED Abstract]

3. Smith RA, von Eschenbach AC, Wender R, et al.: American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers. Also: update 2001--testing for early lung cancer detection. CA Cancer J Clin 51 (1): 38-75; quiz 77-80, 2001 Jan-Feb.[PUBMED Abstract]

4. Ransohoff DF, Lang CA: Screening for colorectal cancer. N Engl J Med 325 (1): 37-41, 1991.[PUBMED Abstract]

5. Fuchs CS, Giovannucci EL, Colditz GA, et al.: A prospective study of family history and the risk of colorectal cancer. N Engl J Med 331 (25): 1669-74, 1994.[PUBMED Abstract]

6. Winawer SJ: Screening for colorectal cancer. Cancer: Principles and Practice of Oncology Updates 2(1): 1-16, 1987.

7. Steinberg SM, Barkin JS, Kaplan RS, et al.: Prognostic indicators of colon tumors. The Gastrointestinal Tumor Study Group experience. Cancer 57 (9): 1866-70, 1986.[PUBMED Abstract]

8. Filella X, Molina R, Grau JJ, et al.: Prognostic value of CA 19.9 levels in colorectal cancer. Ann Surg 216 (1): 55-9, 1992.[PUBMED Abstract]

9. McLeod HL, Murray GI: Tumour markers of prognosis in colorectal cancer. Br J Cancer 79 (2): 191-203, 1999.[PUBMED Abstract]

10. Jen J, Kim H, Piantadosi S, et al.: Allelic loss of chromosome 18q and prognosis in colorectal cancer. N Engl J Med 331 (4): 213-21, 1994.[PUBMED Abstract]

11. Lanza G, Matteuzzi M, Gafá R, et al.: Chromosome 18q allelic loss and prognosis in stage II and III colon cancer. Int J Cancer 79 (4): 390-5, 1998.[PUBMED Abstract]

12. Griffin MR, Bergstralh EJ, Coffey RJ, et al.: Predictors of survival after curative resection of carcinoma of the colon and rectum. Cancer 60 (9): 2318-24, 1987.[PUBMED Abstract]

13. Johnston PG, Fisher ER, Rockette HE, et al.: The role of thymidylate synthase expression in prognosis and outcome of adjuvant chemotherapy in patients with rectal cancer. J Clin Oncol 12 (12): 2640-7, 1994. [PUBMED Abstract]

14. Shibata D, Reale MA, Lavin P, et al.: The DCC protein and prognosis in colorectal cancer. N Engl J Med 335 (23): 1727-32, 1996.[PUBMED Abstract]

15. Bauer KD, Lincoln ST, Vera-Roman JM, et al.: Prognostic implications of proliferative activity and DNA aneuploidy in colonic adenocarcinomas. Lab Invest 57 (3): 329-35, 1987.[PUBMED Abstract]

16. Bauer KD, Bagwell CB, Giaretti W, et al.: Consensus review of the clinical utility of DNA flow cytometry in colorectal cancer. Cytometry 14 (5): 486-91, 1993.[PUBMED Abstract]

17. Sun XF, Carstensen JM, Zhang H, et al.: Prognostic significance of cytoplasmic p53 oncoprotein in colorectal adenocarcinoma. Lancet 340 (8832): 1369-73, 1992.[PUBMED Abstract]

18. Roth JA: p53 prognostication: paradigm or paradox? Clin Cancer Res 5 (11): 3345, 1999.[PUBMED Abstract]

19. Gryfe R, Kim H, Hsieh ET, et al.: Tumor microsatellite instability and clinical outcome in young patients with colorectal cancer. N Engl J Med 342 (2): 69-77, 2000.[PUBMED Abstract]

20. Watson P, Lin KM, Rodriguez-Bigas MA, et al.: Colorectal carcinoma survival among hereditary nonpolyposis colorectal carcinoma family members. Cancer 83 (2): 259-66, 1998.[PUBMED Abstract]

21. Iwashyna TJ, Lamont EB: Effectiveness of adjuvant fluorouracil in clinical practice: a population-based cohort study of elderly patients with stage III colon cancer. J Clin Oncol 20 (19): 3992-8, 2002.[PUBMED Abstract]

22. Chiara S, Nobile MT, Vincenti M, et al.: Advanced colorectal cancer in the elderly: results of consecutive trials with 5-fluorouracil-based chemotherapy. Cancer Chemother Pharmacol 42 (4): 336-40, 1998. [PUBMED Abstract]

23. Popescu RA, Norman A, Ross PJ, et al.: Adjuvant or palliative chemotherapy for colorectal cancer in patients 70 years or older. J Clin Oncol 17 (8): 2412-8, 1999.[PUBMED Abstract]

24. Dignam JJ, Colangelo L, Tian W, et al.: Outcomes among African-Americans and Caucasians in colon cancer adjuvant therapy trials: findings from the National Surgical Adjuvant Breast and Bowel Project. J Natl Cancer Inst 91 (22): 1933-40, 1999.[PUBMED Abstract]

25. Martin EW Jr, Minton JP, Carey LC: CEA-directed second-look surgery in the asymptomatic patient after primary resection of colorectal carcinoma. Ann Surg 202 (3): 310-7, 1985.[PUBMED Abstract]

26. Bruinvels DJ, Stiggelbout AM, Kievit J, et al.: Follow-up of patients with colorectal cancer. A meta-analysis. Ann Surg 219 (2): 174-82, 1994. [PUBMED Abstract]

27. Lautenbach E, Forde KA, Neugut AI: Benefits of colonoscopic surveillance after curative resection of colorectal cancer. Ann Surg 220 (2): 206-11, 1994.[PUBMED Abstract]

28. Khoury DA, Opelka FG, Beck DE, et al.: Colon surveillance after colorectal cancer surgery. Dis Colon Rectum 39 (3): 252-6, 1996.[PUBMED Abstract]

29. Safi F, Link KH, Beger HG: Is follow-up of colorectal cancer patients worthwhile? Dis Colon Rectum 36 (7): 636-43; discussion 643-4, 1993.[PUBMED Abstract]

30. Moertel CG, Fleming TR, Macdonald JS, et al.: An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer. JAMA 270 (8): 943-7, 1993.[PUBMED Abstract]

31. Rosen M, Chan L, Beart RW Jr, et al.: Follow-up of colorectal cancer: a meta-analysis. Dis Colon Rectum 41 (9): 1116-26, 1998.[PUBMED Abstract]

32. Desch CE, Benson AB 3rd, Smith TJ, et al.: Recommended colorectal cancer surveillance guidelines by the American Society of Clinical Oncology. J Clin Oncol 17 (4): 1312, 1999.[PUBMED Abstract]

33. Benson AB 3rd, Desch CE, Flynn PJ, et al.: 2000 update of American Society of Clinical Oncology colorectal cancer surveillance guidelines. J Clin Oncol 18 (20): 3586-8, 2000.[PUBMED Abstract]

34. Clinical practice guidelines for the use of tumor markers in breast and colorectal cancer. Adopted on May 17, 1996 by the American Society of Clinical Oncology. J Clin Oncol 14 (10): 2843-77, 1996. [PUBMED Abstract]

35. Lechner P, Lind P, Goldenberg DM: Can postoperative surveillance with serial CEA immunoscintigraphy detect resectable rectal cancer recurrence and potentially improve tumor-free survival? J Am Coll Surg 191 (5): 511-8, 2000.[PUBMED Abstract]

36. Lonneux M, Reffad AM, Detry R, et al.: FDG-PET improves the staging and selection of patients with recurrent colorectal cancer. Eur J Nucl Med Mol Imaging 29 (7): 915-21, 2002.[PUBMED Abstract]

下一页
译文由 中国国家癌症中心提供
本站由 中国医学科学院医学信息研究所创办并维护 未经许可禁止转载或建立镜像