小结
定义
病史和体格检查
关键诊断因素
- increasing age
- rectal bleeding
- change in bowel habit
- rectal mass
- positive family history
- abdominal mass
其他诊断因素
- abdominal pain
- anemia
- male sex
- weight loss and anorexia
- abdominal distension
- palpable lymph nodes
危险因素
- increasing age
- family history
- adenomatous polyposis coli (APC) gene mutation
- Lynch syndrome (hereditary nonpolyposis colorectal cancer)
- MUTYH/MYH-associated polyposis
- hamartomatous polyposis syndromes
- inflammatory bowel disease
- obesity
- acromegaly
- limited physical activity
- lack of dietary fiber
- smoking
- moderate to heavy alcohol consumption
- low vitamin D
- consumption of red and processed meats
诊断性检查
首要检查
- complete blood count
- liver biochemistry
- renal function
- colonoscopy
- CT colonography
- CT scan of chest, abdomen, and pelvis
- genetic testing
需考虑的检查
- MRI pelvis: rectal cancer protocol
- transrectal endoscopic ultrasound
- biopsy
- carcinoembryonic antigen
- PET scan
- PIK3CA mutation testing
新兴检查
- advanced optical imaging techniques
- blood-based tests
- circulating tumor DNA
治疗流程
rectal cancer, suitable for surgery
rectal cancer, not suitable for surgery
colon cancer, suitable for surgery
colon cancer, not suitable for surgery
撰稿人
作者
David E. Stein, MD, MHCM, FACS, FASCRS
Professor of Surgery
Georgetown University School of Medicine
Georgetown
DC
Regional Chief of Surgery
MedStar Health
Baltimore
MD
利益声明
DES declares that he has no competing interests.
Kamila A. Nowak-Choi, MD
Assistant Professor
Department of Radiation Oncology
University of Maryland Upper Chesapeake Medical Center KCC Radiation Oncology
Bel Air
MD
利益声明
KANC declares that she has no competing interests.
鸣谢
Dr David E. Stein and Dr Kamila A. Nowak-Choi would like to gratefully acknowledge Dr Pallavi P. Kumar, Dr David M. Lisle, Dr Juan L. Poggio, Dr Jascha Rubin, Dr Najjia Mahmoud, Dr Emily Carter Paulson, Dr Gary Atkin, Dr Anne Ballinger, Dr Mark O'Hara, Dr Mark Harrison, and Dr Robert Glynne-Jones, previous contributors to this topic.
利益声明
PPK, DML, JLP, JR, NM, ECP, MOH, GA, and AB declare that they have no competing interests. MH is the chair of the Mount Vernon Upper GI Tumor Site Specific Group and a member of the National Cancer Research Institute anal, rectal, and advanced colorectal groups. He has also received honoraria for speaking and has been supported to attend international meetings on gastrointestinal cancer from Roche. He has also received research funding from Pfizer for a trial in rectal cancer. RGJ is the chief medical adviser to the charity Bowel Cancer UK. He has received honoraria for lectures from Roche, Sanofi, and Pfizer. He has received funding for the EXTRA study, involving capecitabine and radiotherapy in anal cancer, published in the International Journal of Radiation Biology Physics. RGJ has also received funding and free cetuximab for an ongoing phase 1/2 study integrating cetuximab into chemoradiation in rectal cancer, and has an agreement from Roche to supply bevacizumab for 3 months to 60 patients in one randomized phase 2 study as neoadjuvant chemotherapy in rectal cancer (BACCHUS). He has also been supported by Roche to attend international meetings in gastrointestinal cancer.
同行评议者
Susan Clark, BChir, MB
Consultant Colorectal Surgeon
St Mark's Hospital and Academic Institute
Northwick Park
Middlesex
UK
利益声明
SC declares that she has no competing interests.
Steven Wexner, MD, FACS, FRCS, FRCS Ed, FASCRS, FAC
Chief of Staff
Chairman
Department of Colorectal Surgery
Cleveland Clinic
Weston
FL
利益声明
SW declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: colorectal cancer screening [internet publication].全文
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: rectal cancer [internet publication].全文
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: colon cancer [internet publication].全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Irritable bowel syndrome
- Ulcerative colitis
- Crohn disease
更多 鉴别诊断指南
- NCCN clinical practice guidelines in oncology: colon cancer
- NCCN clinical practice guidelines in oncology: rectal cancer
更多 指南患者教育信息
Colon and rectal cancer: should I be screened?
Colon and rectal cancer: what is it?
更多 患者教育信息
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