Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- increasing age
- rectal bleeding
- change in bowel habit
- rectal mass
- positive family history
- abdominal mass
Outros fatores diagnósticos
- abdominal pain
- anemia
- male sex
- weight loss and anorexia
- abdominal distension
- palpable lymph nodes
Fatores de risco
- 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
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- complete blood count
- liver biochemistry
- renal function
- colonoscopy
- CT colonography
- CT scan of chest, abdomen, and pelvis
- genetic testing
Investigações a serem consideradas
- MRI pelvis: rectal cancer protocol
- transrectal endoscopic ultrasound
- biopsy
- carcinoembryonic antigen
- PET scan
Novos exames
- advanced optical imaging techniques
- blood-based tests
- circulating tumor DNA
Algoritmo de tratamento
rectal cancer, suitable for surgery
rectal cancer, not suitable for surgery
colon cancer, suitable for surgery
colon cancer, not suitable for surgery
Colaboradores
Authors
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
Disclosures
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
Disclosures
KANC declares that she has no competing interests.
Acknowledgements
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.
Disclosures
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.
Peer reviewers
Susan Clark, BChir, MB
Consultant Colorectal Surgeon
St Mark's Hospital and Academic Institute
Northwick Park
Middlesex
UK
Divulgaciones
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
Divulgaciones
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.
Referencias
Artículos principales
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: colorectal cancer screening [internet publication].Texto completo
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: rectal cancer [internet publication].Texto completo
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: colon cancer [internet publication].Texto completo
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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