Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- idade mais avançada
- sangramento retal
- alteração no hábito intestinal
- massa retal
- história familiar positiva
- massa abdominal
Outros fatores diagnósticos
- anemia
- sexo masculino
- dor abdominal
- perda de peso e anorexia
- distensão abdominal
- linfonodos palpáveis
Fatores de risco
- idade mais avançada
- história familiar
- mutação de polipose adenomatosa do cólon
- Síndrome de Lynch (câncer colorretal hereditário sem polipose)
- Polipose associada ao MYH/MUTYH
- síndromes da polipose hamartomatosa
- doença inflamatória intestinal
- obesidade
- acromegalia
- atividade física limitada
- ausência de fibras alimentares
- tabagismo
- consumo moderado ou excessivo de bebidas alcoólicas
- níveis baixos de vitamina D
- consumo de carne vermelha e processada
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- hemograma completo
- bioquímica hepática
- função renal
- colonoscopia
- colonografia por TC
- enema de bário com duplo contraste
- TC do tórax, abdome e pelve
- teste genético
Investigações a serem consideradas
- RNM de pelve: protocolo para câncer retal
- ultrassonografia endoscópica transrretal
- biópsia
- antígeno carcinoembriogênico
- tomografia por emissão de pósitrons (PET)
Novos exames
- técnicas avançadas de imagem óptica
Algoritmo de tratamento
câncer retal, adequado para cirurgia
câncer retal, não adequado para cirurgia
câncer de cólon, adequado para cirurgia
câncer de cólon, não adequado para cirurgia
Colaboradores
Autores
David E. Stein, MD, FACS, FASCRS
Professor of Surgery
Georgetown University School of Medicine
Georgetown
DC
Regional Chief of Surgery
MedStar Health
Baltimore
MD
Declarações
DES declares that he has no competing interests.
David M. Lisle, MD
Associate Program Director
Department of Surgery
MedStar Franklin Square Medical Center
Baltimore
MD
Declarações
DML declares that he has no competing interests.
Pallavi P. Kumar, MD
Division Director, Medical Oncology
Sinai and Northwest Hospital
LifeBridge Health
Alvin & Lois Lapidus Cancer Institute
Baltimore
MD
Declarações
PPK declares that she 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
Declarações
KANC declares that she has no competing interests.
Agradecimentos
Dr David E. Stein, Dr David M Lisle, Dr Pallavi P Kumar, and Dr Kamila A Nowak-Choi would like to gratefully acknowledge 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.
Declarações
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 Tumour 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 randomised phase 2 study as neoadjuvant chemotherapy in rectal cancer (BACCHUS). He has also been supported by Roche to attend international meetings in gastrointestinal cancer.
Revisores
Susan Clark, BChir, MB
Consultant Colorectal Surgeon
St Mark's Hospital and Academic Institute
Northwick Park
Middlesex
UK
Declarações
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
Declarações
SW declares that he has no competing interests.
Diagnósticos diferenciais
- Síndrome do intestino irritável
- Colite ulcerativa
- Doença de Crohn
Mais Diagnósticos diferenciaisDiretrizes
- Treatment of metastatic colorectal cancer
- NCCN clinical practice guidelines in oncology: rectal cancer
Mais DiretrizesFolhetos informativos para os pacientes
Câncer de intestino: devo fazer rastreamento?
Câncer de intestino: o que é?
Mais Folhetos informativos para os pacientes
Conectar-se ou assinar para acessar todo o BMJ Best Practice
O uso deste conteúdo está sujeito ao nosso aviso legal