Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- idade mais avançada
- sangramento retal
- alteração no hábito intestinal
- massa retal
- história familiar positiva
- massa abdominal
Other diagnostic factors
- dor abdominal
- anemia
- sexo masculino
- perda de peso e anorexia
- distensão abdominal
- linfonodos palpáveis
Risk factors
- idade mais avançada
- história familiar
- mutação no gene da polipose adenomatosa do cólon (APC)
- 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
Diagnostic investigations
1st investigations to order
- hemograma completo
- bioquímica hepática
- função renal
- teste imunoquímico fecal quantitativo
- colonoscopia
- colonografia por TC
- TC do tórax, abdome e pelve
- teste genético
Investigations to consider
- RNM de pelve: protocolo para câncer retal
- ultrassonografia endoscópica transrretal
- biópsia
- antígeno carcinoembriogênico
- tomografia por emissão de pósitrons (PET)
Emerging tests
- técnicas avançadas de imagem óptica
- testes baseados no sangue
- DNA do tumor circulante
Treatment algorithm
câncer retal, adequado para cirurgia
câncer retal, não adequado para cirurgia
câncer de cólon, adequado para cirurgia
câncer de cólon, não adequado para cirurgia
Contributors
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 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.
Peer reviewers
Susan Clark, BChir, MB
Consultant Colorectal Surgeon
St Mark's Hospital and Academic Institute
Northwick Park
Middlesex
UK
Disclosures
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
Disclosures
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.
References
Key articles
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: colorectal cancer screening [internet publication].Full text
National Institute for Health and Care Excellence. Colorectal cancer. Dec 2021 [internet publication].Full text
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: rectal cancer [internet publication].Full text
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: colon cancer [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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