美国临床肿瘤学会（ASCO）对 2 期结肠癌的辅助治疗建议
ASCO建议，应给予 ⅡA 期结肠癌和高风险特征患者，以及 ⅡB 和 ⅡC 期结肠癌患者辅助化疗。
高风险特征为：神经旁侵犯或淋巴管侵犯、肿瘤分化不良、肿瘤等级未分化、肠梗阻、肿瘤穿孔、≥10 处肿瘤出芽，或手术样本 <12 个淋巴结。共同决策过程中应考虑存在的危险因素数量，因为存在一个以上危险因素可增加复发风险。
对治疗潜在获益和危害及其持续时间进行个体化讨论后，高风险 ⅡA 期、ⅡB 期或 ⅡC 期结肠癌患者应给予 3 至 6 个月治疗。
对于无高危特征的 ⅡA 期结肠癌患者，不应常规给予辅助化疗。
小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 年龄增长
- 直肠出血
- 大便习惯改变
- 直肠肿块
- 阳性家族史
- 腹部肿块
其他诊断因素
- 贫血
- 男性
- 腹痛
- 体重减轻和厌食
- 腹胀
- 可触及的淋巴结
危险因素
- 年龄增长
- 家族史
- 结肠腺瘤样息肉病突变
- Lynch 综合征（遗传性非息肉病性结直肠癌）
- MUTYH/MYH 相关性息肉病
- 错构性息肉病综合征
- 炎症性肠病
- 肥胖
- 肢端肥大症
- 缺乏体育锻炼
- 缺乏膳食纤维
诊断性检查
首要检查
- 全血细胞计数
- 肝脏生化指标
- 肾功能
- 结肠镜检查
- CT 结肠成像术
- 双对比钡灌肠
- 胸部、腹部和盆腔 CT 扫描
- 基因检测
需考虑的检查
- 盆腔 MRI 直肠癌检查方案
- 经直肠超声内镜
- 活检
- 癌胚抗原
- PET 扫描
新兴检查
- 先进的光学影像技术
治疗流程
直肠癌，适合进行手术
不适合手术治疗的直肠癌
适合手术治疗的结肠癌
不适合手术治疗的结肠癌
撰稿人
作者
David E. Stein, MD, FACS, FASCRS
Regional Chief of Surgery
MedStar Health
Baltimore
MD
利益声明
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
利益声明
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
利益声明
PPK declares that she has no competing interests.
Kamila A. Nowak-Choi, MD
Department of Radiation Oncology
MedStar Franklin Square Medical Center
Baltimore
MD
利益声明
KANC declares that she has no competing interests.
鸣谢
Dr David E. Stein, Dr David M Lisle, Dr Pallavi P Kumarm, 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.
利益声明
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 in gastrointestinal (GI) 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 GI 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.
鉴别诊断
- 肠易激综合征
- 溃疡性结肠炎
- 克罗恩病
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