cáncer colorrectal

CNCER COLORRECTAL

Dr. Manuel Huamn Guerrero

Profesor Principal

FAMURP

Cncer colorrectal

NM + frecuente en el mundo (tubo dig.)

(570,000 casos al ao)

De frecuencia significativo

USA: 150,000 casos anuales

50,000 decesos al ao

Comparison of the European Guidelines for the Treatment of Colorectal Cancer Frank P. Schulze, Germany April 5, 2014

Colorectal Cancer - a global problem

Incidence and Mortality

World: 7,200,000,000 people (2013)

1,361,000 new cases of CRC year-1

694,000 deaths for CRC year-1

Europe: 740,000,000 people (2013)

345,000 new cases of CRC year-1

152,000 deaths for CRC year-1

WHO / GloboCan 2012 (International Agency for Research on Cancer) - Cancer Fact Sheet

Toyoda et al, Jpn J Clin Oncol 2009, Trends in Colorectal Cancer Incidence by Subsite in Osaka, Japan

Haggar & Boushey, Clin Colon Rectal Surg. 2009 - Colorectal Cancer Epidemiology: Incidence, Mortality, Survival, and Risk Factors

Ferlay et al, Int J Cancer 2010 - Estimates of worldwide burden of cancer

Jemal et al, CA Cancer J Clin 2011 - Global Cancer Statistics

Comparison of the European Guidelines for the Treatment of Colorectal Cancer Frank P. Schulze, Germany April 5, 2014

Estimated colorectal cancer incidence worldwide in 2012: men

http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx

Comparison of the European Guidelines for the Treatment of Colorectal Cancer Frank P. Schulze, Germany April 5, 2014

Estimated colorectal cancer mortality worldwide in 2012: men

http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx

Comparison of the European Guidelines for the Treatment of Colorectal Cancer Frank P. Schulze, Germany April 5, 2014

Estimated colorectal cancer incidence worldwide in 2012: women

http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx

Comparison of the European Guidelines for the Treatment of Colorectal Cancer Frank P. Schulze, Germany April 5, 2014

Estimated colorectal cancer mortality worldwide in 2012: women

http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx

Cncer colorrectal: Epidemiologa

Edad : 70% (40 a 70 aos)

90% despus de 50 aos

Sexo : Ca. Rectal : Hombres 2- 1 Mujeres 3 -1

Raza : No diferencia

Porcentaje de todos los cnceres

colorrectales

0

5

10

15

20

25

30

80

EDAD

Edad en el momento del diagnstico

Cncer Colorrectal:

Factores ambientales de riesgo

Dieta en grasas y en fibra .

Carcingenos y mutgenos ambientales

Bacterias colnica: FECAPENTAENOS

Carnes y pescado asado: aminas heterocclicas

Consumo de cerveza

Poco selenio en la dieta

CANCER COLORRECTAL: distribucin

Cncer Colorrectal: Epidemiologa

Tasa de Incidencia:

USA, Australia, Nueva Zelanda , Europa.

ASIA ,Amrica del Sur, frica

Distribucin: colon derecho sigmoide

CNCER COLORRECTAL: Factores Protectores

Dieta con vegetales

Consumo en fibra

Calcio

Dieta rica con Vit. A (Carotenos)

Vit. C y E

Aspirina y AINE

Gentica

molecular

Cncer colorrectal:

Adenomas (F. de R.)

Mayor de 1 cm. 3%

Componente velloso 17%

Displasia severa 37%

Cncer colorrectal:

factores de riesgo

Adenomas colorrectales

Carcinona colorectal (sincrnicos, metacrnicos)

Sindrome de Poliposis

A.- Poliposis colnica familiar

B.- Sind. de TURCOR (> 100 adenomas)

C.- Sind. de GARDNER

D.- Sind. de MUIR (adenomas dispersos)

E.- Sind. de Peutz - Jeghers

CNCER COLORRECTAL:

Secuencia evolutiva

Cncer Colorrectal (CCRHSP)

Criterios de msterdam

Cncer colorrectal:

factores de riesgo

Sindrome Familiar de Cncer

Enfermedades inflamatorias del colon

A.- Colitis Ulcerativa

B.- Enfermedad de Crohn (10% por dcada)

Colitis

Ulcerativa

pseudo

plipo

Colitis

Y

cncer

Cncer de recto:

Sntomas y signos

Hemorragia

Eliminacin de moco

Tenesmo

Suboclusin u oclusin

Cncer de colon izquierdo:

Sntomas y signos

Alteracin ritmo intestinal (estreimiento)

Heces calibre

Hemorragia

Dolor abdominal

Cncer de colon derecho:

Sntomas y signos

Anemia

Prdida de peso

Masa palpable

Se altera ritmo intestinal

Suboclusin u obstruccin (tarda)

Cncer colorrectal:

Diagnstico

Rx. Colon doble contraste

Resctosigmoidoscopa

Cncer colorrectal:

Diagnstico

Colonoscopa

De eleccin

Permite realizar biopsias (dx)

Realiza procedimiento teraputicos (ej. Polipectoma

Localiza lesiones sincrnicas

Identifica otras lesiones asociadas

Seguimiento a pacientes con riesgo

Permite seguimiento a operados

Cncer colorrectal:

Diagnstico Diferencial

Enfermedad diverticular con estenosis

Colitis isqumica en zona estentica

Estenosis colnica por Crohn

Lesiones granulomatosas

Estenosis Rectales benignas

Ulcera rectal solitaria

Cncer colorrectal:

Estadiamiento

Rx. Trax

Ultrasonografa

TAC

USG endorrectal

CEA

Urografa excretoria

Evaluacin ginecolgica (US plvica)

Cncer

colorrectal

RX

Cncer colorrectal: Ecografa endosocpica

Clasificacin

DUKES

Cncer colorrectal: clasificacin TNM

PRIMARY TUMOR (T)

TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

Tis Carcinoma in situ

T1 Tumor invades submucosa

T2 Tumor invades muscularis propria

T3 Tumor invades through the muscularis propria into the subserosa

T4 Tumor perforates the visceral peritoneum

Cncer colorrectal: clasificacin TNM

REGIONAL LYMPH NODES (N)

NX Regional lymph nodes cannot be assessed

N0 No regional lymph node metastasis

N1 Metastasis in one to three pericolic or perirectal lymph nodes

N2 Metastasis in four or more pericolic or perirectal lymph nodes

N3 Metastasis in any lymph node along the course of a named vascular trunk

Cncer colorrectal: clasificacin

TNM

DISTANT METASTASIS

MX Presence of distant metastasis cannot be assessed

M0 No distant metastasis

M1 Distant metastasis

Cncer colorrectal: clasificacin TNM

STAGE GROUPING

Dukes

Stage 0 Tis N0 M0

Stage I T1 N0 M0 A

T2 N0 M0 A

Stage II T3 N0 M0 B

T4 N0 M0 B

Stage III Any T N1 M0 C

Any T N2,N3 M0 C

Stage IV Any T Any N M1

Neoplasia Colnica

Oncologa clnica

Evaluar uso quimioterapia

Cuadro clnico

Hemicolectoma

derecha

Ceco

e ascendente

Hemicolectoma

derecha alargada

Ascendente

e flexura esplnica

colectoma

subtotal

Transverso

e angulo esplnico

Hemicolectoma

izquierda

Descendente

e sigmoide

Curativa

Laparatoma laparoscopa

Reseccin

Laparaoscopa

Ostoma

Paliativa

Ciruga

Estadiamiento

Carcinoma colnico

Examen Fsico Colonoscopia con biopsia

Lesin de colon

Irrigacin

colorrectal

Ciruga

Cncer de colon

proximal

Ciruga

Cncer de colon

distal

Cncer

colorrectal:

Tratamiento

Quirrgico I

Cncer

colorrectal:

Tratamiento

Quirrgico II

Cncer

colorrectal:

Tratamiento

Quirrgico III

Cncer

colorrectal:

Tratamiento

Quirrgico IV

Cncer

colorrectal:

Tratamiento

Quirrgico V

Cncer

colorrectal:

Tratamiento

Quirrgico VI

Reseccin

Quirrgica

cncer

de

recto

Cncer

de

recto

Sutura

mecnica

Cncer

Colorrectal

Sobrevida

5 aos

Cncer colorrectal:

Complicaciones Quirrgicas

30% aproximadamente

Respiratorias

Cardicas

Infeccin de herida

Infeccin urinaria

Dehiscencia anastomosis

Hemorragia de anastomosis

Comparison of the European Guidelines for the Treatment of Colorectal Cancer Frank P. Schulze, Germany

www.icsbali2014.com/

April 5, 2014

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