cancer color rectal

8/2/2019 Cancer Color Rectal

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CANCER COLORRECTAL

Vctor Videla M.

INTERNO MEDICINA


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DEFINICIN

TU. Ubicados en I. grueso valvula ileocecal recto. Actualmente agrupados en Tu. de colon der, transverso,

izq y recto Clasificacin histolgica (1):

1. adenocarcinoma (2)2. adenocarcinoma mucinoso3. carcinoma de clulas en anillo de sello4. carcinoma de clulas pequeas

5. carcinoma medular6. carcinoma indiferenciado7. carcinoma neuroendocrino

1. WHO. World Health Organization Classification of Tumours. Lyon, France, IARC scientific publication, 2000.2. Oscar Tapia E. International Journal of Morphology. 2010


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a su vez de acuerdo al grado de diferenciacinen tumores (2).

1. Bien diferenciado

2. Moderadamente diferenciado

3. Poco diferenciados

4. Indiferenciado

2. Oscar Tapia E. International Journal of Morphology. 2010


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AJCC


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AJCC


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AJCC


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Estadio 1: 95%

Estadio 2: 72-85%

Estadio 3: 44-83% Estadio 4: 8%


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Astler and Coller

Stage A: Limited to mucosaStage B1: Extending into muscularis propria butnot penetrating through it; nodes not involved

Stage B2: Penetrating through muscularis propria;nodes not involvedStage C1: Extending into muscularis propria butnot penetrating through it. Nodes involved

Stage C2: Penetrating through muscularis propria.Nodes involvedStage D: Distant metastatic spread


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Oscar Tapia E. International Journal of Morphology. 2010


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EPIDEMIOLOGIA

1 mill al ao mill de muertes Tasa cruda mundial de mortalidad 8,4/100.000

hab 25/100.000 hab 3,9/100.000 hab En chile 4ta causa de muerte x Ca 6,4/100.000 hab

Bannura, G. Rev. Chil. Cir. 2006.Donoso, A. Rev. Med. Chil. 2006.


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FACTORES DE RIESGO

TABACO TPC 30 aos ALCOHOL 30 gr 100 gr DIETA OBESIDAD 45,6% ENF. INFLA. INTESTINALES 8-10 aos CU 20 veces incid.; EC 3 veces POLIPOSIS ADENOMATOSA FAMILIAR SD DE LYNCH (5%, MLH1, MSH2, MSH6) SD PEUTZ-JEGHERS (STK11) POLIPOSIS JUVENIL (SMAD4 Y BMPR1A

Sarebo M, BMC Cancer. 2006,Mizoue T.Am J Epidemiol.2008.Akhter M. Eur J Cancer. 2007.

Naghma Khan. Cancer Lett. 2010.

WHO. World Health Organization Classification of Tumours. 2000


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CLINICA

Hechavarria P. MEDISAN. 2003


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ESTUDIO

COLONOSCOPIA

WHO. World Health Organization Classification of Tumours. 2000


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IMAGENES

CT

MRI

ULTRASONOGRAFIATRANSRECTAL

INVASION METASTASISREGIONAL Y ADISTANCIA


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MARCADORES TUMORALES

CEA (+2,5)

CA 19.9

CK20 TPA


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TRATAMIENTO

QX

ENF. LOCALIZADA: HEMI-COLECTOMA + 12GANGLIOS (RT ADYUVANTE EN RECTO)

ESTADIO 3: + QT OXALIPLATINO, 5 FU, LV. ESTADIO 2: -12 GANGLIOS, T4, OBSTR O

PERFOR, INDIF.

RECTO BAJO: AMPUTACIONABDOMINOPERINEAL + COLOSTOMIAPERMANENTE.


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TRATAMIENTO

EXCISIN TOTAL DE MESORECTO: 50 a 13%

RT PREOP. + ETM: 5%

25 GY EN 5 DIAS O 50,4 GY + QT =CX EN 4-8SEM

CAPECITABINA (XELODA)

Mostafa Abd Elwanis. World J Surg Oncol. 2009


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SEGUIMIENTO


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SEGUMIENTO


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BIBLIOGRAFIA

Sarebo M, Skjelbred CF, Breistein R, Lothe IM, Hagen PC, Bock G, et al. Association between cigarette smoking,APC mutations and the risk of developing sporadic colorectal adenomas and carcinomas.BMC Cancer. 2006;6:71.

WHO. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the DigestiveSystem. Lyon, France, IARC scientific publication, 2000.

Bannura, G. Se puede mejorar la oportunidad del diagnstico del cncer colorrectal en Chile?Rev. Chil. Cir.,58:59-61, 2006.

Donoso, A.; Villarroel, L. & Pinedo, G. Increase in colon cancer mortality rates in Chile, during the period 1990-2003. Rev. Med. Chil., 134(2):152-8, 2006.

Sarebo M, Skjelbred CF, Breistein R, Lothe IM, Hagen PC, Bock G, et al. Association between cigarette smoking,APC mutations and the risk of developing sporadic colorectal adenomas and carcinomas.BMC Cancer. 2006;6:71.

Mizoue T, Inoue M, Wakai K, Nagata C, Shimazu T, Tsuji I, et al. Alcohol drinking and colorectal cancer in Japanese:a pooled analysis of results from five cohort studies.Am J Epidemiol.2008;167:1397406

Akhter M, Kuriyama S, Nakaya N, Shimazu T, Ohmori K, Nishino Y, et al. Alcohol consumption is associated with anincreased risk of distal colon and rectal cancer in Japanese men: the Miyagi Cohort Study.Eur JCancer. 2007;43:38390.

Naghma Khan, Farrukh Afaq, and Hasan Mukhtar. LIFESTYLE AS RISK FACTOR FOR CANCER: EVIDENCE FROMHUMAN STUDIES. Cancer Lett. 2010 July 28; 293(2): 133143.

Dr. Pedro M. Hechavarra Borrero, Dra. Tamara Merio Hechavarra, Dr. Yoel A. Fernndez Moreno y Dr. CM

Arstides Prez Prez. Caractersticas clnicas del cncer de colon. Estudio de 57 pacientes- MEDISAN 2003;7(3):4-9 OConnell JB, Maggard MA and Ko CY. Colon cancer survival rates with the new American Joint Committee on

Cancer Sixth Edition Staging. J Natl Cancer Inst 2004 Oct 6;96(19):1420-5. Mostafa Abd Elwanis,1 Doaa W Maximous,2 Mohamed Ibrahim Elsayed,1and Nabiel NH Mikhail. Surgical treatment

for locally advanced lower third rectal cancer after neoadjuvent chemoradiation with capecitabine: prospectivephase II trial; World J Surg Oncol. 2009; 7: 52.

cancer color rectal

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