cáncer colorrectal
DESCRIPTION
Cancer colon y rectoTRANSCRIPT
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CNCER COLORRECTAL
Dr. Manuel Huamn Guerrero
Profesor Principal
FAMURP
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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
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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
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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
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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
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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
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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
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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
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Porcentaje de todos los cnceres
colorrectales
0
5
10
15
20
25
30
80
EDAD
Edad en el momento del diagnstico
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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
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CANCER COLORRECTAL: distribucin
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Cncer Colorrectal: Epidemiologa
Tasa de Incidencia:
USA, Australia, Nueva Zelanda , Europa.
ASIA ,Amrica del Sur, frica
Distribucin: colon derecho sigmoide
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CNCER COLORRECTAL: Factores Protectores
Dieta con vegetales
Consumo en fibra
Calcio
Dieta rica con Vit. A (Carotenos)
Vit. C y E
Aspirina y AINE
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Gentica
molecular
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Cncer colorrectal:
Adenomas (F. de R.)
Mayor de 1 cm. 3%
Componente velloso 17%
Displasia severa 37%
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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
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CNCER COLORRECTAL:
Secuencia evolutiva
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Cncer Colorrectal (CCRHSP)
Criterios de msterdam
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Cncer colorrectal:
factores de riesgo
Sindrome Familiar de Cncer
Enfermedades inflamatorias del colon
A.- Colitis Ulcerativa
B.- Enfermedad de Crohn (10% por dcada)
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Colitis
Ulcerativa
pseudo
plipo
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Colitis
Y
cncer
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Cncer de recto:
Sntomas y signos
Hemorragia
Eliminacin de moco
Tenesmo
Suboclusin u oclusin
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Cncer de colon izquierdo:
Sntomas y signos
Alteracin ritmo intestinal (estreimiento)
Heces calibre
Hemorragia
Dolor abdominal
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Cncer de colon derecho:
Sntomas y signos
Anemia
Prdida de peso
Masa palpable
Se altera ritmo intestinal
Suboclusin u obstruccin (tarda)
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Cncer colorrectal:
Diagnstico
Rx. Colon doble contraste
Resctosigmoidoscopa
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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
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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
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Cncer colorrectal:
Estadiamiento
Rx. Trax
Ultrasonografa
TAC
USG endorrectal
CEA
Urografa excretoria
Evaluacin ginecolgica (US plvica)
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Cncer
colorrectal
RX
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Cncer colorrectal: Ecografa endosocpica
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Clasificacin
DUKES
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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
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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
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Cncer colorrectal: clasificacin
TNM
DISTANT METASTASIS
MX Presence of distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
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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
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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
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Irrigacin
colorrectal
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Ciruga
Cncer de colon
proximal
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Ciruga
Cncer de colon
distal
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Cncer
colorrectal:
Tratamiento
Quirrgico I
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Cncer
colorrectal:
Tratamiento
Quirrgico II
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Cncer
colorrectal:
Tratamiento
Quirrgico III
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Cncer
colorrectal:
Tratamiento
Quirrgico IV
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Cncer
colorrectal:
Tratamiento
Quirrgico V
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Cncer
colorrectal:
Tratamiento
Quirrgico VI
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Reseccin
Quirrgica
cncer
de
recto
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Cncer
de
recto
Sutura
mecnica
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Cncer
Colorrectal
Sobrevida
5 aos
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Cncer colorrectal:
Complicaciones Quirrgicas
30% aproximadamente
Respiratorias
Cardicas
Infeccin de herida
Infeccin urinaria
Dehiscencia anastomosis
Hemorragia de anastomosis
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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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