cancer colorretal
TRANSCRIPT
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Dda Luciana Ferreira de Almeida
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• Adenocarcinoma Esporádico (75%)
• Carcinoma Colorretal Hereditário
– Polipose Adenomatosa Familiar (FAP) e
variantes
• Câncer Colorretal Hereditário Sem
Polipose
– (HNPCC ou Síndrome de Lynch)
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ADENOCARCINOMA
ESPORÁDICO
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• Brasil: 4º neplasia mais comum.
• H = M
• Incidencia: > 50 anos.
Regiões desenvolvidas.
• Idade média no dx: 62 anos.
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• Alcool e Tabagismo
• Dieta rica em gordura
– Calorias e Carboidratos refinados
• Obesidade
– Predominantemente abdominal
• Doença Inflamatória Intestinal
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VILOSO:
Mais chance de malignizar.
> 2 cm
Displasia grave.
ADENOMAADENOCARCINOM
A
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Ceco e Colón
ascendente:
38%
Transverso:
18%
Descendente
: 18%
Sigmoide e
reto : 35%
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Ceco e Colón
ascendente:
38%
Transverso:
18%
Descendente
: 18%
Sigmoide e
reto : 35%
Sangue oculto/
Anemia
Massa
palpável
Febre
Diarréia
Constipaçã
o
Hematoquezia
Tenesmo
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• Colonoscopia (Padrão ouro)
• Retossigmoidoscopia
• Clister Opaco
• CEA: Não é diagnóstico!
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• TNM
• DUKES
• MAC
ESTÁGIO T N M DUKES MAC
0 Tis N0 M0 - -
I T1 N0 M0 A A1
T2 N0 M0 A B1
II A T3 N0 M0 B B2
II B T4 N0 M0 B B3
III A Qualquer T N1 M0 C C1
III B Qualquer T N2 M0 C C2/C3
III C Qualquer T N3 M0 C C1/C2/C3
IV Qualquer T Qualquer N M1 - D
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• COLON:
– Ressecção com margem de segurança +
linfadenectomia
– QT adjuvante: Dukes B e C
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• RETO:
– Tumores altos (5 -16 cm):
• Ressecção abdominal baixa (RAB)
• Anastomose Colorretal
– Tumores baixos (< 5 cm):
• Ressecção abdominoperineal (Miles) (RAP)
• Colostomia definitiva
– QTx + RTx: Neoadjuvante/ Adjuvante
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• Anamnese + Exame Físico + CEA/CA 19.9– Trimestralmente ( 2 anos)
– Semestralmente (3 a 5 anos)
• Radiografia de tórax + US/CT/RNM de Abdome e Pelve– Semestralmente até o 5º ano
• Colonoscopia:– Primeira em um ano.
– A cada 3 ou 5 anos depois de acordo com risco pessoal e familiar.
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• Todos: (> 50 anos)
– Colono: 10/10 anos
– Sigmoidoscopia: 5/5 anos
– Sangue oculto anual
• Se história familiar:
– > 40 anos ou 10 anos antes da idade do
familiar acometido.
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• Lynch: > 20 anos
– 20 anos: Colono 2/2 anos
– 40 anos: Colono anual
• PAF: > 10 – 12 anos
– Retossigmoidoscopia anual
• DII: 8 – 10 anos de doença
– Colono 2/2 anos
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