CANCER COLORRECTAL

Vctor Videla M. INTERNO MEDICINA

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 mucinoso 3. carcinoma de clulas en anillo de sello 4. carcinoma de clulas pequeas 5. carcinoma medular 6. carcinoma indiferenciado 7. carcinoma neuroendocrino
1. 2. WHO. World Health Organization Classification of Tumours. Lyon, France, IARC scientific publication, 2000. Oscar Tapia E. International Journal of Morphology. 2010

 a su vez de acuerdo al grado de diferenciacin en tumores (2). 1. Bien diferenciado 2. Moderadamente diferenciado 3. Poco diferenciados 4. Indiferenciado
2. Oscar Tapia E. International Journal of Morphology. 2010

AJCC

AJCC

AJCC

Estadio 1: 95% Estadio 2: 72-85% Estadio 3: 44-83% Estadio 4: 8%

Astler and Coller

Stage A: Limited to mucosa Stage B1: Extending into muscularis propria but not penetrating through it; nodes not involved Stage B2: Penetrating through muscularis propria; nodes not involved Stage C1: Extending into muscularis propria but not penetrating through it. Nodes involved Stage C2: Penetrating through muscularis propria. Nodes involved Stage D: Distant metastatic spread

Oscar Tapia E. International Journal of Morphology. 2010

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.

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

CLINICA

Hechavarria P. MEDISAN. 2003

ESTUDIO
COLONOSCOPIA

WHO. World Health Organization Classification of Tumours. 2000

IMAGENES
CT MRI ULTRASONOGRAFIA TRANSRECTAL INVASION METASTASIS REGIONAL Y A DISTANCIA

MARCADORES TUMORALES
CEA (+2,5) CA 19.9 CK20 TPA

TRATAMIENTO
QX ENF. LOCALIZADA: HEMI-COLECTOMA + 12 GANGLIOS (RT ADYUVANTE EN RECTO) ESTADIO 3: + QT OXALIPLATINO, 5 FU, LV. ESTADIO 2: -12 GANGLIOS, T4, OBSTR O PERFOR, INDIF. RECTO BAJO: AMPUTACION ABDOMINOPERINEAL + COLOSTOMIA PERMANENTE.

TRATAMIENTO
EXCISIN TOTAL DE MESORECTO: 50 a 13% RT PREOP. + ETM: 5% 25 GY EN 5 DIAS O 50,4 GY + QT =CX EN 4-8 SEM CAPECITABINA (XELODA)

Mostafa Abd Elwanis. World J Surg Oncol. 2009

SEGUIMIENTO

SEGUMIENTO

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 Digestive System. 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 19902003. 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 an increased risk of distal colon and rectal cancer in Japanese men: the Miyagi Cohort Study. Eur J Cancer. 2007;43:38390. Naghma Khan, Farrukh Afaq, and Hasan Mukhtar. LIFESTYLE AS RISK FACTOR FOR CANCER: EVIDENCE FROM HUMAN 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: prospective phase II trial; World J Surg Oncol. 2009; 7: 52.