雙語字幕
Understanding Colorectal Cancer
兩分鐘了解結直腸癌
Cancer in the large intestine is called colorectal cancer. The parts of your large intestine are the colon, rectum, and anal canal. Most colorectal cancer starts in the colon, in small clumps of cells called polyps. Most polyps are benign, which means they contain abnormal cells that aren't cancer and won't spread to the rest of the body. They are only in the thin layer of tissue lining the inside of the intestine.
大腸癌又稱結直腸癌(colorectal cancer)。大腸包括結腸、直腸和肛管。大多數(shù)結直腸癌始于結腸息肉,即結腸部位的小細胞團。多數(shù)息肉是良性的,它們含有非癌細胞,不會擴散到身體其他部位,只存在于腸內(nèi)壁的薄層組織中。
If the abnormal cells become cancer cells, the polyp can grow bigger and invade deeper into the wall of the large intestine. If not treated, cancer cells can enter the blood stream and spread to nearby lymph nodes. Over time, these cells can travel to other organs and form more tumors. You may have a higher risk for getting colorectal cancer if you have a family history of colorectal cancer, have colon polyps, are aged 50 or older, are obese, smoked cigarettes, aren't physically active, drink too much alcohol, or have a disease that inflames your colon such as ulcerative colitis or Crohn's disease.
異常細胞轉(zhuǎn)變?yōu)榘┘毎螅⑷馍L得更大,并深入大腸壁內(nèi)。如果不治療,癌細胞將進入血流,并擴散到鄰近的淋巴結。隨著時間的推移,這些細胞轉(zhuǎn)移到其他器官,形成更多腫瘤。結直腸癌風險因素包括:結直腸癌家族史、結腸息肉、年齡≥50歲、肥胖、吸煙、體育鍛煉少、過度飲酒、或者潰瘍性結腸炎或克羅恩病等引起結腸發(fā)炎的疾病。
Symptoms for colorectal cancer can include a change in bowel habits such as diarrhea, constipation, or having stools more narrow than usual, bright red or dark blood in the stool, feeling unable to empty your bowel, belly pain, bloating or cramps, unexplained weight loss, feeling weak or very tired, and vomiting. It's important to know that these symptoms can be caused by conditions other than colon cancer. And it's possible to have colorectal cancer without any symptoms, especially in the early stages. If you have questions about colorectal cancer, talk to your healthcare provider.
結直腸癌癥狀包括排便習慣改變,如腹瀉、便秘或便頻,大便帶鮮紅色或暗紅色的血,排便不盡感,腹痛,腹脹或絞痛,不明原因體重減輕,無力感或非常疲倦,以及嘔吐。大家要注意,這些癥狀也可能由結腸癌之外的其他疾病引起。此外,結直腸癌患者也可能不出現(xiàn)癥狀,尤其是早期階段。如對結腸癌存在疑問,請咨詢醫(yī)務人員。
結直腸癌相關知識拓展
癥狀
排便習慣改變(通常大便更稀,更頻繁)
體重減輕
肛周出血
里急后重(即使排便后也出現(xiàn)直腸墜脹感)
缺鐵性貧血
腸梗阻
檢查
結腸鏡檢查
內(nèi)窺鏡檢查顯示全結腸
金標準檢查
可包括可疑病變的活組織檢查或紋身(用于手術標記)
CT結腸造影
腸道準備,對比劑CT顯示結腸
不太適合做結腸鏡檢查的病人的可選項
分期CT掃描
胸部,腹部和骨盆CT
查找轉(zhuǎn)移癌或其他癌癥
除結腸鏡檢查外,考慮對體重減輕的患者進行初步調(diào)查,以排除其他癌癥
癌胚抗原(CEA)
腸癌腫瘤標志物血檢
不用于篩查
有助于預測既往曾治療的腸癌復發(fā)率
Dukes分期
Dukes A期:癌局限于粘膜和部分腸壁肌肉
Dukes B期:癌累及腸壁肌層
Dukes C期:淋巴結轉(zhuǎn)移
Dukes D期:轉(zhuǎn)移性疾病
Dukes分期逐漸被TNM分期系統(tǒng)取代
T (腫瘤)
Tx-原發(fā)腫瘤無法評估
T1-粘膜下受累
T2-固有肌層受累
T3-漿膜層受累
T4-直接侵犯其他組織/腹膜
N (結節(jié))
Nx-區(qū)域淋巴結無法評估
N0- 無淋巴結轉(zhuǎn)移
N1–1-3個淋巴結轉(zhuǎn)移
N2– >3個淋巴結轉(zhuǎn)移
M (轉(zhuǎn)移)
M0-無轉(zhuǎn)移
M1-轉(zhuǎn)移
治療
MDT決策
根據(jù)臨床情況、一般健康狀況、分期放射學、組織學和患者意愿
可選擇手術切除、化療、放療和姑息治療。
腸癌切除原則
結腸切除術,可治愈,也可緩解
腹腔鏡手術可更好地恢復,減少并發(fā)癥
包括切除腫瘤和建立端到端吻合術
回腸造口術
為保護遠端吻合而進行的臨時性回腸造口術
通常留院觀察6-8周,以使吻合口愈合,恢復
通常位于腹部右下方
并發(fā)癥
出血/感染/疼痛
神經(jīng)、膀胱、輸尿管或腸道受損
術后腸梗阻
麻醉風險
中轉(zhuǎn)開放
吻合口滲漏/失敗
需要造口
腫瘤切除失敗
DVT/PE
疝氣
粘連
手術
右半結腸切除術用于切除盲腸、升結腸和近端橫結腸的腫瘤:
左半結腸切除術用于切除遠端橫結腸和降結腸的腫瘤:
乙狀結腸切除術用于切除乙狀結腸腫瘤:
直腸前切除術用于切除低位乙狀結腸或高位直腸的腫瘤:
會陰聯(lián)合直腸癌根治術(APR)用于切除下直腸腫瘤,需要切除直腸和肛門(±乙狀結腸)并縫合肛門,為患者建立一個永久性的結腸造口: