結直腸疾病英文

1、Colorectal Cancer,Colon Ca incidence: 105,500/US/yrColon Ca mortality: 48,100/US/yr implies ~ 45% colon Ca case mortalityRectal Ca incidence: 42,000/US/yrRectal Ca mortality: 8,500/Us/yr implies ~ 2

2、1% rectal Ca case mortality,Epidemiology,3Characteristics in china,Young,Lower location,ulceration,,Ethiology,Dietary habitsPrecancous diseasesEnvironment factorsHeredity factorsOther factors,Dietary habit,,,Heredity

3、 factors,Adenomatous polyposis syndromes (APS)Hereditary “Non-polyposis” Colon Cancer (HNPCC, Lynch syndrome)Familial Adenomatous Polyposis (FAP),Other factors,Anatomy,Arterial supply of the colon,Ileocolic artery

4、Right colic arteryMeddle colic arteryLeft colic arterySigmoid arteries,Venous drainage of the colon,Superior mesenteric veinInferior mesenteric veinSplenic veinHepatic portal vein,Lymphatic drainage of the colon,Ep

5、icolic nodesParacolic nodesIntermediate nodesCentral nodes,Ileocecal region,Arterial supply of the rectum,Superior rectal arteryMiddle rectal arteryInferior rectal artery,Venous drainage of the rectum,Internal hemor

6、rhoidal plexusExternal hemorrhoidal plexus,Rectal region,Model of colorectal carcinogenesis（90%） Nomal epithelium Heperproliferative epithelium Adenoma

7、 Carcinoma,,,,病理生理,Pathology,Morphology,Protrude typeInfiltrate typeUlceration type,Pathology Cytology,CarcinomeMucinous carcinomacarcinoideUndifferentiated carcinoma Squamous carcinoma,,Route

8、of metastasis,Route of metastasis,Infiltration directlymphatic metastasisHematogenous dissemination Implantation metastasis,Liver Metastasis,,Implantation metastasis,,Classification of Pathology,Dukes stages

9、Dukes A、B、C、DTNM stages Ⅰ、Ⅱ、Ⅲ、Ⅳ,DUKES Classification,Dukes Stages,Stage A: limited to mucosa and submucosa 90% Stage B: extends into muscularis or serosa 60-75%Stage C: one positive node - 69% six or more

10、 positive nodes, 27%Stage D: mets. to liver, bone, lung 5%,COLORECTAL CANCER SURVIVAL (Dukes Stages, 5 y),,Stage Classification,Stage 0 ＝Tis, N0, M0 Stage I ＝T1, N0, M0 T2, N0, M0 Stage II ＝T3, N0, M0 T4, N0, M0 Sta

11、ge III＝Any T, N1, M0 Any T, N2, M0Stage IV ＝Any T, Any N, M1,,Clinical findings,Hematochezia (distinct from melena) Change in bowel habit: alternating constipation and diarrhea.Obstipation to clinic

12、al lower bowel obstruction.,Anemia,Weight loss,Abdominal pain,FOBT,Mass,Fever,Anorexia,Location in right colon,Obstruction,Diarrhea,Location in left colon,Blood in feces,Constipation,Blood in stool,Change in normal bowel

13、 habits,Rectal examination,Cancer of rectum,Method of diagnosis,Digital examinationFecal occult bloodEndoscope anoscope Flexible sigmoidoscopeElectrical ColonoscopeAir-contrast barium en

14、ema CEA others－－CT、MRI、PET,Single contrast,Double contrast,Air-contrast barium enema,Endoscopes,Endoscopes,Colonoscopy,Colonoscopy,Colonoscopy,Colonoscopy,Rectal polyp,Rectal CA,CT Scan—Rectal tumor,Treatment,The main

15、 method is the operation,Operation of clolon,Right hemicolectomy Transverse colon resection Left hemicolectomy Sigmoide resection,Right hemicolectomy,Ileo-transversal anastomoseCecumAscending colonHepatic

16、 flexure of colonTerminal ileum 15cmGreater omentumTransverse colonLN of right gastroepiploic artery,Transverse colectomy,Ascendo-descending colon anastomoseHepatic flexure of colonSplenic flexure of colonTransver

17、se colonGreater omentumMesocolonLN of gastrocolic ligament,Radical correction of descending colon,Transversorectal anastomoseSplenic flexure of colonDescending coloSigmoid colonParts of greater omentumMesocolon,R

18、adical correction of sigmoid colon,Descendorectal anastomoseParts of descending colonSigmoid colon Superior extremity of rectumMesocolon of sigmoid,Operation of rectum,Transanus Local resection(APR)---Miles(LAR)---

19、-DixonParksReforming BaconHartmannPost-cavitas pelvis cleareEntire cavitas pelvis cleare,Radical correction of rectum,Dixon location > 5cm dentate line Incisal margin >3cm,,Abdominal Perineal

20、 Resection(Miles),Indication location <5cmExtent,Post-cavitas pelvis cleare,male female,Radical correction of rectum,ParksReforming BaconHartmann,,Complication,Hemorrhage anterosacr

21、um Ureter injuryBladder injuryUrine retentionSexual disturbanceStomal leak,Chemotherapy,Methodsystemic chemotherapyregional chemotherapyMedicin5-FU、CF,Systemic Chemotherapy,Regional hepatic chemotherapy,Chemopor

22、t,Radiotherapy,External radiotherapyInternal radiotherapy,New adjuvant therapy,Sandwich,Chemotherapy + Radiotherapy,operation,Chemotherapy + Radiotherapy,,,Treatment indication,STAGE 0Local excision with clear mar

23、ginsLarge lesion not amenable to local excisionSTAGE 1Wide surgical resection and anastomosis,Treatment indication,STAGE 2Wide surgical resection and anastomosisSystemic or regional chemotherapyRadiation ther

24、apyBiologic therapy,Treatment indication,STAGE 3Surgical resection and anastomosisPre/Postoperative chemotherapy 5-FU/leucovorin 6 M 5FU/levamisol 12MPostoperative radiatio

25、n therapyBiological therapy Alone or combination,Treatment indication,STAGE 4Surgical resection/anastomosis or bypass Surgical resection of isolated metastasesChemotherapyBiologic therapyRadiation ther

26、apy,Postoperative follow up,CEAColonoscopyUltrasonographyComputer TomographyTrans-Rectal UltraSound,Polyps of colon,Incidence in the general population is 1.6-12%Incidence in people over 70 may be as high as 40%Pol

27、yps are classified as neoplastic or nonneoplasticMost polyps are asymptomatic-requiring ten years to double their diameterPolyps may grow large enough to cause symptoms,Adenomatous polyps,Tubular adenoma75% 5%Tubu

28、lovillous 15 % 22%Villousadenoma10 % 40 %,TYPE PREVALENCE % MALIGNANT,,,,,,Adenomatous polyps,Tend to grow slowly and continuously They may be sessile, or pedunculated,Adenomatous polyps

29、,TreatmentRemoval of all polyps is recommendedCareful histologic assessment is mandatory for proper managementResection either endoscopically or by open techniquesFollow-upRegular checkups are recommended since 40%