49
H Tiêu hóa
Map 3.8 Ung thư đ i tr c tràng (CRC)
What is CRC?
This is cancer of the colon and rectum and is the third most common malignancy.
Usually adenocarcinoma on histology.
Signs and symptoms
•
Abdominal pain.
•
Unintentional weight loss.
•
Altered bowel habit.
•
Faecal occult blood.
•
Anaemia.
•
Fatigue.
Causes
Multifactorial and often unknown. There are risk factors that may predispose an
individual to develop CRC (see risk factor box).
Investigations
•
Bowel Cancer Screening Programme: faecal occult blood test in men and women
aged 60–69 years.
•
Bloods: FBC for iron deficiency anaemia and carcinoembryonic antigen (CEA)
tumour marker.
•
Endoscopy: colonoscopy/sigmoidoscopy.
•
Imaging: double contrast barium enema study ‘apple core’ sign; virtual colonoscopy.
Treatment
Depends on the extent of disease. This is assessed using Dukes staging system or
TNM system.
•
Conservative: patient education and referral to Macmillan nurses.
•
N i khoa: hóa tr (oxaliplatin, folinic acid và 5-fluorouracil là ch đ
đi u tr ph bi n nh t); x tr cũng có th đư c s d ng
•
Ph u thu t: ph u thu t c t u thư ng là đi u tr theo l a ch n.
Bi n ch ng
•
T c ru t và di căn.
Risk factors
•
Smoking.
•
Increased age.
•
Family history of CRC.
•
Inflammatory bowel disease (IBD).
•
Streptococcus bovis bacteraemia.
•
Congenital polyposis syndromes:
○
Juvenile polyposis syndrome:
– Autosomal dominant but it may occur spontaneously.
– Not malignant.
○
Peutz–Jeghers syndrome:
– Autosomal dominant.
– Increases risk of CRC.
– Melanosis is present on the oral mucosa.
•
Genetic predisposition:
○
Familial adenomatous polyposis (FAP):
– Autosomal dominant.
– Mutation of APC gene on chromosome 5.
– 100% lead to CRC.
○
Hereditary nonpolyposis colorectal cancer (HNPCC):
– Autosomal dominant.
– Mutation of DNA mismatch repair gene.
Giai đo n
Mô t
T l s ng sau 5 năm
A
Gi i h n
l p cơ niêm
90%
Xâm l n qua
l p cơ niêm
65%
30%
<10%
Di căn h ch
B
C
D
H th ng phân đ Duke
H th ng TNM
Tis – Ung thư t i ch
T1 – Xâm l n l p dư i niêm
T2 – Xâm l n l p cơ niêm
T3 – Xâm l n l p dư i thanh m c nhưng các cơ quan khác chưa b thâm
nh p
T4 – Các cơ quan lân c n b xâm l n
N1 – Di căn 1–3 h ch vùng
N2 – Di căn ≥4 h ch vùng
M0 –
Không di căn xa
M1 – Có di căn xa
MAP 3.8 Ung thư đ i tr c tràng (CRC)
Chapter_03.indd 49
08/12/14 2:30 PM
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