2014年ESMO临床指南：转移性结直肠癌的诊断、治疗和随访.ppt

* Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up 汇报人：李维玲 日期: 2015.10.08 incidence In 2012, there were 447000 new cases of colorectal cancer (CRC) in Europe. CRC is the second most frequent cancer and represents 13.2% and 12.7% of all cancer cases in men and women, respectively. CRC was responsible for 215 000 deaths in Europe in 2012. This represents 11.6% and 13.0% of all cancer deaths in men and women , respectively. Approximately 25% of patients present with metastases at initial diagnosis and almost 50% of patients with CRC will develop metastases, contributing to the high mortality rates reported for CRC. The CRC-related 5-year survival rate approaches 60%. diagnosis Clinical or biochemical suspicion of metastatic disease should always be confirmed by adequate radiological imaging [usually a computed tomography (CT) scan or, alternatively, magnetic resonance imaging (MRI) or ultrasonography]. A fluorodeoxyglucose-positron emission tomography (FDG-PET) scan can be useful in determining the malignant characteristics of tumoural lesions, especially when combined with a CT scan or in the case of elevated tumour markers [carcinoem bryonic antigen (CEA)] without indications of the location of relapse on CT scan in the surveillance of CRC. diagnosis An FDG-PET scan is also especially useful to characterise the extent of metastatic disease and to look for extrahepatic metastases (or extrapulmonary metastases) when the metastases are potentially resectable. Histology of the primary tumour or metastases is always necessary before chemotherapy is started. For metachronous metastases, histopathological or cytological confirmation of metastases should be obtained, if the clinical or radiological presentation is atypical or very late (e.g. later than 3 years) after the initial diagnosis of the primary tumour. Resectable metastases do not need histological or cytological confirmation before resection. multid