colorectal cancer.ppt

Colorectal cancer Wuhan university Cao chuanhua Epidemiology Peak incidence : USA, New Zealand , Australia Lowest incidence: India, South America, Arab Israelis The incidence and mortality rates declined since they peaked in 1985 Etiology Polyps Diet: high fat, caloric ,low fiber, calcium Inflammatory bowel disease a. ulcerative colitis b. crohn’s disease Genetic factors: APC ,FAP Smoking Other factors: family history ,asbestos Pathology and natural history Histology :adenocarcinoma (98%) basaloid(基底细胞的) carcinoma (anal) Location: left colon (2/3) right (1/3) Clinical presentation Clinical course :rectal cancers are three times more likely to reoccur than colonic cancers ;rectal cancers often reoccurs first in the lungs ,colon cancer more reoccurs first in the liver Prognosis studies Biopsy confirmation General evaluation Carcinombryonic antigen (CEA) screening CT or MRI Endoscopy or barium enema EUS Clinical presentation of colorectal cancer Biologic markers CEA: insensitive and nonspecific New markers: CA19-9 Amsterdam criteria for diagnosis of HNPCC Colorectal cancer in 3 or more relatives . One of whom is a first degree relative of the other two Two successive generation affected One cases affected by age 50 years Stage description Tis :carcinoma in situ T1:invasion of the submucosa（黏膜下） T2:invasion of the muscularis propria（肌层） T3: invasion through the muscularis propria in to subserosa（浆膜下） or the nonperitonealized pericolic or prirectal tissues T4:perforation of visceral peritoneum or direct invasion into adjacent organs or tissyes N0:no regional lymph node metastases N1:metastases in 1-3 pericolic or perirectal lymph node N2:metastases in 4 or more lymph node N3: :metastases in lymph node along a named vascular trunk node; tumor invasion of adjacent organs M0: no distant metastases M1 :distant metastases disease TNM grouping Prognostic factors Stage Histoligic grade The anatomic locationof the tumor: rectum worse than the