转移性结直肠癌.pptVIP

Colorectal Cancer: Metastatic (Palliation)转移性结直肠癌;Approximately 20% of patients with colorectal cancer present with established distant metastases. Despite considerable progress Stage IV patients are?not curable. 5-year?survival rate for Stage IV patients diagnosed between 1991?and 2000 was 8%. Systemic chemotherapy,?endoscopic treatments to palliate obstruction, surgical diversion, and surgical resection all have important roles in treatment of Stage IV patients.;将近20%的结直肠癌患者都会发生远处转移 尽管医疗技术有了很大进步，但IV期患者仍无法治愈 1991-2000年IV期患者的5年生存率为8% 系统的化疗，内镜治疗缓解梗阻，造瘘，手术切除都是治疗IV期患者的重要手段;For patients with?good performance status and minimal symptoms from their?primary cancers, standard treatment is systemic chemotherapy, which is well documented to increase survival and quality of life.? Surgical resection of the primary tumor and,?when feasible, of the metastatic lesions can provide excellent?palliation and can, in some cases, provide lasting cure.? In the past decade, there has been remarkable improvement?in the efficacy of chemotherapy for colorectal cancer. FOLFOX or FOLFIRI. Median survival has?improved from 12–14 months to 21 months;对于一般情况好，原发肿瘤症状轻的患者，标准的治疗应为系统的化疗，可以有效的提高生存率和生活质量 对于有转移患者的原发肿瘤切除，如果可以切除的话，有些情况下对病情有良好的缓解作用 在过去的10年里，化疗的疗效有了显著的提高，FOLFOX、FOLFIRI方案的应用使转移癌患者的中位生存时间从12-14月提升至21个月;IV期肿瘤患者的临床表现是多种多样的。大部分与原发病灶有关。 初始的评估手段应有：结肠镜（取活检），肿瘤、肝脏、肺部的影像学检查。 经直肠腔内超声或MRI是指导临床TNM分期的重要手段。胸、腹、盆的CT检查是发现转移的准确有效的方法。 PET可以发现CT发现不了的一些隐性疾病，检出率达20%。;Once the extent of disease workup is complete and distant?metastases have been documented, the surgeon must make?three important judgments. First is whether the patient is fit?for aggressive treatment. Second is whether the primary tumor presents?a clinically significant risk of bowel obstruction. The?third determination is whether the patient’s metastases can be?surgically resected, and therefore treated with curative intent;当常规检查完善，并发现转移时，外科医生需要做3个判断。 1 患者是否适合接受手术治疗。 2 原发肿瘤是否有显著的梗阻风险。 3 转移灶是否可以手术切除。 以达到治愈的目的;Management of patients with advanced