结直肠癌 (英文版）.pptVIP

COLORECTAL CARCINOMA 2● Cecum● Ascending Colon● Transverse Colon● Descending Colon● Sigmoid Colon● RectumANATOMY 3● 12 ~ 15 cm ● peritoneal portion and pelvis portion● mesorectum Mesorectum全直肠系膜切除(TME)Total Mesorectum ExcisionABOUT RECTUM 4● common tumor in gastrointe- stinal tract ● occur mostly at 41~65 years old ● colon cancer seems more and more in recent 20 years● proliferation—adenoma --carcinoma, about 10~15 yearsINTRODUCTION 5PATHOLOGY ● Mass type（隆起型） 多见于升结肠、盲肠，肠腔内生长，转移发生较晚● Invasive type（浸润型） 多见于降结肠，肠壁内生长，易引起狭窄及梗阻● Ulceration type（溃疡型） 最常见类型，向肠壁深处生长，形成溃疡，容易发 生出血、感染或者穿孔 6MASS TYPE 7INVASIVE TYPE 8ULCERATIVE TYPE 9HISTOLOGIC CLASSIFICATION腺癌（Adenocarcinoma） ● 管状腺癌（tubular adenocarcinoma） ● 乳头状腺癌（papillary adenocarcinoma） ● 粘液腺癌（mucinous adenocarcinoma ） ● 印戒细胞癌（signet-ring cell adenocarcinoma）腺鳞癌（Adenosquamous carcinoma） 通常见于低位直肠癌或者肛管癌未分化癌（undifferentiated carcinoma） 10Normal epitheliumMicro-adenomaEarly-stageadenomaMiddle-stageadenomaCarcinomaAdvancedadenomaETIOLOGYOver 50 % come from the cancerationof adenoma. From normal cell to cancercells, it will need 10~15 years 11HIGH RISK FACTORS● Too much animal fat or protein in food● Too little vegetable and fibrin in food● Too little body exercise● Susceptibility in genetics● Familial adenomatous polyposis (FAP)● Others (adenoma, ulcerative colitis, etc) 12adenomaFAP 13CEA (carcinoembryonic antigen)An important marker for colorectal cancer(expressed in 60% of patients)TUMOR MARKER 14EXTENDING ROUTES OFCOLORECTAL CANCER● Lymphatic spread ● Hematogenous spread: hepatic metastasis● Direct invasion of adjacent structures ● Implantation spread 15LYMPHATIC METASTASIS 16PATHOLOGIC STAGING● Dukes Staging: Originally developed by Dukes in 1935, and further modified in 1954● TNM Staging: Recommended by the UICC (International Union Against Cancer)(Union for International Cancer Control) 17Dukes Staging● Stage A: 肿瘤局限于肠壁，未穿透浆膜● Stage B: 肿瘤穿透浆膜，但无淋巴结转移● S