Tumor staging, chemotherapy, radiotherapy and targeted therapy for colon and rectal cancer

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Colorectal cancer is formed by rectum and colon tissue cell malignant transformation.Risk factors: age greater than 50 years, family history

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Colorectal cancer is formed by rectum and colon tissue cell malignant transformation.

Risk factors: age greater than 50 years, family history of colorectal cancer, who had colorectal cancer, ovarian cancer, endometrial cancer or breast cancer, a history of colorectal polyps, inflammatory bowel disease history.

The main symptoms: regular change, blood in the stool (fresh bloody or black stool), diarrhea, or constipation often have no stool discharged, stool thinning, recurrent abdominal pain or cramps, unexplained weight loss, excessive fatigue, vomiting.

Check and diagnosis methods: physical examination and medical history, fecal occult blood test, digital rectal examination, barium enema and colonoscopy and biopsy, colonoscopy.

Prognostic factors: tumor stage, whether there was intestinal infarction or intestinal perforation, tumor recurrence or not.

The basis of treatment options: tumor stage, tumor recurrence, the patient's physical condition.

Staging and treatment of colorectal cancer

branch

stage

Colon cancer treatment

Rectal cancer treatment principles

0

The basement membrane of tumor cells that did not penetrate the intestinal wall.

Local excision or polypectomy

Excision / anastomosis

Local excision or polypectomy

Resection / anastomosis

Radiotherapy (external or internal)

Stage I

Invasion of the mucosa to the wall

Excision / anastomosis

Excision of tumor

Excision of tumor

Radiotherapy (external or internal)

II

II A

II B

More than half of the intestinal wall, penetrate the intestinal wall invasion of the surrounding organs and / or through the peritoneum

Resection / anastomosis

Resection / anastomosis chemotherapy

Excision and anastomosis

Pelvic organ resection and radiotherapy

Radiotherapy + chemotherapy

Intraoperative radiotherapy and chemotherapy

phase iii

III A

III B

III C

In the second phase on the basis of 1-3, or 4 or more lymph node metastasis

Resection and anastomosis

Excision and anastomosis

Pelvic tissue ablation

Radiotherapy + chemotherapy

Intraoperative radiotherapy and chemotherapy

Chemotherapy to relieve symptoms

IV

The tumor has invaded the surrounding lymph nodes and transferred to other sites such as the liver or lung

Chemotherapy to relieve symptoms

Intestinal anastomosis, cut or not cut tumor

Resection of liver, lung and ovary metastases

Local recurrence

Excision / anastomosis relieve symptoms

Resection of liver, lung and ovary metastases

Radiation therapy to relieve symptoms

Surgery plus chemotherapy

surgical treatment

Surgical resection of the tumor is the most common node treatment methods, including: local excision, rectal cancer radical resection (including draining lymph node dissection), radical resection and colostomy, radiofrequency ablation, cryotherapy. Even if the surgeon is able to remove the entire naked eye during surgery, some patients still need to receive chemotherapy or radiotherapy after surgery to kill any remaining cancer cells.

Chemotherapy (chemotherapy) and biotherapy

Commonly used drugs 5- fluorouracil (5-FU), capecitabine (Xeloda), oxaliplatin, irinotecan (CPT-11), cetuximab (Erbitux) etc.. Calcium folinate (LV) can enhance the efficacy of 5-FU, the best 5-FU continuous intravenous infusion, especially with oxaliplatin or irinotecan with cmg. Chemotherapy regimens containing 5-FU failed and capecitabine was ineffective. When the creatinine clearance rate is reduced, the amount of capecitabine should be adjusted as appropriate. Irinotecan is not currently used in postoperative adjuvant chemotherapy.

Adjuvant therapy: postoperative chemotherapy, radiotherapy, and biological therapy are referred to as adjuvant therapy to improve the cure rate.

Adjuvant chemotherapy against patients: phase II and III stage; and is associated with adverse factors (such as positive margin, vascular invasion, differentiation and lymph node were too few).

Adjuvant chemotherapy: 5-FU/LV, 5-FU, capecitabine (Xeloda), FLOX, FOLFOX 4, m FOLFOX 6.

Unresectable or metastatic colorectal cancer chemotherapy: first-line chemotherapy (FOLFOX, CapeOX, FOLFIRI, 5-FU/LV, capecitabine) plus bevacizumab (currently not listed); second and three line scheme is to replace the chemotherapy plus cetuximab with chemotherapy based on (Erbitux). Liver metastases were treated with chemotherapy, resection and metastasis; radiofrequency ablation or cryotherapy; transcatheter arterial chemoembolization combined with radiotherapy. Preoperative chemotherapy, chemotherapy can change.

(Note: FOLFOX:5-FU/LV/ FOLFIRI:5-FU/LV/CPT-11, CapeOX: oxaliplatin, oxaliplatin and Xeloda)

Radiation therapy (radiotherapy)

Because there is no serosal layer in the rectum and is closely connected with the surrounding tissue, the tumor is easy to invade, and the rectal anatomical position is fixed, so the radiotherapy is widely used in the preoperative and postoperative treatment of rectal cancer. Radiotherapy plays an important role in stage I to IV or recurrent rectal cancer. In the palliative treatment of advanced colon cancer, radiotherapy can relieve the symptoms of intestinal obstruction, bleeding and other symptoms.

follow-up

Follow up means that after the treatment, the patients' health status, blood CEA level and imaging examination were checked regularly, so as to evaluate the curative effect, guide the follow-up treatment, and monitor the recurrence of the tumor.

 

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