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1、DepartmentofSurgeryRuijinClinicalMedicalCollegeShanghaiJiaoTongUniversityColonCaincidence:105,500/US/yrColonCamortality:48,100/US/yrimplies45%colonCacasemortalityRectalCaincidence:42,000/US/yrRectalCamortality:8,500/Us/yrimplies21%rectalCacasemortalityEpidemiology3 3Characteristics in chinaYoungLowe
2、r locationulcerationEthiologyDietaryhabitsPrecancousdiseasesEnvironmentfactorsHeredityfactorsOtherfactorsDietary habitHeredity factorsAdenomatouspolyposissyndromes(APS)Hereditary“Non-polyposis”ColonCancer(HNPCC,Lynchsyndrome)FamilialAdenomatousPolyposis(FAP)Other factorsAnatomyArterial supply of the
3、 colonIleocolicarteryRightcolicarteryMeddlecolicarteryLeftcolicarterySigmoidarteriesVenous drainage of the colonSuperiormesentericveinInferiormesentericveinSplenicveinHepaticportalveinLymphatic drainage of the colonEpicolicnodesParacolicnodesIntermediatenodesCentralnodesIleocecal regionArterial supp
4、ly of the rectumSuperiorrectalarteryMiddlerectalarteryInferiorrectalarteryVenous drainage of the rectumInternalhemorrhoidalplexusExternalhemorrhoidalplexusRectal regionModelofcolorectalcarcinogenesis（90%） Nomal epithelium Heperproliferative epithelium Adenoma Carcinoma 病理生理病理生理PathologyMorphologyPro
5、trudetypeInfiltratetypeUlcerationtypePathology CytologyCarcinomeMucinouscarcinomacarcinoideUndifferentiatedcarcinomaSquamouscarcinomaRoute of metastasis Route of metastasis InfiltrationdirectlymphaticmetastasisHematogenousdisseminationImplantationmetastasisLiver MetastasisImplantation metastasisClas
6、sification of PathologyDukesstagesDukesA、B、C、DTNMstages、DUKES ClassificationDukes StagesStageA:limitedtomucosaandsubmucosa90%StageB:extendsintomuscularisorserosa 60-75%StageC:onepositivenode-69%sixormorepositivenodes,27%StageD:mets.toliver,bone,lung5%COLORECTAL CANCER SURVIVAL (Dukes Stages, 5 y)Sta
7、ge ClassificationStage0Tis,N0,M0StageIT1,N0,M0T2,N0,M0StageIIT3,N0,M0T4,N0,M0StageIIIAnyT,N1,M0AnyT,N2,M0StageIVAnyT,AnyN,M1Clinical findingsHematochezia(distinctfrommelena)Changeinbowelhabit:alternatingconstipationanddiarrhea.Obstipationtoclinicallowerbowelobstruction.AnemiaWeight lossAbdominal pai
8、nFOBTMassFeverAnorexiaLocation in right colonObstructionDiarrheaLocation in left colonBlood in fecesConstipation Blood in stoolChange in normal bowel habitsRectal examinationCancer of rectumMethod of diagnosisDigitalexaminationFecaloccultbloodEndoscopeanoscopeFlexiblesigmoidoscopeElectricalColonosco
9、peAir-contrastbariumenema CEA othersCT、MRI、PETSingle contrastDouble contrastAir-contrast barium enemaEndoscopesEndoscopesColonoscopyColonoscopyColonoscopyColonoscopyRectal polypRectal CACT ScanRectal tumorTreatmentThe main method is the operationOperation of clolonRighthemicolectomyTransversecolonre
10、sectionLefthemicolectomySigmoideresectionRight hemicolectomy Ileo-transversalanastomoseCecumAscendingcolonHepaticflexureofcolonTerminalileum15cmGreateromentumTransversecolonLNofrightgastroepiploicarteryTransverse colectomyAscendo-descendingcolonanastomoseHepaticflexureofcolonSplenicflexureofcolonTra
11、nsversecolonGreateromentumMesocolonLNofgastrocolicligamentRadical correction of descending colonTransversorectalanastomoseSplenicflexureofcolonDescendingcoloSigmoidcolonPartsofgreateromentumMesocolonRadical correction of sigmoid colon DescendorectalanastomosePartsofdescendingcolonSigmoidcolonSuperio
12、rextremityofrectumMesocolonofsigmoidOperation of rectumTransanusLocalresection(APR)-Miles(LAR)-DixonParksReformingBaconHartmannPost-cavitaspelviscleareEntirecavitaspelviscleareRadical correction of rectumDixonlocation5cmdentatelineIncisalmargin3cmAbdominal Perineal Resection(Miles)Indicationlocation
13、5cmExtentPost-cavitas pelvis clearemalefemaleRadical correction of rectumParksReformingBaconHartmannComplicationHemorrhageanterosacrumUreterinjuryBladderinjuryUrineretentionSexualdisturbanceStomalleakChemotherapyMethodsystemicchemotherapyregionalchemotherapyMedicin5-FU、CFSystemic ChemotherapyRegiona
14、l hepatic chemotherapyChemoportRadiotherapyExternalradiotherapyInternalradiotherapyNew adjuvant therapySandwichChemotherapy+ RadiotherapyoperationChemotherapy+ RadiotherapyTreatment indicationSTAGE0LocalexcisionwithclearmarginsLargelesionnotamenabletolocalexcisionSTAGE1Widesurgicalresectionandanasto
15、mosisTreatment indicationSTAGE2WidesurgicalresectionandanastomosisSystemicorregionalchemotherapyRadiationtherapyBiologictherapyTreatment indicationSTAGE3SurgicalresectionandanastomosisPre/Postoperativechemotherapy5-FU/leucovorin6M5FU/levamisol12MPostoperativeradiationtherapyBiologicaltherapyAloneorc
16、ombinationTreatment indicationSTAGE4Surgicalresection/anastomosisorbypassSurgicalresectionofisolatedmetastasesChemotherapyBiologictherapyRadiationtherapyPostoperative follow upCEAColonoscopyUltrasonographyComputerTomographyTrans-RectalUltraSoundPolyps of colonIncidenceinthegeneralpopulationis1.6-12%
17、Incidenceinpeopleover70maybeashighas40%PolypsareclassifiedasneoplasticornonneoplasticMostpolypsareasymptomatic-requiringtenyearstodoubletheirdiameterPolypsmaygrowlargeenoughtocausesymptomsAdenomatous polypsTubularadenoma 75%5%Tubulovillous15%22%Villous adenoma 10%40%TYPEPREVALENCE%MALIGNANTAdenomato
18、us polypsTendtogrowslowlyandcontinuouslyTheymaybesessile,orpedunculatedAdenomatous polypsTreatmentRemovalofallpolypsisrecommendedCarefulhistologicassessmentismandatoryforpropermanagementResectioneitherendoscopicallyorbyopentechniquesFollow-upRegularcheckupsarerecommendedsince40%willhavereoccurrence(F/U6m-1year)Multiple Polyposis SyndromesFamilialadenomatouspolyposisGardnerssyndromeTurcotssyndromeFamilial adenomatous polyposisThankyou
