Cancerul colic

Cmf sporadic(80-90%)(factori de mediu) sau genetic10% Mf>50 ani, a doua cauza ca frecv.Fact. de risc: istoric familial(sdr.cancerului familial: FAP,

HNPCC, s.Gardner)Polipii(>1cm, tubulovilosi, displastici) CU/b.Crohn de lunga durata,extinsa(10%>30ani

pancolita)dieta bogata in grasimi animale si carne sau saraca in

fibre vegetaleRisc de aparitie 1la 50 respectiv 1la 17 la cei cu o ruda

afectata

Mostenire, histologie

anomalii genetice incriminate: activarea oncogenelor(K-ras, c-myc), inactivarea genelor supresoare(MCC< DCC, p53)

Secventa adenom-carcinomInvazia prin perete, limfatice, singe-in ficatClasificarea Dukes A(in perete),

B(depaseste peretele), C( in ganglioni), D(meta la distanta) sau TNM(tu,nodul, metastaza)

Trasaturi clinice

Localizare frecv.colon stg: stenoza cu ocluzie progresiva, colica, constipatie/falsa diaree, rectoragie(singe amestecat)

Cc cec si ascendent se manifesta mf prin anemie feripriva sau tu in fosa dr, hdoculta

Invazie locala: durere, obstructie ureterala, vezicala, fistula

Casexie neoplazica: anorexie, astenieEx clinic mf normal sau tu/ hepatomegalie

explorari

Colonoscopie(5%cc sincrone)/ba in dublu contrast(85%)/CTpneumocolon+PET

Hemograma(anemie), teste biochimice hepatice(meta hepatice)

CEA-dg+recidive/metaTeste de singerare oculta(pt screening)

Tratament, prognostic

Rezectie(hemicolectomie) si anastomoza T-T /stoma(30% meta postch.curativa)

5fluorouracil si levamisole(Duke C/TNMIII)Radioterapie pre/post op. in cc rectalRezectie meta hepatice+ chimioterapie paleativa40% la 5ani dar 95% in Dukes AScreening:

sigmo+hemoccult>50ani/colono>50aniprevenire:calorii, grasimi, fibre, Sulindac(FAP)