Diagnostic and Therapeutic Management of Early Colorectal Cancer.

IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Visceral Medicine Pub Date : 2023-03-01 Epub Date: 2022-11-30 DOI:10.1159/000526633
Mathilda Knoblauch, Florian Kühn, Viktor von Ehrlich-Treuenstätt, Jens Werner, Bernhard Willibald Renz
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引用次数: 0

Abstract

Background: Early colorectal cancer (eCRC) is defined as cancer that does not cross the submucosal layer of the colon or rectum, including carcinoma in situ (pTis), pT1a, and pT1b. Early carcinomas differ in their prognosis depending on the risk profile. The differentiation between low and high risk is essential. The low-risk group includes R0-resected, well (G1) or moderately (G2) differentiated tumors without lymphatic vessel invasion (L0), without blood vessel invasion (V0) and a tumor size ≤3 cm. In this constellation, the estimated risk of lymph node metastasis is around 1% or below. The high-risk group includes tumors with incomplete resection (Rx), poor (G3) or undifferentiated (G4) carcinomas, and/or lymphatic and blood vessel invasion (L1) and size ≥3 cm. In a "high-risk" situation, there is a risk for lymph node metastasis of up to 23%.

Summary: The incidence of eCRC is rising with a rate of 10% in all endoscopically removed lesions during colonoscopy. For a correct histological evaluation, all suspected lesions should be completely resected. In case of a pT1 lesion in the rectum, pelvic magnetic resonance imaging should be performed to evaluate for suspicious lymph nodes. The therapeutic approach for eCRC is based on histological assessment and ranges from endoscopic resection to radical oncological surgery. The advantages, disadvantages, and associated risks of the individual treatment strategy need to be carefully discussed on a tumor board and with the patient.

Key messages: Treatment options for early colorectal cancer depend on the histological assessment. Poorly differentiated carcinomas, a Kudo ≥ SM2 classified lesion, and a Haggitt level 4 always represent a "high-risk" situation. It should also be mentioned that in rectal cancer, local surgical tumor excision (full-wall excision) is also sufficient for pT1 carcinomas with a "low-risk" constellation (G1/G2; L0, size <3 cm) and an R0 resection.

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早期结直肠癌的诊断和治疗管理。
背景:早期结直肠癌(eCRC)是指未跨越结肠或直肠粘膜下层的癌症,包括原位癌(pTis)、pT1a 和 pT1b。早期癌的预后因风险状况而异。区分低风险和高风险至关重要。低风险组包括 R0 切除、分化良好(G1)或中度(G2)、无淋巴管侵犯(L0)、无血管侵犯(V0)且肿瘤大小≤3 厘米的肿瘤。在这种情况下,估计发生淋巴结转移的风险约为 1%或以下。高风险组包括未完全切除(Rx)、差(G3)或未分化(G4)癌和/或淋巴及血管侵犯(L1)且肿瘤大小≥3 厘米的肿瘤。在 "高危 "情况下,淋巴结转移的风险高达 23%。小结:eCRC 的发病率正在上升,在结肠镜检查的所有内镜下切除病灶中的发病率为 10%。为了进行正确的组织学评估,所有疑似病灶都应完全切除。如果是直肠内的 pT1 病变,则应进行盆腔磁共振成像,以评估可疑淋巴结。eCRC 的治疗方法以组织学评估为基础,从内窥镜切除到根治性肿瘤手术不等。需要在肿瘤委员会上与患者仔细讨论各种治疗策略的优缺点和相关风险:早期结直肠癌的治疗方案取决于组织学评估。分化较差的癌、工藤≥SM2 级病变和 Haggitt 4 级病变始终代表着 "高风险 "情况。还应提及的是,在直肠癌中,对于 "低风险 "的 pT1 癌(G1/G2;L0,大小
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来源期刊
Visceral Medicine
Visceral Medicine Medicine-Surgery
CiteScore
4.50
自引率
0.00%
发文量
40
期刊介绍: This interdisciplinary journal is unique in its field as it covers the principles of both gastrointestinal medicine and surgery required for treating abdominal diseases. In each issue invited reviews provide a comprehensive overview of one selected topic. Thus, a sound background of the state of the art in clinical practice and research is provided. A panel of specialists in gastroenterology, surgery, radiology, and pathology discusses different approaches to diagnosis and treatment of the topic covered in the respective issue. Original articles, case reports, and commentaries make for further interesting reading.
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