Pregledni rad
Colorectal Carcinoma
Tomislav Brkić
Mislav Grgić
Sažetak
Colorectal cancer is the third most common
malignant neoplasm worldwide, but also one of the few preventable
cancers. Effective primary and secondary preventive
approaches must be developed to reduce morbidity and mortality.
The best prevention strategy is still under investigation
(cost/benefi t studies). Colorectal cancer results from a series
of histopathologic and molecular changes caused by complex
interactions between genetic susceptibility and environmental
factors. These molecular changes include multiple acquired
genetic alterations within epithelial oncogenesis and tumor
suppressor genes. The stage of colorectal cancer is the most
important feature predicting curability and survival. The fi rst
colorectal cancer staging system was developed in 1932 and it
is known as the Dukes’ classifi cation. In an effort to minimize
confusion over which Dukes’ stage is implied and to standardize
all organ system cancer staging, the TNM system has been
adopted. The diagnosis of colorectal cancer is most often made
during a colonic evaluation performed for gastrointestinal symptoms,
colorectal cancer screening, or as part of endoscopic
surveillance. Surgery achieves 5-year overall survival rates of
80% to 90% for stages I and II disease, yet only 40% to 60%
for stage III disease. Systemic chemotherapy in the adjuvant
setting defi nitely improves the curative rate for those patients
with localized colon cancer. This benefi t is more obvious in stage
III than in stage II disease. Adjuvant chemotherapy should be
recommended in stage III and high-risk stage II patients. Adjuvant
therapy for rectal cancer is standard in patients with stage
II and III. It consists of regimens that include both concurrent
chemoradiotherapy and adjuvant chemotherapy. The chemoradiotherapy
may be administered either pre- or postoperatively.
First-line chemotherapy for advanced CRC is rapidly moving
from modulation (leucovorin) and infusional administration of
fl uoropyrimidines to more complex and more active regimens,
with new chemotherapy drugs, oxaliplatin and irinotecan, and
molecular targeted drugs inhibiting angiogenesis (bevacizumab)
or the epidermal growth factor receptor - EGFR (cetuximab).
The use of two to three lines of combination therapies has
raised the median survival to almost 2 years in patients with
metastatic CRC.
Ključne riječi
colorectal cancer; primary and secondary prevention; early detection; tumor genetics; staging systems; diagnosis; therapy
Hrčak ID:
18836
URI
Datum izdavanja:
26.1.2006.
Posjeta: 14.581 *