Venook Alan P, Weiser Martin R, Tepper Joel E
From the Helen Diller Family Comprehensive Cancer Center University of California, San Francisco, San Francisco, CA; Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; UNC/Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC.
Am Soc Clin Oncol Educ Book. 2014:83-9. doi: 10.14694/EdBook_AM.2014.34.83.
The past 50 years has seen substantial progress in our understanding of and in the management of colorectal cancer (CRC). Surveillance colonoscopy with resection of premalignant polyps has led to a decreased incidence of CRC even though compliance with the recommendations is suboptimal. Epidemiologic and genetic information allow us to identify individuals at risk for cancer and should allow us to prevent the disease in many individuals. Patients diagnosed with metastatic CRC live much longer than in the past, and some with metastatic disease are cured. This is attributed to many factors, including cross-sectional imaging that identifies metastases earlier, new surgical and radiation techniques, and numerous new chemotherapies. Higher resolution imaging modalities have improved the ability to find limited and resectable metastatic disease; surgical advances include laparoscopic-assisted procedures and safer and more extensive hepatic resection; and radiation techniques allow for higher dose and less morbidity. Biologic therapies have not yet been maximized, but we are learning when and where some should be used. Soon we expect to be staging patients by biologic and genetic characteristics rather than by gross pathology-treating patients based on biologic features but preferably identifying people at risk and preventing CRC altogether.
在过去的50年里，我们对结直肠癌（CRC）的理解和管理取得了重大进展。通过监测结肠镜检查切除癌前息肉，即使对建议的依从性不理想，也导致了CRC发病率的下降。流行病学和基因信息使我们能够识别患癌风险个体，并应使我们能够在许多个体中预防该疾病。被诊断为转移性CRC的患者比过去活得更长，一些患有转移性疾病的患者被治愈。这归因于许多因素，包括能更早识别转移灶的横断面成像、新的手术和放疗技术以及众多新的化疗方法。更高分辨率的成像方式提高了发现有限且可切除转移性疾病的能力；手术进展包括腹腔镜辅助手术以及更安全、更广泛的肝切除术；放疗技术允许更高剂量且发病率更低。生物疗法尚未得到充分利用，但我们正在了解何时以及何处应使用某些生物疗法。很快，我们预计将根据生物学和基因特征而非大体病理学对患者进行分期——根据生物学特征治疗患者，但最好是识别有风险的人群并完全预防CRC。
