Ribeiro Maria Sylvia, Wallace Michael B
Dr Ribeiro is a gastroenterology fellow at the Cancer Institute at the University of São Paulo in São Paulo, Brazil. Dr Wallace is a professor of medicine at the Mayo Clinic in Jacksonville, Florida.
Gastroenterol Hepatol (N Y). 2015 Jul;11(7):445-52.
Colorectal cancer is the fourth most common cancer diagnosis worldwide and the second leading cause of cancer death. In the United States, it is estimated that in 2015 there will be 132,700 new cases of colorectal cancer (representing 8.43% of all new cancer cases) and 49,700 deaths. Colonoscopy plays a fundamental role in the prevention and management of colorectal cancer patients and is used for both the diagnosis and treatment of early colorectal cancer and its precursors. Improvements in colonoscopy preparation, new techniques of adenoma detection, and recent progress in endoscopic imaging methods are providing higher-quality results and reducing the incidence and mortality of the disease. Traditionally, colonoscopy has been used to remove precursor lesions. Invasive cancer was treated by surgical resection with or without chemoradiotherapy. During the past decade, endoscopic resection techniques have advanced, and cancers confined to the mucosal and superficial submucosal layers can now be resected via flexible endoscopes. Therefore, it is important to understand the indications and limitations of endoscopic resection, determine whether the cancer can be curatively resected, and assess the risk of lymph node metastasis, which precludes endoscopic treatment.
结直肠癌是全球第四大常见癌症诊断类型，也是癌症死亡的第二大主要原因。在美国，据估计2015年将有132,700例新的结直肠癌病例（占所有新癌症病例的8.43%）以及49,700例死亡病例。结肠镜检查在结直肠癌患者的预防和管理中发挥着重要作用，可用于早期结直肠癌及其癌前病变的诊断和治疗。结肠镜检查准备工作的改进、腺瘤检测的新技术以及内镜成像方法的最新进展正在提供更高质量的结果，并降低该疾病的发病率和死亡率。传统上，结肠镜检查用于切除癌前病变。浸润性癌症则通过手术切除并辅以或不辅以放化疗进行治疗。在过去十年中，内镜切除技术取得了进展，现在局限于黏膜层和浅表黏膜下层的癌症可以通过柔性内镜进行切除。因此，了解内镜切除的适应证和局限性、确定癌症是否能够被根治性切除以及评估淋巴结转移风险（这排除了内镜治疗）非常重要。
