结直肠息肉:病理生理学、恶性潜能及治疗策略进展

Colorectal polyps: pathophysiology, malignant potential, and advancements in therapeutic strategies.

作者信息

Kotula Anna E, Korde Yash V, Oyler Hayden J, Wakefield Mark R, Fang Yujiang

机构信息

Department of Microbiology, Immunology & Pathology, Des Moines University, West Des Moines, IA, 50266, USA.

Department of Surgery, University of Missouri School of Medicine, Columbia, MO, 65212, USA.

出版信息

Med Oncol. 2025 Jun 27;42(8):287. doi: 10.1007/s12032-025-02861-8.

Abstract

Colorectal cancer (CRC) is among the most common causes of cancer-associated death. The American Cancer Society predicts a significant increase in both the incidence and mortality of CRC over the next decade for individuals 54 years or younger. This prediction underscores the urgent need for effective screening and management strategies. CRC is the third most common type of non-skin cancer in both men (after prostate and lung cancer) and women (after breast cancer and lung cancer). In 2025, it is predicted that 693,452 people will be diagnosed with metastatic colorectal cancer. Colon polyps from both an adenoma and a serrated polyp have a significant risk of developing into CRC. This is why it is essential to correctly identify and manage sessile serrated lesions to help improve the quality and reliability of screening colonoscopy. The frequency of colonoscopies is determined by the size, number, and type of polyp found. If 1-2 polyps < 1 cm in size are removed, a colonoscopy in 5 years is appropriate. If the patient had 3-4 polyps < 1 cm in size or one polyp > 1 cm removed, a colonoscopy in 3 years is recommended. If five or more small or three or more large polyps are removed, then a 1-year colonoscopy is appropriate. To prevent colon cancer, it is recommended that patients get regular screening to help prevent and detect it. Some of the treatment options include laparoscopic and robotic surgical procedures, transanal minimally invasive surgery (TAMIS), hyperthermic intraperitoneal chemotherapy (HIPEC) surgery, and Intraoperative radiation therapy (IORT). Reviewing the previous literature on the management of colorectal adenomatous polyps and colorectal cancer, it becomes apparent that the various polyps need to be thoroughly categorized, and colorectal cancer needs to be screened for effectively, and then a proper management course needs to be set in place to maximize positive patient outcomes. Such a study will be very helpful for colorectal cancer specialists to manage patients with colorectal adenomatous polyps and colorectal cancer.

摘要

结直肠癌(CRC)是癌症相关死亡的最常见原因之一。美国癌症协会预测,在未来十年中,54岁及以下人群的CRC发病率和死亡率将显著上升。这一预测凸显了对有效筛查和管理策略的迫切需求。CRC是男性(仅次于前列腺癌和肺癌)和女性(仅次于乳腺癌和肺癌)中第三常见的非皮肤癌类型。预计到2025年,将有693452人被诊断为转移性结直肠癌。腺瘤性息肉和锯齿状息肉发展为CRC的风险都很高。这就是正确识别和管理无蒂锯齿状病变对于提高结肠镜筛查质量和可靠性至关重要的原因。结肠镜检查的频率取决于发现的息肉大小、数量和类型。如果切除1-2个直径小于1厘米的息肉,5年后进行结肠镜检查是合适的。如果患者切除了3-4个直径小于1厘米的息肉或一个直径大于1厘米的息肉,建议3年后进行结肠镜检查。如果切除了五个或更多小息肉或三个或更多大息肉,那么1年后进行结肠镜检查是合适的。为预防结肠癌,建议患者定期进行筛查以帮助预防和检测。一些治疗选择包括腹腔镜和机器人手术、经肛门微创手术(TAMIS)、热灌注化疗(HIPEC)手术和术中放射治疗(IORT)。回顾以往关于结直肠腺瘤性息肉和结直肠癌管理的文献,很明显需要对各种息肉进行彻底分类,对结直肠癌进行有效筛查,然后制定适当的管理方案以最大限度地提高患者的积极预后。这样的研究对于结直肠癌专家管理结直肠腺瘤性息肉和结直肠癌患者将非常有帮助。

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