Conroy T, Guillemin F, Stines J, Denis B
Centre Alexis-Voutrin.
Rev Prat. 1994 Dec 15;44(20):2706-13.
Early colorectal cancer produces no symptom, thus justifying efforts at detection in screening programs. Symptoms are usually secondary to obstruction, local invasion, perforation or bleeding. Any fecal bleeding must be investigated to rule out a colorectal cancer. The initial imaging study to identify a colorectal cancer is often colonoscopy, which is frequently supplemented with a double contrast barium enema. Once the presence of cancer is histologically proven, the preoperative evaluation includes detection of hepatic and extrahepatic spread, especially with ultrasound and CT scan. Endorectal ultrasonography has been shown to be a significant advance for staging rectal cancer. It provides the best staging in selecting patients for preservation of sphincter function and for adjuvant therapies. The most useful prognostic factors in tumors without distant metastases are the depth of tumor extension, the number of positive lymph nodes and the histologic grade. Preoperative CEA level, vascular invasion and ploidy are also important prognostic factors.
早期结直肠癌没有症状，因此在筛查项目中进行检测是合理的。症状通常继发于梗阻、局部侵犯、穿孔或出血。任何便血都必须进行检查以排除结直肠癌。用于识别结直肠癌的初始影像学检查通常是结肠镜检查，常辅以双重对比钡灌肠。一旦通过组织学证实存在癌症，术前评估包括检测肝内和肝外转移，尤其是通过超声和CT扫描。直肠内超声已被证明是直肠癌分期的一项重大进展。它在选择保留括约肌功能的患者和辅助治疗方面提供了最佳分期。在没有远处转移的肿瘤中，最有用的预后因素是肿瘤浸润深度、阳性淋巴结数量和组织学分级。术前癌胚抗原水平、血管侵犯和倍体也是重要的预后因素。
