Díaz-Cantón E A, Pazdur R
Departamento de Oncología Médica Gastrointestinal y Enfermedades del Aparato Digestivo, University of Texas M.D. Anderson Cancer Center, Houston, USA.
Medicina (B Aires). 1996;56(4):414-22.
Colorectal cancer is the second leading cause of cancer-related death in the US in both sexes after lung cancer. In 1995 colorectal cancer became the third most common neoplasm after lung and prostate cancer in men and after lung and breast carcinomas in women. The etiologic factors related to this disease are unknown although environmental, genetic, dietary and familial factors have been implicated. From the standpoint of the treatment it is important to remark that a high percentage of patients with colorectal cancer are curable if the disease is diagnosed in early stages. Adjuvant therapy with 5-fluorouracil (5-FU) and levamisole (lev) has shown an increase in the cure rate in stage III (Dukes'C) colon cancer patients. In rectal cancer patients adjuvant therapy with chemotherapy and radiation therapy increased the cure rate in stages II (Dukes' B2) and III patients. When colorectal cancer is disseminated (stage IV or Dukes'D), it is incurable in the majority of the patients. In fact, the only curative possibility in this group of patients is, when indicated, surgical resection of the metastatic focus. If resection is unfeasible, palliative treatment with 5-FU-based chemotherapy is the usual approach. Regardless of the advances made in treatment, almost 50% of the colorectal cancer patients still die due to progression of their disease. Better programs of primary and secondary prevention, new therapeutic modalities and better chemotherapeutic agents will be necessary to improve survival in colorectal cancer patients.
在美国，结直肠癌是继肺癌之后男女癌症相关死亡的第二大主要原因。1995年，结直肠癌成为男性继肺癌和前列腺癌之后、女性继肺癌和乳腺癌之后的第三大常见肿瘤。尽管环境、遗传、饮食和家族因素被认为与该病有关，但其病因尚不清楚。从治疗的角度来看，重要的是要指出，如果结直肠癌在早期被诊断出来，很大比例的患者是可以治愈的。5-氟尿嘧啶（5-FU）和左旋咪唑（lev）的辅助治疗已显示出可提高III期（杜克C期）结肠癌患者的治愈率。在直肠癌患者中，化疗和放疗的辅助治疗提高了II期（杜克B2期）和III期患者的治愈率。当结直肠癌发生转移（IV期或杜克D期）时，大多数患者无法治愈。事实上，这类患者唯一的治愈可能性是在有指征时手术切除转移灶。如果无法进行切除，以5-FU为基础的化疗姑息治疗是常用的方法。尽管治疗取得了进展，但仍有近50%的结直肠癌患者因疾病进展而死亡。需要更好的一级和二级预防计划、新的治疗方式和更好的化疗药物来提高结直肠癌患者的生存率。
