Kolorektales Karzinom
Zuletzt bearbeitet: Zuletzt revidiert:
Zuletzt revidiert von:Thomas M. HeimDefinition:
Karzinom des Kolons oder Rektums. Fast 2/3 davon sind im Rektum und Colon sigmoideum lokalisiert. 98 % sind Adenokarzinome. Die Ursachen sind genetische und Umweltfaktoren.
Häufigkeit:
Die Lebenszeitinzidenz beträgt ca. 5 % bei Männern und ca. 4 % bei Frauen. Die Inzidenz liegt in Deutschland bei etwa 40/100.000/Jahr; das kolorektale Karzinom ist die zweithäufigste krebsbedingte Todesursache bei Männern und Frauen.
Symptome:
Die Symptome hängen von der Lokalisation ab und treten in der Regel erst bei fortgeschrittener Erkrankung auf. Die häufigsten Spätsymptome sind veränderter Stuhl, Gefühl der unvollständigen Darmentleerung, Anämie, Blut oder Schleim im Stuhl und Schmerzen bei der Defäkation.
Befunde:
Der klinische Befund hängt von der Lokalisation ab. Durch rektale Palpation können bis zu 10 % der Fälle erkannt werden. Ansonsten Befunde nur in der Bildgebung einschließlich Endoskopie.
Diagnostik:
Komplette Koloskopie ist Goldstandard. Evtl. Rektoskopie bei Verdacht auf Rektumkarzinom. Die Histologie bestätigt die Diagnose.
Therapie:
Das Karzinom wird chirurgisch möglichst komplett reseziert. Bei einem fortgeschrittenen Kolonkarzinom ist meist eine adjuvante Chemotherapie, bei fortgeschrittenem Rektumkarzinom eine neoadjuvante Radiochemotherapie angezeigt. Metastasen werden medikamentös, evtl. mit Strahlentherapie, und in einigen Fällen chirurgisch oder mit lokoregionär ablativen Verfahren behandelt.
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten. Kolorektales Karzinom. AWMF-Leitlinie 021–007OL. S3, Stand 2017. www.awmf.org
- European Society for Medical Oncology. ESMO Consensus Guidelines: Management of Patients with Colon and Rectal Cancer. A personalized approach to clinical decision making. Stand 2012. www.esmo.org
- European Society for Medical Oncology. ESMO Consensus Guidelines for the Management of Patients with Metastatic Colorectal Cancer. Stand 2016. www.esmo.org
- Deutsche Krebsgesellschaft. Psychoonkologische Diagnostik, Beratung und Behandlung von erwachsenen Krebspatienten. AWMF-Leitlinie Nr. 032-051OL. S3, Stand 2014 (abgelaufen). www.awmf.org
- Deutsche Gesellschaft für Palliativmedizin. Palliativmedizin für Patienten mit einer nicht heilbaren Krebserkrankung. AWMF-Leitlinie Nr. 128-001OL. S3, Stand 2019. www.awmf.org
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten. Colitis ulcerosa - Living Guideline. AWMF-Leitlinie Nr. 021-009LG. S3, Stand 2021. www.awmf.org
- Weitz J, Koch M, Debus J, Höhler T, Galle PR, Büchler MW. Colorectal cancer. Lancet 2005; 365: 153-65. PubMed
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten. S3-Leitlinie Kolorektales Karzinom. AWMF-Leitlinie 021–007OL, Stand 2017. www.awmf.org
- Wittekind C, Meyer HJ: TNM Klassifikation maligner Tumoren, 7. Auflage. Wiley-VCH, Weinheim 2010.
- Deutsche Krebsgesellschaft. Tumorstadien bei Enddarmkrebs. Onko-Internetportal. 25.11.2019. www.krebsgesellschaft.de
- American Society of Clinical Oncology. Colorectal Cancer: Stages. November 2018. www.cancer.net
- Dukes-Klassifikation. Pschyrembel online. April 2016. www.pschyrembel.de
- Gesellschaft der epidemiologischen Krebsregister in Deutschland (GEKID). GEKID-Atlas. Stand 8.12.2017 www.gekid.de
- Russo MW, Wei JT, Thiny MT, et al. Digestive and liver diseases statistics, 2004. Gastroenterology 2004; 126: 1448-53. Gastroenterology
- Jemal A, Tiwari RC, Murray T, et al. Cancer statistics, 2004. CA Cancer J Clin 2004; 54: 8-29. PubMed
- Scholefield JR, Robinson MHE, Mangham C, Hardcastle JD. Screening for colorectal cancer reduces emergency admissions. Eur J Surg Oncol 1998; 24: 47-50. PubMed
- Colorectal Cancer. In: Steward BW, Kleihues P, eds. World Cancer Report. Lyon: IARC Press, 2003: 198-202.
- Lynch HT, de la Chapelle A. Hereditary colorectal cancer. N Engl J Med 2003; 348: 919-32. pubmed.ncbi.nlm.nih.gov
- Half EE, Bresalier RS. Clinical management of hereditary colorectal cancer syndromes. Curr Opin Gastroenterol 2004; 20: 32-42. PubMed
- Umar A, Boland R, Terdiman JP, et al. Revised Bethesda guidelines for hereditary nonpolyposis colorectal cancer (Lynch syndrome) and microsatellite instability. J Natl Cancer Inst 2004; 96: 261-68. PubMed
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten. Colitis ulcerosa - Living Guideline. AWMF-Leitlinie Nr. 021-009LG. S3, Stand 2021. www.awmf.org
- Itzkowitz SH, Hapraz N. Diagnosis and management of dysplasia in patients with inflammatory bowel disease. Gastroenterology 2004; 126: 1634-48. Gastroenterology
- Byrne RM, Tsikitis VL. Colorectal polyposis and inherited colorectal cancer syndromes. Ann Gastroenterol 2018;31:24-34. PMID: 29333064 PubMed
- Park Y, Hunter DJ, Spiegelman D, et al. Dietary fiber intake and risk of colorectal cancer. JAMA 2005; 294: 2849-57. www.ncbi.nlm.nih.gov
- Bonithon-Kopp C, Kronborg O, Giacosa A, Rath U, et al. Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial. Lancet 2000; 356: 1300-06. www.ncbi.nlm.nih.gov
- Chao A, Thun MJ, Connell CJ, et al. Meat consumption and risk of colorectal cancer. JAMA 2005; 293: 172-82. www.ncbi.nlm.nih.gov
- Deschoolmeester V, Van Marck V, Baay M, et al. Detection of HPV and the role of p16INK4A overexpression as a surrogate marker for the presence of functional HPV oncoprotein E7 in colorectal cancer. BMC Cancer 2010: 10: 117. www.ncbi.nlm.nih.gov
- Chao A, Thun MJ, Jacobs EJ, Henley SJ, Rodriguez C, Calle EE. . Cigarette smoking and colorectal cancer mortality in the cancer prevention study II.. J Natl Cancer Inst 2000; 92: 1888-96. PubMed
- Deutsches Institut für Medizinische Dokumentation und Information (DIMDI): ICD-10-GM Version 2021. Stand 18.09.2020; letzter Zugriff 05.05.2021. www.dimdi.de
- Gemeinsamer Bundesausschuss: Richtlinie für organisierte Krebsfrüherkennungsprogramme (Erstfassung und Programm zur Früherkennung von Darmkrebs) und Änderung der Krebsfrüherkennungs-Richtlinie, vom 19. Juli 2018. Inkrafttreten 19.10.2018. BAnz AT 18.10.2018 B3. www.g-ba.de
- Brenner H, Stock C, Hoffmeister M. Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies. BMJ. 2014 Apr 9;348:g2467. doi: 10.1136/bmj.g2467. DOI
- Atkin WS, Edwards R, Kralj-Hans I, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial . Lancet 2010; 375: 1624-33. PubMed
- Elmunzer BJ, Hayward RA, Schoenfeld PS, Saini SD, et al. Effect of Flexible Sigmoidoscopy-Based Screening on Incidence and Mortality of Colorectal Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS Med. 2012;9(12):e1001352. pubmed.ncbi.nlm.nih.gov
- Holme Ø, Bretthauer M, Fretheim A, et al. Flexible sigmoidoscopy versus faecal occult blood testing for colorectal cancer screening in asymptomatic individuals. Cochrane Database Syst Rev. 2013 Sep 30;9. www.ncbi.nlm.nih.gov
- Imperiale TF, Ransohoff DF, Itzkowitz SH et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med 2014; 370:1287-1297. DOI: 10.1056/NEJMoa1311194. DOI
- Shaukat A, Mongin SJ et al. Long-Term Mortality after Screening for Colorectal Cancer. N Engl J Med 2013; 369:1106-1114. www.nejm.org
- Wentling GK, Metzger PP, Dozois EJ, Chua HK, Krishna M. Unusual bacterialinfections and colorectal carcinoma--Streptococcus bovis and Clostridium septicum: report of three cases. Dis Colon Rectum. 2006 Aug;49(8):1223-7. PMID: 16845563 PubMed
- Lee JK, Liles EG, Bent S, et al. Accuracy of fecal immunochemical tests for colorectal cancer: systematic review and meta-analysis. Ann Intern Med. 2014 Feb 4;160(3):171. PMID: 15657155. PubMed
- Konishi T, Shimada Y, Hsu M, et al. Association of Preoperative and Postoperative Serum Carcinoembryonic Antigen and Colon Cancer Outcome. JAMA Oncology 2018 Mar 1; 4(3): 309-315. pmid:29270608 PubMed
- Deutsche Krebsgesellschaft. Psychoonkologische Diagnostik, Beratung und Behandlung von erwachsenen Krebspatienten. AWMF-Leitlinie Nr. 032-051OL, Klasse S3, Stand 2014 (abgelaufen). www.awmf.org
- Deutsche Gesellschaft für Palliativmedizin. Palliativmedizin für Patienten mit einer nicht heilbaren Krebserkrankung. AWMF-Leitlinie Nr. 128-001OL, Klasse S3, Stand 2019. www.awmf.org
- Fakih MG. Metastatic colorectal cancer: current state and future directions. J Clin Oncol. 2015 Jun 1;33(16):1809-24. www.ncbi.nlm.nih.gov
- European Society for Medical Oncology. ESMO Consensus Guidelines: Management of Patients with Colon and Rectal Cancer. A personalized approach to clinical decision making, Stand 2012. www.esmo.org
- European Society for Medical Oncology. ESMO Consensus Guidelines for the Management of Patients with Metastatic Colorectal Cancer, Stand 2016. www.esmo.org
- Cecil TD, Sexton R, Moran BJ, Heald RJ. Total mesorectal excision results in low local recurrence rates in lymph node-positive rectal cancer. Dis Colon Rectum 2004; 47: 1145-50. PubMed
- Simunovic M, Sexton R, Rempel E, Moran BJ, Heald RJ. Optimal preoperative assessment and surgery for rectal cancer may greatly limit the need for radiotherapy. Br J Surg 2003; 90: 999-1003. PubMed
- Wibe A, Møller B, Norstein J et al. A national strategic change in treatment policy for rectal cancer-- implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum 2002; 45: 857-66. PubMed
- Colorectal Cancer Collaborative Group. Palliative chemotherapy for advanced colorectal cancer: systematic review and meta-analysis. BMJ 2000; 321: 531-5. pubmed.ncbi.nlm.nih.gov
- Andre T, Boni C, Mounedji-Boudiaf L et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 2004; 350: 2343-51. pubmed.ncbi.nlm.nih.gov
- Wolmark N, Wieand HS, Kuebler JP et al. A phase III trial comparing FULV to FULV + oxaliplatin in stage II or III carcinoma of the colon: Results of NSABP Protocol C-07. Proc ASCO 2005, abstract 3500. ascopubs.org
- Kerr DJ, McArdle C, Lederman J . Intrahepatic arterial versus intravenous fluorouracil and folinic acid for colorectal cancer liver metastases: a multicentre randomised trial . Lancet 2003; 361: 368-73. PubMed
- Adam R. Chemotherapy and surgery: new perspectives on the treatment of unresectable liver metastases. Ann Oncol 2003; ii(suppl 2): 13-6. www.ncbi.nlm.nih.gov
- Fernandez FG, Drebin JA, Lineham DC, Dehdashti F, Siegel BA, Strasberg SM. Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by position emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg 2004; 240: 438-47. PubMed
- Adam R, Lucidi V, Bismuth H. Hepatic colorectal metastases: methods of improving resectability. Surg Clin N Am 2004; 84: 659-71. PubMed
- Cashin PH, Dranichnikov F, Mahteme H. Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy treatment of colorectal peritoneal metastases: cohort analysis of high volume disease and cure rate. J Surg Oncol. 2014 Aug;110(2):203-6. www.ncbi.nlm.nih.gov
- Sloothaak DA, Mirck B,Punt CJ, et al. Intraperitoneal chemotherapy as adjuvant treatment to prevent peritoneal carcinomatosis of colorectal cancer origin: a systematic review. Br J Cancer. 2014 Sep 9;111(6):1112-21. doi: 10.1038/bjc.2014.369. dx.doi.org
- Sebag-Montefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 2009; 373: 811-20. PubMed
- Gunderson LL, Haddock MG, Schild SE. Rectal cancer: preoperative versus postoperative irradiation as a component of adjuvant treatment. Semin Rad Oncol 2003; 13: 419-32. www.ncbi.nlm.nih.gov
- Kapiteijn E, Marijnen CAM, Nagetgaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345: 638-46. pubmed.ncbi.nlm.nih.gov
- Gögenur I, Wittendorff H-E, Colstrup H, Rosenberg J, Fischer A. Følger efter behandling af kolorektal cancer med særlig fokus på stomiproblemer, urologiske følgetilstande og seksuel dysfunktion. Ugeskr Læger 2005; 167: 4272-5. PubMed
- Robertson I, Leung E, Hughes D et al. Prospective analysis of stoma-related complications. Colorectal Dis 2005; 7: 279-85. PubMed
- Maurer CA, Z´graggen K, Renzulli P et al. Total mesorectal excision preserves male genital function compared with conventional rectal cancer surgery. Br J Surg 2001; 88: 1501-5. PubMed
- Lindsey I, Guy RJ, Warren BF et al. Anatomy of Denonvilliers' fascia and pelvic nerves, impotence, and implications for the colorectal surgeon. Br J Surg 2000; 87: 1288-99. PubMed
- Nesbakken A, Nygaard K, Bull-Njaa T et al. Bladder and sexual dysfunction after mesorectal excision for rectal cancer. Br J Surg 2000; 87: 206-10. PubMed
- Fong Y, Gonen M, Rubin D et al. Long-term survival is superior after resection for cancer in high-volum centers. Ann Surg 2005; 242: 540-4. PubMed
- Nordlinger B, Benoist S. Benefits and risks of neoadjuvant therapy for liver metastases. J Clin Oncol 2006; 24: 4954-5. PubMed
- Mi K, Kalady MF, Quintini C, et al. Integrating systemic and surgical approaches to treating metastatic colorectal cancer. Surg Oncol Clin N Am. 2015 Jan;24(1):199-214. www.ncbi.nlm.nih.gov
- an Blarigan EL, Fuchs CS, Niedzwiecki D et al. Association of Survival With Adherence to the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors After Colon Cancer Diagnosis The CALGB 89803/Alliance Trial. JAMA Oncol 2018; 4: 783-790. pmid:29710284 www.ncbi.nlm.nih.gov
- Stein CJ, Colditz GA. Modifiable risk factors for cancer. Br J Cancer 2004; 90: 299-303. PubMed
- Yang B, Jacobs EJ, Gapstur SM, et al. Active Smoking and Mortality Among Colorectal Cancer Survivors: The Cancer Prevention Study II Nutrition Cohort. J Clin Oncol 2015; 33: 885-93. doi:10.1200/JCO.2014.58.3831 DOI
- Alberts DS, Martinez ME, Roe DJ, et al. Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. N Engl J Med 2000; 342:1156-62. pubmed.ncbi.nlm.nih.gov
- Asano T, McLeod RS. Dietary fibre for the prevention of colorectal adenomas and carcinomas (Cochrane Review). In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. pubmed.ncbi.nlm.nih.gov
- Hawk ET, Umar A, Viner JL. Colorectal Cancer Chemoprevention: an overview of the science. Gastroenterology 2004; 126: 1423-47. Gastroenterology
- Bjelakovic G, Nagorni A, Nikolova D, Simonetti RG, Bjelakovic M, Gluud C. Meta-analysis: antioxidant supplements for primary and secondary prevention of colorectal adenoma. Aliment Pharmacol Ther 2006; 24: 281-91. PubMed
- Chung-Faye GA, Kerr DJ. Innovative treatment for colon cancer. BMJ 2000; 321: 1397-9. PubMed
- Dannenberg AJ, Zakim D. Chemoprevention of colorectal cancer through inhibition of cyclooxygenase-2. Semin Oncol 1999; 26: 499-504. PubMed
- Chan AT, Giovannucci EL, Meyerhardt JA, Schernhammer ES, Curhan GC, Fuchs CS. Long-term use of aspirin and nonsteroidal anti-inflammatory drugs and risk of colorectal cancer. JAMA 2005: 294: 914-23. www.ncbi.nlm.nih.gov
- Huls G, Koornstra JJ, Kleibeuker JH. Non-steroidal anti-inflammatory drugs and molecular carcinogenesis of colorectal carcinomas. Lancet 2003; 362: 230-2. PubMed
- U.S. Preventive Services Task Force. Routine aspirin or nonsteroidal anti-inflammatory drugs for the primary prevention of colorectal cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2007; 146: 361-4. www.ncbi.nlm.nih.gov
- Rostom A, Dube C, Lewin G, et al. Nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors for primary prevention of colorectal cancer: A systematic review prepared for the U.S. Preventive Services Task Force. Ann Intern Med 2007; 146: 376-89. www.ncbi.nlm.nih.gov
- Sandler RS, Halabi S, Baron JA, et al. A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Engl J Med 2003; 348: 883-90. PubMed
- Baron JA, Cole BF, Sandler RS, et al. A randomized trial of aspirin to prevent colorectal adenomas. N Engl J Med 2003; 348: 891-9. PubMed
- Flossmann E, Rothwell PM; British Doctors Aspirin Trial and the UK-TIA Aspirin Trial. Effect of aspirin on long-term risk of colorectal cancer: consistent evidence from randomised and observational studies. Lancet 2007; 369: 1603-13. PubMed
- Poynter JN, Gruber SB, Higgins PD et al. Statins and the risk of colorectal cancer. N Engl J Med 2005; 352: 2184-92. pubmed.ncbi.nlm.nih.gov
- Secco GB, Fardelli R, Gianquinto D, et al. Efficacy and cost of risk-adapted follow-up in patients after colorectal cancer surgery: a prospective, randomized and controlled trial. Eur J Surg Oncol 2002;28:418-23. PubMed
- Renehan AG, O'Dwyer ST, Whynes DK. Cost effectiveness analysis of intensive versus conventional follow up after curative resection for colorectal cancer. BMJ 2004; 328: 81. PubMed
- Rodriguez-Moranta F, Salo J, et al. Postoperative surveillance in patients with colorectal cancer who have undergone curative resection: a prospective, multicenter, randomized, controlled trial. J Clin Oncol 2006; 24: 386-93. PubMed
- Mi K, Kalady MF, Quintini C, et al. Integrating systemic and surgical approaches to treating metastatic colorectal cancer. Surg Oncol Clin N Am. 2015 Jan;24(1):199-214. www.ncbi.nlm.nih.gov
- Thomas M. Heim, Dr. med., Wissenschaftsjournalist, Freiburg
- Jean-François Chenot, Prof. Dr. med., Facharzt für Allgemeinmedizin, Institut für Community Medicine, Universitätsmedizin Greifswald (Review)