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Kolorektales Karzinom

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Definition:
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  
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  • Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten. Colitis ulcerosa - Living Guideline. AWMF-Leitlinie Nr. 021-009LG. S3, Stand 2021. www.awmf.org 
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  • Thomas M. Heim, Dr. med., Wissenschaftsjournalist, Freiburg
  • Jean-François Chenot, Prof. Dr. med., Facharzt für Allgemeinmedizin, Institut für Community Medicine, Universitätsmedizin Greifswald (Review)