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1、ColorectalCancer:Metastatic(Palliation)轉移性結直腸癌Approximately20%ofpatientswithcolorectalcancerpresentwithestablisheddistantmetastases.DespiteconsiderableprogressStageIVpatientsarenotcurable.5-year?survivalrateforStageIVpatientsdiagnosedbetween1991?and2000was8%.Systemicche

2、motherapy,endoscopictreatmentstopalliateobstruction,surgicaldiversion,andsurgicalresectionallhaveimportantrolesintreatmentofStageIVpatients.將近20%的結直腸癌患者都會發(fā)生遠處轉移盡管醫(yī)療技術有了很大進步，但IV期患者仍無法治愈1991-2000年IV期患者的5年生存率為8%系統(tǒng)的化療，內鏡治療緩解梗阻，造瘺，手術切除都是治療IV期患者的重要手段Forpatientswith?goodperfor

3、mancestatusandminimalsymptomsfromtheir?primarycancers,standardtreatmentissystemicchemotherapy,whichiswelldocumentedtoincreasesurvivalandqualityoflife.Surgicalresectionoftheprimarytumorand,?whenfeasible,ofthemetastaticlesionscanprovideexcellent?palliationandcan,insomecas

4、es,providelastingcure.Inthepastdecade,therehasbeenremarkableimprovement?intheefficacyofchemotherapyforcolorectalcancer.FOLFOXorFOLFIRI.Mediansurvivalhas?improvedfrom12–14monthsto21months對于一般情況好，原發(fā)腫瘤癥狀輕的患者，標準的治療應為系統(tǒng)的化療，可以有效的提高生存率和生活質量對于有轉移患者的原發(fā)腫瘤切除，如果可以切除的話，有些情況下對病情有良好的緩

5、解作用在過去的10年里，化療的療效有了顯著的提高，F(xiàn)OLFOX、FOLFIRI方案的應用使轉移癌患者的中位生存時間從12-14月提升至21個月BiologyofMetastaticDiseaseTheclinicalpresentationofStageIVpatientsisvariable.Most?presentwithsymptomsreferabletotheprimarytumor.Initialstagingevaluationshouldincludecolonoscopywith?biopsy,andimagingo

6、ftheprimarytumor,liver,andlungs.EndorectalultrasoundorMRIisrecommendedforrectalcancerstodocument?theinitialTandNstage.CT?scanningofthechest/abdomen/pelvisisahighlyaccurateand?efficientmethodofdetectingmetastases.PETscanningdetectsoccultdiseasenotseenon?CTscanin20%ofStag

7、eIVpatients.Diagnosis/StagingIV期腫瘤患者的臨床表現(xiàn)是多種多樣的。大部分與原發(fā)病灶有關。初始的評估手段應有：結腸鏡（取活檢），腫瘤、肝臟、肺部的影像學檢查。經直腸腔內超聲或MRI是指導臨床TNM分期的重要手段。胸、腹、盆的CT檢查是發(fā)現(xiàn)轉移的準確有效的方法。PET可以發(fā)現(xiàn)CT發(fā)現(xiàn)不了的一些隱性疾病，檢出率達20%。診斷/分期Oncetheextentofdiseaseworkupiscompleteanddistant?metastaseshavebeendocumented,thesurgeonmust

8、make?threeimportantjudgments.Firstiswhetherthepatientisfit?foraggressivetreatment.Secondiswhethertheprimarytum