Clinical Characteristics of Patients with Sporadic Colorectal Cancer and Primary Cancers of Other Organs

大腸直腸癌合併其他原發性惡性腫瘤之臨床表徵

甘蓉瑜(Jung-Yu Kan) ； 謝建勳(Jan-Sing Hsieh) ； 潘永生(Yong-Sang Pan) ； 王文明(Wen-Ming Wang) ； 陳芳銘(Fang-Ming Chen) ； 詹昌明(Chang-Ming Jan) ； 黃裕勝(Yu-Sheng Huang) ； 黃宗人(Tsung-Jen Huang) ； 王照元(Jaw-Yuan Wang)

《The Kaohsiung Journal of Medical Sciences》 22卷11期 (2006/11) Pp. 547-553

摘要

癌症因現今醫療進步，已有較好的治療及控制，普遍病人有較佳之存活率。而大部分病人，忽略有其他惡性腫瘤發生之可能。目前大腸直腸癌已成為台灣惡性腫瘤第三死亡原因。本篇主要探討其他惡性腫瘤合併大腸直腸癌之臨床特徵，以便對合併大腸直腸癌之雙重惡性腫瘤病人，能夠做到早期診斷，早期治療之可能。本篇回朔本院l，031位大腸直腸癌病人，發現合併腫瘤以胃癌與乳癌之患者居多，其他癌症包括甲狀腺癌、肺癌、卵巢癌、膀胱癌、皮膚癌。病人大多呈現血便症狀，並且經由大腸鏡鏡檢發現。合併大腸直腸癌之位置，以乙狀結腸居多。少部分病人因腸阻塞與被便秘發現，但若以腸阻塞被診斷之病人，大多以大腸直腸癌後期較多，而且檢查需較高成本。所以我們認為曾罹患胃癌或乳癌之病人，合併血便或腸胃道症狀時要特別小心是否有合併大腸直腸癌之可能，宜給予大腸鏡檢查，並宜每年定期追蹤。

關鍵字

大腸直腸癌 ； 其他原發性腫瘤 ； 偶發性

並列摘要

Most cancer patients often neglect the possibility of secondary cancer. Colorectal cancer (CRC) is the third leading cause of cancer death in Taiwan. It is important to be aware of the clinical characteristics of double cancer in CRC patients for early diagnosis and treatment. We retrospectively analyzed 1,031 CRC patients who underwent surgical treatment at the Department of Surgery of Kaohsiung Medical University Hospital between January 1998 and December 2004. Among these patients, CRC was accompanied by cancer of other organs in 17 patients (1.65%), either synchronously or metachronously. Therefore, we describe our experience regarding the location of CRC, the clinical symptoms and signs of these patients, the TNM stage, histology, phase, association with other malignancies, interval between cancers and clinical outcomes. Of the 17 patients in whom CRC was accompanied by primary cancer of other organs, there were four synchronous and 13 metachronous multiple cancer patients. Our patient group comprised six men and 11 women with ages ranging from 47 to 88 years (median age, 66 years). The most common location of CRC was the sigmoid colon. Six gastric cancers (35.2%) and six breast cancers (35.2%) were associated with primary CRC. The remaining six second primary cancers were one lung cancer, one thyroid cancer, one cervical cancer, one ovarian cancer, one skin cancer, and one urinary bladder cancer. Of the 13 metachronous multiple cancer patients, eight patients developed subsequent CRC after primary cancers of other organs, whereas two patients developed a subsequent second primary cancer after CRC. The intervals between the development of metachronous multiple cancers ranged from 2 to 19 years. In this retrospective analysis, breast and gastric cancer patients were at increased risk of developing subsequent secondary CRC. Careful attention should always be paid to the possibility of secondary CRC in treating these cancer patients. Cancer patients with hematochezia or gastrointestinal symptoms/signs should be evaluated for the possibility of second primary CRC during their regular follow-up.

並列關鍵字

colorectal cancer ； other primary cancer ； sporadic