大腸直腸癌篩檢

Colorectal Cancer Screening

陳哲民(Jer-Min Chen) ； 李熹昌(Hsi-Chang Lee) ； 林光洋(Kuang-Yang Lin) ； 陳建志(Chien-Chih Chen) ； 郭冠良(Kuan-Liang Kuo) ； 黃惠娟(Wai-Kuen Wong) ； 吳岱穎(Tai-Yin Wu)

《北市醫學雜誌》 3卷1期 (2006/01) Pp. 1-10

https://doi.org/10.6200/TCMJ.2006.3.1.01

摘要

在西方國家及臺灣，大腸直腸癌都是相當重要且常見的癌症。據衛生署的報告，臺灣大腸直腸癌的發生率及死亡率節節高升，西元2001年共有7366人被診斷出大腸直腸癌，發生率男性僅次於肝癌、肺癌；女性僅次於子宮頸癌、乳癌，皆居第三位。該癌症的死亡率不論男女也居第三位，僅次於肝癌、肺癌。大腸直腸癌的致病原因與遺傳、飲食、環境息息相關。其中75%的大腸直腸癌是偶發性，並無特殊危險因子或家族史，15~20%則有明顯家族史，其他則與遺傳的非瘜肉性結腸癌(Hereditary non-polyposis colon cancer; HNPCC)、家族遺傳性大腸瘜肉症(Familial adenomatous polyposis; FAP)、慢性發炎性大腸炎(Inflammatory bowel disease)等有關。大腸直腸癌從正常的上皮(normal epithelium)，過度增生上皮(hyperproliferative epithelium)，小腺瘤(small adenoma)，大腺瘤(large adenoma)進而演化成癌症，須經過許多基因改變的步驟，這稱為腺瘤到癌過程(adenoma-carcinoma sequence)，根據統計，這過程一般需要約10-15年的時間，我們如何在這段時間內早期篩檢出病變，是努力的方向。而且，早期大腸直腸癌在臨床上可能毫無症狀，但若大腸直腸癌大到出現症狀時，通常腫瘤分級和預後都變得不理想。篩檢策略(screening strategies)主要取決於病人的危險因子，分為一般危險性(average-risk group)、中度危險性(moderate-risk group)、高危險性(high-risk group)三群。經由適當的篩檢及瘜肉移除確能降低大腸直腸癌的發生率及死亡率。

關鍵字

大腸直腸癌 ； 遺傳的非瘜肉性結腸癌 ； 家族遺傳性大腸瘜肉症 ； 篩檢策略

並列摘要

Colorectal cancer is a significant contributor to morbidity and death in the Western world and Taiwan. According to a report by the Department of Health in Taiwan, both the incidence and mortality rate associated with the disease are increasing. There were 7366 people diagnosed with colorectal cancer in 2001 in Taiwan. Colorectal cancer affects men and women with nearly equal frequency and is the third leading cause of cancer deaths (after hepato-cellular carcinoma and lung cancer). Factors associated with an increased risk for the development of colorectal cancer include hereditary conditions, diet, and environment. Approximately 75% of colorectal cancers are sporadic with no known predisposing factors for the disease, while approximately 15-20% of colorectal cancers occur in patients with positive family history. Other patients have been associated with hereditary non-polyposis colon cancer, familial adenomatous polyposis, and inflammatory bowel disease. Adenomacarcinoma sequence, a term which describes the stepwise progression from healthy to dysplastic epithelium to adenoma to carcinoma associated with the accumulation of multiple clonally selected genetic alterations. It is believed this progression takes 10 to 15 years. Methods used to detect colorectal cancers during the early, curable stages can aid physicians in identification and removal of adenomas. According to the American Cancer Society guidelines, screening strategies for early detection of colorectal polyps and cancer can help to prevent colorectal cancer and reduce mortality rates.

並列關鍵字

Colorectal cancer ； hereditary non-polyposis colon cancer ； familial adenomatous polyposis ； screening strategies