大腸直腸腫瘤的篩檢與追蹤：文獻回顧與最新指引

Screening and Surveillance of Colorectal Neoplasm-Review and Update of Guidelines

曾嘉慶(Chia-Ching Tseng) ； 李嘉龍(Chia-Long Lee) ； 吳啓華(Chi-Hwa Wu)

《內科學誌》 20卷6期 (2009/12) Pp. 506-513

https://doi.org/10.6314/JIMT.2009.20(6).05

摘要

大腸直腸癌(Colorectal cancer, CRC)在台灣不論男性或女性，一直居於癌症死亡原因的第三位，死亡率也持續增加；根據衛生署統計資料，民國九十五年大腸直腸癌的年發生率已經超過一萬人次，並首度超越肝癌成爲年發生率第一位的癌症。大腸直腸癌如果早期（侷限性大腸直腸癌localized）被診斷治療，五年的存活率高達90%，相對於晚期大腸直腸癌（遠端轉移distal metastasis）五年存活率只有10%，因此大腸直腸癌是一個能透過適當篩檢追蹤而達到預防的癌症。根據美國最新指引，提出將大腸直腸腫瘤的篩檢(screening)與追蹤(surveillance)的對象分成三大族群：一般風險(average risk)族群、增加性風險(increased risk)族群以及高風險(high risk)族群；國際上也一直有許多消化系及癌症相關學會機構制定了許多準則，也有許多學者單位根據不同篩檢方法做了一些建議。本文就近期的研究論文以及準則，做一個重點式的文獻及最新指引回顧。

關鍵字

大腸直腸癌 ； 篩檢 ； 追蹤

並列摘要

In 2007, the mortality rate of colorectal cancer (CRC) has been, both for males and females, the third leading cause of cancer decease in Taiwan. The adenoma-carcinoma sequence usually has a long latent period, approximately 8 years. Still, early screening with remove with potential malignant transforming foci offers preventive measure. Most CRC screening guideline classes the patients into 3 categories according to related risk: (1) averaged-risk, aged 50 or older; (2) increased-risk, with polyps in previous colonoscopy, or with CRC, or with a family history of CRC; (3) high-risk, with genetic or clinical diagnosis of familial adenomatous polyposis (FAP) or hereditary nonpolyposis colon cancer (HNPCC), or with a chronic inflammatory bowel disease (IBD). Recently, newer screening modalities have emerged and clinicians should offer patients all screening options. With patients' full understanding of each modality's advantages and disadvantages, including false positive and false negative rate, the clinician then select the mode of screening option. Up to date review of CRC screening and surveillance protocols were done and reviewed here.

並列關鍵字

Colorectal cancer, CRC ； Screening ； Surveillance