直腸癌概述OVERVIEWOFRECTALCANCER目錄

CONTENDS定位解剖直腸癌概述0102分期治療0304定位直腸：消化管位于盆腔下部的一段，在S3前方起自乙狀結(jié)腸，沿骶尾骨前面下行，穿過盆膈移行于肛管，全長10-14cm解剖解剖上，直腸癌分為：低位直腸癌：腫瘤的最下緣距離肛緣小于5cm中位直腸癌：腫瘤的最下緣距離肛緣5-10cm高位直腸癌：腫瘤的最下緣距離肛緣超過10cmRectalCancer-MRstaging2.0RhiannonvanLoenhout,FrankZijta,MaxLahaye,ReginaBeets-TanandRobinSmithuisRadiologyDepartementoftheMedicalCentreHaaglandenintheHague,TheNetherlandsCancerInstituteinAmsterdamandtheAlrijneHospitalinLeiderdorp,theNetherlands解剖RectalCancer-MRstaging2.0RhiannonvanLoenhout,FrankZijta,MaxLahaye,ReginaBeets-TanandRobinSmithuisRadiologyDepartementoftheMedicalCentreHaaglandenintheHague,TheNetherlandsCancerInstituteinAmsterdamandtheAlrijneHospitalinLeiderdorp,theNetherlands直腸系膜筋膜（MRF）只環(huán)繞在腹膜反折以下的低位直腸周圍。直腸中段、上段前方為腹膜覆蓋而非MRF。解剖原發(fā)腫瘤或淋巴結(jié)距MRF的最短距離為環(huán)周切緣（CRM）的寬度。CRM陽性為原發(fā)腫瘤或淋巴結(jié)距離MRF小于1mm。解剖原發(fā)腫瘤（T）Tx原發(fā)腫瘤無法評(píng)價(jià)T0無原發(fā)腫瘤的證據(jù)Tis原位癌，黏膜內(nèi)癌（侵犯固有層，未穿透黏膜肌層）T1腫瘤侵及黏膜下層T2腫瘤侵及固有肌層T3腫瘤穿透固有肌層，至漿膜下T4T4a腫瘤穿透臟層腹膜（包括通過腫瘤的腸穿孔和通過內(nèi)臟腹膜表面的炎癥區(qū)域的連續(xù)侵入）T4b腫瘤直接侵入或者黏附于鄰近器官和結(jié)構(gòu)T3a超越固有肌層<1mmT3b超越固有肌層1-5mmT3c超越固有肌層5-15mmT3d超越固有肌層>15mmT3MRF+：腫瘤距MRF≤1mmMRF-：腫瘤距MRF>1mm解剖原發(fā)腫瘤（T）Nx區(qū)域淋巴結(jié)不能評(píng)價(jià)N0無區(qū)域淋巴結(jié)轉(zhuǎn)移N11～3個(gè)區(qū)域淋巴結(jié)轉(zhuǎn)移N1a1個(gè)區(qū)域淋巴結(jié)陽性N1b2～3個(gè)區(qū)域淋巴結(jié)陽性N1c無區(qū)域淋巴結(jié)陽性，但是在漿膜下、腸系膜或者無腹膜覆蓋的直腸周圍組織中發(fā)現(xiàn)癌結(jié)節(jié)N2≥4個(gè)區(qū)域淋巴結(jié)轉(zhuǎn)移N2a4～6個(gè)區(qū)域淋巴結(jié)轉(zhuǎn)移N2b7個(gè)以上區(qū)域淋巴結(jié)轉(zhuǎn)移遠(yuǎn)處轉(zhuǎn)移（M）M0無遠(yuǎn)處轉(zhuǎn)移M1M1a有1個(gè)位置或1個(gè)器官轉(zhuǎn)移，無腹膜轉(zhuǎn)移M1b有2個(gè)或更多的位點(diǎn)／器官轉(zhuǎn)移，無腹膜轉(zhuǎn)移M1c有腹膜轉(zhuǎn)移，伴／不伴其它器官轉(zhuǎn)移解剖分期TNM0期TisN0M0I期T1,T2N0M0IIA期T3N0M0IIB期T4aN0M0IIC期T4bN0M0IIIA期T1-2N1/N1cM0IIIA期T1N2aM0IIIB期T3-T4aN1/N1cM0IIIB期T2-3N2aM0IIIB期T1-2N2bM0IIIC期T4aN2aM0IIIC期T3-4aN2bM0IIIC期T4bN1-2M0IVA期AnyTAnyNM1aIVB期AnyTAnyNM1bIVC期AnyTAnyNM1c

治療直腸癌的兩種主要治療手段是全直腸系膜切除