Dr. Huamán - Neoplasia de Colon

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  • 7/24/2019 Dr. Huamn - Neoplasia de Colon

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    TEORIA # 23 QX GENERAL

    2013201320132013 ---- IIII

    DR.DR.DR.DR. HUAMNHUAMNHUAMNHUAMN CA COLORRECTALCA COLORRECTALCA COLORRECTALCA COLORRECTALNM ms frecuente en tubo digestio

    !"#ADENOCARC$NOMA

    E%idemio&og'(E%idemio&og'(E%idemio&og'(E%idemio&og'(!)) ))) c(sos nueos*(+oA&t( mort(&id(d, -)#

    e/o,0Ed(d 1" 2$ncidenci( (ument( con &( ed(d3 Menores de ")(, ).4*5))) 6(b

    M(7ores de 8)(, 4."*5))) 6(bM(7or incidenci( en %('ses des(rro&&(dos ti%o de diet(

    Loc(&i9(ci:nLoc(&i9(ci:nLoc(&i9(ci:nLoc(&i9(ci:n

    ""#rectosigmoidesrectosigmoidesrectosigmoidesrectosigmoides;Aumento< de CA en co&on %ro/im(& D/ tem%r(no de %o&i%osis rectosigmoide(

    M(7or contro& de CA de co&on dist(&

    T$=O E>?N COM=ORTAM$ENTOT$=O E>?N COM=ORTAM$ENTOT$=O E>?N COM=ORTAM$ENTOT$=O E>?N COM=ORTAM$ENTO(@

    incr:nicoincr:nicoincr:nicoincr:nico "#@, cncer %uede &oc(&i9(rse en B sitiosde& co&on (& mismo tiem%o. .i se encuentr( cncer enrectosigmoideC e(&u(r con co&onosco%'( 7 busc(r

    cncer en otr( &oc(&i9(ci:n.

    b@ Met(cr:nicoMet(cr:nicoMet(cr:nicoMet(cr:nico, recidi(riesgo (ument( con &os(+os.

    ACTORE DE R$E>OACTORE DE R$E>OACTORE DE R$E>OACTORE DE R$E>ODiet(Diet(Diet(Diet( ric( en gr(s(gr(s(gr(s(gr(s(ssss 2&(s s(&es bi&i(ress(&es bi&i(ress(&es bi&i(ress(&es bi&i(res %roducto de&

    met(bo&ismo de &(s gr(s(sC se e&imin(n (& tubo

    digestio 7 (dEuieren %otenci(& c(rcinogFnico%otenci(& c(rcinogFnico%otenci(& c(rcinogFnico%otenci(& c(rcinogFnico3

    %obre en fibr(fibr(fibr(fibr( 2trnsito intestin(& &entotrnsito intestin(& &entotrnsito intestin(& &entotrnsito intestin(& &ento (ument( e& tiem%o de cont(cto de s(&es bi&i(res

    con mucos( co&:nic( riesgo c(rcinriesgo c(rcinriesgo c(rcinriesgo c(rcinogFnicoogFnicoogFnicoogFnico3 C(rnes (s(d(s (min(s 6eteroc'c&ic(s@

    >enFtic(>enFtic(>enFtic(>enFtic( A=CA=CA=CA=C im%ort(nte en %o&i%osis (denom(tos(@ GHr(sC DCC 7 %"-

    =:&i%os (denom(tosos=:&i%os (denom(tosos=:&i%os (denom(tosos=:&i%os (denom(tososTodo %:&i%o 6(&&(do debe bio%si(rseC %osibi&id(d dedegener(ci:n m(&ign( en funci:n de,

    Aumento de t(m(+o 05cm -#@ Com%onente e&&oso 58#@

    Dis%&(si( seer( -8#@

    e %ueden %resent(r (is&(dos o en un s'ndrome des'ndrome des'ndrome des'ndrome de%o&i%osis%o&i%osis%o&i%osis%o&i%osis,,,, =o&i%osis co&:nic( f(mi&i(r=o&i%osis co&:nic( f(mi&i(r=o&i%osis co&:nic( f(mi&i(r=o&i%osis co&:nic( f(mi&i(r, mI&ti%&es %:&i%os dur(nte

    &( %ubert(d. Des(rro&&( cncer (ntes de &os 4). Tto,co&o%roctectom'( tot(&co&o%roctectom'( tot(&co&o%roctectom'( tot(&co&o%roctectom'( tot(&.

    ind. de Turcor ind. de >(rdner ind. de Muir ind. de =eut9 Jeg6ers

    =rogresi:n de &esiones

    Cncer co&orrect(& 6eredit(rio sin %o&i%osis CCRH=@Cncer co&orrect(& 6eredit(rio sin %o&i%osis CCRH=@Cncer co&orrect(& 6eredit(rio sin %o&i%osis CCRH=@Cncer co&orrect(& 6eredit(rio sin %o&i%osis CCRH=@Criterios de Amsterd(m 5 : ms c(sos (ntes de &os ") (+os(ntes de &os ") (+os(ntes de &os ") (+os(ntes de &os ") (+os

    B : ms gener(ciones (fect(d(sgener(ciones (fect(d(sgener(ciones (fect(d(sgener(ciones (fect(d(s - : ms f(mi&i(res con cncef(mi&i(res con cncef(mi&i(res con cncef(mi&i(res con cncerrrr

    Enfermed(des inf&(m(tori(s intestin(&esEnfermed(des inf&(m(tori(s intestin(&esEnfermed(des inf&(m(tori(s intestin(&esEnfermed(des inf&(m(tori(s intestin(&es Co&itis u&cer(ti(Co&itis u&cer(ti(Co&itis u&cer(ti(Co&itis u&cer(ti(, (ument( &( %rob(bi&id(d con

    &os (+os

    Enfermed(d de Cro6nEnfermed(d de Cro6nEnfermed(d de Cro6nEnfermed(d de Cro6n

    (ctores %rotectores(ctores %rotectores(ctores %rotectores(ctores %rotectoresDiet( ric( en eget(&eseget(&eseget(&eseget(&es it(min(sit(min(sit(min(sit(min(s A C 7 E fibr(fibr(fibr(fibr( c(&cioc(&cioc(&cioc(&ciose&eniose&eniose&eniose&enioAs%irin( 7 A$NEsmenor incidenci( de CA co&orrect(&

    Cu(dro c&'nicoCu(dro c&'nicoCu(dro c&'nicoCu(dro c&'nico segIn &oc(&i9(ci:nsegIn &oc(&i9(ci:nsegIn &oc(&i9(ci:nsegIn &oc(&i9(ci:n

    RectoRectoRectoRecto Co&on i9uCo&on i9uCo&on i9uCo&on i9uiiiierdoerdoerdoerdo Co&ono derec6oCo&ono derec6oCo&ono derec6oCo&ono derec6oHemorr(gi( Estre+imiento Anemi(Moco Heces de Kc(&ibre (( de %esoTenesmo Hemorr(gi( M(s( %(&%(b&eOc&usi:n Do&or (bdomin(& A&ter(ci:n ritmo

    Oc&usi:n t(rd'(

    Rectorr(gi( %or 6emorroides%roctosigmoidosco%i(%(r( D*C cncer

    Tumores de co&on derec6o crecen 6(ci( &( &u9&ent(mente oc&usi:n t(rd'(@ 7 se erosion(n s(ngr(do

    ocu&to 7 (nemi(@.Tumores de co&on i9Euierdo infi&tr(n &( %(red 7reducen &umen estre+imiento 7 6eces de K c(&ibre@

  • 7/24/2019 Dr. Huamn - Neoplasia de Colon

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    TEORIA # 23 QX GENERAL

    2013201320132013 ---- IIII

    Di(gn:sticoDi(gn:sticoDi(gn:sticoDi(gn:stico$nici(&, R ( dob&e contr(ste 7 rectosigmoidosco%'(

    igno de &( m(n9(n( mordid(

    Co&onosco%'(Co&onosco%'(Co&onosco%'(Co&onosco%'( de e&ecci:n@ Re(&i9(r bio%si(s 7 tr(t(miento %o&i%ectom'(@ Loc(&i9( &esiones sincr:nic(s 7 otr(s (soci(d(s eguimiento ( %(cientes de riesgo 7 o%er(dos

    cncer met(cr:nico@

    D/ difeD/ difeD/ difeD/ diferenci(&renci(&renci(&renci(&Enfermed(d dierticu&(rCo&itis isuFmic(Lesiones gr(nu&om(tos(sLesiones gr(nu&om(tos(sLesiones gr(nu&om(tos(sLesiones gr(nu&om(tos(s D*C tubercu&om(@D*C tubercu&om(@D*C tubercu&om(@D*C tubercu&om(@Estenosis co&:nic( %or Cro6nEstenosis rect(&es benign(sU&cer( rect(& so&it(ri(

    Est(di(mientoEst(di(mientoEst(di(mientoEst(di(mientoR/. T:r(/ U TAC U> endorrect(&CEA (nt'geno c(rcino embrion(rio@,Iti& en seguimiento 8)# tienen (&ores e&e(dos ")# d/ &esi:n &oc(&i9(d(.

    Urogr(f'( e/cretori(, en cncer de co&on descendenteE(&u(ci:n gineco&:gic( U %F&ic(@

    C&(sific(ci:n de DuesC&(sific(ci:n de DuesC&(sific(ci:n de DuesC&(sific(ci:n de Dues,,,, $ndic( Pinfi&tr(ci:nQ de &( %(redintestin(& 7 com%romiso g(ng&ion(r.A. $nfi&tr( &( mucos( 7 submucos(.. $nfi&tr( %&(no muscu&(r sin &esi:n seros(.C. obre%(s( &( seros(.

    C5. Com%romiso g(ng&ios %ro/im(&es.CB. Com%romiso g(ng&ios dist(&es.

    C&(sific(ci:nC&(sific(ci:nC&(sific(ci:nC&(sific(ci:n TNMTNMTNMTNMT tumor %rim(rio@T tumor %rim(rio@T tumor %rim(rio@T tumor %rim(rio@T/T/T/T/ No se %uede estudi(rT)T)T)T) No eidenci(TisTisTisTis C(rcinom( in situT5T5T5T5 $n(de submucos(TBTBTBTB $n(de %&(no muscu&(rT-T-T-T- Atr(ies( %&(no muscu&(r sin

    &esion(r seros(T4T4T4T4 =erfor( %eritone( iscer(&

    N g(ng&ios region(&es@N g(ng&ios region(&es@N g(ng&ios region(&es@N g(ng&ios region(&es@N/N/N/N/ No se %uede estudi(rN)N)N)N) No metst(sis

    N5N5N5N5 5- %erico&icos o %erirrect(&esNBNBNBNB 04 %eric:&icos o %erirrect(&esN-N-N-N- Cu(&uier g(ng&io

    M metst(sis@M metst(sis@M metst(sis@M metst(sis@M/M/M/M/ No se %uede estudi(rM)M)M)M) No metst(sisM5M5M5M5 Metst(sis dist(nte

    C$RU>AC$RU>AC$RU>AC$RU>A$rrig(ci:n co&:nic(

    Arco de Rio&(noArco de Rio&(noArco de Rio&(noArco de Rio&(no, irrig(m(rco co&:nico.

    Tr(t(miento uirIrgico segIn com%romiso

    Cncer de recto, (@ resecci:n con conser(ci:n deesf'nter o b@ resecci:n (bdomino%erine(& de Mi&esresecci:n sin %reser(ci:n de esf'nter con co&ostom'(@

    Com%&ic(ciones -)#@ Res%ir(tori(s c(rd'(c(s $nfecci:n de 6erid( $TU De6iscenci( 7 6emorr(gi( de (n(stomosis

    Mientr(s ms b(( &( (n(stomosis S meor%ron:stico@

    Est(dios c&'nicosEst(dios c&'nicosEst(dios c&'nicosEst(dios c&'nicos

    DuesEst(dioEst(dioEst(dioEst(dio )))) Tis N) M)Est(dioEst(dioEst(dioEst(dio $$$$

    T5 N) M)A

    TB N) M)

    Est(dioEst(dioEst(dioEst(dio $$$$$$$$T- N) M)

    T4 N) M)

    Est(dioEst(dioEst(dioEst(dio $$$$$$$$$$$$An7 T N5 M)

    CAn7 T NBN- M)

    Est(dioEst(dioEst(dioEst(dio $$$$ An7 T An7 N M5