Kolorektal cancer - Regionalt cancercentrum syd

INNEHÅLL
1. INLEDNING ............................................................................................................................................1
1.1 VÅRDPROGRAMGRUPP .........................................................................................................................1
1.2 DEFINITIONER ......................................................................................................................................2
1.3 LOKALISATION......................................................................................................................................2
1.4 VANLIGA FÖRKORTNINGAR....................................................................................................................2
2. EPIDEMIOLOGI......................................................................................................................................4
3. ETIOLOGI OCH RISKFAKTORER – HEREDITET – PREVENTION.....................................................7
3.1 ETIOLOGI OCH RISKFAKTORER..............................................................................................................7
3.2 HEREDITÄR KOLOREKTAL CANCER.........................................................................................................7
3.3 PREVENTION AV KOLOREKTAL CANCER..................................................................................................9
4. SYMTOM ..............................................................................................................................................10
5. UTREDNING.........................................................................................................................................11
5.1 DIAGNOSTIK VID SYMTOMGIVANDE SJUKDOM .......................................................................................11
5.2 PREOPERATIV UTREDNING..................................................................................................................13
6. PATOLOGI............................................................................................................................................14
6.1 PRIMÄRDIAGNOSTIK ...........................................................................................................................14
6.2 HANDHAVANDE AV PREPARAT .............................................................................................................19
6.3 HISTOPATOLOGISK BEDÖMNING...........................................................................................................22
6.3 TRANSLATIONELL FORSKNING .............................................................................................................25
7. TUMÖRMARKÖRER I BLOD...............................................................................................................28
8. KIRURGISK BEHANDLING..................................................................................................................29
8.1 PREOPERATIVA FÖRBEREDELSER........................................................................................................29
8.2 PRINCIPER VID RADIKAL RESEKTION ....................................................................................................30
8.3 KOLONOPERATIONER .........................................................................................................................31
8.4 REKTUMOPERATIONER .......................................................................................................................33
8.5 OPERATIONSJOURNAL........................................................................................................................35
8.6 KOMPLIKATIONER OCH FUNKTIONSSTÖRNINGAR .................................................................................36
9. ADJUVANT BEHANDLING ..................................................................................................................37
9.1 STRÅLBEHANDLING VID RECTALCANCER ..............................................................................................37
9.2 STRÅLBEHANDLING VID COLONCANCER ...............................................................................................42
9.3 STRÅLBEHANDLINGENS GENOMFÖRANDE ............................................................................................43
9.4 BIVERKNINGAR TILL ADJUVANT STRÅLBEHANDLING...............................................................................48
9.5 CYTOSTATIKA ....................................................................................................................................49
9.6 INTRAVENÖS POSTOPERATIV CYTOSTATIKA..........................................................................................49
10. BEHANDLING AV AVANCERAD SJUKDOM OCH RECIDIV............................................................52
10.1 LOKALT AVANCERAD KOLOREKTAL CANCER .......................................................................................52
10.2 GENERALISERAD SJUKDOM...............................................................................................................54
11. UPPFÖLJNING...................................................................................................................................62
12. NUTRITIONSBEHANDLING VID KOLOREKTAL CANCER..............................................................64
12.1 BEHANDLING AV UNDERNÄRING VID KEMOTERAPI ELLER STRÅLBEHANDLING ........................................64
12.2 BEHANDLING AV UNDERNÄRING I SAMBAND MED OPERATION...............................................................65
12.3 RIKTLINJER FÖR NUTRITIONSBEHANDLING..........................................................................................66
13. POSTOPERATIVA FUNKTIONSNEDSÄTTNINGAR EFTER REKTALCANCERBEHANDLING......70
13.1 ANOREKTAL DYSFUNKTION ...............................................................................................................70
13.2 ORSAKER TILL POSTOPERATIVA KONTINENSSTÖRNINGAR ...................................................................70