肿瘤临床诊断研究●Cecum●AscendingColon●TransverseColon●DescendingColon●SigmoidColon●Rectum●12~15cm●peritonealportionandpelvisportion●mesorectum●commontumoringastrointe-stinaltract●occurmostlyat41~65yearsold●coloncancerseemsmoreandmoreinrecent20years●proliferation—adenoma--carcinoma,about10~15yearsPATHOLOGYMASSTYPEINVASIVETYPEULCERATIVETYPEHISTOLOGICCLASSIFICATIONNormalepitheliumHIGHRISKFACTORSadenomaCEA(carcinoembryonicantigen)Animportantmarkerforcolorectalcancer(expressedin60%ofpatients)EXTENDINGROUTESOFCOLORECTALCANCERLYMPHATICMETASTASISPATHOLOGICSTAGINGDukesStagingTNMStaging2009年UICC第九版分期TNMStagingHIGH-RISKPATIENTSCARCINOMAOFCOLONCLINICALFEATURESDifferencesofColonCancerinAscendingwithindescendingIMAGINGSTUDIESBARIUMENEMARADIOGRAPHYCOLONOSCOPYCTSCANNINGTREATMENT(1)RadicalColectomy右半结肠癌切除范围(2)WithAcuteObstructionInDescendingColon●首先横结肠造瘘解除梗阻●然后在充分肠道准备下手术切除ChemotherapyCARCINOMAOFRECTUM●Morethancoloncarcinoma(1.5:1)●60%~75%inlowerrectum●10%~15%<30yearold(1)DirectInvasionto:wallofbowel,adjacentorgan,suchas:womb,prostate,bladder,seminalis,vagina,ureter……腹主动脉旁淋巴结(B)低位肿瘤向上方或者侧方转移(C)齿状线周围的肿瘤向上方、侧方或者腹股沟淋巴结转移(3)HematogenousSpread(4)ImplantationMetastasisCLINICALFEATURESDIAGNOSIS(4)影像学检查●结肠钡剂造影：评价有无多发瘤及定位●腹部B超:评价有无肝脏及腹腔淋巴结转移●腔内超声:评价中低位癌肿肠壁浸润深度●MRI检查：评价中低位癌肿肠壁浸润深度●CT造影:评价有无肝脏、腹腔淋巴结转移及盆腔内的浸润情况●PET-CT:评价有无远处转移及估测预后(5)OTHERS:●腹股沟淋巴结活检,●阴道内诊或者腹部双合诊●膀胱镜检查TREATMENT(1)局部切除LocalResection:suitableforearlystage,withasmallsize,locatedinmucosa●经肛门局部切除术●骶后径路局部切除术（2）腹会阴联合直肠癌根治术既往—金标准手术DixonOperation:suitablefortumorover5cmapartfromanus(4)经腹直肠癌切除、近端造口、远端封闭手术●后盆腔脏器清扫（PosteriorPelvicExenteration）radicalresectionwithhysterectomy●全盆腔脏器清扫（PelvicExenteration）radicalresectionwithcystectomyandhysterectomy(2)Ridiotherapy(3)Chemotherapy*Newadjuvanttherapy(4)Others:●Biotherapy●ImmunityTherapy●TargetTherapy●GeneTherapyOurResearchProjectThankYouforYourAttention