臨牀消化器内科 Vol.27 No.8(2-6)


特集名 下部消化管粘膜下腫瘍の診断と治療
題名 各論 (6) 転移性大腸癌の診断
発刊年月 2012年 07月
著者 中川 義仁 藤田保健衛生大学消化管内科
著者 丸山 尚子 藤田保健衛生大学消化管内科
著者 平田 一郎 藤田保健衛生大学消化管内科
【 要旨 】 転移性大腸癌は他臓器を原発とする悪性腫瘍が大腸壁に転移し,発育浸潤した腫瘍である.転移性大腸癌は原発性大腸癌に比べて遭遇する機会が少ない疾患である.転移の形態としては直接浸潤,腹腔内播種,腫瘍塞栓性転移があるが,転移性大腸癌の典型例とされる牛眼所見は腫瘍塞栓性転移でみられる.しかしながら腫瘍塞栓性転移型のすべてで牛眼所見がみられるわけではない.原発巣は胃癌が多く,形態は腹腔内播種が多い.治療は原則的に外科切除であるが,早期発見が予後に大きく影響するため,適切な診断が重要である.原発巣の鑑別に表面マーカーの免疫染色も併用される.
Theme Diagnosis and Treatment of Lower Gastrointestinal Tract Submucosal Tumors
Title Diagnosis of Metastatic Colorectal Carcinoma
Author Yoshihito Nakagawa Department of Gastroenterology, Fujita Health University School of Medicine
Author Naoko Maruyama Department of Gastroenterology, Fujita Health University School of Medicine
Author Ichiro Hirata Department of Gastroenterology, Fujita Health University School of Medicine
[ Summary ] Information concerning metastatic colorectal carcinomas is reviewed. Metastatic colorectal carcinomas are rare compared to the incidence of primary colorectal carcinoma (0.1-1 %). Metastatic colorectal carcinoma is primarily a cancer of gastric origin. The rate of metastasis is higher than that for uterine or ovarian cancer. The rate of hamatoganeous and lymphatic metastasis is higher than for lung cancer. Metastatic colorectal carcinoma is found to be non-symptomatic in many cases. However, metastatic colorectal carcinoma presents with symptoms, such as abdominal pain, abdominal distention, dyschezia, or bloody stools. Metastatic colorectal carcinoma presents in various forms, such as strangulation, submucosal tumors, or Bullʼs-eye lesions. Bullʼs-eye lesions are characterised by embolic metastasis (hamatoganeous and lymphatic metastasis). The principal therapeutic procedure recommended operative is resection. However, chemotherapy is frequently employed, because many cases present with multiple metastasis which has spread to other organs. The prognosis in these cases is generally poor. On the other hand, if metastatic colorectal carcinomas are found early on, extension of survival periods may be expected. Early detection and early treatment are important for effective treatment of metastatic tumors.
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