CT虚拟结肠镜福建医科大学附属协和医院CT室2前言•在美国是肿瘤发病率中居第三位•2009年有近146970例新发病例•占肿瘤死亡的第二位•2009年全美有49920例死亡•超过100万的美国人患有结肠直肠癌3结肠直肠癌散发散发((一般危险因素一般危险因素))(65%–85%)(65%–85%)家族史家族史(10%–30%)(10%–30%)遗传性非息肉性结肠直肠癌(HNPCC)(5%)(HNPCC)(5%)家族性多发性腺癌(1%)(1%)罕见综合征罕见综合征(<0.1%)(<0.1%)CENTERSFORDISEASECONTROLANDPREVENTION4危险度因子-息肉分类•异常增生–较小癌变可能•腺瘤样–大约90%结肠直肠癌由腺瘤样息肉发展而来5结肠腺瘤进展小腺瘤<5mm异常增殖进展性结肠腺瘤>10mm癌10yrs大多数是增生改变通常不会发展为癌症6筛查的优势•预防癌症–切除癌前病变（恶性息肉）防止癌症发生•提高生存率–早期检测显著增加长期生存机会7筛查的优势91.4%66.1%8.5%0204060801005-yrSurvivalLocalRegionalDistantStageofDetectionSurvivalRatesbyDiseaseStage8结肠直肠癌筛查率•只有40%的结肠直肠癌在早期阶段发现•近一半多一点的超过50岁的美国人有进行近期的结肠直肠癌筛查。*variesbasedondatasource931281634291639321741331845361905101520253035404550TotalLessthanahighschooleducationNohealthinsurancePrevalence(%)19971999200120022004近年来光学直肠镜检查的普及率(%)的趋势,大于50岁的美国人,1997-2004*Aflexiblesigmoidoscopyorcolonoscopywithinthepastfiveyears.Note:DatafromparticipatingstatesandtheDistrictofColumbiawereaggregatedtorepresenttheUnitedStates.Source:BehavioralRiskFactorSurveillanceSystemCD-ROM(1996-1997,1999)andPublicUseDataTape(2001,2002,2004),NationalCenterforChronicDiseasePreventionandHealthPromotion,CentersforDiseaseControlandPreventionandPrevention,1999,2000,2002,2003,2005.1020168211691812221691914924051015202530TotalLessthanahighschooleducationNohealthinsurancePrevalence(%)19971999200120022004近年来粪便潜血试验的普及率(%)的趋势,大于50岁的美国人,1997-2004*Afecaloccultbloodtestwithinthepastyear.Note:DatafromparticipatingstatesandtheDistrictofColumbiawereaggregatedtorepresenttheUnitedStates.Source:BehavioralRiskFactorSurveillanceSystemCD-ROM(1996-1997,1999)andPublicUseDataTape(2001,2002,2004),NationalCenterforChronicDiseasePreventionandHealthPromotion,CentersforDiseaseControlandPreventionandPrevention,1999,2000,2002,2003,2005.11结肠直肠癌筛查率低:原因(依照患者的说法)•对结肠直肠癌不重视•缺乏对结肠直肠癌筛查好处的了解•害怕,难为情,不舒服•没时间•费用高•“我医生从来没跟我提到过!”12The2008CRCGuidelinesUpdatewasaJointEffortof5Organizations•AmericanCancerSociety•U.S.Multi-SocietyTaskForceonColorectalCancer–AmericanGastroenterologicalAssociation–AmericanCollegeofGastroenterology–AmericanSocietyofGastrointestinalEndoscopists•AmericanCollegeofRadiology13CRCScreeningGuidelines:WhatElseisNew?•Twonewtestsrecommended:•stoolDNA(sDNA)and•computerizedtomographiccolonography(CTC)–sometimesreferredtoasvirtualcolonoscopy•Theguidelines:•establishasensitivitythresholdforrecommendedtests•delineateimportantquality-relatedfactorsforeachformoftesting•continuetoemphasizeoptionsfortesting•Anoverridinggoalofthisupdateistoprovideapracticalguidelineforphysiciansandthepublic142008CRCScreeningGuidelinesAverageriskadultsage50andolder•Teststhatdetectadenomatouspolypsandcancer–Flexiblesigmoidoscopy(FSIG)every5years*,or–Colonoscopyevery10years,or–Doublecontrastbariumenema(DCBE)every5years*,or–CTcolonography(CTC)every5years*•Teststhatprimarilydetectcancer–Annualguaiac-basedfecaloccultbloodtest(gFOBT)*withhightestsensitivityforcancer,o...
