结腸癌术前常问问题：
问：我在结腸镜下发现一個可疑息肉，医生说要马上开刀，是否可以等？
答：至少要等病理报告出来再决定下一步。
问：病理报告为中度分化腺癌，是否应该马上开刀？
答：不。应该做以下检查：1）血液化验包括血常规，肝功能，血肌酐，电介质，出凝血和癌胚抗原。2）胸腹盆腔增强CT。
问：为何要先查癌胚抗原？
答：原因1）作为基线值，以与今后比较；2）若病人不抽烟，但癌胚胎抗原值很高，要怀疑转移，可考虑PET/CT。3）作为预后参考。
问：为何术前要先做CT？
答：主要是判断有否转移或有其他情况，是否会影响治疗的程序或方法。
问：能不能举些例子？
答：若发现肝脏有可疑的占位病变，应该先穿刺活检，若病理证实为转移，一般应该先化疗，然后再决定今后是否要手术，以及做何种手术。
再譬如，若CT发现肺内有单個或多個可疑阴影而其他部位都正常，也应该考虑PET/CT，若仍为单個病灶，应该先活检。若为结腸癌转移，应该先化疗，然后决定何时手术。若是多個肺内转移灶，一般不手术，而给予姑息性化疗。若活检为肺癌，治疗方法另当别论。
问：为什么要做增强CT？
答：增强CT使用静脉内造影剂。肝内病变在不增强的CT上不易发现；另外，淋巴结和腸子有时也不易区别。要是肾功能差或对静脉造影剂过敏而不能做增强CT，可以做PET/CT。
肿瘤萌芽显示 III 期结肠癌的预后价值 (4/3/2022)
Tumor budding demonstrates independent prognostic value in stage III colon cancer
TNM 分期系统仍然是恶性肿瘤分类的基本标准。 肿瘤萌芽是结肠癌中新兴的预后生物标志，目前影响 pT1 和 II 期结肠癌患者的护理。
肿瘤萌芽被定义为在肿瘤侵袭边缘最多有四个癌细胞的单个癌细胞。它可能反映了一种激进的增长模式, 作为代表癌症浸润动态过程的上皮-间质转化的形态表达的替代物。 2016 年，国际肿瘤萌芽共识会议 (ITBCC) 推荐了结直肠癌病理学家的标准化肿瘤萌芽评估及其报告。 在 pT1 结肠癌患者中，中间 (Bd2) 和高度 (Bd3) 肿瘤出芽类别与淋巴结受累有关，用于决定内镜切除后是否进行补充根治性手术。在 II 期结肠癌中，高肿瘤出芽类别 (Bd3) 代表不良预后因素，应考虑指导术后化疗。
IDEA-France III 期研究评估肿瘤出芽在 III 期结肠癌患者中的预后作用。这项事后研究是对来自 1,048 名 III 期结肠癌患者的组织切片进行的。根据 ITBCC 2016 标准通过中央审查对肿瘤出芽进行评分，分为 Bd1（0-4 个芽/0.785 mm2）、Bd2（5-9 个芽）和 Bd3（≥10 个芽）。临床病理学特征和 Immunoscore® 与肿瘤出芽相关。 总体而言，在 39%、28% 和 33% 的结肠癌患者中观察到 Bd1、Bd2 和 Bd3。 Bd2 和 Bd3 与血管 (p = 0.002) 和神经周围侵袭 (p = 0.0009) 相关。 肿瘤出芽的 3 年无进展生存率和 5 年总生存率（Bd1 对 Bd2-3）分别为 79.4% 对 67.2%（p = 0.001）和 89.2% 对 80.8%（p = 0.001）。在调整无进展生存率的相关临床病理学特征后证实了这一相关（风险比 [HR] 1.41，95% 置信区间 [CI] 1.12 至 1.77；p = 0.003）和总生存率（HR 1.65，95% CI 1.22 至 2.22；p = 0.001）的。 当与 pTN 分期和 Immunoscore® 亚组相结合时，肿瘤出芽显着改善了疾病预测。
在 IDEA-France 研究中, 接受奥沙利铂的标准辅助化疗的 III 期结肠癌患者中，中间 (Bd2) 和高度 (Bd3) 肿瘤出芽类别与较差的总生存率和无进展生存率密切相关。除了风险组和 Immunoscore® 之外，肿瘤出芽似乎提供了额外的和临床相关的预后信息。
作者认为，肿瘤出芽应根据 ITBCC 2016 标准, 作为切除的 III 期结肠癌患者的常规病理报告。
The TNM staging system remains the gold standard for the classification of cancers. Tumor budding is an emerging prognostic biomarker in colon cancer that affects the management of patients with pT1 and stage II colon cancer. Tumor budding is defined as the presence of a single tumor cell or small clusters of up to 4 cells at the invasive margin of the tumor. It may reflect an aggressive growth pattern. It may serve as a surrogate for the morphological expression of the epithelial-mesenchymal transition that represents the dynamic process of cancer invasion. In 2016, the International Tumor Budding Consensus Conference (ITBCC) recommended a standardized tumor budding assessment and reporting by colorectal cancer pathologists. In patients with pT1 colon cancer, intermediate (Bd2) and high-grade (Bd3) tumor budding categories were associated with lymph node involvement and were used to decide whether to perform complementary curative surgery after endoscopic resection. In stage II colon cancer, the high tumor budding category (Bd3) represents a poor prognostic factor and should be considered to guide adjuvant chemotherapy.
The IDEA-France phase III study evaluated the prognostic role of tumor budding in patients with stage III colon cancer. The post hoc study was conducted on tissue sections from 1,048 patients with stage III colon cancer. Tumor budding was scored by central review according to ITBCC 2016 criteria and classified as Bd1 (0-4 buds/0.785 mm2), Bd2 (5-9 buds), and Bd3 (≥10 buds). Clinicopathological features and Immunoscore® were associated with tumor budding.
Overall, Bd1, Bd2 and Bd3 were observed in 39%, 28% and 33% of colon cancer patients. Bd2 and Bd3 were associated with vascular (p = 0.002) and perineural invasion (p = 0.0009). The 3-year progression-free survival and 5-year overall survival for tumor budding (Bd1 vs Bd2-3) were 79.4% vs 67.2% (p = 0.001) and 89.2% vs 80.8% (p = 0.001), respectively. This was confirmed after adjustment for relevant clinicopathological features for DFS (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.12 to 1.77; p = 0.003) and overall survival (HR 1.65, 95 %CI 1.22 to 2.22; p = 0.001). When combined with pTN staging and Immunoscore® subgroups, tumor budding significantly improved disease prognostication.
In the IDEA-France study, intermediate (Bd2) and high-grade (Bd3) tumor budding categories were strongly associated with poorer overall and progression-free survival in patients with stage III colon cancer receiving standard oxaliplatin -based adjuvant chemotherapy. In addition to risk groups and Immunoscore®, tumor budding appears to provide additional and clinically relevant prognostic information.
The authors believe that tumor budding should be routinely reported as a microscopic biomarker in patients with resected stage III colon cancer according to ITBCC 2016 criteria.
参考文献 Reference Basile D et al. Ann Onc 2022; DOI:https://doi.org/10.1016/j.annonc.2022.03.002结腸肿瘤术后常问问题：
问：术后病理要包括哪些方面？
答：1）深度，是指肿瘤浸润或侵犯至哪一层：粘膜下（T1），肌层（T2），浆膜层（T3），腹膜，周围组织或脏器（T4）。2）淋巴结清扫的数目以及多少是阳性；是否有淋巴结以外的肿瘤浸润。AJCC和美国病理协会认为清扫的淋巴结至少要12個才能准确定为第二期。3）肿瘤分化程度（良好，中等，或低分化）。4）近远端及周围切缘是否阴性。5）是否有肿瘤细胞浸润血管，淋巴管或神经。
问：如何分期？
答：根据TNM，如T1N0，T2N0为第一期；T3N0，T4N0为第二期；任何T，只要有局部淋巴结转移（N1，N2）都为第三期。若有远处转移（M1）则为第四期。
问：既然是根据TNM分期，为何病理报告还需要其他特点，象上面提到的3－5？
答：同一期的肿瘤，其生物行为，预后都不会一样，有时也会影响治疗。譬如第二期结腸癌，一般不需要化疗，但倘若属于低分化，或还发现有肿瘤细胞浸润血管或神经，应该考虑化疗。
问：术后化疗应该什么时候开始？
答：一般术后4個星期开始。
问：要是我术后还疲倦，仍然有贫血，是否可以多等一些时间？
答：已经有报道结腸肿瘤术后化疗开始得早，可以减少今后的復发。若术后发现有显著贫血，要想方设法纠正，包括补充铁质（加上维生素C，都在饭前服用）和营养，以及轻度锻炼至逐步恢复体力。
问：如何知道化疗达到了治疗要求？
答：只有时间才能证实。因为肿瘤己被切除，至今任何化验或扫描都无法达到判断治疗效果之目的。
闷：是否在化疗同时通过查血的癌胚抗原来监查肿瘤是否重新生长起来？
答：不主张。有些病人在化疗时血癌胚抗原会升髙，化疗后自动恢复正常。要是化疗中频繁查肿瘤抗原，会多做不必要的检查，延误治疗，可能因此而增加复发的机会。
11/2/2024: 最近进展 Recent Progress–>细胞周期蛋白依赖性激酶 4/6 抑制剂治疗伴有 GNAS 突变的腹膜粘液癌 Novel therapy using CDK 4/6 inhibitor for peritoneal mucinous carcinomatosis with GNAS mutations (more often in appendiceal carcinoma)
Sotorasib治疗具有KRASG12C基因突变的肿癌 (9/27/2020)
Sotorasib targeting cancers harboring KRASG12C mutation
目前为止，还没有针对具有KRAS突变癌症的疗法,。 Sotorasib是一个选择性且不可逆地靶向KRASG12C的小分子（这种突变发生在13％的非小细胞肺癌和1-3％的大肠癌和其他癌症中）。
这是一项I期临床试验, 在剂量递增和扩展队列中, 总共129例患者参加（59例非小细胞肺癌，42例大肠癌，28例其他肿瘤）。患者以前接受过中位数为3种的转移性抗癌治疗（0到11）。患者每天口服一次Sotorasib。主要终点是安全性。关键的次要终点是药代动力学和客观响应。治疗中没有观察到剂量限制的毒性作用或与治疗有关的死亡。共有73例患者（56.6％）发生治疗相关的不良事件； 15名患者（11.6％）为3或4级事件。
在患有非小细胞肺癌的亚组中，32.2％（19例患者）有确诊的客观响应（完全或部分响应），88.1％（52例患者）疾病得到控制（客观响应或疾病稳定）；中位无进展生存期为6.3个月（范围从0.0+到14.9 [+表示该值包括在数据截止时患者的数据]）。在患有大肠癌的亚组中，有7.1％（3例患者）有确诊的客观响应和73.8％（31例患者）疾病得到控制。中位无进展生存期为4.0个月（范围从0.0+到11.1+）。在胰腺癌，子宫内膜癌，阑尾癌和黑色素瘤患者中也观察到了响应。
So far, there is no target therapy for cancers harboring KRAS mutations. Sotorasib is a small molecule that selectively and irreversibly targets KRASG12C, which occurs in 13% of non-small cell lung cancer and 1-3% of colorectal cancer and other cancers.
So far, there is no target therapy for cancers harboring KRAS mutations. Sotorasib is a small molecule that selectively and irreversibly targets KRASG12C, which occurs in 13% of non-small cell lung cancer and 1-3% of colorectal cancer and other cancers.
This is a phase I clinical trial. In the dose escalation and expansion cohort, a total of 129 patients participated (59 cases of non-small cell lung cancer, 42 cases of colorectal cancer, 28 cases of other tumors). Patients have previously received a median of 3 anticancer treatments in the metastatic setting (0 to 11). Patient took Sotorasib orally once a day. The primary endpoint is safety. The key secondary endpoints are pharmacokinetics and objective response. No dose-limiting toxic effects or treatment-related deaths were observed during treatment. A total of 73 patients (56.6%) had treatment-related adverse events; grade 3 or 4 events were seen in 15 patients (11.6%).
In the subgroup with non-small cell lung cancer, 32.2% (19 patients) had a confirmed objective response (complete or partial response), and 88.1% (52 patients) had disease under control (objective response or stable disease); The median progression-free survival was 6.3 months (range from 0.0+ to 14.9 [with + indicating that the value includes patient’s data at the time of data cutoff]). In the subgroup with colorectal cancer, 7.1% (3 patients) had a confirmed objective response and 73.8% (31 patients) had disease under control. The median progression-free survival was 4.0 months (range from 0.0+ to 11.1+). Responses have also been observed in patients with pancreatic cancer, endometrial cancer, appendix cancer and melanoma.
参考文献 Reference Hong DS et al. NEJM 2020; 383:1207