共識20診斷初步評估處置必要性檢查 CEA Colonoscopy +biopsy CXR Abdominal/pelvic CTMRI 選擇性檢查 Chest CT Sigmoidoscopy + LGI series Abdominal echo PET-CT Rigid proctoscop

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1 共識19臨床診斷臨床部位 -1 處置直腸癌診療指引 * ptis pt1, <0.1cm * pt1 1.>0.1cm

2 共識20診斷初步評估處置必要性檢查 CEA Colonoscopy +biopsy CXR Abdominal/pelvic CTMRI 選擇性檢查 Chest CT Sigmoidoscopy + LGI series Abdominal echo PET-CT Rigid proctoscopy CEAColonoscopy +biopsy 6-2 臨床分期 Stage I ct1-2, N0 Stage II ct3, N0 Stage III ct Any, N1-2 2 ct4 and/or Stage IV ct Any, N Any, M1 Workup 直腸癌定義 : 15>11cm>7cm &11cm7cm 1875 直腸癌診療指引

3 共識21-3 臨床分期輔助性治療 pt1, Nx Margin negative pt1, NX pt2, Nx 3 處置治療 Stage I ct1-2, N0 Stage I pt1-2, N0, M0 Stage II A pt3, N0, M0-7 Risk factor(s)*: SM3(Submucosa layer 3) invasion Stage IIB~C pt4, N0, M0 Stage III pt1-4, N1-2 直腸癌診療指引

4 共識22-4 臨床分期輔助性治療 Stage II ct3, N0, M0 Stage III ct1-3, N1-2 Stage I pt1-2, N0, M0 Stage II pt3, N0, M0 Stage III pt1-4, N1-2 4 處置治療 (*1) (*2) -7 T4 and/ Any T 1. The use of agents other than fluoropyrimidines (eg, oxaliplatin) are not recommended concurrently with RT Fluoropyrimidinesoxaliplatin 2. For patients with proximal T3, N0 disease with clear margins and favorable prognostic features, the incremental benefit of RT is likely to be small. Consider chemotherapy alone T3,N0RT 直腸癌診療指引

5 共識23-5 臨床分期 * 5 處置治療 Stage IV Metastases * -7 * 直腸癌診療指引*Stage IV RAS MutationStage Optional

6 共識24臨床分期初步評估處置 Recurrence / Colonoscopy Chest/ abdominal+ pelvic CT Consider PET-CT Scan * * 直腸癌診療指引*RAS Mutation

7 共識25-7 Follow up Program for Rectal Cancer Patients ( at least 5 years ) CEA 3-6 (1) High risk patients egstage III or lymphatic or venous invasion by tumor ; Chest /Abdomen + pelvic CT poorly differentiated tumors) (2) Stage IV patients 直腸癌診療指引Colonoscopy or Barium enema + Sigmoidoscopy Rigid proctoscopy Abdomen sono PET-CT scan advanced adenoma1 3.advance adenoma35

8 共識26臨床診斷 -1 腫瘤部位 * ptis 1 處置 -6-2 大腸癌診療指引 pt1, <0.1cm * pt1 1. >0.1cm (+)

9 共識27初步評估診斷處置病理分期輔助性治療必要性檢查 CEA Colonoscopy+Biopsy CXR Abdominal/pelvic CTMRI 選擇性檢查 Chest CT Sigmoidoscopy+LGI series Abdominal echo PET-CT 註 : CEAColonoscopy+biopsy 6-2 ptis-2, N0, M0 pt3, N0, M0 pt3-4, N0 (high risk factors*) 2 pt Any, N1-2 ptis-2, N0, M0 T3-4N0 pt Any, N *High risk factors : 1.(poorly differentiated) 2. or(lymphatic/vascular/perineural invasion) 3. <12(<12 lymph nodes examined) 4. (localized perforation) 5. (bowel obstruction) 6. (close, indeterminate or positive margins) 大腸癌診療指引

10 共識28初步評估診斷處置必要性檢查 CEA Colonoscopy +Biopsy CXR Abdominal/ pelvic CTMRI 選擇性檢查 Chest CT Sigmoidoscopy +LGI series Abdominal echo PET-CT -3 3 * * * -6 大腸癌診療指引

11 共識29初步評估必要性檢查 CEA Colonoscopy+Biopsy CXR Abdominal/pelvic CTMRI KRAS gene status 選擇性檢查 Chest CT Sigmoidoscopy+ LGI series Abdominal echo PET-CT Needle biopsy, if clinically indicated Multidisciplinary team evaluation, including a surgeon experienced in the resection of hepatobiliary and lung metastases -4 診斷 4 處置 * * * *RAS Mutation *< 大腸癌診療指引

12 共識30診斷評估處置 Recurrence Chest/ abdominal/ pelvic CT Consider PET-CT Scan (2-3) 大腸癌診療指引

13 共識31-6 CEA Chest /Abdomen + pelvic CT Follow up Program for Rectal Cancer Patients ( at least 5 years ) 3-6 (1)High risk patients egstage III or lymphatic or venous invasion by tumor ; poorly differentiated tumors) (2)Stage IV patients 大腸癌診療指引Colonoscopy or Barium enema + Sigmoidoscopy Rigid proctoscopy Abdomen sono PET-CT scan advanced adenoma1 3.advance adenoma35

14 考文獻 321. NCCN Clinical Practice in OncologyRectal Cancer V NCCN Clinical Practice in OncologyColon Cancer V Andre T, Quinaux E, Louvet C, Colin P, Gamelin E, Bouche O, Achille E, Piedbois P, Tubiana-Mathieu N, Boutan-Laroze A, Flesch M, Lledo G, Raoul Y, Debrix I, Buyse M, de Gramont A. Phase III Study Comparing a Semimonthly With a Monthly Regimen of Fluorouracil and Leucovorin As Adjuvant Treatment for Stage II and III Colon Cancer Patients Final Results of GERCOR C96.1. L Clin Oncol , André, Corrado Boni, Lamia Mounedji-Boudiaf, Matilde Navarro, Josep Tabernero, Tamas Hickish, Clare Topham, Marta Zaninelli, Philip Clingan, John Bridgewater, Isabelle Tabah-Fisch, Aimery de Gramont, for the Multicenter International Studyof Oxaliplatin / 5-Fluorouracil / Leucovorin in the Adjuvant Treatment of Colon Cancer MOSAIC Investigators Oxaliplatin, Fluorouracil, and Leucovorin as Adjuvant Treatment for Colon Cancer. NEJM , Chris Twelves, Alfred Wong, Marek P. Nowacki, Markus Abt, Howard Burris, III, et al. Capecitabine as Adjuvant Treatment for Stage III Colon Cancer. NEJM , Kato T, Ohashi Y, Nakazato H, Koika A, Saji S, Suzuki H, et al. Efficacy of oral UFT as adjuvant chemotherapy to curative resection of colorectal cancer multicenter prospective randomized trial. Langenbecks Arch Surg Akasu T, Moriya Y, Ohashi Y, Yoshida S, Shirao K, Kodaira S. Adjuvant chemotherapy with uraciltegafur for pathological stage III rectal cancer after excision with selective lateral pelvic lymphadenectomy a multicenter randomized controlled trial. Jpn J Clin Oncol Barry C. Lembersky, H. Samuel Wieand, Nicholas J. Petrelli, Michael J. OConnell, Linda H. Colangelo, Roy E. Smith, Thomas E. Seay, Jeffrey K. Giguere, M. Ernest Marshall, Andrew D. Jacobs, Lauren K. Colman, Atilla Soran, Greg Yothers, and Norman Wolmark. Oral Uracil and Tegafur Plus Leucovorin Compared With Intravenous Fluorouracil and Leucovorin in Stage II and III Carcinoma of the Colon Results From National Surgical Adjuvant Breast and Bowel Project Protocol C-06. Journal of Clinical Oncology Daniel G. Haller, Josep Tabernero, Jean Maroun, et al. Capecitabine Plus Oxaliplatin Compared with Fluorouracil and Folinic Acid as Adjuvant Therapy for Stage III Colon Cancer. Journal of Clinical Oncology , 2011 大腸直腸癌診療指引參

15 10. E Bajetta,M Di Bartolomeo,R Buzzoni,et al.uracil/ftorafur/leucovorin combined with irinoteca(tegafiri) or 考文獻 33oxaliplatin(TEGAFOX) as 11. first-line treatment for metastatic colorectal cancer patients:results of randomised phase II study.british Journal of Cancer , 2007 大腸直腸癌診療指引參

大腸直腸癌診療指引年版與上一版差異 : 103 年版 104 年修訂版 Risk factor CEAColonoscopy + biopsy6 StageI, ct1-2,n0 pt1nx Margin negative pt1nx pt2nx S

大腸直腸癌診療指引年版與上一版差異 : 103 年版 104 年修訂版 Risk factor CEAColonoscopy + biopsy6 StageI, ct1-2,n0 pt1nx Margin negative pt1nx pt2nx S 大腸直腸癌診療指引一參院參與討論同仁主席附設醫院萬芳醫院雙和醫院二討論日期 :104 年 09 月 09 日三校稿人員 : 郭立人主任 / 黃雅惠個管師大腸直腸癌診療指引 16104 年版與上一版差異 : 103 年版 104 年修訂版 -1-2 -3-3 -3-3 -3 Risk factor CEAColonoscopy + biopsy6 StageI, ct1-2,n0 pt1nx

共識20診斷初步評估處置 必要性檢查 CEA Colonoscopy +biopsy CXR Abdominal/pelvic CTMRI 選擇性檢查 Chest CT Sigmoidoscopy + LGI series Abdominal echo PET-CT Rigid proctoscop

共識20診斷初步評估處置必要性檢查 CEA Colonoscopy +biopsy CXR Abdominal/pelvic CTMRI 選擇性檢查 Chest CT Sigmoidoscopy + LGI series Abdominal echo PET-CT Rigid proctoscop