Kolorektalkreft
Sist oppdatert: Sist revidert:
Sist revidert av:Silje Folven Barlindhaug
Definisjon:
Kreftsvulst i kolon eller rektum. Nesten 2/3 er lokalisert til rektum og sigmoideum. 98% er adenokarsinom. Skyldes både genetiske og miljømessige faktorer
Forekomst:
Livstidsinsidens er ca. 7% for menn og ca. 6% for kvinner, og den er økende
Symptomer:
Avhenger av lokalisasjon. Ofte diffuse tidlig i forløpet. Mest typisk er avføringsendringer, følelse av ufullstendig tømning, symptomer på anemi, blod i avføringen (rødt), slim i avføringen og defekasjonssmerter
Funn:
Avhenger av lokalisasjon, men sjekk oppfylninger, ev. tegn til metastaser til lymfeknuter og lever. Rektal palpasjon kan avdekke 10%
Diagnostikk:
Test på blod i avføring, Hb, leverfunksjonsprøver. Koloskopi ved mistanke om endetarmskreft. Histologi bekrefter diagnosen
Behandling:
Kirurgi ved lokalisert kreft. Ved lokalavansert kreft opereres etter preoperativ kjemoterapi/ strålebehandling. Metastaser behandles medikamentelt, ev. med stråler, i en del tilfeller kirurgisk
- Helsedirektoratet. Kreft i tykktarm og endetarm - handlingsprogram. Sist faglig oppdatert mai 2022
- Tom-Harald Edna, overlege i kirurgi Sykehuset Levanger og professor ved det medisinske fakultet, NTNU
- Helsedirektoratet. Kreft i tykktarm og endetarm - handlingsprogram. Sist faglig oppdatert mai 2022. Siden besøkt 14.03.2023 www.helsedirektoratet.no
- TNM: classification of malignant tumors. (2016). (8 utg.). Oxford: Wiley-Blackwell. www.uicc.org
- Kreftregisteret. Cancer in Norway 2021. Oslo: Kreftregisteret, 2022, www.kreftregisteret.no. www.kreftregisteret.no
- Sinicrope FA. Increasing Incidence of Early-Onset Colorectal Cancer. N Engl J Med. 2022;386(16):1547-1558. PubMed
- GBD 2017 Colorectal Cancer Collaborators. The global, regional, and national burden of colorectal cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2019 Dec;4(12):913-933. doi: 10.1016/S2468-1253(19)30345-0. Epub 2019 Oct 21. Erratum in: Lancet Gastroenterol Hepatol. 2020 Mar;5(3):e2. PMID: 31648977 PubMed
- Lotfollahzadeh S, Recio-Boiles A, Cagir B. Colon Cancer. 2022 Dec 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 29262132. www.ncbi.nlm.nih.gov
- Schoen RE, Razzak A, Yu KJ, et al. Incidence and mortality of colorectal cancer in individuals with a family history of colorectal cancer. Gastroenterology, Nov 2015; 149: 1438-1445. pmid: 26255045 PubMed
- Ubago-Guisado E, Rodríguez-Barranco M, Ching-López A et al. Evidence Update on the Relationship between Diet and the Most Common Cancers from the European Prospective Investigation into Cancer and Nutrition (EPIC) Study: A Systematic Review. Nutrients. 2021 Oct 13;13(10):3582. PMID: 34684583 PubMed
- Wang L, Du M, Wang K, et al. Association of ultra-processed food consumption with colorectal cancer risk among men and women: results from three prospective US cohort studies. BMJ 2022; 378: e068921. doi:10.1136/bmj-2021-068921 DOI
- Dalla Libera LS, de Siqueira T, Santos IL et al. Detection of Human papillomavirus and the role of p16INK4a in colorectal carcinomas. PLoS One. 2020 Jun 25;15(6):e0235065. PMID: 32584870 PubMed
- Botteri E, Iodice S, Bagnardi V, et al. Smoking and colorectal cancer: a meta-analysis. JAMA 2008; 300:2765. Journal of the American Medical Association
- Chao A, Thun MJ, Connell CJ, et al. Meat consumption and risk of colorectal cancer. JAMA 2005; 293: 172-82. PubMed
- Li X, Jansen L, Chang-Claude J, et al. Risk of Colorectal Cancer Associated With Lifetime Excess Weight. JAMA Oncol 2022. pmid:35297997 PubMed
- Hovde Ø, Høivik ML, Henriksen M, et al. Malignancies in Patients with Inflammatory Bowel Disease: Results from 20 Years of Follow-up in the IBSEN Study. Journal of Crohn's and Colitis, 2017; 11 (5): 571–577. academic.oup.com
- Nieminen U, Färkkilä M. Malignancies in inflammatory bowel disease. Scand J Gastroenterol 2015; 50(1): 81-9. pmid:25523559 PubMed
- Brenne SS, Madsen PH, Pedersen IS, Hveem K, Skorpen F, Krarup HB, Giskeødegård GF, Laugsand EA. Colorectal cancer detected by liquid biopsy 2 years prior to clinical diagnosis in the HUNT study. Br J Cancer. PMID: 37438612 PubMed
- Holme Ø, Bretthauer M, Fretheim A, Odgaard-Jensen J, Hoff G. Flexible sigmoidoscopy versus faecal occult blood testing for colorectal cancer screening in asymptomatic individuals. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD009259.pub2 Cochrane (DOI)
- Shaukat A, Mongin SJ, Geisser MS, et al. Long-term mortality after screening for colorectal cancer. N Engl J Med 2013; 369: 1106-14. pmid:24047060 PubMed
- Lee SJ, Boscardin WJ, Stijacic-Cenzer I, et al. Timelag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark. BMJ 2012; 345: e8441. BMJ (DOI)
- Juul FE, Cross AJ, Schoen RE, et al. 15-Year Benefits of Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality : A Pooled Analysis of Randomized Trials. Ann Intern Med 2022. pmid:36215714 PubMed
- Bretthauer M, Loberg M, Wieszczy P, et al. Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death. N Engl J Med. 2022. PMID: 36214590 PubMed
- Fretheim A, Reinar LM, Brettahuer M. Helseeffekter av screening for kolorektal kreft. Rapport 2016. Oslo: Folkehelseinstituttet 2016. helsedirektoratet.no
- Randel KR, Schult AL, Botteri E, et al. Colorectal cancer screening with repeated fecal immunochemical test versus sigmoidoscopy: baseline results from a randomized trial published online ahead of print, 2020 Nov 20. Gastroenterology. 2020;S0016-5085(20)35440-8. PMID: 33227280. PubMed
- Cardoso R, Guo F, Heisser T, et al. Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study. Lancet Oncol. 2021 Jul;22(7):1002-1013. Epub 2021 May 25. PMID: 34048685 PubMed
- Brenner H, Chang-Claude J, Seiler CM, Hoffmeister M. Long-term risk of colorectal cancer after negative colonoscopy. J Clin Oncol 2011; 29: 3761. PubMed
- Kapidzic A, Grobbee EJ, Hol L, et al. Attendance and yield over three rounds of population-based fecal immunochemical test screening. Am J Gastroenterol 2014; 109: 1257-64. doi:10.1038/ajg.2014.168 DOI
- Bretthauer M, Kaminski MF, Løberg M, et al. Population-based colonoscopy screening for colorectal cancer. JAMA Intern Med 2016; 176: 894-902. doi:10.1001/jamainternmed.2016.0960 DOI
- Edna TH, Karlsen V, Jullumstrø E, Lydersen S. Prevalence of anaemia at diagnosis of colorectal cancer: assessment of associated risk factors. Hepatogastroenterology 2012; 59: 713-6. PubMed
- Gjør kloke valg. Norsk forening for medisinsk biokjemi. Unngå å bestille tumormarkører, særlig CEA, CA-125, HE4, AFP og CA19-9 når det ikke foreligger kjent kreftsykdom, spesifikk mistanke om en bestemt krefttype eller en sterk, underliggende predisposisjon. 04.07.2018 www.legeforeningen.no
- Gjør kloke valg. Norsk forening for medisinsk biokjemi. Unngå test for okkult blod i avføringen ved andre indikasjoner enn mistanke om kolorektal kreft. Kvantitative immunologiske tester for okkult blod (iFOBT) bør erstatte kjemiske tester. Publisert 9. januar 2023. www.legeforeningen.no
- Lee JK, Liles EG, Bent S, et al. Accuracy of fecal immunochemical tests for colorectal cancer: Systematic review and meta-analysis. Ann Intern Med 2014; 160: 171-81. doi:10.7326/M13-1484 DOI
- Randel KR, Botteri E, Romstad KMK, et al. Effects of Oral Anticoagulants and Aspirin on Performance of Fecal Immunochemical Tests in Colorectal Cancer Screening. Gastroenterology 2019. doi:10.1053/j.gastro.2019.01.040 DOI
- Martín-López JE, Beltrán-Calvo C,Rodríguez-López R, et al. Comparison of the accuracy of CT colonography and colonoscopy in the diagnosis of colorectal cancer. Colorectal Dis. 2014;16(3):O82-9. doi: 10.1111/codi.12506 DOI
- Gao Y, Wang J, Lv H, et al. Diagnostic value of magnetic resonance and computed tomography colonography for the diagnosis of colorectal cancer: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(39):e17187. PMID: 31574825. PubMed
- Konishi T, Shimada Y, Hsu M, et al. Association of Preoperative and Postoperative Serum Carcinoembryonic Antigen and Colon Cancer Outcome. JAMA Oncology 2018; 4: 309-315. pmid: 29270608 PubMed
- Aune D, Chan DSM, Lau R, et al. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-respons meta-analysis of prospective studies. BMJ 2011; 343: d6617. BMJ (DOI)
- Yang B, Jacobs EJ, Gapstur SM, et al. Active Smoking and Mortality Among Colorectal Cancer Survivors: The Cancer Prevention Study II Nutrition Cohort. J Clin Oncol 2015; 33: 885-93. doi:10.1200/JCO.2014.58.3831 DOI
- Van Blarigan EL, Fuchs CS, Niedzwiecki D et al. Association of Survival With Adherence to the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors After Colon Cancer Diagnosis The CALGB 89803/Alliance Trial. JAMA Oncol 2018; 4: 783-790. pmid:29710284 PubMed
- Yao Y, Suo T, Andersson R, et al. Dietary fibre for the prevention of recurrent colorectal adenomas and carcinomas. Cochrane Database of Systematic Reviews 2017, Issue 1. Art. No.: CD003430. DOI: 10.1002/14651858.CD003430.pub2. DOI
- Friis S, Riis AH, Erichsen R, et al. Low-dose aspirin and nonsteroidal anti-inflammatory drug use and colorectal cancer risk: A population-based, case-control study. Ann Intern Med 2015. doi:10.7326/M15-0039 DOI
- Rothwell PM, Wilson M, Elwin C-E, et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. Lancet 2010; 376: 1741-50. PubMed
- Rothwell PM, Price JF, Fowkes FGR, et al. Short-term eff ects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefi ts in 51 randomised controlled trials. Lancet 2012; : DOI:10.1016/S0140-. DOI
- Burn J, Sheth H, Elliott F, et al. Cancer prevention with aspirin in hereditary colorectal cancer (Lynch syndrome), 10-year follow-up and registry-based 20-year data in the CAPP2 study: a double-blind, randomised, placebo-controlled trial. Lancet North Am Ed 2020;395:1855–63. PMID: 32534647 PubMed
- Compton CC. Pathology and prognostic determinants of colorectal cancer. UpToDate, last updated Feb 27, 2020. UpToDate
- Petrelli F, Tomasello G, Borgonovo K et al. Prognostic Survival Associated With Left-Sided vs Right-Sided Colon CancerA Systematic Review and Meta-analysis. JAMA Oncol. Published online October 27, 2016. pmid:27787550 PubMed
- Løberg M, Kalager M, Holme Ø, et al. Long-Term Colorectal-Cancer Mortality after Adenoma Removal. N Engl J Med 2014; 371: 799-807. doi:10.1056/NEJMoa1315870 DOI
- Jeffery M, Hickey BE, Hider PN. Follow‐up strategies for patients treated for non‐metastatic colorectal cancer. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD002200. DOI: 10.1002/14651858.CD002200.pub4. DOI
- Silje Folven Barlindhaug, spesialist i allmennmedisin, redaktør NEL