Hopp til hovedinnhold

Kolorektalkreft

Sist oppdatert: Sist revidert:
Sist revidert av:


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
  • Nasjonal kompetansetjeneste for seneffekter etter kreftbehandling, nettsted 
  • Nasjonal behandlingstjeneste for hyperterm intraperitoneal kjemoterapi (HIPEC) ved kolorektal kreft, pseudomyksoma peritoneii og peritonealt mesoteliom, Oslo universitetssykehus HF, nettsted 
  • 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
  1. Helsedirektoratet. Kreft i tykktarm og endetarm - handlingsprogram. Sist faglig oppdatert mai 2022. Siden besøkt 14.03.2023 www.helsedirektoratet.no  
  2. TNM: classification of malignant tumors. (2016). (8 utg.). Oxford: Wiley-Blackwell. www.uicc.org  
  3. Kreftregisteret. Cancer in Norway 2021. Oslo: Kreftregisteret, 2022, www.kreftregisteret.no. www.kreftregisteret.no  
  4. Sinicrope FA. Increasing Incidence of Early-Onset Colorectal Cancer. N Engl J Med. 2022;386(16):1547-1558. PubMed  
  5. 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  
  6. 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  
  7. 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  
  8. 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  
  9. 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  
  10. 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  
  11. 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  
  12. Chao A, Thun MJ, Connell CJ, et al. Meat consumption and risk of colorectal cancer. JAMA 2005; 293: 172-82. PubMed  
  13. Li X, Jansen L, Chang-Claude J, et al. Risk of Colorectal Cancer Associated With Lifetime Excess Weight. JAMA Oncol 2022. pmid:35297997 PubMed  
  14. 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  
  15. Nieminen U, Färkkilä M. Malignancies in inflammatory bowel disease. Scand J Gastroenterol 2015; 50(1): 81-9. pmid:25523559 PubMed  
  16. 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  
  17. 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)  
  18. 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  
  19. 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)  
  20. 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  
  21. 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  
  22. Fretheim A, Reinar LM, Brettahuer M. Helseeffekter av screening for kolorektal kreft. Rapport 2016. Oslo: Folkehelseinstituttet 2016. helsedirektoratet.no  
  23. 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  
  24. 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  
  25. 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  
  26. 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  
  27. 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  
  28. 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  
  29. 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  
  30. 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  
  31. 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  
  32. 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  
  33. 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  
  34. 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  
  35. 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  
  36. 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)  
  37. 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  
  38. 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  
  39. 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  
  40. 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  
  41. 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  
  42. 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  
  43. 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  
  44. Compton CC. Pathology and prognostic determinants of colorectal cancer. UpToDate, last updated Feb 27, 2020. UpToDate  
  45. 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  
  46. 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  
  47. 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