Advanced colon cancer

晚期结肠癌
  • 文章类型: Review
    背景:晚期结肠癌的治疗选择主要是化疗和靶向药物的组合。然而,身体状况不佳和药物不耐受限制了抗癌药物的选择。结肠癌肝硬化是一个特殊的患者群体,对临床治疗提出了挑战。
    方法:本文介绍一例肝硬化失代偿期患者,诊断为晚期结肠癌。最初的演讲是他肚脐上的一个结节,命名为玛丽·约瑟夫修女的结节,后来通过活检和PET-CT证实为结肠癌的转移之一。患者接受西妥昔单抗和5-氟尿嘧啶治疗,剂量低于指导剂量;然而,门静脉血栓形成并导致死亡。这整个过程,从诊断到死亡,发生在三个月内。
    结论:肝硬化是一个值得关注的特殊群体。这些患者没有统一的治疗指南,尤其是肝外原发性肿瘤。今后在为此类患者选择治疗时,我们应该更加谨慎。化疗和靶向治疗都可能导致门静脉血栓形成,与没有肝硬化的癌症相比,这种癌症的发病率更高,预后更差。
    BACKGROUND: Treatment options for advanced colon cancer are mainly combinations of chemotherapy and targeted drugs. However, poor physical health and medication intolerance limit the choice of anticancer drugs. Colon cancer with cirrhosis is a particular patient group that poses a challenge to clinical treatment.
    METHODS: This article presents a case of a patient in the decompensated stage of cirrhosis who was diagnosed with advanced colon cancer. The initial presentation was a nodule on his navel named the Sister Mary Joseph\'s nodule, which was later confirmed by biopsy and PET-CT as one of the metastases of colon cancer. The patient was treated with cetuximab and 5-fluorouracil at a below-guideline dose; however, portal vein thrombosis developed and led to death. This entire process, from diagnosis to death, occurred within a span of three months.
    CONCLUSIONS: Cancers with cirrhosis are a special group that deserves more attention. There is no unified treatment guideline for these patients, especially those with extrahepatic primary tumors. We should be more cautious when choosing treatment for such patients in the future. Both chemotherapy and targeted treatment may potentially induce portal vein thrombosis, which appears to have a higher incidence and worse prognosis than cancers without cirrhosis.
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  • 文章类型: Case Reports
    与西方国家相比,在亚洲国家,姑息治疗和临终关怀服务的使用频率较低。虽然这两种类型近年来都在中国大陆实施,他们的利用率没有令人满意地提高。此外,中国大陆很少有医院使用临终关怀共享护理模式实施临终关怀护理。
    本研究调查了一例在中国大陆某三级综合医院接受治疗的晚期结肠癌患者实施了临终关怀共享护理模式的案例。
    护理要点包括疼痛症状管理,营养支持,疾病通知共享模型的应用,协助医疗决策的家庭会议,放松疗法缓解抑郁症状,解决临终愿望的规定,以及对主要护理人员的支持。
    患者的基本疼痛得到控制(数字评定量表,NRS2-3),住院期间干预后抑郁筛查量表(PHQ-9)评分从15分下降到10分。最后,病人在家里舒适平静地死去。
    临终关怀共享护理团队帮助患者减轻了身体和心理上的痛苦,满足了她临终的愿望,并为家庭提供支持。
    UNASSIGNED: Compared to Western countries, palliative and hospice care services are used less often in Asian countries. While both types have been implemented in mainland China in recent years, their utilization rates have not increased satisfactorily. Moreover, few hospitals in mainland China implement hospice care using the hospice shared care model.
    UNASSIGNED: This study investigated a case in which the hospice shared care model was implemented for one patient with advanced colon cancer who had received treatment at a general tertiary hospital in mainland China.
    UNASSIGNED: Critical points of care included pain symptom management, nutritional support, application of the SHARE model for disease notification, family meetings to assist medical decision-making, relaxation therapy to relieve depressive symptoms, provisions to address end-of-life wishes, and support for primary caregivers.
    UNASSIGNED: The patient\'s basic pain was controlled (Numeric Rating Scale, NRS2-3), and the score of the Depression Screening Scale (PHQ-9) decreased from 15 to 10 after intervention during hospitalization. In the end, the patient died comfortably and peacefully at home.
    UNASSIGNED: The hospice shared care team helped the patient with her physical and psychological pain, met her end-of-life wishes, and provided support for the families.
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  • 文章类型: Case Reports
    未经授权:结直肠癌(CRC)是仅次于乳腺癌和肺癌的第三大常见恶性肿瘤,占患者的9.4%。一些患者在诊断时发生远处转移,没有手术机会。延长患者生存期和提高生活质量尤为重要。
    未经评估:一名73岁女性因2个月以上的不适入院。在胸部计算机断层扫描(CT)中观察到左侧锁骨上窝的肿大淋巴结。增强腹部CT显示右结肠壁增厚,腹部多发转移淋巴结。结肠镜检查显示回盲部肿块,病理显示中、低分化腺癌。体格检查显示左侧锁骨上窝可触及2*2cm淋巴结。通过组织病理学检查和影像学发现,患者被诊断为晚期结肠癌。事实上,很难彻底切除。
    未经批准:Sintilimab与XELOX联合使用。初始治疗后两个疗程,腹腔镜右半结肠癌根治术成功。
    UNASSIGNED:转换处理后,肿大的淋巴结和原发肿瘤明显减少。术后3周患者顺利出院。标本和解剖的14个淋巴结均未见病理恶性。肿瘤消退分级(TRG)为0,其指示完全消退,没有包括淋巴结的残留肿瘤细胞。患者获得病理完全缓解(pCR)。
    UNASSIGNED:在这种情况下,患者通过上述化学疗法获得了巨大的治疗益处。该病例为使用免疫检查点抑制剂(ICIs)治疗pMMRCRC患者提供了潜在参考。
    UNASSIGNED: Colorectal cancer (CRC) is the 3rd most common malignant tumors after breast cancer and lung cancer, accounting for 9.4% of patients. Some patients had distant metastasis at the time of diagnosis without surgery opportunity. It is particularly important to prolong patient survival and improve quality of life.
    UNASSIGNED: A 73-year-old female was admitted with discomfort over 2 months. Enlarged lymph nodes in the left supraclavicular fossa were observed in chest computed tomography (CT). Enhanced abdominal CT showed thickening of the right colon wall with multiple metastatic lymph nodes in the abdomen. Colonoscopy showed ileocecal mass and pathology showed moderately and poorly differentiated adenocarcinoma. Physical examination showed a 2*2 cm lymph node could be touched in the left supraclavicular fossa. The patient was diagnosed advanced colon cancer by the histopathological examination and imaging findings. Actually, it is hardly to resect radically.
    UNASSIGNED: Sintilimab combined with XELOX was initiated. Two period of treatment after initial therapy, laparoscopic radical resection of right colon cancer was performed successfully.
    UNASSIGNED: After conversion treatment, the enlarged lymph nodes and primary tumor were significantly reduced. The patient was discharged successfully three weeks after surgery. Both specimen and 14 lymph nodes dissected showed no malignancy in pathology. Tumor regression grading (TRG) is 0, which indicate complete regression with no residual tumor cells including lymph nodes. The patient obtained a pathological complete response (pCR).
    UNASSIGNED: The patient achieved a great therapeutic benefit with the above-mentioned chemotherapy in this case. The case provides a potential reference for pMMR CRC patients treating with immune checkpoint inhibitors (ICIs).
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