Diagnostik und Therapie des kolorektalen Karzinoms

Dirk Wilhelm; Peter Klare; Simon Nennstiel; Hendrik Dapper; Stefanie Combs; Lucia Liotta; Michael Quante

doi:10.1055/a-0957-2659

Der Klinikarzt, Table of Contents

Der Klinikarzt 2019; 48(06): 251-259
DOI: 10.1055/a-0957-2659

Schwerpunkt

Diagnostik und Therapie des kolorektalen Karzinoms

Bedeutung und Zusammenspiel der verschiedenen Behandlungsmethoden

Authors

Dirk Wilhelm

¹Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München
Peter Klare

²II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München
Simon Nennstiel

²II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München
Hendrik Dapper

³Klinik für Strahlentherapie, Klinikum rechts der Isar, Technische Universität München
Stefanie Combs

³Klinik für Strahlentherapie, Klinikum rechts der Isar, Technische Universität München
Lucia Liotta

²II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München
Michael Quante

²II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München

Abstract

ZUSAMMENFASSUNG

Das kolorektale Karzinom (KRK) ist der häufigste Tumor des Gastrointestinaltraktes, weltweit der zweithäufigste Tumor bei Frauen und der dritthäufigste bei Männern. Die Koloskopie ist in Deutschland seit fast 20 Jahren als endoskopische Vorsorgeuntersuchung anerkannt. Die Steigerung der Polypen- und Adenomdetektionsrate ist ein stetiges Bestreben aller Endoskopiker. Anspruch jeder endoskopischen Therapie ist die komplette Entfernung des verdächtigen Befundes. Nach der aktuellen S3-Leitlinie wird zur Behandlung von Tumoren des unteren und mittleren Rektumdrittels im Stadium II/III (cT3/4 und/oder cN+) und im oberen Rektumdrittels bei Risikofaktoren eine neoadjuvante Radiochemotherapie (RCTx) empfohlen. Das Nebenwirkungsspektrum leitet sich maßgeblich aus dem Bestrahlungsvolumen, der Einzeldosis pro Fraktion, sowie der Gesamtdosis, der Behandlungsdauer und der konkomitant eingesetzten Chemotherapie ab. Während das Kolonkarzinom in der nicht metastasierten Situation primär operiert wird, stellt die neoadjuvante R(C)Tx den Standard beim lokal fortgeschrittenen Rektumkarzinom dar. Eine adjuvante Chemotherapie ist bei Patienten mit Kolonkarzinom im UICC-Stadium II mit Risikofaktoren und Stadium III indiziert. Die Therapie bei Kolonkarzinom in Stadium UICC IV richtet sich nach der Lokalisation und Anzahl der Metastasen sowie dem Allgemeinzustand des Patienten.

Full Text

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