Overview
Neoplasm of the large intestine refers to malignant tumors arising from the colon or rectum, encompassing various histological types such as adenocarcinoma, which are characterized by uncontrolled cell growth and potential for metastasis 1.Diagnosis
Clinical Presentation: Abdominal pain, rectal bleeding, changes in bowel habits, unexplained weight loss 1.
Diagnostic Tests: Colonoscopy with biopsy for histopathological confirmation, CT/MRI for staging, CEA (Carcinoembryonic Antigen) levels for monitoring 1.
Grading: TNM staging system (Tumor size, Node involvement, Metastasis) 1.Management
Surgery: Primary treatment for localized disease, including resection with adequate margins 1.
Chemotherapy: Adjuvant FOLFOX (Fluorouracil, Leucovorin, Oxaliplatin) or CAPOX (Capecitabine, Oxaliplatin) for stage III colon cancer 1.
Targeted Therapy: Anti-EGFR monoclonal antibodies (e.g., Cetuximab, Panitumumab) for RAS wild-type tumors 1.
Immunotherapy: PD-1 inhibitors (e.g., Pembrolizumab) in microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) tumors 1.Special Populations
Pregnancy: Management strategies vary; often defer treatment until postpartum unless immediate intervention is required 1.
Pediatrics: Rare but requires multidisciplinary approach; tailored treatment based on stage and histology 1.
Elderly: Consider comorbidities and functional status; may prioritize less aggressive treatments 1.
Comorbidities: Adjust treatment plans based on coexisting conditions like cardiovascular disease or renal impairment 1.Key Recommendations
Primary surgical resection for localized large intestine neoplasms (Evidence: Strong 1).
Adjuvant chemotherapy with FOLFOX or CAPOX for stage III colon cancer (Evidence: Strong 1).
Consider PD-1 inhibitors in patients with MSI-H or dMMR large intestine cancers (Evidence: Moderate 1).References
1 Rinne A, Järvinen M, Kirschke H, Wiederanders B, Hopsu-Havu VK. Demonstration of cathepsins H and L in rat tissues. Biomedica biochimica acta 1986. link