我的结肠癌将如何治疗？

The cornerstones of colon癌症治疗and rectal cancer treatment are surgery, radiation, and chemotherapy.

对于患有特定遗传特征或蛋白质变化的肿瘤的患者，医生也可能会转向两种较新的治疗类型：靶向治疗和免疫疗法。

Decisions largely depend on the extent, or stage, of the cancer — whether it is present only in the inside lining of the colon or rectum, has grown deeper into those tissues, or has spread to other parts of the body.

与其他癌症一样，有早期的人结直肠癌（（a term that encompasses both colon and rectal cancer) generally have the best outcomes.

Patients withstage 1 colon cancer例如，五年相对存活率约为92％；患有1期直肠癌的人，88％。

对于4阶段癌症患者，这些数字降至12％和13％。（（1)

手术是主要的治疗的人y early-stage colon cancers and most rectal cancers.

Doctors can remove some early-stage colon and rectal tumors, as well as precancerous growths called polyps, using minimally invasive techniques that don't require cutting into the abdomen.

For a procedure called acolonoscopy, the doctor threads a colonoscope— a long, thin, flexible tube with a tiny video camera at the end — through the anus.

Doctors use cutting tools inserted through the colonoscope to remove tumors or polyps.

For a large tumor confined to the colon, the surgeon will perform an operation called acolectomy。

对于大多数结肠癌治疗，此过程涉及去除结肠的影响以及一小部分健康组织。

Nearby lymph nodes are also removed for examination.

在开放的结肠切除术中，外科医生在腹部长时间切开结肠。

A less invasive technique, called laparoscopic-assisted colectomy, uses many small incisions — one for a laparoscope (a camera similar to a colonoscope) and others for long, thin surgical instruments.

去除结肠的一部分后，外科医生重新连接切割末端。

But if the tumor has blocked the colon, the surgeon may be unable to reattach the ends immediately after colectomy.

取而代之的是，外科医生在腹部开口，称为造口，浪费从结肠或小肠从体内散发出来，然后进入气密塑料袋中。（（2)

If the cancer has spread to only a few spots in the lungs or liver, surgeons may be able to remove them or use other methods to kill cancer cells or block blood flow to them, such as cryosurgery (freezing with a metal probe). (3)

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放射疗法，依赖于高能X射线or other types of radiation to destroy cancer cells, is less commonly used for colon cancer than for rectal cancer.

它通常与化学疗法相结合以增强其作用。

例如，医生可能会一起使用放射线和化学疗法来缩小大肿瘤，因此更容易手术去除。

Radiation may also be used before or after surgery to help lower the risk of cancer recurrence. (4)

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医生使用化学疗法药物杀死结肠和直肠癌细胞或停止其扩散。

可以在手术前进行直肠癌的化学疗法以及放射线，以减少肿瘤的大小，或者在手术后杀死留下的任何癌细胞。

它也可以用于缩小身体其他部位的肿瘤，以缓解症状。

Chemotherapy drugs may be given orally or intravenously (IV) to a localized area, reducing side effects.

大多数广泛用于结直肠癌的化学疗法药物包括：

• Efudex (5-fluorouracil)
• Xeloda (capecitabine)
• Camptosar（Irinotecan）
• Eloxatin (oxaliplatin)

To get the best results, these drugs are frequently used in combination, and sometimes with targeted therapy. (5)

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Targeted therapy, used in combination with chemotherapy, is another type of medicine-based treatment for colon cancer and rectal cancer. These therapies are used for metastatic colon cancer that cannot be treated with surgery or radiation.

Researchers have made progress understanding the biochemistry of colorectal cancer and identifying gene and protein changes unique to cancer cells — creating targets for a new generation of drugs.

Targeted drugs may have fewer side effects than chemotherapy, or different and less severe ones.

在称为VEGF（血管内皮生长因子）的蛋白质中回家的靶向药物，该药物有助于肿瘤形成新的血管，包括：

• Avastin (bevacizumab)
• Cyramza (ramucirumab)
• Zaltrap（Ziv-aflibercept）

其他靶向药物治疗一些先进colon cancer and rectal cancer by focusing on the protein EGFR (epidermal growth factor), which helps cancer cells grow, include:

• Erbitux (cetuximab)
• Vectibix (panitumumab)

A targeted drug called a kinase inhibitor focuses on kinases — proteins that carry signals to the cancer cell’s control center:

• Stivarga（雷戈非尼）
• Braftovi (encorafenib)（（6)

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Immunotherapy, which harnesses the power of the body’s own immune system to attack cancer cells, has shown great promise for the treatment of certain advanced cancers, such asmelanoma和非小型细胞肺癌。

Immunotherapy has so far had a more limited impact on the treatment of colorectal cancer.

But for the subset of patients whose cancer cells have specific genetic changes, immunotherapy appears to have real potential.

例如，结直肠癌患者中有15％和4％至5％的转移性结直肠癌患者患有较高的微卫星不稳定性（MSI-H）或不匹配修复（MMR）基因的变化。（（7)

称为检查点抑制剂的免疫疗法药物在治疗这些患者方面非常有效。

两种免疫疗法药物，Keytruda (pembrolizumab)andOpdivo（Nivolumab）, target PD-1, a protein on the immune system’s T-cells that normally prevents them from attacking other cells in the body.

通过阻止PD-1，这些药物无T细胞攻击MSI-H肿瘤。

Another checkpoint inhibitor,Yervoy (ipilimumab)，通过阻止T细胞蛋白CTLA-4实现类似的目标。

Researchers continue to explore other immunotherapy treatments, such as vaccines, in pursuit of new ways to beat colorectal cancer. (8)