Detección y Vigilancia del Cáncer Colorrectal

El cáncer de colon o recto (comúnmente conocido como cáncer colorrectal), afecta al colon (intestino grueso) o recto (6 pulgadas del colon). El cáncer colorrectal es el cuarto cáncer más común, excluyendo los cánceres de piel.

HECHOS Y ESTADÍSTICAS

  • Los pólipos colorrectales (crecimientos anormales benignos) afectan aproximadamente del 20% al 30% de los adultos estadounidenses.
  • Un estimado de 140.000 personas son diagnosticadas con cáncer colorrectal cada año y cerca de 50.000 mueren de la enfermedad.
  • Los cánceres precoces pueden curarse hasta en un 90% de los casos.
  • Una vez que el cáncer colorrectal causa sangrado, cambios en los hábitos intestinales o dolor abdominal, generalmente ha progresado a una etapa más avanzada en la que menos del 50% de los pacientes están curados.

FACTORES DE RIESGO

El riesgo de desarrollar cáncer colorrectal durante toda la vida es de 1 en 22 (4,5%). Los siguientes factores aumentan el riesgo:

  • Edad: Más del 90% de las personas son diagnosticadas de cáncer de colon después de los 50 años
  • Antecedentes familiares de cáncer colorrectal (especialmente padres o hermanos)
  • Antecedentes personales de enfermedad de Crohn o colitis ulcerosa por 8 años o más
  • Pólipos colorrectales
  • Antecedentes personales de cáncer de mama, útero u ovario

¿POR QUÉ DEBEN PERSONAS EXAMINARSE PARA LA DETECCIÓN?

El cáncer colorrectal raramente causa síntomas en sus etapas iniciales. Generalmente comienza como un pólipo colorrectal benigno. Estos pólipos se encuentran comúnmente durante los exámenes de detección estándar del colon y el recto. Mientras que la mayoría de los pólipos no se convertirá en cáncer, ciertos tipos pueden ser precancerosos. La eliminación de pólipos reduce el riesgo futuro de cáncer colorrectal de una persona.

PRUEBAS PARA LA DETECCIÓN

Los análisis de sangre oculta en heces y la sigmoidoscopía flexible se usan a menudo para detectar el cáncer colorrectal. Sin embargo, la colonoscopia se considera el "estándar de oro" prueba de detección y es el método preferido a menos que los problemas médicos lo impidan.

Análisis de sangre oculta en heces: Una prueba simple que detecta cantidades invisibles de sangre en múltiples muestras de heces. Si se encuentra sangre, puede ser un signo de un pólipo colorrectal o cáncer. Si la prueba es positiva, se necesita una colonoscopia.

Colonoscopia: Examen de todo el colon con un tubo flexible largo y delgado con una cámara y una luz en el extremo (colonoscopia). Esto permite a los médicos no sólo ver todo el colon, sino quitar pólipos al mismo tiempo.

Sigmoidoscopia flexible: Examen del recto y del colon bajo con un instrumento flexible e iluminado. Si se encuentra una anomalía, se necesita una colonoscopia.

Enema de bario con contraste de aire: Durante esta prueba de rayos X, el colon se llena de aire y contraste (colorante) para hacer visible el revestimiento. Se utiliza principalmente si no se puede realizar una colonoscopia completa.

Colonoscopía virtual: esta prueba utiliza la tomografía computarizada (TC) o la resonancia magnética (MRI) para crear una imagen tridimensional del revestimiento interior del colon y el recto. Si se encuentran anormalidades, se necesita una colonoscopia. También es útil cuando una colonoscopia es incompleta. Sin embargo, la mayoría de los planes de seguro y Medicare no pueden cubrir este procedimiento.

RECONOCIMIENTOS DE EXAMEN

Como parte de un programa de detección de cáncer colorrectal, la colonoscopia se recomienda habitualmente para adultos a partir de los 50 años. La realización de una colonoscopia cada 10 años es práctica habitual. La sigmoidoscopía flexible cada 5 años con pruebas de sangre oculta en las heces anuales es una opción aceptable cuando no se puede realizar la colonoscopia.

  • Las personas con parientes cercanos (padres o hermanos) con cáncer colorrectal o pólipos deben comenzar a ser examinadas a los 40 años o 10 años antes de la edad más temprana en que se diagnosticó a un familiar. Estos exámenes deben realizarse cada 5 años, incluso si la prueba es normal.
  • Los tipos menos comunes de cáncer de colon hereditario (por ejemplo, cáncer de colon hereditario no relacionado con poliposis y poliposis adenomatosa familiar) pueden requerir un examen mucho más frecuente, comenzando a una edad mucho más joven.

RECOMENDACIONES DE VIGILANCIA

Las personas que tienen pólipos precancerosos completamente eliminados deben realizar una colonoscopia cada 3 a 5 años. La frecuencia de la colonoscopia depende del tamaño, tipo y número de pólipos y resultados de la biopsia. Si un pólipo no se elimina completamente durante la colonoscopia o la cirugía, se debe realizar una colonoscopia de seguimiento en 3 a 6 meses.

La mayoría de los pacientes con cáncer colorrectal deben someterse a una colonoscopia dentro de un año de la cirugía inicial y luego cada tres años después para la vigilancia. Si el colon entero no pudo ser examinado antes de la cirugía, la colonoscopia se debe hacer dentro de 3 a 6 meses de la cirugía.

Los pacientes con colitis ulcerosa o enfermedad de Crohn durante 8 o más años deben realizarse una colonoscopia con biopsias múltiples cada 1 a 2 años.

¿QUÉ ES UN CIRUJANO DE COLON Y RECTO?

Cirujanos de colon y recto son expertos en el tratamiento quirúrgico y no quirúrgico de las enfermedades del colon, recto y ano. Han completado el entrenamiento quirúrgico avanzado en el tratamiento de estas enfermedades, así como la formación en cirugía general completa. Cirujanos certificados por la junta de colon y recto completan residencias en cirugía general y cirugía de colon y recto, y pasan los exámenes intensivos llevados a cabo por la Junta Americana de Cirugía y la Junta Americana de Cirugía de Colon y Recto. Ellos están bien versados en el tratamiento de enfermedades tanto benignas como malignas del colon, recto y ano. Ellos son capaces de realizar exámenes de detección rutinas y de tratar quirúrgicamente condiciones, si está indicado para hacerlo.

AVISO LEGAL

La Asociación Americana de Cirujanos de Colon y Recto está dedicada a asegurar la atención al paciente de alta calidad, al avance de la ciencia, la prevención y el tratamiento de los trastornos y enfermedades del colon, recto y ano.  El propósito de estos folletos es proporcionar información sobre los procesos de enfermedades, y no la de indicar una forma específica de tratamiento. Están diseñados para el uso de  los médicos, trabajadores sanitarios y pacientes que deseen información sobre la gestión de las condiciones tratadas. Estos folletos no incluyen o excluyen otros métodos apropiados de atención médica de estas enfermedades. La última palabra sobre el tratamiento a seguir le corresponde al médico basándose en las circunstancias  de cada paciente.

 



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