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Der Klinikarzt 2019; 48(06): 251-259
DOI: 10.1055/a-0957-2659
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Diagnostik und Therapie des kolorektalen Karzinoms

Bedeutung und Zusammenspiel der verschiedenen Behandlungsmethoden
Dirk Wilhelm
1   Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München
,
Peter Klare
2   II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München
,
Simon Nennstiel
2   II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München
,
Hendrik Dapper
3   Klinik für Strahlentherapie, Klinikum rechts der Isar, Technische Universität München
,
Stefanie Combs
3   Klinik für Strahlentherapie, Klinikum rechts der Isar, Technische Universität München
,
Lucia Liotta
2   II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München
,
Michael Quante
2   II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München
› Author Affiliations
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Publication History

Publication Date:
17 July 2019 (online)

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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.

 

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