遺伝子検査
Chemotherapy
Surgery (colectomy)
KRAS Testing
Antiangiogenic Therapy
Polyp Removal
Anti-EGFR Therapy
Radiation
Clinical Trials
 
ステージ0
ステージI
ステージII
ステージIII
ステージIV
First-Line
Second-Line
Third-Line
Stage II - ChemotherapyX
Chemotherapy may be used before surgery, primarily to facilitate the procedure, or after surgery to help prevent recurrence of the cancer. Your treatment regiment will be determined by the site of the tumor, your age and risk of recurrence. You can also enroll in clinical trials of “new chemotherapy schedules or new drugs.”
Stage III - ChemotherapyX
Cancer cells have spread to the lymph nodes so the risk of recurrence is high. Chemo is commonly recommended as adjuvant therapy following your primary treatment for stage III colon cancer, whereas radiotherapy may be used alone or with chemo for rectal cancer. FOLFOX is the preferred chemo regimen for stage III patients. Other regimen options include FLOX, CapeOX, capecitabine or 5-FU/LV, but other factors, such as age and site of tumor, will help to determine the best regimen for you.
Stage IV - Chemotherapy - First-LineX
There are 4 different chemotherapies commonly used to treat metastatic colorectal cancer. Treatment outcomes for stage IV patients are maximized when patients are exposed, at some point throughout their treatment, to these three chemotherapies: 5-FU, irinotecan and oxaliplatin. Your previous treatment will affect which therapy you will receive moving forward. There are many possible chemotherapy combinations and regimes. Work with your medical team to select the best regime for your condition.
ステージ IV – 化学療法- 第二線治療X
転移性大腸がんには4種類の化学療法を使用できます。治療過程でこれら3種類の化学療法:5-FU、イリノテカン、オキサリプラチンの投与を受けた ステージIVの患者は、治療で最大限の効果を得られるでしょう。 前治療薬によって、これから受ける治療にも影響を与えます。化学療法は様々な治療レジメンと併用できます。医療チームと一緒にご自身の症状に最も適した治療法を選択しましょう。
Stage IV - Chemotherapy - Third-LineX
There are 4 different chemotherapies commonly used to treat metastatic colorectal cancer. Treatment outcomes for stage IV patients are maximized when patients are exposed, at some point throughout their treatment, to these three chemotherapies: 5-FU, irinotecan and oxaliplatin. Your previous treatment will affect which therapy you will receive moving forward. There are many possible chemotherapy combinations and regimes. Work with your medical team to select the best regime for your condition.
Stage 0 - SurgeryX
Surgery is rare for stage 0 patients but may be needed after a polypectomy, depending on where polyps are located and how many are present. If cancer is found during polyp removal, your doctor will examine the colon and rectum again before planning next steps. Your surgeon should collaborate with your medical oncologist.
Stage I - SurgeryX
Surgery is used to remove the part of the colon with cancer (a procedure called a colectomy). The location and extent of the cancer will determine how much of the colon is removed. Local lymph nodes are tested for cancer. Your surgeon should collaborate with your medical oncologist.

ステージII – 手術X
手術では、がんが広がっている組織と周辺のリンパ節を切除します。がんのリスク要因、部位、範囲によって切除するがんの量や再発予防の療法の種類が異なります。外科医とがん専門医が協力し合うことが大切です。

→ リスクが低い場合
再発のリスクが低いステージIIのCRC患者の術後フォローアップの選択肢として、臨床試験、経過観察、化学療法があります。

→ リスクが高い場合
再発のリスクが高いステージIIのCRC患者への術後フォローアップとしては、主に化学療法が適用されます。また、腫瘍が周辺の組織や臓器まで浸潤している直腸がんの術後では、放射線療法が効果的であることもあります。
Stage III - SurgeryX
Surgery is used to remove tissue and lymph nodes to which cancer has spread. Chemo may follow to prevent recurrence of colon cancer, and radiotherapy may be an option for rectal cancer. Your surgeon should collaborate with your medical oncologist.
Stage IV - First-Line SurgeryX
Surgery before or after primary treatment may be done to remove the primary tumor and metastatic tumors in the lungs or liver. It may also be used as palliative care to make the patient more comfortable by reducing the size of tumors. Your surgeon should collaborate with your medical oncologist.

Stage IV - Second-Line - SurgeryX
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Stage 0 - Polyp RemovalX
If polyps are found during a colorectal screening (called a colonoscopy), they are removed and tested for cancer. The removal of polyps is called a polypectomy.
ステージI – ポリープの除去 X
大腸スクリーニング(大腸内視鏡検査といいます)の最中にポリープがあったら、除去してがんの検査を行います。ポリープの除去はポリープ切除術と呼ばれます。大腸内でがんが広がっていたら、手術が適用されることもあります。
ステージ IV – 1次治療- 血管新生阻害薬による治療 X
べバシズマブはFDAに認可されており、mCRCの1次治療に有効で化学療法と併用します。2週間ごとに静脈点滴します。べバシズマブとの併用化学療法によって、症状がとれ、副作用を管理できるようだったら、化学療法が終わった後も投与を続ける場合があります。
Stage IV - Second-Line - Antiangiogenic TherapyX
Bevacizumab is FDA-approved as a second-line treatment in combination with chemotherapy. It is given as an infusion every two weeks. Patients begin taking bevacizumab with chemotherapy and may continue the treatment after stopping chemo as long as the disease is controlled and side effects are manageable.

Ziv-aflibercept is FDA-approved as a second-line therapy for use with a chemotherapy combination (FOLFIRI) to treat mCRC. It is used in mCRC patients whose disease did not respond to, or has come back, after first-line treatment. Patients receive ziv-aflibercept every two weeks through an IV infusion in combination with the chemotherapy regimen. Treatment continues indefinitely as long as the disease does not progress, and side effects are manageable.
Stage IV - Third-Line - Antiangiogenic TherapyX
Regorafenib is FDA approved for treating patients with mCRC that continues to progress or recur after multiple treatments. Regorafenib is an oral medication in the form of a tablet that is typically taken once a day for twenty-one days. A seven-day rest period is taken before beginning another twenty-one-day cycle.
Stage IV - First-Line - Anti-EGFR TherapyX
Two EGFR inhibitors are approved for CRC patients without the KRAS mutation: cetuximab and panitumumab. Both may be used with different chemo regimes.
ステージIV – 2次治療- 抗EGFR療法X
KRAS変異が認められないCRC患者には、2種類の抗EGFR阻害薬が認められています: セツキシマブとパニツムマブです。いずれも化学療法と併用することがあります。
Stage IV - Third-Line - Anti-EGFR TherapyX
Two EGFR inhibitors are approved for CRC patients without the KRAS mutation: cetuximab and panitumumab. Both may be used with different chemo regimes.
Stage II - RadiationX
Radiotherapy is used primarily to treat rectal cancer pre and post-surgery. In cases of recurrent cancer or when tumors have grown into nearby organs or structures, radiotherapy alone or in combination with chemo may be considered as secondary therapy following surgery.
ステージ III –放射線療法X
直腸癌の術前と術後には放射線療法と化学療法を併用することが一般的です。結腸がんの場合、ステージIIIの患者には化学療法が推奨されます。腫瘍が周辺の組織や臓器まで浸潤している場合や再発した時は、放射線療法を使用することがあります。
Stage IV - First-Line - RadiationX
Radiation therapy may be used as part of palliative care to improve patient quality of life; debulking (make tumor smaller in size); or to target liver metastases (target hot spot in liver to make smaller).
Stage IV - Second-Line - RadiationX
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ステージ0X
最初のステージです:がんは結腸の内部に留まり、まだ広がっていません。
ステージIX
がんは広がり始めていますが、結腸の内部に留まっています。
ステージIIX
がんは結腸や直腸の近隣臓器まで広がっていますが、リンパ節までには至っていません。
ステージIIIX
がんはリンパ節まで転移していますが、遠隔臓器までは広がっていません。
ステージIVX
がんが肺や肝臓など、遠隔臓器まで達して(転移して)います。
First-LineX
“First-line” therapy is the first time a patient is treated for metastatic disease.
Second-LineX
“Second-line” therapy is used as another treatment if the cancer progresses or reoccurs during or after first-line therapy.
Third-LineX
“Third-line” therapy is used if second-line therapy fails to produce the desired benefit.
KRAS検査X
RAS遺伝子は、抗EGFR療法の効果に影響するので、変異が起きていないか確かめる必要があります。がん細胞中のKRAS (ケイ‐ラスと読みます)はRAS遺伝子の一種で、大腸がんのおよそ40%で変異が起きています。KRAS変異を有する腫瘍に抗EGFR阻害薬は効き目がないので、抗EGFR治療を選択する前にKRASの変異状況を確認しておくことが大切です。
遺伝子検査X
CRCのリスクを高め、治療の反応にも影響する特定の遺伝子があります。全てのCRCの症例の内、およそ30%は遺伝性で、がんの家族歴があると発症リスクが高まります。 家族歴を細かく分析し、関連する遺伝子検査を行えば、CRCのリスクレベルを判定できます。必要に応じて、遺伝カウンセリングをすればご自身に適したスクリーニングのアプローチと治療法がわかります。
臨床試験X
臨床試験を受ければ、医療チームと治療の選択肢について話し合うことが出来ます。臨床試験をもっと知りたい方は、 www.clinicaltrials.gov をご覧ください。
SourcesX
NCCN Guidelines for Patients: Colon Cancer, Version 1.2012 [Brochure]. Fort Washington, PA: National Comprehensive Network, Inc., n.d.

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Rectal Cancer, Version 1.2014 [Brochure]. Fort Washington, PA: National Comprehensive Network, Inc., 2013.

Jasperson KW, Tuohy TM, Neklason DW, et al. Hereditary and Familial Colon Cancer. Gastroenterology. 2010 June;138(6):2044–2058.
Where Am I?X
The location and extent of your cancer will determine the most effective treatment for your condition.
X
No Cancer

If no cancer is found, then we encourage you to learn about risk factors and the lifestyle choices you can make to prevent CRC in the future.

Cancer

If cancer is found:

1) Find a medical oncologist and a team of doctors who will collaborate to coordinate your care.

2) Get a second or third opinion!
Don’t worry about insulting your doctor—the most important priority is to know your options as a CRC patient.

3) Learn about your stage and understand your treatment options.
Know the extent of your disease: your doctor will assess which polyps are cancerous, how many, and where they were located. Your doctor will also identify if the cancer has spread to other parts of the body. This information will help to determine your treatment plan and can be obtained via biopsy or imaging tools (CT, MRI). You can ask for a copy of the pathology report and imaging tests.
DirectionsX

This chart lists the possible therapies and treatments you may need to consider with your doctors, depending on the stage of your colorectal cancer progression. Stage describes the extent and location of the cancer, and is used to plan the most effective treatment for each patient.

チャートの使い方をご説明します。ご自身のステージを示すコラムを探し、ご自身に合った治療の選択肢を見つけて、そのセクションをクリックして下さい。解説をご覧になり、医師と治療の選択について相談してみましょう。 
HelpX

To use this chart, find the column that represents your stage, scan down the column to see the treatments that may be options for you, and hover over the section to learn more so you can discuss your options with your doctor(s).
Patient Road MapX

チャートの使い方をご説明します。ご自身のステージを示すコラムを探し、ご自身に合った治療の選択肢を見つけて、そのセクションをクリックして下さい。解説をご覧になり、医師と治療の選択について相談してみましょう。

上の赤い X をクリックすると始まります。