結腸および直腸 Colon and Rectum（C18-C20）

1 1 Colon and rectum C18-C20 ICD-O - ICD-O Cecum Appendix Ascending Hepatic flexure of Transverse Splenic flexure of Descending Sigmoid , NOS , NOS , NOS ,NOS , NOS ICD-O-3 S , NOS S Rectosigmoid junction S , NOS , NOS rectum Rectal RSC . 10 4 (2004 ) 10 10 2 2000 2 1990 1990.

2 ( Colon and rectum ) (cecum) ( Colon ) ( rectum ) 1 (ascending Colon ) (transverse Colon ) (descending Colon ) S (sigmoid Colon ) S (anal canal) UICC TNM (appendix vermiformis) cm cm hepatic flexure splenic flexure cm S S 2 8cm / / / cm ( ) ( ) ( )

3 3 1 TNM (UICC 6 2002 ) T- TX T0 Tis : 1 T1 T2 T3 T4 2, 3 / 1: Tis ( ( 2: T4 S 3: T4 pT3 T) D) A) S) C) I) V) S Rs C19 Ra Rb P (E C20 1 2 3N- NX N0 N1 1-3 N2 4 UICC TNM 7 M1 D-number D3 UICC TNM UICC TNM (V) (#201, #202, #203 (C) (#201, #202, #203 (#211, #212, #213) (A) (#201, #202, #203 (#211, #212, #213) (#221, #222, #223)

4 (#221, #222, #223) (#211, #212, #213) (T) (#211, #212, #213) (#221, #222, #223) (#231, #232) (#253) (#221, #222, #223) (#231, #232) (#253) (D) (#231, #232) (#253) (S)S (#241, #242, #252) (#231, #232) ( ) (#251, #252) (#253) S (#251, #252) (RS, Ra,Rb) (#251, #252) ( (#251) (#253) (#263) (#251) (#260) (#270) Gerota)(#270) 1 UICCTNM 2 UICC TNM (A) (T) (D) (S) (Ra, Rb) #201, #202, #203 #211, #212, #213 #221, #222, #223 #251, #252 #253 S #241, #242, #252 ( ) ( ) #251, #252 ( )#251 #263 S #251, #252 Gerota)#260, #270 4M- MX M0 M1 pTNM pT, pN, pM T, N, M pN0 12 pN0 TisN0M0I T1,T2N0M0 IIA T3N0M0 IIB T4N0M0 IIIA T1,T2N1M0 IIIB T3,T4N1M0 IIIC T N2M0IV T,N M1 53 2 ( (2003 ) )

5 TNM mTis (m) smT1(sm)mp T2 (mp)ssT3 (ss)a n1 (1-3 ) 2n1 (1-3 ) n2(4 ) 2n2 (4 )n3 3 se, si T4 (se,si) ai P1-3M1H1-3M1 ( ) 1 (m) TNM Tis 2 3 TNM * mTis (m)*1 smT1(sm)mp T2 (mp)ssT3 (ss)a n1 (1-3 ) 2n1 (1-3 ) n2(4 ) 2n2 (4 )n3 3 se,si T4 (se,si) ai P1-3M1H1-3M1 ( ) * TNM 1 (m)

6 TNM Tis 2 3 63 3 2006 3 7 M SM MP SS SE Si A Ai NX N0 N1 3 N2 4 N3 7 HX H0 H1 4 5cm H2 H1 H3 H3 4 5cm PX P0 P1 P2 P3 MX M0 M1 7 TNM N0N1N2 Tis03cT113a3cT213a3cT32a3b3cT42b3b3cM144 4 TNM N0N1*N2**Tis(M) T1(SM) T2(MP) T3(SS,A) T4(SE,Si,Ai) M1 *: 1-3 **.

7 4 7 N0N1N2N3M03a3b3bSM, MP13a3b3bSS, A, SE, Si, Ai23a3b3bP1-P3, H1-H3, M( ), M14444 7 7 N(-)N1N2N3M SM, MP SS, A SE, Si, Ai P1-3, H1-3,M1( , M1(+) TNM Dukes Dukes Dukes A Dukes B Dukes C Dukes D Dukes A I Dukes B II Dukes C III Dukes D IV 8 TNM TNM 1) ICD-O-3 (3 ) ICD-O Cecum V Appendix vermiformisA Ascending colonT Transverse colonD Descending colonS Sigmoid Colon S Rectosigmoid junction S RaRbR, , NOS rectum Rectal AmpullaRsC 2 (T) N M TNM UICC 6 UICCTNM MTis0 SMT1 MPT2SS, AT3 SESi, AiN1N3 1-3 N2N3 4 P(1,2,3)H 1,2,3 M12 TNM M1)

8 M14 UICCTNM N TNM D D3 TNM N1N2 1 1 1 T43 97 3 ( ) ICD-O-3 ( ) ( ) , NOSP apillary adenocarcinoma, NOS8260/3 Tubular adenocarcinoma8211/3 Mucinous adenocarcinoma (muc)8480/3 Signet ring cell carcinoma (sig)8490/3 , NOSS quamous cell carcinoma, NOS (scc)8070/3 Adenosquamous carcinoma (asc)8560/3 , NOSU ndifferentiated carcinoma, NOS8020/3 , NOSC arcinoid tumor, NOS8240/3 Poorly differentiated adenocarcinoma por 8140/33 solid type por1 8140/33 non-solid type por2 8140/33 Endocrine cell carcinoma8246/3 Choriocarcinoma (Chorioepithelioma)

9 9100/3 -fetoprotein -fetoprotein-producing adenocarcinoma8140/3 GIST, NOSG astrointestinal stromal tumor, NOS8936/1 GIST, Gastrointestinal stromal tumor, Malignant8936/3 Mucinous cystadenocarcinoma8470/3 Basaloid carcinoma8123/3 Paget Extramammary Paget disease8542/3 Malignant melanoma8720/3 7 B B-cell lymphoma9599/36 MALT MALT lymphoma9699/36 Follocular lymphoma9690/36 Mantle cell lymphoma9673/36 B Diffuse large B-cell lymphoma9680/36 Burkitt Burkitt lymphoma9687/36T T-cell lymphoma9702/35 Hodgkin Hodgkin lymphoma9650/3* 8140/3( ) : , 8140/32 m /2 m m 0 1 m 10 7 DX 0 1 2 3 ) ) HMX HM0 HM1 ) VMX VM0 VM1 ) ) PMX PM0 PM1 ) DMX DM0 DM1 )

10 RMX RM0 RM1 RX R0 R1 R2 ) EA CurEA HM VM EC CurEC HM1 VM1 ) A CurA Stage0 StageI StageII StageIII R0 B CurB R1 StageIV R0 C CurC R2 1 B R1 StagIV R0 11 B 2 D N 12 1 2 X 3 CT/MRI 4 5 CEA CA19-9 9 1 (1)