高齢者消化管癌の病理学的特徴

Pathological Characteristics of Gastrointestinal Carcinomas Occurring in the Elderly

要旨　高齢者のがん診療に資する目的で，高齢者消化管癌の病理学的特徴を解析した．高齢者の食道癌は，非高齢者と比較して特別な臨床病理学的特徴を有していなかった．胃癌は，高齢者で胃下部発生例が増加し，隆起型の肉眼型を示すものが多く，早期癌の大部分が分化型癌であり，多発癌が多く認められた．大腸癌では，加齢とともに右側結腸発生例が増加し，直腸癌が減少した．また，胃癌，大腸癌では，胃充実型低分化腺癌，大腸髄様型低分化腺癌，大腸粘液癌などの一部で，マイクロサテライト不安定性を示し，臨床病理学的にもそれぞれ類似した特徴を有する組織型群が存在していた．これら高齢者消化管癌の特徴を理解し，その特徴に合わせたがん診療を行う必要があると考えられた．

　We analyzed the pathological features of gastrointestinal cancer in the elderly. Esophageal carcinoma in the elderly did not have special clinicopathological features compared with the non-elderly. In gastric cancer in the elderly, it tends to occur in the lower-third of the stomach. These cancers are often elevated types macroscopically. The majority of early cancers are differentiated type. Many multiple cancers were observed. In colorectal cancer, with age, right colon cancers increase with age, and rectal cancers decrease. In gastric and colorectal cancer, the histological group with similar clinicopathological and molecular pathological characteristics, such as solid-type poorly differentiated gastric adenocarcinoma, medullary type poorly differentiated colorectal adenocarcinoma, and mucinous colorectal carcinoma are presented. Most of them show microsatellite instability. We need to understand the characteristics of these elderly gastrointestinal cancers and to provide cancer care tailored to the characteristics.