Introduction
Colorectal cancer(carcinoma of colon and rectum) common malignant tumors in the gastrointestinal tract, early symptoms are not obvious, with the increase of cancer, showing changes in bowel habits, blood in the stool, diarrhea, diarrhea and constipation, local abdominal pain and other symptoms, in the late stage Systemic symptoms such as anemia and weight loss. Its incidence and mortality are second only to gastric cancer, esophageal cancer and primary liver cancer in digestive system malignancies.
Overview
Colorectal cancer is a common malignant tumor in the gastrointestinal tract. The early symptoms are not obvious. The symptoms of bowel habits change, blood in the stool, diarrhea, diarrhea and constipation, local abdominal pain and other symptoms with the increase of cancer. It shows systemic symptoms such as anemia and weight loss. Its incidence and mortality are second only to gastric cancer, esophageal cancer and primary liver cancer in digestive system malignancies. China is a low-incidence region in the world, but its incidence has increased in varying degrees in many regions.
Men with more than a middle-aged disease are most common in the 40-70 age group, but it is not uncommon to find those under 30 years old at the end of the 20th century. The ratio of male to female sex is about 2:1. The disease is the same as other malignant tumors. The cause of the disease is still unclear. It can occur in any part of the colon or rectum, but it is most common in the rectum and sigmoid colon. The rest are found in the cecum, ascending colon, descending colon and transverse colon. Most of the cancers are adenocarcinomas, and a few are squamous cell carcinomas and mucinous carcinomas. The disease can be spread to other tissues and organs through lymphatic, blood circulation and direct spread.
According to clinical manifestations, X-ray barium enema or fiberoptic colonoscopy, the diagnosis can be confirmed. The key to treatment is early detection, timely diagnosis and radical surgery. The prognosis of this disease depends on early diagnosis and timely surgical treatment. Generally, the cancer is limited to the intestinal wall, and the prognosis is poor. The prognosis of the invasive to the intestine is poor. The prognosis of young patients, cancer infiltrates, metastasis or complications is poor.
Cause
Not very clear, however, already known to be related to the following precancerous lesions and some factors:
1 In many clinical practice, colon polyps can be malignant, of which papillary adenoma is the most malignant, up to 40%; in patients with familial polyposis, the incidence of cancer is higher, indicating colon cancer and colon polyps Close relationship.
2 parts of chronic ulcerative colitis can be complicated by colon cancer, the incidence may be 5 to 10 times higher than the normal population. The cause of colon cancer may be related to the chronic inflammatory stimuli of the colonic mucosa. It is generally believed that during the process of inflammatory hyperplasia, cancer occurs through the inflammatory polyp stage.
3 In China, schistosomiasis complicated with colon cancer is not uncommon, but there is still debate about its causal relationship.
4 According to the World Cancer Epidemiological Survey, the incidence of colon cancer in North America, Western Europe, Australia, New Zealand and other places is high, but lower in Japan, Finland, Chile and other places. According to the study, this geographical distribution is related to the dietary habits of residents, and the incidence of high-fat diet is higher.
5 The incidence of colon cancer may be related to genetic factors, which has been paid more and more attention.
pathology
Ulcer-type colorectal cancer occurs in the left colon, and the cancer is small. It forms a depressed ulcer in the early stage, which easily causes bleeding and penetrates the intestinal wall to invade adjacent organs and tissues.
Clinical manifestations of bloody stools are the main symptoms of colon cancer, and are the first and most common symptoms of rectal cancer. The amount of bleeding and traits vary depending on where the cancer is located.
Patients with polypoid colorectal cancer may have localized abdominal pain and diarrhea in the lower right abdomen. The stool is sparsely watery, pus-like or jam-like, and the fecal occult blood test is mostly positive. As the cancer grows, a lump can be felt in the corresponding part of the abdomen.
Stenotic colorectal cancer is prone to intestinal obstruction, alternating abdominal pain, bloating, diarrhea or diarrhea and constipation. Feces are pus or bloody stools.
Patients with ulcerative colorectal cancer may have abdominal pain, diarrhea, blood in the stool or pus and bloody stools, and may cause intestinal stenosis and obstruction. Once complete obstruction occurs, abdominal pain is aggravated, and abdominal distension, nausea, vomiting may occur, and the systemic condition changes drastically. .
In the late stage of the tumor. Sustained small amount of blood in the stool can cause anemia; long-term anemia, malnutrition and local ulceration, poisoning symptoms caused by absorption of toxins, leading to patients with weight loss, mental dysfunction, general weakness and cachexia; acute peritonitis can be caused by acute perforation Liver enlargement, ascites, neck and supraclavicular lymph nodes, often suggesting advanced tumor metastasis.
diagnosis
The disease should be diagnosed early. For patients with recent changes in bowel habits or bloody stools, the rectal examination, X-ray barium enema, sigmoidoscopy or fiberoptic colonoscopy should be performed without loss of opportunity. X-ray tincture air double contrast angiography can show signs of sputum filling defect, intestinal stenosis, mucosal destruction, etc., to determine the location and extent of the tumor. Sigmoidoscopy and fiberoptic colonoscopy can directly observe the morphology of the whole colon and rectal mucosa. It can be used for biopsy of suspicious lesions under direct vision, which is valuable for improving the accuracy of diagnosis, especially for the early diagnosis of small lesions.
Rectal examination is the simplest and most important method for the diagnosis of rectal cancer. It can not only find the mass, but also determine the location, size, shape, surgical procedure and prognosis of the tumor. Many patients with rectal cancer often do not have it. Timely doing this examination was misdiagnosed as sputum, enteritis, etc., resulting in long-term delay in treatment.
Fecal occult blood test is a simple and easy method for early diagnosis of early diagnosis. Although it has no specificity, it can treat patients with persistent, repeated occult blood positive and no cause to be found. It is often alert to the possibility of colon cancer, especially to the right half. Colon cancer is more important. Carcinoembryonic antigen (CEA) is considered to be associated with malignant tumors, but it is not specific for colorectal cancer. It can be used as an adjunct to diagnosis. As the cancer CEA gradually declines after cancer resection, it will increase again when there is recurrence, so it can It is used to judge the prognosis of the disease or whether there is recurrence.
Right colon cancer showing symptoms such as diarrhea, positive fecal occult blood test, and right abdomen mass should be distinguished from intestinal tuberculosis, localized colitis, schistosomiasis, amebiasis, etc.; manifested as abdominal pain, diarrhea and Left colon cancer with symptoms such as constipation alternation, bloody stool or pus and bloody stool should be distinguished from diseases such as convulsions, dysentery, ulcerative colitis, and colon polyps.
treatment
Surgical treatment
Radical treatment of colorectal cancer has so far been the first surgical treatment. The 1st National Intestinal Cancer Conference proposed that the radical resection of invasive intestinal cancer is defined as a radical resection of the tumor seen in the eye, including the primary lesion and the lymph node in the drainage area. Resection of the lesion, but the residual of the naked eye or the tumor is a palliative operation. Therefore, the lesions should be limited to the primary or regional lymph nodes should be radical surgery; local lesions are extensive, it is estimated that it is not easy to completely remove, but there is no distant metastasis can be used for palliative resection; local lesions can be removed more widely, but There is a distant metastasis, in order to relieve obstruction, improve symptoms can also be palliative resection; local lesions are extensive, adhesion, fixation, can not be removed, can be used for shortcut surgery or rash to relieve symptoms; there are distant metastasis such as liver metastasis Or other visceral metastases, but the original lesion can still be resected according to the specific circumstances of the patient to consider whether to remove at the same time, of course, this is also a palliative operation. Postoperative syndrome: Straight and colon cancer often have intestinal motility disorders after surgery, and the frequency of bowel movements increases; constipation is often caused by the destruction of colonic coordinated solid transport function after sigmoid colon resection; often after anal canal and colon anastomosis Changes in bowel function, such as increased frequency of bowel movements, incontinence, etc. Rectal cancer often has urinary dysfunction and sexual dysfunction after surgery. For patients with non-reserved anus, the "artificial anus" placed in the perineum is being studied and designed, and the device for controlling the stool can be used to solve the patient's defecation problem. The muscle excitatory technique of applying muscle instead of the sphincter is currently a promising approach.
Radiation Therapy
In the past 50 years, despite the rapid development of surgical techniques, the surgical cure rate and 5-year survival rate of colorectal cancer have been hovering around 50%. The main reason for the failure of treatment is the high local recurrence rate. Therefore, the treatment effect of colorectal cancer must be considered. Comprehensive Treatment. At present, there are many studies and better results in the comprehensive treatment of surgery and radiation, including preoperative radiation, intraoperative radiation, postoperative radiation, "sandwich" radiotherapy, etc., and various comprehensive treatments have different characteristics. For advanced rectal cancer, especially local tumor infiltration into nearby tissues (pre-rectal, pre-rectal, abdominal lymph nodes, bladder, urethra, pubic symphysis) and patients with surgical contraindications, palliative radiation is often used with satisfactory results.
Radiotherapy and surgical treatment
1, preoperative radiation
(1) Improve surgical resection rate
(2) reduce lymph node involvement rate and percentage of advanced patients
(3) Reduce distant transfers.
(4) reduce local recurrence rate and improve survival rate
2, postoperative radiation
(1) Reduce the local recurrence rate: patients with early postoperative radiation will have better results.
(2) Improve survival rate: The 5-year survival rate of postoperative radiotherapy patients is significantly higher than that of surgery alone.
(3) "Sandwich" radiotherapy
In order to give full play to the advantages of preoperative radiation and postoperative radiation, and to overcome the shortcomings of both, the preoperative radiation-surgery-postoperative radiation method is called the "sandwich" method.
(4) intraoperative radiation
In order to increase the dose of tumor tissue and reduce the unnecessary irradiation of normal tissues, radiation therapy under direct vision during surgery has been reported in recent years.
Radiation therapy alone
(1) intracavitary emission
Appropriate lesion selection, the local control rate of early rectal cancer can reach 96%.
(2) Simple external radiation
For patients with locally advanced tumors, inoperable surgery for various reasons, and postoperative recurrence, external exposure can relieve symptoms and relieve pain. In patients who are sometimes unable to undergo surgery, surgical resection is possible after radiation therapy.
In order to further improve the therapeutic effect of colorectal cancer, some new treatment methods are being explored, and the clinical application value of new ray neutrons is being further explored.
Chemotherapy
(1) Single drug treatment: 5-Fu is now the basis of standard chemotherapy for intestinal cancer. The efficacy of 5-Fu is related to the location of the lesion. In terms of efficiency, the abdominal lesion is 32%, the lymph node metastasis is 25%, the liver metastasis is 24%, the skin and subcutaneous metastasis is 16%, and the other parts are 8%. The worst, 6.4%.
(2) Combination chemotherapy: Combination chemotherapy has the advantages of improving efficacy, reducing or not increasing toxicity, reducing or delaying the emergence of drug resistance. Many combination chemotherapy regimens have been used for the treatment of colorectal cancer, basically including 5-Fu. .
(3) Adjuvant chemotherapy: Adjuvant chemotherapy refers to the use of anti-tumor drugs that are active against certain tumors to assist radical treatment. For intestinal cancer, it refers to adjuvant chemotherapy for surgery. The research on adjuvant chemotherapy for colorectal cancer has been carried out for a long time, and it is the most widely used in 5-Fu. 5-Fu + CF has achieved better results than 5-Fu alone. The combination of 5-Fu and MTX, α-IFN and DDP can improve the efficiency or survival rate.
Biological cell immunotherapy
Biological cell immunotherapy is an emerging and remarkable therapeutic treatment mode for cancer, and it is a new type of treatment for autoimmune and anti-cancer. It is a method for in vitro culture and amplification of immune cells collected from a patient by using biotechnology and biological agents, and is used for inducing and enhancing the body's own immune function, thereby achieving the purpose of treating tumors. Biological cell immunotherapy is the fourth largest cancer treatment technology after surgery, radiotherapy and chemotherapy. It is recognized by the medical community as a new treatment that hopes to completely overcome cancer.
immunity therapy
1. Activate immune cells such as phagocytic cells, natural killer cells, and noxious T cells to induce secretion of cytokines such as leukocyte, interferon-γ, and tumor necrosis factor-α.
2. Inducing apoptosis in cancer cells.
3, combined with traditional chemotherapeutic drugs (mizomycin, carmetine, etc.), both to increase the efficacy, but also reduce the side effects of chemotherapy.
4. With immunotherapeutic drugs (Interferon-α2b) There is synergy.
5. Slow down the pain of patients with advanced cancer, increase appetite, and improve the quality of life of patients.
Chinese treatment
When selecting Western medicine treatment, radiotherapy and chemotherapy, it is possible to treat drugs with anti-tumor and immunity, which can alleviate the side effects of radiotherapy and chemotherapy.
First, the American cockroach: the American cockroach epidermis contains scleral and chitin, bromine, zinc, nickel, fierce, potassium, calcium, titanium, chlorine, sulfur, silicon, aluminum, magnesium and other elements. Muscle hydrolyzes 13 amino acids. In addition, the body stores vitamin B1B2, niacin and ascorbic acid, and the lymph contains trehalose, trehalase, glycoprotein, inositol, protocatechuic acid vines and the like. All contain ergothione, lobster myocardium, fenugreek, glycine, betaine, analgin, trimethylamine, adenine and the like. The extract of the American cockroach has a certain inhibitory effect on the tissue growth of various types of cancer, and can promote the apoptosis of tumor cells.
Second, suede: suitable for all types of cancer, its miso, warm, toxic. Return to the heart, with detoxification, pain relief, reclamation and other effects. The Chinese Folk Medicine Research and Development Association edited the "unique secret recipe for cancer" containing: ecdy acne, cold, slightly toxic, functional detoxification, water, swelling, and attending various cancers. In 1999, a large number of sub-medical tests were conducted in Shanghai, especially for the treatment of cancer, cirrhosis, and pain. The effective content of the ingredients was over 8,000 (there were more than 8,000-volume or more immunological components). Huaxia Publishing House "Chinese Medicine Complete" contains: 蟾 clothing poison is lighter, mainly used for sore swollen poison and hoarding in children, modern treatment of tumors. According to the remote publishing house "Chinese herbal medicine Daquan", 蟾衣 can cure cancer, leukemia, lymphoma and so on. However, it has certain side effects, especially the side effects of the gastrointestinal tract. Long-term use can cause discomfort in the upper abdomen, nausea, vomiting, abdominal pain, diarrhea, numbness of the lips and limbs, palpitations, slow heart rate, and irregular heart rate.
three. Cordyceps sinensis: Cordyceps sinensis is a complex of larvae fungus Cordyceps sinensis parasitic on the larvae of bat moth insects and larvae. There are many species. Cordyceps sinensis is a traditional nourishing Chinese herbal medicine. The main ingredients include Cordycepic acid and Cordyceps. Amino acids, amino acids, sterols, mannitol, alkaloids, vitamin B1, B2, polysaccharides and minerals. It has anti-cancer, nourishing, immune regulation, antibacterial, sedative and hypnotic effects. Traditional medicine "Materia of Herbs" records: "Sweet and warm, secret and qi, dedicated to life." Modern medical research confirmed that its ingredients contain fat, protamine, fine fiber, cordycepic acid, cordycepin and vitamin B12, etc. It is used for anti-tumor, improve immunity, improve cell ability, improve heart function, regulate respiratory system, kidney function, improve hematopoietic function, regulate blood lipids, regulate sexual function, etc. Among them, the anti-tumor effect and the improvement of immune function can also be used for the treatment of clinical malignant tumors. Mainly used for patients with nasal cancer, pharyngeal cancer, lung cancer, leukemia, brain cancer and other malignant tumors.
Fourth, the ginsenoside rh2 source is the dried root of the ginseng of the Araliaceae plant. It is suitable for patients with early cancer and immunocompromised to prevent tumorigenesis. Acute, severe, and advanced cancer patients, weak constitution, taking can improve autoimmune function, enhance anti-tumor ability, reduce side effects such as: bone marrow suppression, peripheral blood changes, immunosuppression, nausea and vomiting, fatigue, hair loss, etc.; Quality of life, extending life expectancy.
What are the side effects of radiotherapy and chemotherapy
1, common chemotherapy causes hair loss, can be low temperature treatment or reduce blood flow to reduce the severity of hair loss.
2, affecting the bone marrow hematopoietic system, patients may have fever caused by low white blood cells, treatment can use broad-spectrum antibiotics and white blood cell growth hormone to improve the infection caused by white blood cells.
3, common gastrointestinal side effects, such as diarrhea can be based on the nature of the drug to give anticholinergic drugs or antidiarrheal drugs, water and electrolytes. For drugs that are prone to nausea and vomiting, preventive antiemetics can be given before treatment.
Postoperative diet
Postoperative diet for rectal cancer:
1. Foods rich in vitamins A, C, E, K, and folic acid, such as fresh vegetables, fruits, and animal livers. ;
2, rich in trace elements, such as mushrooms, kelp, seaweed, egg yolk, pumpkin, Chinese cabbage, animal liver and kidney, ginseng, medlar, yam, ganoderma lucidum, etc., they contain selenium, molybdenum and other minerals have anti-cancer effects;
3, esophageal cancer patients due to poor appetite, eating difficulties, eat more easily digested and absorbed lipids, sweets, such as honey, sugar and vegetable oil, butter, etc.;
4, protein-rich foods: such as lean meat, eggs, beans, milk and supplement all kinds of essential amino acids, maintaining the balance of amino acids in the body can inhibit the development of cancer.
Dietary considerations
It is worth mentioning that prevention of colorectal cancer should pay attention to diet. The medical profession generally believes that people who eat more fat and less fiber diet have a higher risk of colorectal cancer. Studies have shown that people in some areas have a diet rich in fiber-rich foods such as vegetables and fruits, and patients with intestinal cancer are lower than those in other regions.
The University of Cambridge has published a large study on diet and cancer, with more than 400,000 respondents, the largest diet and cancer research ever. The results show that a high-fiber diet can effectively reduce the risk of developing a fatal cancer by 40%, especially colon and rectal cancer.
In the past, studies in the French medical community have found that 30% of cancer cases are directly related to the patient's eating habits. The French Academy of Medical Sciences pointed out in the "Diet and Cancer" survey report that high-fat foods and saturated fatty acid foods such as whole milk and meat are not only easy to cause a variety of cancers, especially colon and rectal cancer, but also prone to cardiovascular disease. Experts believe that dietary fiber can stimulate the peristalsis of the intestines, and can also shorten the time of food passage through the intestines, reduce the chance of contact between carcinogens in the feces and intestinal mucosa, and expel stools and toxins as soon as possible.
Dietary fiber is mainly derived from natural vegetables, fruits, cereals and beans. Cruciferous vegetables in vegetables are rich in antioxidant vitamin C and carotene, which can inhibit the synthesis of carcinogenic nitrosamines, such as broccoli, mustard, and cabbage. Most of the yellow and green fruits and vegetables are rich in flavonoids. Other foods such as onions and apple skins also contain flavonoids. Eating more can also help prevent cancer.
Psychological care
1. Give the patient comfort and spiritual encouragement.
For patients with negative despair, they should be given spiritual comfort. Do a good job in mental health and life guidance, and tell patients about the treatment process and treatment methods of the cure cases, so that patients can build confidence, be encouraged in spirit, and see hope in treatment.
2, to learn to care for critically ill patients, careful care.
For patients who need to have a permanent artificial anus, it is necessary to euphemistically tell the patient about the impact of the surgery on the patient before surgery. Careful care after surgery to eliminate the patient's mental pain, enhance the patient's sense of trust and security, so that patients build confidence in the fight against disease.
3. Protect the patient's optimism.
Within a week after the patient's operation, especially in the case of fecal overflow, the patient's self-image is hit, often resulting in a painful feeling of life, and this time it is recommended to reduce the visits of relatives and friends to avoid stimulating the patient.
4. Infect patients with confidence and enthusiasm.
Patients should have a high degree of compassion and responsibility, be treated equally, and infect patients with a confident spirit and a warm attitude.
5, try to match the patient's psychological needs, learn to empathize.
For patients with suspicion, satisfy their desire to do various examinations, and patiently and meticulously explain the relevant situation to the patient.
The mentality that must be possessed in the advanced stage of rectal cancer
One: During the treatment of patients with rectal cancer, the patient's physical injury is relatively large, and the treatment effect will not be so fast. The patient may have an annoyed feeling about the treatment, and does not cooperate with the treatment. Therefore, the patient should be guided psychologically. Understanding of rectal cancer diseases.
Second: we should make a clinical observation of the patient's body moment, and make a record, the patient's body is afraid of sudden situations during the treatment, so the patient's care should always observe the patient's body changes, in a timely manner Processing.
Three: Due to the erosion of the tumor, the body of patients with rectal cancer is very weak, so the body of the patient can be supplemented by diet to help the patient to effectively repair.
High-risk crowd
1. Age of onset, most patients develop after 50 years of age.
2. Family history: If a first-degree relative of a person, such as a parent, has had a colorectal tumor, he is eight times more likely to suffer from the disease than in the general population. About a quarter of newly diagnosed people have a family history of colorectal tumors.
3. History of colonic disease: Certain colonic diseases such as Crohn's disease or ulcerative colitis may increase the chance of developing colorectal tumors. Their colon cancer is 30 times more dangerous than ordinary people.
4. Polyps: Most colorectal tumors develop from small precancerous lesions, which are called polyps. Among them, villus-like adenomatous polyps are more likely to develop into cancer, and the chance of cacao becomes about 25%; the malignant rate of tubular adenomatous polyps is 1-5%.
5. Gene characteristics: Some familial tumor syndromes, such as hereditary nonpolyposis colon tumors, can significantly increase the incidence of colorectal cancer. And the onset time is younger.
Postoperative care
Postoperative care measures for rectal cancer:
1, after the operation of the bath, the perineal incision is open, after the gauze is removed, you can use 1:5000 potassium permanganate solution bath, 2 times a day to prevent infection.
2, after radical resection of rectal cancer, the catheter should be indwelled and should be extended. The urine volume and urine properties should be closely observed to facilitate the early detection of urinary tract infection and early treatment.
3, strengthen the care of the perineum, apply 0.2% furan cillin cotton ball to scrub the perineum, 2 times a day.
4, female patients should strengthen the perineum during menstruation to prevent infection of the incision.
5, after the removal of the urethra 7-10 days after surgery, should drink plenty of water, maintain sufficient urine volume to achieve the role of flushing the urinary tract. Dream weaving content management system
6. Strengthen the care of the perineal incision. When the perineal incision is healed in the first stage, the outer dressing should be kept clean and dry.
7. After the female patient has removed the urinary catheter, the female urinal is used to receive urine to prevent the urine from contaminating the incision.
8, postoperative patients should take a semi-recumbent position, to facilitate drainage. The drainage tube should last for 7-10 days, and should be removed by the doctor according to the number of drainage. The patient or family members are strictly forbidden to be removed.
Precautions for postoperative rectal cancer:
1, diet should use high protein, low fat, high calorie, easy to digest food, and according to the characteristics, frequency, amount of stool, add and subtract.
2, to maintain a happy mood, psychological balance, especially patients who have performed artificial anus should be brave to accept the facts, and master the management of new excretion pathway, the skin around the artificial anus is kept clean and dry, can be coated with talcum powder, zinc oxide ointment Skin to prevent skin erosion.
3, develop regular bowel habits, adhere to the artificial anus with finger expansion to prevent stenosis.
4. Review every 2 to 3 months, review once every six months in the second year, and review once every year for the third year.
5, when the artificial anus is found abnormal, it should be promptly come to the hospital for examination and treatment.
6, adhere to the completion of various courses of radiotherapy, chemotherapy and other consolidation treatment to prevent recurrence.
Common diagnostic methods for rectal cancer
Digital rectal examination: about 90% of rectal cancer, especially the lower rectal cancer, can be found only by fingerprint. However, there are still some doctors who do not perform this routine examination on patients with suspected rectal cancer, which delays diagnosis and treatment. In fact, this method of diagnosis is simple and feasible. After rectal examination, the size and infiltration degree of the sputum and the mass can be judged, whether it is fixed, whether there is an intestinal wall or a pelvic implanted mass.
Proctoscopy or sigmoidoscopy: rectal examination should be performed after rectal examination, assist in diagnosis under direct vision, observe the shape of the mass, the upper and lower edges and the distance from the anal margin, and take the tumor tissue for pathological biopsy to determine The nature of the mass and its degree of differentiation. It is located in the rectum and the upper segment of the cancer, and the fingers cannot be touched. It is a better method to use sigmoidoscopy.
Barium enema, fiber colonoscopy: the diagnosis of rectal cancer is not helpful, it is not listed as a routine examination, only to rule out multiple colorectal tumors.
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