At the invitation of Wenzhou Voice’s "Wenzhou Medical Officer" column group, Dr. Zuo Zhigui gave a lecture on health at Wenzhou Voice on the morning of June 4, and made a popular science program "Preventing bowel cancer starts from changing living habits" for the people of Wenzhou. In the program, Dr. Zuo Zhigui introduced the pathogenesis of colorectal cancer, the current status of colorectal cancer in Wenzhou, the strategies and methods of early diagnosis and treatment of colorectal cancer, and especially pointed out that electronic colonoscopy and treatment are used in the prevention of colorectal cancer. The role of colorectal cancer, the changes in lifestyle and eating habits required for the prevention of colorectal cancer, and the introduction of different stages of colorectal treatment strategies.
On the afternoon of June 4, I went back to the hospital to perform gastrointestinal endoscopy for more than ten patients. Two patients were found to have nodular polyps to be removed, and another patient with bowel cancer was found. Preoperative examination was arranged for the patient, and the patient's condition was confirmed. Develop an optimal treatment plan.
Dr. Zuo Zhigui has been practicing colorectal cancer screening and prevention strategies, performing gastrointestinal endoscopy for thousands of patients every year, and performing colon polypectomy for hundreds of patients to prevent colorectal cancer. The concept of integrated treatment and full-process management of colorectal cancer has been implemented for all colorectal cancer patients, and the full-process management of diagnosis, treatment, comprehensive treatment and follow-up has been implemented for all colorectal cancer patients, so that patients can run less and make Patients get the most comfortable medical experience.
The following is the main content of this health lecture for friends' reference
The first part of the pathogenesis and status of bowel cancer
Question 1: Can hemorrhoids become cancerous? Why do many patients with hemorrhoids find bowel cancer when they go to the hospital?
From a medical point of view, hemorrhoids are definitely not cancerous. The reason is that hemorrhoids are formed by the normal elastic fiber structure of the human body being destroyed and prolapsed due to long-term hard defecation and prolonged sitting and prolonged squatting. It is a benign lesion.
Intestinal cancer is a malignant disease. It is the result of gene mutations that cause infinite proliferation of intestinal mucosal epithelial tissue. It is caused by normal cells in the body that become abnormal cells after mutations and continue to proliferate. Its growth is not controlled by the body's own immune system. It can invade and destroy nearby or distant tissues and organs. Therefore, benign hemorrhoids and malignant bowel cancer are essentially different in pathogenesis and tissue morphology, and their final consequences are completely different.
So why do many patients who suffer from hemorrhoids for a long time find bowel cancer? The reason is that bowel cancer is often mistaken for hemorrhoids by the patients themselves. There are no obvious symptoms in the early stage of bowel cancer. After a certain degree of development, the symptoms are very similar to the symptoms of hemorrhoids. Both are so that blood is the main symptom. Therefore, ordinary people often treat both Confused, some patients with bowel cancer are treated as hemorrhoids, which delays the treatment of bowel cancer. However, it is very simple for specialists to distinguish between the two. Our colorectal surgeons can distinguish between the two by just doing a digital rectal examination. 80% of rectal cancer patients who are misdiagnosed are because they received the rectum from the colorectal anal surgeon. Referral. Therefore, the majority of patients with anal symptoms such as blood in the stool must go to the hospital to be checked by a specialist to rule out bowel cancer before they can use hemorrhoid drugs with peace of mind. Once the misdiagnosis causes the disease to be delayed or even advanced bowel cancer, it will be too late to regret!
Question two Is the incidence of bowel cancer high? I can't get bowel cancer at such a young age!
As a “riches disease” related to high-fat, high-protein, and low-fiber diets, the incidence of bowel cancer has increased significantly in recent years. At present, the incidence of bowel cancer among all malignant tumors in economically developed cities has increased from the seventh in the last century. Leaping to the second place, Wenzhou is an economically developed area in the country, so it is also an area with a high incidence of bowel cancer. In the past, due to poor economic conditions and poor diets, the incidence of gastric cancer was high. The trend in the past 20 years has been As the dietary structure tends to become more refined, the incidence of bowel cancer has increased significantly, and it has surpassed that of gastric cancer. Therefore, it is especially important to improve people's awareness of bowel cancer and awareness of prevention.
Although in general the incidence of bowel cancer is more common in middle-aged and elderly people, the incidence of bowel cancer in young people is also increasing, mainly due to poor living and eating habits. The youngest patient I diagnosed and treated was a sophomore , Very young, every time his parents came to see the doctor, I performed surgery on him, and received standard chemotherapy after the surgery. After standard treatment, the current patient's treatment effect is very good.
Part Two Early Screening Program for Bowel Cancer
The earlier the detection of intestinal cancer, the better the treatment effect. Our colorectal surgeons often tell patients that "intestinal cancer is detected 3 months earlier and lives longer for 30 years." This is indeed a well-known saying. Why do you say that? The reason is that the cure rate after standardized surgery for early colorectal cancer can reach more than 90%, while the treatment effect of middle-advanced colorectal cancer is significantly worse. The statistical results of a large number of cases show that the cure rate of stage I colorectal cancer can reach 93%, and that of stage II. The cure rate of colorectal cancer can also reach 70%-80%, and the cure rate of stage III colorectal cancer can only reach 50%-60%. Stage IV colorectal cancer is not only complicated to treat, but the overall treatment effect is not good. Therefore, early detection of colorectal cancer is improved The foundation of the effect of colorectal cancer treatment is also the goal of colorectal surgeons.
Question 1: Is there any way to detect early bowel cancer?
There are many ways to find colorectal cancer, including stool test, blood test, CT, barium enema, etc., all of which have certain value in the diagnosis of colorectal cancer. At the same time, there are also some methods for detecting early colorectal cancer by genetic testing of blood or stool. However, at present, only colonoscopy can be the most accurate and reliable method. It is the gold standard for the diagnosis of intestinal diseases. Other methods need to be diagnosed by colonoscopy even if they are highly suspected. Moreover, colonoscopy can not only find intestinal lesions, but also take biopsy of the lesions to confirm the diagnosis. After colonoscopy finds intestinal polyps, they can be directly removed under colonoscopy to relieve the hidden danger of bowel cancer. Therefore, colonoscopy can not only detect bowel cancer, but also remove polyps and prevent bowel cancer!
In clinical practice, we often encounter some patients who are very scared when they hear that they need colonoscopy. The reason is that they think colonoscopy is perforated and unsafe, and the process of colonoscopy is very painful. In fact, this is a huge misunderstanding of colonoscopy. With the continuous improvement of colonoscopy technology, the probability of perforation during colonoscopy is very low and the pain is very light. Of course, if the patient is really scared, they can also undergo a painless colonoscopy. The so-called painless colonoscopy is to allow the patient to undergo an electronic colonoscopy under anesthesia, so that the patient can complete the examination without knowing it while sleeping. Therefore, our various concerns about colonoscopy are completely unnecessary.
Question 2: Who is susceptible to bowel cancer?
Intestinal cancer has an obvious genetic predisposition, so family members of cancer patients need to be vigilant, especially those in the immediate family who have bowel cancer, especially those who have bowel cancer, because genetic inheritance is an important factor in the onset of intestinal cancer, research It shows that if one of the immediate family members (parents, siblings) has colorectal cancer, the incidence of family members is 2-3 times that of the general population, and if two people have colorectal cancer, the incidence of family members is 3-4 times that of the general population , With the increase in the immediate family members of the disease, the probability of family members suffering from bowel cancer also increases rapidly. When the standard of some special hereditary bowel cancer is reached, the incidence rate will increase significantly. For example, there is a special hereditary bowel cancer called familial polyposis (FAP). The prevalence rate of the patients’ children reaches almost 100%. Hereditary bowel cancer is called Lynch syndrome (HNPCC for short). If family members live long enough, the chance of developing bowel cancer is as high as 60-70%. There are other special inherited bowel cancers. If you say more, just see a specialist. All cancer family members need to have regular checkups when they are relatively young, because they are a high-risk group of bowel cancer and need to be more prepared and vigilant. Obviously, if there is a colon cancer patient in the family, it is still necessary to have a colonoscopy. Although neighbors or friends are not related by blood, bowel cancer is not contagious, but because neighbors or friends have similar living environments and habits, they have the same pathogenic factors, so do it when your neighbors or friends have bowel cancer A colonoscopy will also be more at ease.
If we do not belong to the above-mentioned high-risk groups, we strongly recommend that we have a colonoscopy if any of the following dangerous symptoms occurs. These symptoms include: ①Recurrent gastrointestinal symptoms such as abdominal pain, bloating, diarrhea or constipation; ② Stools become thin or unshaped; ③have symptoms of gastrointestinal bleeding such as blood in the stool; ④have anemia other than hematological diseases; ⑤abnormal intestinal wall detected by double gas barium imaging or CT examination; ⑥CEA or CA199 and other tumor markers Increased; ⑦ wasting or weight loss for unknown reasons.
Even if there is no family history of bowel cancer, there are no such dangerous symptoms, but as long as we reach the age of 50, it is recommended to add a colonoscopy during the physical examination, because the US bowel cancer database research shows that about 80% of bowel cancer patients are concentrated In the age group of 50-75 years old, the colonoscopy in this age group can detect about 80% of patients with bowel cancer, which is obviously of great significance.
As early as 20 years ago, the United States formulated a complete bowel scope screening program, so the current incidence of bowel cancer in the United States is decreasing year by year. The incidence of bowel cancer in our country is still in a rapid growth stage. For people with a family history of bowel cancer, dangerous symptoms and more than 50 years of age, more colonoscopy can detect bowel cancer early and improve the treatment effect.
Part 3 Analysis of the prevention plan for bowel cancer
Question 1: Can bowel cancer really be prevented? How can bowel cancer be prevented?
Intestinal cancer is indeed one of the preventable cancers. This is based on scientific evidence. As early as the 1960s, scientists have found that most intestinal cancers are gradually evolved from intestinal polyps, and the evolution time is about 5 to 15 years. , The longer the time, the higher the chance of cancer. In such a long process, as long as we can find intestinal polyps and remove them, we can prevent the occurrence of intestinal cancer. In clinical practice, I would recommend the family members of patients with intestinal cancer to strengthen intestinal cancer. Screening.There was once a 75-year-old elderly patient who underwent bowel cancer surgery here. We suggested that his son go for a colonoscopy. However, a large polyp was found during the colonoscopy. I then removed this polyp. It should be said that the patient Fortunately, if his son does not find and remove polyps, he will surely become a bowel cancer patient in a few years. Through health education for the family members of bowel cancer patients, many family members of patients have found and removed bowel polyps. Thereby preventing the occurrence of bowel cancer and avoiding the fate of becoming a patient with bowel cancer.
So when do you start colonoscopy? For some special hereditary bowel cancer family members, colonoscopy should be performed as soon as possible, such as the familial adenomatous polyposis (FAP) family member mutation carrier we mentioned earlier, it is recommended to have colonoscopy once a year from 10-15 years old Check, for carriers of gene mutations in Lynch family members, it is recommended to have colonoscopy once a year from the age of 20-25. When colonoscopy is more complicated for carriers of other special inherited bowel cancer gene mutations, I still have to see a specialist and let our specialist help. For those who have bowel cancer among their immediate family members, it is recommended to have a bowel endoscopy after the age of 40. Through colonoscopy, we can find intestinal polyps and remove them, and eliminate the intestinal cancer in its budding state. This is a major contribution made by modern scientific progress to our health.
Question 2 What should we pay attention to in life to prevent bowel cancer?
Because the occurrence and development of colorectal cancer is the result of multiple factors, a healthy lifestyle and eating habits play a very important role in preventing the occurrence and development of colorectal cancer. A large number of clinical studies have shown that bad lifestyles related to the occurrence of bowel cancer include: smoking, alcohol abuse, less exercise, and depression. Bad eating habits include high-protein, high-fat and delicate diets, fried and preserved foods, excessive red meat, etc. The so-called red meat is pork, beef, lamb, etc., while white meat is mainly fish. We must abandon bad habits, do not smoke or drink alcohol, exercise more, and maintain an optimistic and positive attitude. Healthy eating habits include reducing high-protein, high-fat and refined diets, reducing frying and smoking foods, and increasing vegetables, fruits, and whole grains. . In addition, it is also important to form a good and regular bowel habit. Patients with long-term repeated constipation will cause repeated accumulation of toxins, which is a high-risk factor leading to intestinal diseases and one of the predisposing factors of intestinal cancer. The above-mentioned healthy lifestyle and eating habits are important preventive ways to reduce the incidence of bowel cancer. Follow a healthy lifestyle from now on.
Apply the slogan: Preventing colorectal cancer, it's that simple! Everyone can do it.
Part Four Standardized Diagnosis and Treatment Strategies for Colorectal Cancer
Question: Is the death sentence pronounced as soon as colorectal cancer is discovered, and treatment does not help much?
In all types of cancer, the overall treatment effect of bowel cancer is still very good. If you unfortunately find bowel cancer, don’t be pessimistic and disappointed. We need to have the right attitude to face it positively, as long as we take correct and standardized comprehensive treatment under the guidance of doctors. Can overcome the disease to obtain long-term survival and ensure a better quality of life.
The treatment of bowel cancer is a comprehensive treatment based on surgery. At present, medicine has formulated standardized treatment plans based on the different stages of bowel cancer. After the patient is diagnosed with bowel cancer, doctors need to perform relevant examinations on the patient to clarify the stage, and then the doctor The treatment plan that is most beneficial to the patient will be formulated according to the specific stage of the patient.
Patients in the early stage can be completely cured by surgical resection, while patients in the middle and late stages need comprehensive treatments other than surgery to obtain the best therapeutic effect. These treatment methods include preoperative radiotherapy and chemotherapy, postoperative radiotherapy and chemotherapy, molecular targeted therapy, and immunotherapy And Chinese medicine treatment, etc.
The main basis for choosing different treatment methods is the preoperative imaging evaluation of bowel cancer and the postoperative pathological results, especially for rectal cancer because of its special anatomical characteristics, its preoperative imaging evaluation is very important. Enhanced CT and rectal MRI can allow doctors to clarify the patient's condition. If the imaging examination does not find distant metastasis and lymph node metastasis around the rectum, and the tumor does not invade the intestinal wall, the patient can directly undergo surgery. Once the preoperative rectal MRI examination finds that the patient has lymph node metastasis around the rectum or the tumor invades the intestinal extramural tissue, preoperative radiotherapy and chemotherapy are required. Preoperative radiotherapy and chemotherapy are also called neoadjuvant radiotherapy and chemotherapy, because only neoadjuvant radiotherapy and chemotherapy can be more assured Complete radical resection, otherwise the tumor cells may remain around the pelvic wall and easily lead to postoperative recurrence. If the imaging examination finds distant metastasis of colorectal cancer, the staging is stage IV. There are also many treatment options for stage IV patients, which cannot be given up lightly. It is necessary to give systemic chemotherapy first to strive for radical surgery, but do not give up easily even if systemic systemic treatment cannot be cured, because the current systemic chemotherapy combined with molecular targeted therapy can also make the average survival time of such patients reach about 3 years , The treatment effect is also good.
Once the patient has completed the surgical treatment, the surgically resected specimen must be sent to the pathology department for pathological examination. Colorectal cancer specimens can be divided into three stages in pathological examination. Stage I colorectal cancer is what we usually call early colorectal cancer. The cure rate can reach more than 90% through standardized surgery. It is currently believed that adjuvant treatment such as postoperative radiotherapy and chemotherapy is not required. Pathologically, stage II colorectal cancer does not require adjuvant therapy such as postoperative radiotherapy and chemotherapy if there are no high-risk factors. However, for pathologically stage II colorectal cancer with high-risk factors and stage III colorectal cancer, comprehensive treatment such as radiotherapy and chemotherapy is required after surgery. It should be noted that if the patient has received neoadjuvant radiotherapy and chemotherapy before surgery, then regardless of the postoperative pathology of the patient All require postoperative adjuvant chemotherapy. However, patients who have received standardized neoadjuvant radiotherapy before surgery cannot receive radiotherapy after surgery, because the body can withstand a certain dose of radiotherapy, and patients who have received standardized radiotherapy before surgery will cause serious complications after surgery.
About the Author
Zuo Zhigui (Unit: Department of Colorectal Surgery, The First Affiliated Hospital of Wenzhou Medical University)