Good host, good listeners and friends! Many of my friends have had blood in the stool. Some were nervous and worried about whether it was a tumor; some didn't care much, thinking it was hemorrhoids, which was normal. In fact, neither attitude is right. Seeing a doctor in time is the best choice, let professional doctors judge. Of course, if we have some basic medical knowledge, we can reduce some unnecessary worries. Today, I will use this opportunity to talk about blood in the stool and colorectal tumors.
First of all, the so-called blood in the stool refers to the discharge of blood from the anus. The color of the stool is bright red, dark red or tarry. Blood in the stool is only a symptom, not a disease. It is an early warning from the body. Hematochezia is more common in lower gastrointestinal bleeding, especially bleeding from colon and rectal lesions, but also in upper gastrointestinal bleeding. The color of blood in the stool depends on the location of the gastrointestinal bleeding, the amount of bleeding and the time the blood stays in the gastrointestinal tract. From the characteristics of blood in the stool, there are fresh blood, pus blood or mucus blood in the stool, melena, occult blood and so on. Fresh blood in the stool is mostly acute bleeding. The blood flows out of the blood vessel and is discharged in the stool through the anus for a short time, or it flows out directly after the stool. The color is bright red or dark red, and it can coagulate into a blood clot after a long time. Commonly seen in hemorrhoids, intestinal polyps, rectal prolapse, anal fissure, etc. Pus, blood or mucus, blood in the stool is the excretion of both pus or mucus and blood. It is often seen in rectal or colon tumors or inflammation. Such as colorectal cancer, ulcerative colitis, intestinal infectious diseases such as bacillary dysentery, amoebic enteropathy, etc.
Black stool is also called tarry stool. The stool is black or brownish-black and is one of the most common symptoms of upper gastrointestinal bleeding. If the amount of bleeding is small, the bleeding speed is slow, the blood stays in the intestines for a long time, and the excreted stool is black. If the amount of bleeding is large and the residence time in the intestines is short, the discharged blood is dark red and bleeding The amount is very large, and it can be bright red when discharged quickly. A small or trace amount of gastrointestinal bleeding will not cause a change in the color of the stool. It is only positive in the stool occult blood test, which is called occult blood. Occult blood can occur in all gastrointestinal bleeding diseases, which are common in ulcers, inflammations and tumors. Early fecal occult blood of intestinal polyps or colorectal cancer can be positive, and regular fecal occult blood testing is an important way to screen for colorectal tumors. Due to the popularity of colonoscopy, occult blood tests are rarely used for screening.
1. Moderator: Dr. Deng, you just introduced several situations of blood in the stool. I would like to ask which blood in the stool is caused by hemorrhoids or anal fissure, and which blood in the stool may be colorectal tumors?
Dr. Deng: Generally speaking, internal hemorrhoids and anal fissures often bleed after stool or during stool. Hemorrhoid bleeding is often spotted or sprayed out. The color is bright red. The anus is generally painless unless hemorrhoids are incarcerated. An anal fissure is blood attached to the surface of the stool or stained with toilet paper, which causes less bleeding and intense pain in the anus. Colorectal tumor bleeding is blood in the stool, mucus or pus and blood in the stool. Of course, rectal cancer can also be blood in the stool. Blood in the stool alone cannot be completely distinguished. It must be combined with medical history, digital rectal examination and related examinations.
2. Moderator: Colorectal cancer is a senile disease, is it far away from young people?
Dr. Deng: Colorectal cancer is one of the most common cancers. Advanced age is its most important risk factor. The risk of occurrence increases with age. 90% of cases are over 50 years old at the time of diagnosis. However, with the Chinese lifestyle With the changes in dietary structure and the acceleration of population aging, the incidence is on the rise, and the age of onset tends to be younger. The incidence is gradually increasing among people younger than 40 years old. According to statistics from the National Cancer Center in 2015, colorectal cancer ranks second among high-incidence cancers in women and third among men;
3. Moderator: What is the specific cause of colorectal cancer?
Dr. Deng: Although the etiology of colorectal cancer is not clear, its related high-risk factors are gradually being recognized. 1. Dietary factors: high fat, high meat, low fiber diet. A high-fat diet can significantly increase the concentration of neutral cholesterol and bile acid in the large intestine, both of which have a three-dimensional structure similar to carcinogen polycyclic aromatic hydrocarbons, and their degradation products also have carcinogenic or auxiliary effects. And cellulose can absorb water, thus increasing the amount of feces, shortening its residence time in the intestinal tract, adsorbing harmful substances, and promoting excretion. 2. Genetic factors: Family members with a family history of colorectal cancer are 2-6 times more likely to develop colorectal cancer than the general population; 15% of colorectal cancer patients have a clear family history; 4. Chronic inflammation:
Such as excessive animal fat and animal protein diet, lack of fresh vegetables and cellulose food; lack of moderate physical activity; genetic susceptibility also plays an important role in the incidence of colorectal cancer; such as hereditary non-polyposis colon cancer Family members of mutation carriers of mismatch repair technology should be regarded as high-risk groups;
4. Moderator: What are the symptoms of colorectal cancer patients and how to find early colorectal cancer?
Dr. Deng: Colorectal cancer often has no special symptoms in the early stage. Due to the different anatomical structures, the clinical manifestations of colon cancer and rectal cancer are not the same. Generally speaking, the main manifestations of right colon cancer are systemic symptoms, anemia, and abdominal masses. Side colon cancer is characterized by obstruction, constipation, diarrhea, blood in the stool and other symptoms. After colon cancer develops, the bowel often has: 1. Changes in bowel habits and stool characteristics (the earliest symptoms are increased bowel frequency, diarrhea, constipation, stool Blood, pus or mucus); 2. Abdominal pain (persistent pain with inaccurate positioning, or only abdominal discomfort or bloating, abdominal pain aggravates or paroxysmal colic when obstruction occurs. 3. Abdominal mass ( The masses are mostly hard and nodular); 4. Symptoms of bowel obstruction (mid-late symptoms, manifested as abdominal distension and constipation, abdominal pain or paroxysmal colic); 5. Systemic symptoms: due to chronic blood loss, cancer ulceration, Infection, toxin absorption, etc., patients may develop anemia, weight loss, fatigue, low-grade fever, etc. There are no obvious symptoms in the early stage of rectal cancer. Symptoms only appear when the cancer ruptures and forms ulcers or infections, often: 1. Rectal irritation: frequent bowel movements , Changes in bowel habits, distended anus before defecation, tenes, heavy defecation, incomplete defecation, and complete lower abdominal pain; 2. Symptoms of bowel stenosis: cause partial obstruction including abdominal pain, abdominal distension, and incomplete obstruction such as hyperintestinal sounds; 3: Cancer ulcer infection symptoms: stool surface with blood and mucus, even pus and blood in the stool. The frequency of symptoms is: blood in the stool, frequent stool, thin stool, mucus in the stool, anal pain, tenesmus, constipation, etc.
5. Moderator: Is colorectal cancer inherited?
Dr. Deng: There are two factors in the onset of any disease: external factors and internal factors. Internal factors refer to genetic factors; hereditary colon cancer only accounts for about 15%; one of hereditary colon cancers is called Lynch syndrome (hereditary non-polyposis) Colorectal cancer) is an autosomal dominant genetic disease caused by germline mutations of mismatch repair genes. Its median age of onset is about 44 years old, and its onset time only takes 2-3 years; there is another kind called In familial adenomatous polyposis, adenomatous polyps can appear at the age of 12 or 13, and polyps have spread throughout the large intestine at the age of 20. If not treated in time, malignant changes will occur before the age of 40 without exception. About 80% of colorectal cancers are malignant transformations of adenomatous polyps, and the evolution from adenoma to cancer takes about 10-15 years. Such a long evolution provides a favorable opportunity for the prevention of colorectal cancer; Most of them are non-hereditary colorectal cancer, and external factors play a major role. For non-hereditary colorectal cancer, there are no abnormalities in specific genes, but defects in certain genes. Because there are certain differences in the same gene between individuals, the most common is gene polymorphism. These differences will affect the activity of some enzymes, such as carcinogen metabolic enzymes, nucleic acid repair enzymes and so on. When the enzyme activity decreases, the risk of cancer is higher when the same carcinogen is accepted. Although the vast majority of non-hereditary colorectal cancers cannot be inherited, the defect in this nucleic acid is heritable, that is, the susceptibility to colorectal cancer is heritable. For this majority of people, as long as they maintain good living habits, the occurrence of colorectal cancer can still be avoided.
External factors are environmental factors, such as high fat, high protein, especially red meat, etc. We must eat more fresh fruits and vegetables and a high-fiber diet, and at the same time change bad habits. Why is it said that eating a high-fat, high-protein diet can easily lead to the onset of colon cancer, because a high-fat diet may increase the secretion of bile acids, which will become secondary bile acids under the action of intestinal bacteria, which is a kind of Carcinogens, plus inactivity, will cause constipation. The longer the carcinogens stay in the intestines, the longer they will interact with the intestinal epithelium.
6. Moderator: What are the current treatment methods and effects of colorectal cancer?
Dr. Deng: The main treatments for colorectal cancer are surgery, radiotherapy and chemotherapy. Surgery is the only method that can cure the tumor. Colorectal cancer is a malignant tumor with a long survival period. The average 5-year survival rate is 64%. Patients living with tumors are common in the population; the 5-year survival rate of colorectal cancer I and II is as high as 80-90%. Because the early symptoms are not obvious, about 60% of the patients are found to be in the middle and advanced stages, especially the advanced stages. The opportunity for surgery has been lost, and the 5-year survival rate is only about 8%. Therefore, to reduce the harm caused by colorectal cancer, the best way is early detection, early diagnosis and early treatment.
7. Moderator: Is the early check-up you said about colonoscopy? I heard that it is very painful and many people are unwilling to accept this test.
Dr. Deng: With the popularity of colonoscopy, colonoscopy has almost become the gold standard method for diagnosing colorectal cancer; early examination includes two meanings: first, if there is no symptoms, take the initiative to go to the hospital for screening; second, find symptoms Seek medical attention as soon as possible (do not avoid the disease and avoid the doctor); Colonoscopy currently includes: virtual colonoscopy, capsule colonoscopy, ordinary electronic colonoscopy; it is not the first time I have heard about the pain of colonoscopy, it is mainly discomfort caused by abdominal distension. Some people may have some pain, but they can also apply for a painless colonoscopy.
8. Moderator: As a surgeon, what is the focus of his work in the treatment of colorectal cancer?
Dr. Deng: Surgical treatment improves survival rate; surgical methods improve patient quality of life: minimally invasive and anus preservation. The focus of postoperative work: 1. Reduce the risk of recurrence and metastasis, 2. Promote the recovery of patients with bowel cancer, 3. Do a good job of follow-up review of patients.
9 Moderator: China's prevention strategy for colorectal cancer?
Dr. Deng: There are mainly three levels of prevention: Primary prevention: Reduce and eliminate the pathogenic factors of colorectal cancer, and inhibit the cancerous process of normal cells. 1. Diet adjustment, 2. Change of living habits, 3. Drugs, 4. Treatment of precancerous lesions; secondary prevention: early detection, early diagnosis, and early treatment to prevent or reduce deaths caused by tumors. Tertiary prevention: Active treatment of cancer patients to improve the quality of life of patients and prolong survival. At present, surgical treatment is mainly used for patients with colorectal cancer, supplemented by appropriate radiotherapy and chemotherapy, traditional Chinese medicine treatment, and immunotherapy to improve the treatment effect of colorectal cancer.
Through primary prevention, lifestyle changes can reduce the incidence of colorectal cancer by about 35%; through secondary prevention colorectal cancer screening census, it can reduce its death and incidence by about 53%; and tertiary prevention, Better treatment can only improve by 12%.
Thank you host, and goodbye, friends and listeners!