2020年12月21日星期一

hemorrhoids cancer,The elderly and colorectal cancer

    With the development of social economy and the improvement of material living standards, the average life expectancy of the people has been significantly extended, and the incidence of colorectal cancer in the elderly is also increasing year by year. Domestic scholars unanimously call colorectal cancer of the elderly people over 60 years of age. The incidence of colorectal cancer in China was 29.7 per 100,000, and the mortality rate over the same period was 13.39 per 100,000, accounting for the 3rd and 5th places in the incidence and mortality of malignant tumors respectively.

    Research results in recent years have shown that colorectal cancer in the elderly is the result of a synergistic effect of environment, diet, living habits and genetic factors. Due to the role of carcinogens, combined with the background of cytogenetics, it leads to genetic mutations in cells and gradually develops into cancer. The physiological function of the elderly aged 60 and above gradually declines, the large intestine mucosa and muscle layer are atrophy, and the water absorption and peristalsis are reduced. The content of the intestinal cavity needs a larger amount to cause the feeling of expansion. Constipation causes the bacteria in the intestinal cavity to produce and The contact time of chemical carcinogens produced during cooking and the intestinal mucosa is prolonged. In addition to the intake of more fat and cholesterol in food, the intestinal anaerobic bacteria degrade bile acids into secondary bile acids, which have a proliferation effect on intestinal mucosal cells. Combined with the inactivation of the repair gene and the mutation of K-ras gene, the intestinal mucosal cell mutation, the formation of pre-cancerous lesions, and the gradual development of cancer.

    The organ function of the elderly is reduced compared with the young, and they are prone to various diseases. Therefore, the colorectal cancer of the elderly has its particularity compared with the colorectal cancer of the young and middle-aged. Elderly colorectal cancer usually takes 3 months to 3 years from symptom to diagnosis, with an average of 8.5 to 9.5 months. The clinical symptoms of colorectal cancer in the elderly are similar to those of young people. They lack specificity. They are often atypical. They are easily confused with the symptoms of other diseases of the gastrointestinal tract and abdominal cavity. The most common symptoms are bloody stools, mucus and bloody stools. Changes in bowel habits. Followed by abdominal masses, diarrhea, abdominal pain, anemia, unexplained weight loss, and acute and chronic intestinal obstruction. Due to the gradual decline of the physiological function of the elderly and the poor ability to respond to pain, the proportion of consultations with abdominal pain is low. In addition, the proportion of well-differentiated cancers is higher, and the growth is slow. Clinically, the proportion of consultations with abdominal masses is higher. Especially patients with colon cancer almost always use this as their chief complaint. In severe cases, the patient does not come to the hospital until the patient has intestinal obstruction or even intestinal perforation.

    The bowel habits of the elderly with colorectal cancer are changed so that secretion is the main reason, followed by changes in stool frequency and stool shape. This is due to the poor metabolic function of the elderly, slow bowel movements, and the tumor's blocking of the stool. If the tumor is located in the rectum, changes in stool shape or frequent stools may occur. For elderly patients with bloody stools and mucous bloody stools, consideration should be given to distinguishing from hemorrhoids or intestinal inflammatory diseases. Even if long-term hemorrhoids or inflammatory bowel diseases have been identified, colonoscopy should be performed to rule out combined colorectal tumors. Possibility. For patients with unexplained progressive anemia, weight loss, abdominal masses, abdominal pain, abdominal distension and fever, the possibility of right colon cancer and colon cancer coexisting appendicitis and peri-appendicular abscess should be considered.

    According to international epidemiological investigations and studies, elderly people eat more fiber-containing foods, and the fiber is derived from fruits and vegetables, rather than from cereals. At the same time, reducing meat and animal fat in foods can reduce fruit The incidence of rectal cancer, so some people advocate that the elderly should eat more fresh fruits, vegetables, meat and also low-fat fish and poultry, in order to achieve the purpose of preventing or reducing the incidence of colorectal cancer.

    At present, the treatment of colorectal cancer in the elderly is still a comprehensive treatment based on surgery. As the organ function of the elderly is weaker than that of the young and middle-aged, the body's resistance and immunity gradually decline, and it is easy to be accompanied by chronic organic diseases of various systems, of which the most common are cardiovascular and cerebrovascular diseases, Respiratory diseases and metabolic diseases. Elderly patients with colorectal cancer who really cannot tolerate surgery can also consider chemotherapy, local radiotherapy, laser treatment, cryotherapy and Chinese herbal medicine. Elderly colorectal cancer is mostly differentiated and has a lower lymph node metastasis rate. There are more early cases than middle-aged and young people, so the prognosis is better. In addition, the elderly colorectal cancer is not sensitive to radiotherapy and chemotherapy, and the elderly Human tolerance to chemotherapy is limited, and colorectal cancer may eventually lead to complications such as intestinal obstruction. According to domestic data, 70% to 80% of colorectal cancer in the elderly can be resected, and the radical resection rate is 45% to 55%. Domestic reports have reported a 5-year survival rate of 36% to 54%, while foreign data reported that its 5-year survival rate was 49% to 55%, and its 5-year survival rate after radical resection reached 68% to 74%. Therefore, once colorectal cancer in the elderly is diagnosed, conditions should be actively created to rationally treat the accompanying diseases and improve the overall condition, and strive for surgical treatment as soon as possible.

    Special attention should be paid to the insidious growth of colorectal cancer in many elderly people. There are no specific symptoms in the early clinical stage. In addition, the elderly are slow to respond and are easy to ignore the general abdominal discomfort, resulting in delayed diagnosis and delayed diagnosis. The elderly often have unexplained chronic constipation, diarrhea, and abdominal pain. The main symptoms of colorectal cancer in the elderly are mainly constipation. Therefore, the elderly should be alert to the presence of colon cancer in the habit of bowel movements. At the same time, it is necessary to exclude the co-existence of rectal cancer before the treatment of hemorrhoids and fistulas in the elderly. Since colorectal cancer and anal cancer are more common in the elderly, it is not uncommon for rectal cancer to be misdiagnosed and delayed due to hemorrhoids and fistulas in China.

    Once the elderly have increased blood in the stool, changed the number of stools, dull abdominal pain, persistent anemia, or mucus-like stools, they cannot blindly judge the condition and abuse of antibiotics to delay the condition, miss the best time for treatment, and not to age after the diagnosis is confirmed For this reason, as soon as it is "delayed", one should go to a specialist hospital for examination in time to strive for early detection and early treatment.

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