Misunderstandings in the treatment of colorectal cancer
At present, there are still many conceptual misunderstandings in the diagnosis and treatment of colorectal cancer. Colorectal cancer is a collective term for colon cancer and rectal cancer. The incidence of malignant tumors ranks third in the world, and second in developed countries such as Europe and the United States. , The incidence of colorectal cancer in China also accounts for the third place among all malignant tumors. According to the cancer incidence spectrum compiled by Shanghai in 2003, colorectal cancer has surpassed gastric cancer, ranking second among common malignant tumors, and is currently one of the fastest growing malignant tumors in Shanghai. In recent years, in addition to the increasing incidence of colorectal cancer, the sex ratio, location of onset, age of onset, and tumor type have all changed.
The treatment of colorectal cancer is based on surgery, combined with chemotherapy, radiotherapy and other methods of comprehensive treatment. At present, the surgical techniques for colorectal cancer are relatively mature, the incidence of complications is low, and the efficacy of comprehensive treatment is quite significant. However, there are still some conceptual misunderstandings in the diagnosis and treatment of colorectal cancer, which require attention:
Misunderstanding 1: Intestinal preparations are required before and after surgery for colorectal cancer
Surgery for colorectal cancer has a lot of stool in the large intestine, and traditional preoperative preparation methods are used, which takes a long time to prepare, which has a great impact on patients and slow recovery after surgery. Since 2005, "fast-track surgery", which has emerged in European and American countries, has improved perioperative management, encouraging patients to eat early after surgery and get out of bed early to achieve the purpose of promoting patients' recovery after surgery. The General Surgery Department of Zhongshan Hospital is the first to carry out this technology in China and has completed nearly 300 patients. Preliminary experience has shown that patients can get out of bed and eat a liquid diet on the first day after surgery, compared with traditional patients 3-4 days after surgery. Compared with resuming diet, it has obvious advantages, and the average length of hospital stay can be shortened by 2 days, which has been well received by patients.
Misunderstanding 2: Blood in the stool is a manifestation of hemorrhoids
Stool bleeding may be a manifestation of hemorrhoids, but it is often also a clinical manifestation of low colorectal cancer. Sometimes the two can be completely confused. Some patients often think it is hemorrhoids and delay the diagnosis. When the colorectal cancer is diagnosed, it is already at an advanced stage and even has distant metastasis. In addition, fecal occult blood screening is also an important means of early screening for colorectal cancer. The colorectal cancer professional group of Zhongshan Hospital Affiliated to Fudan University has accepted the scientific research project of the 11th Five-Year Plan of the Ministry of Science and Technology, and carried out a community early colorectal cancer screening and questionnaire screening in Xujiahui Street, Xuhui District, Shanghai. More than 100 cases of colorectal cancer and pre-cancerous lesions were found in this period, and all patients received timely treatment.
Myth 3: Colonoscopy is unnecessary for asymptomatic patients
The main symptoms of colorectal cancer include blood in the stool, abdominal pain, diarrhea, weight loss and so on. Most of the symptoms are mild at the initial stage of onset and will not cause the patient to pay enough attention. When the symptoms become obvious, they are mostly in the late stage and the treatment effect is not good. Colonoscopy is conducive to early detection. Moreover, the development of painless endoscopy has greatly reduced the pain of colonoscopy. However, letting everyone do colonoscopy will cause a certain amount of waste. Therefore, colonoscopy should be checked every 1-2 years for the following high-risk groups. That is, people over 40 years old in the high-incidence area of colorectal cancer with symptoms; people after colorectal cancer surgery; people after colorectal polyps undergoing enteroscopic electrocautery; immediate family members with a family history of colorectal cancer; immediate family members with a family history of colorectal polyps Patients with ulcerative colitis; patients with schistosomiasis rectal granuloma; people after cholecystectomy.
Misunderstanding 4: Anemia is very serious and cannot be operated on
Colorectal cancer usually manifests as hematochezia before surgery, especially blind ascending colon cancer. Because it is difficult to find, has a long course of disease and has clinical manifestations of chronic blood loss, preoperative anemia is more serious. Many patients worry about their poor health and cannot tolerate the surgery. Blood transfusion before surgery to improve nutritional status. It has been reported that although blood transfusion before surgery can improve anemia, it can cause autoimmune suppression in the body, promote tumor growth, and affect the patient's surgical efficacy. Therefore, as long as hemoglobin exceeds 7 grams before surgery, surgery can be accepted. Anemia will not really recover until the tumor is surgically removed. Appropriate preoperative blood transfusion can be considered if it is less than 7 grams.
Misunderstanding 5: It is found that there is liver metastasis before operation, and the operation is meaningless
Liver metastasis, for patients, is already at an advanced stage. How significant is the surgical resection of the primary tumor? Among all liver metastases that occur in cancer, the treatment of liver metastasis from colorectal cancer has the best effect. First, about 10%-15% of patients have the possibility of surgical resection of metastases. The median survival time of these patients is about 35 months, and the 5-year survival rate can reach 30%-40%. Secondly, because chemotherapy drugs are very sensitive to liver metastasis of colorectal cancer, another 15% of patients with liver metastases who were previously inoperable have obtained a second chance to surgically remove the primary tumor after chemotherapy. Therefore, surgery is the first choice for patients with liver metastases from colorectal cancer. Under the guidance of a doctor with professional experience, the liver metastases should be carefully evaluated before surgery. For unresectable colorectal cancer with liver metastases, you can choose to surgically remove the primary tumor of colorectal cancer, and then give the patient an active comprehensive treatment. Studies have reported that the median survival of patients who have removed the primary colorectal cancer lesion combined with other chemotherapy and radiotherapy can reach about 20 months, and the 3-year survival rate is as high as 35%, and the median survival of abandoning the primary tumor surgery and chemotherapy alone The period is only 6.9 months, and the 3-year survival rate is only 13%.
Misunderstanding 6: Give up treatment if cancer relapses after chemotherapy and chemotherapy is invalid
With the advancement of science and technology, patients who are ineffective with traditional chemotherapy or who relapse after chemotherapy can choose biological targeted therapy. The so-called biological targeted therapy is like a "biological missile." Such drugs will specifically select the "special location" of the tumor to play the role of the drug, directly inhibit the growth of the tumor or cut off the "nutrient supply" of the tumor. Good tumor treatment. In addition, some patients with local recurrence or liver and lung metastasis can still get the opportunity of surgical resection.
Misunderstanding 7: Patients with acute intestinal obstruction need abdominal colostomy
Acute intestinal obstruction is a sudden inability to "defecate and exhaust", and the patient has symptoms such as abdominal pain and fever. About 70% of patients with acute intestinal obstruction are caused by late-stage obstruction of colorectal cancer, and 20% of patients with colorectal cancer start with acute intestinal obstruction. The traditional treatment method is to remove the colorectal cancer lesion and cannot reattach it, but can only do abdominal colostomy, "feces are discharged from the belly", the patient is very painful and the quality of life is seriously affected. At present, the development of endoscopic technology can completely avoid colonic abdominal wall fistula. First, choose endoscopic intestinal obstruction catheter and metal stent drainage. After the obstruction is relieved, the first-stage radical surgery is performed after the intestine is cleaned, which not only avoids the patient's abdominal wall and colon The suffering of fistula, and it increases the thoroughness of the operation, which greatly helps the patient's comprehensive curative effect.