At present, there seems to be a phenomenon around us. There are more and more cancer patients. Many of our colleagues and friends will find various malignant tumors, especially colorectal cancer, and not only the elderly but also the young. People also get cancer, and cancer seems to have a high incidence. From the current clinical treatment situation in our hospital, 80% of the inpatients in our colorectal surgery ward have colorectal cancer. The hospital has an average of 2-3 colorectal cancer operations per day, and most of them are advanced colorectal cancer in the middle and late stages. The situation of colorectal cancer prevention and treatment is very serious. Need to attract our attention.
Authoritative data: First, the global incidence of cancer is rising. Whether in cities or rural areas in China, malignant tumors have ranked first in deaths since 2007. The incidence of malignant tumors in the country is 235 per 100,000, but Shanghai is already 274 per 100,000 is much higher than the national level. This is a very high figure. With the improvement of urban modernization, the improvement of living standards, changes in lifestyle, changes in diet, chicken, duck and fish are high in calories, fat, and high. With the increase in protein food intake and the aging of the population, the problem of high incidence of tumors will become more and more prominent, which deserves our attention.
So in China, the annual average number of new cases of colorectal cancer in China is 130,000, and the annual growth rate is increasing by 4%. The incidence of colorectal cancer in cities is 2-3. Young people under 40 suffer from the disease. The proportion of rectal cancer accounts for about 20% of the total number of colorectal cancers. The incidence of colorectal cancer in Shanghai is 54/100,000. China has entered the ranks of areas with high incidence of colorectal cancer. The high incidence and mortality of colorectal cancer are increasingly threatening people's physical and mental health.
Let us look at the situation in a developed country like the United States. The United States is also a country with a high incidence of colorectal cancer. From the data in 2001, the incidence of colorectal cancer was as high as 61 per 100,000. Since 2001, the incidence and mortality of colorectal cancer in the United States have been For 20 consecutive years, it has continued to decline at a rate of 3%; the 5-year survival rate for colorectal cancer has increased from 50% to 70%. It is a very big achievement. Why has the incidence and mortality of colorectal cancer in the United States dropped so significantly? In fact, the public health system and medical institutions have done a lot of work in the prevention and treatment of colorectal cancer, mainly the three-level prevention measures for colorectal cancer have played an important role. Their successful experience tells us that colorectal cancer is preventable and curable.
Simply speaking, it takes at least five years to change from a normal intestinal mucosa to a colorectal cancer, and most of them take nearly 10 years. 80% of colorectal cancers have some adenomas and polyps. The normal intestinal mucosa first manifests as small benign hyperplastic changes, then becomes a benign polyp, and then gradually becomes cancerous. If we can find it at the stage of polyp, then of course it will be solved. It won’t become cancerous. Second, if you become cancerous and I discovered it early and resolved it, the effect will be very good and it can reach the standard of cure. Colorectal cancer actually develops from occurrence to cancer. It is a very long process. It provides time and opportunities for our prevention work. Compared with other tumors, such as lung cancer, liver cancer, pancreatic cancer, etc., for colorectal cancer In other words, we have more methods to prevent, and the control of colorectal cancer is actually much more important than treatment.
Therefore, colorectal cancer can be prevented. The incidence of colorectal cancer ranges from normal mucosa to hyperplastic polyps, to adenomas, to early cancers, to advanced cancers. From the perspective of this whole process, primary prevention, secondary prevention, Tertiary prevention is involved in different stages. The ultimate goal of tertiary cancer prevention is to reduce the incidence and mortality of cancer. So what is the tertiary prevention of colorectal cancer?
The prevention of the cause of primary prevention is a very important stage of prevention and treatment; to prevent the occurrence of cancer, the cause of cancer must first be removed. What is the cause of colorectal cancer? Scientific research shows that colorectal cancer is completely related to lifestyle Malignant tumors are mainly related to dietary structure. It can be said to be a disease of wealth. For example, when we were relatively poor in the past, we ate more vegetables and seldom ate protein or fish. At that time, colorectal cancer The morbidity rate is very low, but our living standards have improved over the years, and we have eaten better. As a result, the problems with eating have increased. On weekdays, we eat less vegetables and more meat.
1. We eat too many high-protein and high-fat foods. It is easy to differentiate through bacteria in the intestines and can produce some so-called toxins. It is a stimulating factor that can induce bowel cancer, like we eat pickled and fried foods. These, these all significantly increase the probability of colorectal cancer,
2. High-protein and high-fat foods tend to increase the secretion of bile acids in the intestine, and the latter can cause irritation and damage to the intestinal mucosa.
3. In addition, we have eaten too much sperm and the intestinal peristalsis is too slow, so that the feces stay in the intestine for too long, leading to the accumulation of carcinogens. In the long run, it will naturally induce malignant transformation of intestinal cells. In fact, we are not talking about high-protein and high-fat things. It can’t be eaten, but we should limit its amount, because certain protein and fat are still needed by our body, so we should eat some fat and protein that we should eat, but we must add appropriate vegetables and fruits, because vegetables and fruits There are a lot of fiber and vitamins. High-fiber vegetables, such as celery, leeks, and water spinach, can stimulate bowel movements and assist large bowel defecation. On the other hand, fiber in the intestine can also absorb carcinogens in food residues, dilute and reduce the intestine The concentration of carcinogens in the tract, so if you want to prevent bowel cancer, you must eat more fruits and high-fiber vegetables.
2. Change your lifestyle
① Too little physical activity and obesity are risk factors for colorectal cancer. Physical activity can affect colonic peristalsis and facilitate fecal discharge, thereby achieving the effect of preventing colorectal cancer. Insist on proper exercise and maintain a suitable weight.
②The relationship between smoking, alcohol and colorectal cancer is not very sure, but smoking and alcohol are risk factors for colorectal adenomas, and it has been confirmed that reducing alcohol intake will help prevent colorectal cancer.
④ Maintaining a healthy and happy mental state also helps prevent cancer.
We earnestly improve our lifestyle, reduce the intake of high-protein, high-fat, fine, pickled and smoked foods; increase the consumption of vegetables, fruits, and whole grains; reduce smoking and excessive drinking; strengthen exercise, reduce obesity, and prevent colorectal cancer from the cause occur.
We all know that many colorectal cancers have some benign colorectal lesions that gradually evolve over a long period of time, such as colorectal adenomas, polyps, colitis, etc. We call them precancerous lesions and actively treat precancerous lesions. If we can treat and cure these precancerous lesions early, they will not develop into colorectal cancer and reduce the incidence of colorectal cancer. In addition, for colorectal cancer that has occurred, we must strive for early detection, early diagnosis, and early treatment as possible. Early treatment of malignant tumors can be cured. Compared with advanced colorectal cancer, its treatment cost, treatment difficulty and treatment effect are all Very big gap
So what we call secondary prevention actually contains two aspects. 1 Active treatment of precancerous lesions 2 Early diagnosis and early treatment of colorectal cancer Screening and screening of healthy people is an important means of secondary prevention. Anyone has a chance to get cancer. Popularize more cancer prevention knowledge and health knowledge, so that everyone can participate in the secondary prevention of cancer.
(1) Treatment of precancerous lesions In our population, there are many people suffering from colorectal adenoma polyps and colitis. 20% to 30% of people are likely to develop benign adenomas, which requires attention. 80% of the large intestine Cancers are all transformed from colorectal adenomas. From a normal intestinal mucosa to a colorectal cancer, it usually takes at least five years, most of which take nearly 10 years, so it first manifests as small benign hyperplasia The sexual change then becomes a benign polyp and then gradually becomes cancerous. If we can find it at the stage of polyp, then of course it will be resolved, and it will not become cancerous at all. Second, if you become cancerous, I found it very early and resolved it, then the effect will be very good. This kind of early cancer can easily reach the standard of cure. Surgery alone is enough and no other radiotherapy or chemotherapy is needed. , So if we can deal with it early, it is indeed different, and it is also the same in terms of therapeutic effects.
At the stage of removing precancerous lesions, there is a five to ten year chance to reduce the chance of tumors. So we want to thank colonoscopy, which can not only search for tumors, but also characterize the tumors, but also cut off the adenomas. There is such a study in the United States. They have regularly performed colonoscopy for 100,000 people. If adenomas are found, they will be removed in time. A few years later, the risk of colorectal cancer in this population has been reduced by more than 80%.
(2) Pay attention to colorectal cancer screening and general survey
How can we find precancerous lesions of the large intestine? How to find early cancer? At present, referring to some successful experiences in European and American countries, it is to actively carry out screening census for colorectal cancer in healthy people. Screening and census abroad started in 1975, and developed countries in Europe and the United States have gradually begun. Their screening method is basically a combination of fecal occult blood and colonoscopy, and screening has a clear effect on reducing the mortality of colorectal cancer. Our countries such as Shanghai, Beijing and Tianjin are also formulating such screening census standards. Generally speaking, starting at the age of 60, it will be done every five years. If there is an adenoma, it is a benign tumor, it may cost two. Once every three years, if there is a family history, the first one is not 50 years old, then raise to 40 years old and start the first examination. At the same time, his frequency is not five years, it is every two to three years. For example, some people have a history of bowel cancer, and other siblings or children need to undergo related examinations. This will help us to find some potential patients who may have undergone cancer or are in the precancerous stage. It can be diagnosed and treated early.
The screening of colorectal cancer in Shanghai has made the screening of colorectal cancer in Shanghai an important project of the "Twelfth Five-Year Plan". The target population is 50 to 74-year-old adults in Shanghai who have passed stool occult blood to the questionnaire and designated hospitals Inspection. In 2013, more than 1.1 million people were screened, more than 9,500 cases of precancerous lesions were treated, and 914 cases of malignant tumors were treated, accounting for 40% of the early stage. This is very An important change. Although the social health service system paid a certain fee for a large-scale screening survey, it has significantly reduced the incidence of colorectal cancer and the proportion and number of advanced colorectal cancer. We know that surgery for advanced colorectal cancer, The cost of radiotherapy and chemotherapy is very high, which is a great burden on the family and society. The expenditure on screening and census is quite cost-effective, saving medical resources, medical insurance costs, and social burdens. Although this type of colorectal cancer screening census has not yet been carried out in most tier-2 and tier-2 cities, our audience and friends should increase awareness of health care, pay attention to intestinal symptoms, and prompt colonoscopy if there are problems. Many of the early-stage cancer patients in our ward were found by physical examination, and the treatment effect was very good.
Emphasize that some special groups of people should focus on. Medical research has proven that colorectal cancer is not only closely related to diet and lifestyle, but also genetic factors are also very important. People with a family history of colorectal cancer are susceptible to cancer. It must be monitored regularly. Even if there is a bowel cancer patient in this family, he is more likely to develop bowel cancer than others, and heredity is still very closely related to colorectal cancer. We are all hospitalized patients with colorectal cancer to understand the family history. If there are multiple people in the patient’s family with colorectal cancer, we recommend that all the immediate family members go for colonoscopy. Indeed, patients with colorectal adenoma and colorectal cancer have indeed been found.
In the second case, some people with colorectal cancer have a clear inheritance. There is a familial adenomatous polyposis. The patient has thousands of densely packed adenomas throughout the large intestine. It can develop in young people. After 45 years of age, almost 100% of them become cancerous. A total colorectal resection before the age of the year is clearly familial. For example, we treated a patient in the previous period. He had diarrhea all the year round. Colonoscopy found that there were a large number of adenomas in the large intestine, which was cancerous. Polyposis, cancer, and follow-up medical history. His father died of intestinal disease. Your immediate family should have a colonoscopy after 40 years old. As a result, during the operation of this patient, his sister heard from our doctor. After I was told, I had colonoscopy, familial adenomatous polyposis, hospitalized together, underwent full colorectal resection, after surgery, some of the pathological adenomas have become cancerous, such cases are not rare, so these colorectal cancers are genetic The population must be closely monitored.
(3) Pay attention to the danger signals of colorectal cancer
Early detection, early diagnosis, and early treatment. That is to say, if you find that you have symptoms, you have to make a clear diagnosis and treat it later. In this, I think early diagnosis of colorectal cancer is the most critical issue, because we know that in terms of treatment, it is simple Surgery can be cured. Even with the rapid medical development of advanced bowel cancer, some patients are still unsatisfied with the comprehensive use of various methods, so early detection is very important. Early diagnosis depends on people's own knowledge of colorectal cancer, and understanding of the symptoms of colorectal cancer in the early stage
How to detect colorectal cancer early
1. First of all, check whether the stool is bloody, with pus. The blood is red or bright red, which is very similar to the symptoms of early internal hemorrhoids. In the later period, blood in the stool is mostly dark red, mixed with stool, mucus, blood, or pus.
The early symptoms of colorectal cancer are very secretive and easy to be overlooked. In fact, it usually takes 3 to 12 months from the appearance of discomfort to the diagnosis of colorectal cancer. Almost most patients will be diagnosed as hemorrhoids, enteritis, ascariasis or ascariasis by themselves or their doctors. Difficulty in early diagnosis rate for tortuous experiences such as stomach disease, one person does not pay enough attention to it. Many people think that hemorrhoids are a small problem and it’s no big deal. They don’t know that hemorrhoids are not terrible, but the scary thing is that patients with rectal cancer hidden behind hemorrhoids lack medical knowledge, self-diagnosis and self-medication based on experience. Maybe there are many people who have this kind of psychology, because they are afraid of illness, so they are more taboo from doctors or people around to give him such advice. He always feels that I may not have it, and even if he has symptoms, he does not go for examination He thinks it’s not necessarily a tumor. It may be fine after two years. The result is a delay in time. We often encounter this type of patient and misdiagnose a patient with bowel cancer as hemorrhoids. A case that could have been detected early may be To late.
The other is to go to the hospital and be delayed by the doctor. This kind of hospital is often a relatively small hospital, because blood in the stool is one of the common symptoms of bowel cancer, and patients have diarrhea or constipation, always thinking they are Treat dysentery or enteritis as hemorrhoids or inflammatory diseases. Take some anti-inflammatory drugs.It was so delayed. The patient came and said that I had blood in my stool. The doctor was not serious. He was unwilling to do an anal finger examination. He said it was probably hemorrhoids, so it was delayed. In our clinical practice, we found that most of them were The patients we admitted for treatment have been delayed by ourselves for some time. Generally speaking, once the patients have these similar symptoms, if there are more than two weeks of unknown cause, it is best to find an experienced specialist to do one. Diagnosis and treatment. Such words will be of great help to you in diagnosing this disease. Generally, if you go to a major hospital, this kind of opportunity will be much less.
2. The second thing is to see whether the stool characteristics have changed, such as the shape of the stool becomes thinner or flat.
3. In addition, do you have any changes in your bowel habits? For example, the frequency of bowel movements or the increase in bowel intentions, and there is always a feeling of uncleanness. Due to the secretions produced by rectal masses and their cancerous ulcers, intestinal irritation can occur, causing patients to have frequent bowel movements, incomplete defecation, tenesmus and other symptoms, but the discharge is mostly mucus, pus, blood, and stool shape. It has also changed, and the stool is getting thinner.
4. Next, do you have a dull abdominal pain or other uncomfortable sensations? And whether you have constipation or alternate constipation, diarrhea, and a lump in your abdomen?
5. In addition, unexplained anemia occurs. For unexplained weight loss, fatigue, and loss of appetite, patients must pay attention to and go to a professional hospital for examination and treatment.
If the patient observes himself more carefully, for example, we say that there are some blood in the stool and changes in stool habits. If you can catch these clues early, you should go for some related examinations and see some doctors. If so, I think you may find that the probability of early bowel cancer will be greatly increased.
Tertiary prevention and tertiary prevention actively treat 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, standard comprehensive multidisciplinary treatment, the complexity of colorectal cancer treatment, and the effectiveness of multiple methods require us to correctly choose the reasonable and most appropriate rehabilitation treatment plan to reduce tumor recurrence and/ Or transfer, prolong survival time, and put forward higher requirements for doctors. In Europe and the United States, colorectal cancer treatment doctors are colorectal surgeons who have received specialized training to obtain colorectal cancer treatment qualifications. I will soon introduce a colorectal cancer treatment admission system. We recommend that the diagnosis and treatment of colorectal diseases should go to a regular specialist institution to avoid treatment failures. Standardization, under-treatment, over-treatment, ensuring treatment effect
Every doctor is not only a healer but also a preventer! Only by disseminating the correct concepts of changing lifestyles, seeing a doctor in time, actively participating in screening surveys, actively treating precancerous lesions, and standardizing the treatment of clinical tumors, can the incidence and mortality of colorectal cancer be reduced, and the quality of life of colorectal cancer patients can be improved. .