2009 Jingshan TV Station Science Lecture
At present, the incidence of colorectal cancer in China is increasing year by year. The number of new cases is about 130,000 to 160,000, and the death toll is about 60,000 to 90,000, mostly in large and medium cities. Among gastrointestinal tumors, it is second only to gastric cancer. The high incidence of colorectal cancer in China is over 50 years old. However, the proportion of young people suffering from colorectal cancer has been rising in recent years, and there are more men than women.
Moderator: What kind of disease is colorectal cancer?
Answer: As the name implies, colorectal cancer is a malignant tumor that occurs in the large intestine. It is called rectal cancer in the rectum. This is also the most prone part of the large intestine to develop malignant tumors. It accounts for about 50% of colorectal tumors. It occurs in the colon and is called colon cancer. The sigmoid colon and ascending colon are also prone to tumors, accounting for about 40% of colorectal tumors. Medical research has proved that colorectal cancer can be prevented because it is a process of gradual occurrence and development, and there is an understanding of its etiology. I think it can be prevented.
Moderator: Since it is said that colorectal cancer can be prevented, what are the reasons that make a normal body cause the lesions of colorectal cancer?
Answer: Colorectal cancer is a malignant tumor that is completely related to lifestyle. The most important thing is related to diet. For example, when we were relatively poor in the past, we ate more vegetables instead of protein, fish, and meat. At that time, the incidence of colorectal cancer was 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. Therefore, the incidence of colorectal cancer has increased a lot over the years, mainly because we eat. Too much high-protein, high-fat, large reduction of vegetables. These high-protein, high-fat foods are easy to differentiate through bacteria in the intestines, and can produce some so-called toxins, which are a stimulating factor that can induce bowel cancer. We eat pickled, smoked, and fried foods, which significantly increase the probability of colorectal cancer. Generally speaking, the risk can be increased by two to three times. In fact, we are not saying that high-protein and high-fat foods cannot be eaten, but we should limit the amount of it, because a certain amount of protein and fat is still needed by our body, so we should eat some fat and protein, but we must add appropriate Vegetables and fruits, because there are a lot of fiber and vitamins in vegetables and fruits, can reduce the concentration of carcinogens and reduce the occurrence of tumors. Especially those high-fiber vegetables may be better, such as celery, leeks, water spinach, etc., which are rich in cellulose, which can stimulate the intestinal motility, increase the frequency of bowel movements, and reduce the effect of toxins on the intestinal wall. The pickled, smoked, and fried foods really taste good and can be eaten, but try to eat as little as possible.
Moderator: Actually, there are many reasons for a healthy body to produce disease. What other reasons are there?
Answer: Some people with colorectal cancer have an obvious family history. About 20 to 30% of people have this condition. Simply put, some colorectal tumors are hereditary tumors, that is, your family has hereditary bowel cancer. If you have a very high proportion, even 50%, 80% will be affected. The second case is that there is a colorectal cancer patient in this person, and he has more chances of developing colorectal cancer than others. Therefore, genetics is still very closely related to colorectal tumors.
Moderator: How can we find and get treatment earlier? It should belong to the category of prevention?
Answer: Colorectal cancer actually takes a long time from occurrence to development to cancer. So in such a process, if we can find it early, if we deal with it in time, it will be different. Simply speaking, we From a normal intestinal mucosa to a colorectal cancer, it usually takes at least five years, most of which takes nearly 10 years, so it first manifests as a small benign proliferative change, and then becomes a benign The polyp gradually becomes cancerous. If we can find it at the stage of polyp, then of course it will be resolved. It will not become cancer at all. Second, if you become cancerous, I discovered it very early If it is resolved, the effect will be very good, so if we can deal with it early, it is indeed different, and the same is true in terms of the therapeutic effect.
How to detect colorectal cancer early? First of all, check whether the stool is bloody and pus; secondly, whether you have a dull pain in the abdomen, or other uncomfortable feelings, and whether you have constipation or alternate constipation and diarrhea, and then look at the stool Are there any changes in traits, such as thinning or flat stools, and whether your bowel habits have changed, such as increased stool frequency or increased bowel intentions, and there is always a feeling of uncleanness. If you have anemia or weight loss for unknown reasons , Fatigue, low fever, etc., also be vigilant.
Colorectal cancer needs 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. I think this is the biggest key in the treatment of colorectal cancer, because we know that in terms of the treatment effect, We can cure 90% to 95% of the first-stage colorectal cancer, which means that it is basically cured. So if we find the first-stage patients, then our effect will be very good, but if it reaches the advanced stage Because of deep infiltration or metastasis, the quality of life of the patient is low and the prognosis is poor. So early detection is very important.
Moderator: What is the difference between digital anal examination and colonoscopy?
Answer: Digital anal examination is a very simple and effective method. As a prevention of colorectal cancer, I think it is a very simple and effective method. It can be said that it costs almost no money, just wear a glove and touch it. How much can be found The chance of colorectal cancer, that is, in the past, when rectal cancer was very common, an anal finger examination can detect 50% of colorectal cancer, which means that 50% of colorectal cancer is 8 cm away from the anus, so I I feel that 50% of the chances of colorectal cancer can be detected by me. Of course, the proportion of rectal cancer is slightly less now, but if an anal finger examination can detect about 30% of colorectal cancer, the anal finger examination is simple It is effective again, but you can only detect 30% after all. If you want to really complete the entire large intestine examination, it must be colonoscopy. Colonoscopy is a bit painful. People who have had colonoscopy experience have a deep understanding. However, with the continuous development of technology, new technologies have been continuously developed in recent years, such as a painless colonoscopy. The short-term anesthesia is done when you wake up. You don't know it. This is also a widely used method. Colonoscopy can not only see where the tumor is, but it can also take pathology and make a clear pathological diagnosis. At the same time, it can also treat small benign tumors without surgery. For example, it can grow to 0.5 cm and go directly through the endoscope. It’s done, even two or three centimeters can be done.
Now our country sets the standard for colorectal cancer screening. Generally speaking, colonoscopy is performed routinely at the age of 50. If there is no problem, then it will be done once every five years. If there is an adenoma, it is a benign tumor. It may be every two or three years; if there is a family history, it must be raised to 40, or even 30 years old to start the first colonoscopy, and his frequency is not five years, it is two to two. once three years.
Moderator: I have also discovered a phenomenon. In the early stage, many people think that his physical condition is similar to hemorrhoids or other symptoms, but the result is a delay in time?
Answer: We often encounter this kind of patients. We misdiagnose a patient with bowel cancer as hemorrhoids. A case that could have been detected early may be delayed to a late stage. The patient came and said that I had blood in my stool. This doctor could not be serious and unwilling. Zhang Shou did an anal finger examination and said it was probably hemorrhoids, so it was delayed. We can see the data at the National Colorectal Cancer Conference show that there are 38 to 96% of different reports, there is a chance of misdiagnosis, and the average misdiagnosis That's 50%. In our clinical practice, we found that most of the patients who were admitted to us for treatment were delayed by ourselves for a while, and the other was that they went to the hospital and was delayed by the doctor. Such hospitals are often relatively small hospitals, so Delayed treatment, generally if you go to a large hospital specialist hospital, this opportunity will be much less.
Moderator: Let’s not confuse certain diseases with colorectal cancer. Which ones are easier to confuse?
Answer: I just mentioned a problem of hemorrhoids, because blood in the stool is one of the common symptoms of colon cancer, and patients have diarrhea or constipation. They always think that they are dysentery or enteritis, and treat it as an inflammatory disease. , Take some anti-inflammatory drugs, so it’s delayed. Generally speaking, once the patient has these similar symptoms, if there are more than two weeks of unknown cause, it is best to find an experienced specialist for a diagnosis and treatment. In this case It will be very helpful for you to diagnose this disease.
The early symptoms of colorectal cancer are very secretive and easy to be ignored. In fact, it usually takes 3 to 12 months from the appearance of discomfort to the diagnosis of colorectal cancer. Almost all patients will be diagnosed as hemorrhoids, enteritis, ascariasis or ascariasis by themselves or their doctors. Gastric disease and other tortuous experiences, the current early diagnosis rate of colorectal cancer is less than 20%, which is closely related to the following factors. First, the lack of personal attention, many people think that hemorrhoids are a small problem, not a big deal, but they don’t know that hemorrhoids are not terrible. The scary thing is rectal cancer that hides behind the hemorrhoids; second, the patient lacks medical knowledge, self-diagnosis based on experience, and self-medication; third, doctors deal with it based on experience, lazy to do digital examinations or colonoscopy, and delay diagnosis. It seems that early diagnosis of colorectal cancer requires everyone's high vigilance and attention.
Moderator: I feel that in treating colorectal cancer, it is not necessary to perform surgery. It seems that a lot of disciplines are needed to cooperate?
Answer: Yes, for example, in the past, objectively speaking, about 90 years ago, it was basically a knife problem. It would be fine if the knife can be opened. However, after the 90s, chemotherapy drugs have developed greatly. For example, For stage III bowel cancer, if you only have surgery without chemotherapy, that is about 50% chance of being cured, but if you use chemotherapy, you can increase it to 65 to 70%. I think this is still very valuable. Of course, in our clinic, we often encounter some patients who report hair loss and vomiting. I don't want to treat it, but objectively speaking, it is indeed worthwhile for you to improve such opportunities. In the past, the era of surgery alone has passed. We generally talk about team work and make the best use of various methods to achieve the best results.
Moderator: Many chemotherapy patients will experience hair loss, including some symptoms of infection. Will the benefits of chemotherapy outweigh the disadvantages?
Answer: There is no doubt that the benefits of chemotherapy far outweigh its harms. Adverse reactions during chemotherapy are common, but experienced doctors can handle them well, and they must be controlled within a relatively acceptable range. The patient can bear it and spend it safely. A large number of studies have proved that for elderly patients, the same adjuvant treatment can improve the curative effect. Hair loss may be unavoidable, but once the chemotherapy is stopped, the hair will grow out, and even Grow better and more beautiful hair.
Moderator: Surgery for rectal cancer may affect the function of the patient's anus. Many people will mention the problem of anus preservation, and for many problems, it may affect their quality of life after surgery?
Answer: This is indeed a very difficult problem. Many patients are very worried about this problem. We can often encounter anal diversion and I will not open it. I would rather die but not open it. They are worried about the impact of anal diversion, objectively Speaking, some people even strongly demanded, you just prescribe it for me, and you connect it again. I don’t care if this recurrence or not. In fact, this is not good. If the anus is forcibly preserved, the scope of resection will be smaller. Recurrence often recurs quickly. This recurrence is very difficult to treat and the effect is very poor. In fact, if the anus is rerouted, the quality of life is not as bad as many of us think. Foreign studies have shown that a group of low-level Rectal cancer undergoes anal diversion, and another part of patients undergoes anal preservation treatment. Comparing the quality of life between the two groups, it is found that the people with anal diversion have a good quality of life. Because of the lower anus preservation, anal function is poor and bowel control is not good. Stool is exposed in the anus, so I can’t get out of the Tiantianmen, but the real anus is changed. There is a bag and a sticker. Most people can live a normal life and return to work. I think this problem is hoped for such patients , Able to actively treat.
Moderator: Finally, we have a few questions. What should I pay attention to after the first question?
Answer: Surgery is definitely the most important step. After this step, chemotherapy or radiotherapy is required. If chemotherapy or radiotherapy is no longer needed, we must consider regular follow-up in this case. In fact, follow-up is also a very important part of our treatment. Generally, we have a rule, every three to six in the first two years Have a checkup once a month and a CT checkup once a year. There are some guidelines for us to tell our doctors how to do it. In clinical practice, many patients will see bye after seeing the hospital and never come to the hospital. In fact, it is very bad, because the follow-up process is the continuation of the treatment. After you finish the treatment, the tumor may recur first, and secondly, there may be some uncomfortable conditions. Thirdly, new tumors can occur. During the follow-up process, the doctor can check in time to find that you have a recurrence. If the recurrence is early, it can be treated with good results.
Moderator: How to avoid metastasis or recurrence of colorectal cancer after recovery
Answer: Regarding the prevention of metastasis and recurrence, this is a very complicated topic. For example, the most fundamental thing we just talked about is early detection and early treatment. This is the best way to prevent metastasis and recurrence. We cut it off early. It is not easy to metastasize. Once the disease has reached the relatively middle and advanced stages, although surgical resection is performed, the chance of recurrence and metastasis will be significantly increased. So we say that you need to have colonoscopy, stool occult blood test, etc. . Tumor recurrence is only a possibility. CT, B-ultrasound and other imaging examinations are necessary, and the tumor must be seen to confirm that it is a recurrence. Therefore, in this case, we can only say to maintain a good attitude and often find a doctor for follow-up , Close follow-up is a treatment in itself, don’t worry too much.
Host: We very much hope that through such a program, we can raise everyone’s awareness of disease prevention, so that everyone can stay away from disease and protect their health. At the end of the program, we will send blessings to the audience in front of the TV.