Colorectal cancer has no symptoms at the early stage, or the symptoms are not obvious, only feeling uncomfortableindigestion、Fecal occult bloodEtc.With the development of cancer, symptoms gradually appear, which are shown asChange of stool habits、abdominal pain, blood in stoolAbdominal mass、intestinal obstructionWait, with or withoutanemia、feverAnd emaciation.tumourBecause of metastasis and infiltration, the affected organ may be changed.Colorectal cancer shows different clinical symptoms and signs due to its different location.
The main clinical symptoms of the right colon areAnorexia, nausea, vomiting, anemia, fatigue, abdominal pain.Right colon canceriron-deficiency anemia, showing fatigue, fatigue, shortness of breath and other symptoms.Right hemicolineIntestinal cavitywide,tumor growth Abdominal symptoms do not appear until a certain volume is reached, which is also one of the main reasons for the late staging of tumors when they are diagnosed.
The left colon cavity is narrower than the right colon cavity, and the left colon cancer is more likely to cause complete or partial cancerintestinal obstruction。Intestinal obstruction leads to change of stool habits, constipation, bloody stool, diarrhea, abdominal pain, abdominal spasmabdominal distentionEtc.Stool with fresh bleeding indicates that the tumor is located at the end of the left colon or rectum.The diagnosis of disease stage is often earlier than that of right colon cancer.
The main clinical symptoms of rectal cancer are bloody stool, change of bowel habits and obstruction.Those with low tumor position and hard fecal mass are prone to bleeding due to friction of fecal mass, which are mostly bright red or dark red. They are not mixed with formed feces or attached to the surface of fecal column, and are misdiagnosed as "hemorrhoid" bleeding.Focal irritation and mass ulcerSecondary infection, constantly causingDefecation reflex, easy to be misdiagnosed as“enteritis”Or“Bacillary dysentery”。The circular growth of the cancer will lead to the narrowing of the intestinal cavity. The early manifestation is the deformation and thinning of the fecal column, and the late manifestation is incomplete obstruction.
4. Tumor invasion and metastasis
The most common form of invasion of colorectal cancer is local invasion. The tumor invades surrounding tissues or organs, causing corresponding clinical symptoms.Anal incontinence, lower abdomen andLumbosacral regionPersistent pain is caused by rectal cancer invading the sacral plexus.tumor cellThe implant is transferred to the abdominal and pelvic cavity, forming corresponding symptoms and signs,Digital rectal examinationIt can touch the mass in the vesicorectal fossa or the uterorectal fossa. The tumor is widely planted and metastasized in the abdominal and pelvic cavity, formingAscites。There are two main ways of distant metastasis of colorectal cancer: lymphatic metastasis andHematogenous metastasis。Tumor cells passlymph glandTransfer tolymph glandIt can also be transferred to liver, lung, bone and other parts through blood.
ColonoscopyYes willFiber colonoscopeReach into the beginning of colonIleocecal part, check colon andrectumIntestinal cavityAnd perform biopsy and treatment during the examination.ColonoscopyCheck barium comparatorenemaX-rayMore accurate, especially for small colonpolyp, removed by colonoscopy in parallelPathologydiagnosis.The removal of benign polyps can prevent them from turning into colorectal cancer, and cancerous polyps can help to make clear diagnosis and treatment.
Biopsy for colorectal cancer, especiallyEarly cancerAnd polyp canceration, as well as the differential diagnosis of lesions, is of decisive significance, which can clarify the nature of tumorsHistologyType, malignant degree and judgmentprognosisAnd guide clinical treatment.exfoliative cytology accuracyIt is difficult to obtain satisfactory specimens and has few clinical applications.
fourScreening method
There are two traditional methods for early screening of colon cancer: one isFecal occult blood testSecondEnteroscope。faecesDNAIntestinal cancer detection is a new screening method, which can detect the overall intestinal cancersusceptibilityUp to 84.22%,SpecificityUp to 97.85%.It can detect the progress period with a diameter of more than 1cmadenomaAnd intestinal cancer focus, timely detect the early stageIntestinal cancer gene mutation。[1]
In the prevention and treatment of colorectal cancer,GastroenterologyConduct colorectal surgery regularlyAdenomatous polypOn the basis of screening and endoscopic treatment, it participated in the national key science and technology support project "NationalColorectal polypsManaging Projects ".And carried out fecal DNADetection technology, by detectingExfoliative cellGene mutation to screen colorectal cancer andPrecancerous lesion, for colorectal cancerHigh risk group, perform colonoscopy, ultrasound colonoscopy and other examinations to improve the early stageColon cancerDiagnosis and treatment rate.[2]
1. The treatment plan for colon cancer is mainly surgical resectioncombined treatmentProgramme.Stage I, II and III patients often use radical resection+regionlymph glandSweep, determine the scope of radical resection and operation mode according to the location of the cancer.In case of phase IV patientsintestinal obstruction, seriousintestinal hemorrhageNot yetradical operation, palliative resection is feasible to relieve symptoms and improve patientsQuality of life。
tworectal cancerRadical treatment is based on surgery.rectumThe operation is more difficult than colon.Common surgical methods include: transanal resection (near the anal margin in very early stage), total rectumMesenteryExcision, low anterior resection, transabdominalAnal sphincterAbdominoperineal resection.For stage II and III rectal cancer, preoperative radiationChemotherapy, Zoom Outtumour, reduce the local tumor stage, and thenRadical operationtreatment.
combined treatment
1. Auxiliary chemotherapy
OxaliplatinunionFluorouracilThe regimen of 5-fluorouracil (5-FU) is the standard treatment regimen for patients with stage III colorectal cancer and some colorectal cancer with high-risk factors, and the treatment time is 6 months.Applicable to patients who do not receive new assistance before operationRadiotherapyEighty five percent of rectal cancer patients need adjuvant radiotherapy after operation.
2. IV Treatment of colorectal cancer
It is mainly a comprehensive treatment scheme based on chemotherapy,chemotherapyDrugs include 5-fluorouracilCapecitabine, OxaliplatinIrinotecanBevacumab, cetuximabPanizumabAnd other drugs. Common chemotherapy schemes include FOLFOX, XELOX, FOLFIRI, etc., which are combined as appropriate based on chemotherapyTargeted drugsTreatment (bevacizumab, cetuximab, panizumab).
