Benign polyps evolve into regular bowel cancer screening key to survival

Article Feng Shuling, “Ming Pao“

Depending on the stage of colorectal cancer, regardless of the treatment and survival rate, regular screening is the key to improving the survival rate.

Colorectal cancer is also the most common cancer in Asian countries, second only to lung cancer.

(Hong Kong News) The causes of colorectal cancer are related to living and eating habits, age and family history. Most of them start as benign polyps and slowly develop into cancer over the years, while early colorectal cancer has no symptoms.

The large intestine is the last part of the digestive system and is divided into the colon, rectum and anus. The moisture and nutrients of the food are absorbed through the digestive system, and the remaining residue forms stool and is discharged through the anus.

benign polyps turning into cancer

Since the Hong Kong colorectal cancer screening program was launched in 2016, about 348,000 people have participated in the stool immunochemical test (fecal occult blood test), accounting for less than 10% of the target group (people aged 50 to 75), and the participation rate is low. More than 41,100 people tested positive in the first round of tests, and about 2,400 people were diagnosed with colorectal cancer.

Among the confirmed cases, preliminary analysis of 1,700 cases showed that about 57% belonged to early cases with a relatively high cure rate.

Dr. Li Zhaokang from the Department of Clinical Oncology pointed out that common symptoms of colorectal cancer include: change in bowel habits for unknown reasons, such as diarrhea or constipation, and last for more than 2 weeks; Persistent pain, bloating, fullness, or cramping; unexplained weight loss and tiredness.

However, the symptoms cannot be generalized, depending on the location of the tumor. “If the tumor is in the ascending colon or transverse colon, the patient may appear anemia first, followed by intestinal blockage; if the tumor is in the descending colon, sigmoid colon, or rectum, the stool will be bloody or obvious Mucus secretion, or change in bowel habits, or passing mushy stools instead of formed stools.”

He pointed out that if colorectal cancer is not treated early, the tumor will gradually grow and cause intestinal blockage, and the patient will have bloating and vomiting; cancer cells may also spread to other organs through the blood and lymph, “most of the time they will spread to the liver, lungs and bones. These organ functions are slowly affected, leading to failure.”

The current ostomy bag has less odor

He also reminded that colorectal cancer does not have any symptoms in the early stage, and early diagnosis can improve the chance of cure. “Everyone should pay attention to the changes in their bodies, and if they find any symptoms, seek medical examination as soon as possible.”

When a patient is suspected of having colorectal cancer, the doctor will usually use a colonoscopy to check whether there is a tumor and confirm the location, and at the same time remove the polyp or take a tissue test; secondly, computer scan, magnetic resonance or positron emission scan can help determine the stage of cancer number. “This is very important. Knowing the stage of the tumor can make a treatment plan for the patient.”

“Early colorectal cancer, the tumor is mainly removed by surgery;

For stage 3 colorectal cancer, it depends on the location of the tumor.

If the tumor is in the colon, chemotherapy will also be given after surgery.

When it develops to stage 4, because the cancer cells have metastasized,

The treatment plan is generally chemotherapy combined with targeted therapy to control the disease. “

When it comes to colorectal cancer surgery, the most worrying issue for patients is the artificial stoma. Li Zhaokang pointed out that in recent years, colorectal cancer surgery is mostly minimally invasive surgery, which can shorten the recovery period of patients and reduce the risk of complications; however, in many cases, rectal cancer patients need to install a temporary or permanent stoma after surgery. There is a peculiar smell, as long as the patient is properly cared for and cleaned, the patient can also live a normal social life, so there is no need to worry.”

Regular colonoscopy over 50 years old

The risk factors for colorectal cancer, Li Zhaokang said, are inseparable from bad living habits, including daily diet with less vegetables and more meat, lack of exercise, obesity, drinking and smoking; in addition, 50 years old, male, family history of colorectal cancer, long-term inflammation of the large intestine, etc. People also have a higher risk of colorectal cancer.

Therefore, to prevent colorectal cancer, over 50 years old should undergo regular colonoscopy screening, early detection and removal of polyps, to reduce the risk of disease; in addition, a balanced diet, less meat and more vegetables, regular exercise, quit smoking and alcohol.

According to the condition of the treatment plan, early diagnosis and treatment can improve the survival rate

Colorectal cancer is staged by the TNM system. T stands for tumor (tumour), which refers to the size of the tumor and the scope of invasion; N stands for lymph (node), which represents whether cancer cells have invaded nearby lymph; M stands for metastasis (metastasis), whether the tumor has metastasized to other organs. “

Colorectal cancer survival rates and treatment vary by condition.

Dr. Wu Jiaen from the Department of Gastroenterology and Hepatology pointed out that early detection and treatment are crucial to improving the survival rate. Patients should discuss their specific condition with their doctor to determine the best treatment plan.

Issue 0───────────────────────────────────────────────────────────────────────────

T: Cancer cells are limited to the mucosa of the large intestine and have not spread; also known as carcinoma in situ

N: No spread to lymph

M: no distant metastasis

Treatment: mainly endoscopic resection

5-year survival rate: up to 95%

Phase 1─────────────────────────────────────────────────────────────────────

T:

◆1A: Cancer cells have invaded the submucosa of the large intestine, but not the muscle layer of the large intestine wall

◆1B: Cancer cells have invaded into the muscle layer, but have not penetrated the wall of the large intestine

N: No spread to lymph

M: no distant metastasis

Treatment: surgical resection of the tumor, some patients may require adjuvant chemotherapy

5-year survival rate: 85% to 95%

Phase 2─────────────────────────────────

T:

◆2A: Cancer cells penetrate the wall of the large intestine

◆2B: Cancer cells penetrate the wall of the large intestine and invade nearby tissues

◆2C: Cancer cells penetrate the wall of the large intestine, invade nearby tissues, and reach the surface of the peritoneum

N: No spread to lymph

M: no distant metastasis

Treatment: mainly surgery plus chemotherapy, some patients need to add electrotherapy

5-year survival rate: 65% to 85%

Phase 3─────────────────────────────────────────────────────────────────────

T:

◆3A: Cancer cells invade lymph

◆3B: Cancer cells penetrate the wall of the large intestine and invade nearby tissues

◆3C: Cancer cells penetrate the wall of the large intestine, invade nearby tissues, and reach the surface of the peritoneum

N: spread to lymph

M: no distant metastasis

Treatment: Surgical resection plus chemotherapy, radiotherapy, or targeted therapy

5-year survival rate: about 50% to 65%

Phase 4───────────────────────────────────────────────────────────────────────

TNM: Metastasis of cancer cells to one or more organs, such as liver, lung, bone, brain, or distant lymph nodes

Treatment: Chemotherapy, radiotherapy and target therapy are the main treatments, and surgery is only auxiliary

5-year survival rate: about 10% to 15%

Cross the roadsevere asthma

Diagnosed with bowel cancerIssue 3

Helen was diagnosed with colorectal cancer at the age of 37. She recalled that one day she had severe asthma after hurriedly crossing the road. She felt that something was wrong with her body and decided to see a doctor.

A blood test revealed anemia. She then underwent a series of tests, including colonoscopy, and found a tumor in the colon. The doctor arranged surgery to remove the tumor.

“The pathology report after the operation indicated that there were cancer cells in one lymph node, and the colorectal cancer was stage 3, requiring chemotherapy.”

Exercise improves physical condition

Helen has received 8 rounds of chemotherapy. “I was prone to diarrhea at the beginning after the treatment, and then my intestines got used to it and there was no problem. However, after chemotherapy, I was very afraid of the wind and cold. I haven’t worn short-sleeved clothes to go out in the street for two years. Also often paralyzed, I thought it would be like this for the rest of my life.”

However, due to the COVID-19 epidemic, Helen mostly went hiking because she was unable to travel outside. “Exercise has greatly improved my physical condition; people are not so afraid of the cold, and the numbness of hands and feet has disappeared.”

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