[Special Topic on Colorectal Cancer]Patients with unhealthy lifestyles are becoming younger and colorectal cancer is the number one cancer killer in men.

Report◇Compiled by He Jianxing◇Liang Yingxiu

(Kuala Lumpur News) Colorectal cancer is the third most common cancer in the world and the number one cancer killer of men in Malaysia. It is also the most common cancer in women after breast cancer.

Fortunately, it is the only preventable cancer among many cancers. When polyps are found during colonoscopy screening and they are removed, it can prevent them from turning into cancer.

Cancer refers to mutations in human genes that cause cells to grow uncontrollably. Colorectal cancer can appear in different parts of the large intestine, including the ascending colon, transverse colon, descending colon, sigmoid colon, and finally the rectum. Therefore, colorectal cancer is actually the collective name for colon cancer and rectal cancer.

60% of patients are over 55 years old

Dr. Gan Ing Earn, Consultant of Hepatogastroenterology, pointed out that 60% of colorectal cancer cases occur on the left side (i.e., descending colon, sigmoid colon, and rectum), and the other 40% occur on the right side (i.e., ascending colon); Some medical studies have found that the reason why there are more cases in the left descending colon is that this part of the intestine is relatively narrow. Therefore, once carcinogenic chemicals touch the intestinal mucosa, they will adsorb and gradually form Polyps, or even tumors, can cause intestinal obstruction, causing patients to complain of discomfort.

“But at the same time, if polyps or even tumors appear on the right side of the ascending colon, they are often discovered later and are more difficult. This is the difference between the two.”

How is colorectal cancer divided into cancer stages? If it is in the first stage, the tumor will invade the submucosa (sub mucosa), but has not yet invaded the lymph nodes or metastasized far away. Since there is no nervous system here, the patient will not feel any discomfort; but in the second stage, In the early stage, the tumor will penetrate the submucosal layer to the tissues around the colon and rectum, such as the stomach, uterus, ovary or bladder, but will not invade the lymph nodes. However, because the surrounding tissues have a nervous system, the patient will feel some discomfort at this time. The most common Just stomachache.

In the third stage, the tumor has metastasized to lymph nodes, while in the fourth stage, distant metastases have occurred, including the brain, lungs, liver, and bones.

Colorectal cancer is the third most common cancer in the world, after lung and breast cancer. According to the latest data from the Ministry of Health, 15 out of every 100,000 men are suffering from colorectal cancer, and 11 out of every 100,000 women are suffering from colorectal cancer. As for the cancer-stricken age group, 60% are over 55 years old, and 60% are under 55 years old. 40%, and there is a trend of younger people.

Researchers in the United States have found that the rate of colorectal cancer among younger Americans is increasing by 2% per year. Although there is no similar study in Malaysia, from a clinical point of view, colorectal cancer patients do tend to become younger. The main reason is inseparable from the unhealthy lifestyles of modern men and women, including smoking, drinking, staying up late and even poor eating habits. good factors.

The study also found that there are more cases of colorectal cancer in European and American countries than in Asia, but Asian men and women develop cancer 10 years earlier than in European and American countries. The exact cause is still unknown.

Eating overnight meals is not related to bowel cancer

He reminded that when many people mention smoking, they think of lung cancer, but smoking (including e-cigarettes) affects not only lung cancer, but also brain cancer, kidney cancer, pancreatic cancer, and colorectal cancer. Alcoholic beverages are also carcinogens. From a doctor’s perspective, drinking alcohol will increase the risk of cancer, so drinking is definitely not encouraged.

“Processed foods (such as sausages or sausages) that can be seen everywhere in today’s society are also one of the common carcinogens; medical research has also found that if a person consumes too much red meat (that is, it is red before cooking), consumes too many refined carbohydrates or Unhealthy diets such as too much fat may also cause colorectal cancer.”

He pointed out that it is incorrect to say that overnight meals or overeating can cause colorectal cancer. If overnight meals are not properly handled, it will at best cause gastric problems. As for the damage caused by overeating, it is also related to gastric discomfort. .

In terms of personal immune system, staying up late, lack of exercise and long-term stress will affect a person’s immunity. Especially for people who have been stressed for a long time, the immune system will inevitably be damaged. “In fact, a person’s financial ability will also affect immunity, including whether the food he eats is nutritious enough or whether he lacks enough sleep.”

10% to 20% of cases inherited

He said that research has found that only 10% to 20% of colorectal cancer cases are hereditary, and more are caused by acquired factors. Therefore, if you want to avoid colorectal cancer, it is best to avoid the common carcinogens mentioned above.

“According to research, colorectal cancer and uterine and ovarian cancer belong to the same gene. Therefore, if there are close relatives in the family suffering from the aforementioned cancers, it is even more necessary to screen as early as possible to detect the presence of the cancer. And Lynch Syndrome (HNPCC) is also inherited in the family. People who carry this gene will greatly increase the risk of cancer and must be treated with caution. “

“It must be emphasized that the carcinogenic factors mentioned before only increase the chance of cancer, but are not the real causes of cancer. In the outpatient clinic, there are indeed some patients who do not have the mentioned carcinogens, but are diagnosed with colorectal cancer. , so it is necessary for everyone to understand the symptoms of colorectal cancer and take preventive measures based on the symptoms.”

“Colorectal cancer is caused by polyps or adenomatous polyps. It is harmless. It takes 8 to 10 years for polyps to deteriorate into tumors. If the presence of polyps can be detected in time during this period, then can truly prevent it.”

Symptoms begin to appear in the second stage

He said that although colorectal cancer has no special symptoms in the first stage, some symptoms will begin to appear in the second stage. The most common is blood in the stool. Generally, the blood is mixed in the stool. If it appears in the form of drops after defecation, If it is passed out, it may be caused by hemorrhoids.

“Because symptoms only appear in the second stage, most patients seen in the outpatient clinic belong to the second or third stage. In addition to blood in the stool, the patient’s defecation habits will also change. For example, he defecated once in the past three days. , changing to defecation every day, or changing from defecation every day to defecation once every three days, whether it is from more to less or from less to more, it is a change in defecation habits and is accompanied by symptoms of constipation or diarrhea. “

In addition, some patients will find that the stool becomes very thin, like a pencil, or it may become very thin. “The abdominal pain caused by colorectal cancer is also different from the general situation. It is usually concentrated in one point and the pain is excruciating. However, I have seen pain in more than one point in the outpatient clinic. It turns out that there are two tumors, but this kind of situation does not See more.”

“Being bloated and emaciated due to lack of appetite are also common symptoms of colorectal cancer. However, this type of lack of appetite is different from the elderly who often complain about a lack of appetite. Taking the latter as an example, people do tend to eat less as they age. , and even some elderly people only eat one meal a day, which may be affected by physical or psychological diseases (such as depression). Therefore, it is still necessary to test to identify the type of condition that causes lack of appetite.

Finding polyps through AI

Colonoscopy is a good helper for diagnosis

How to screen and diagnose colorectal cancer?

The most common screening test is Fecal Occult Blood (FOB), which is also a test currently promoted by the Ministry of Health for colorectal cancer. Its advantages are that it is cheap, convenient and non-invasive, but it is The disadvantage is that it is not accurate enough, and even if blood in the stool is found, it may be caused by other reasons such as hemorrhoids.

Yan Rongen said that with the deoxyribonucleic acid (DNA) test of blood and stool, these two tests will be more accurate, but the price will be slightly higher; the tumor marker test is also another screening method, with an accuracy of 30 % to 50%.

Colonoscopy without hospitalization

At present, the most accurate screening test is colonoscopy, which can see whether there are polyps or intestinal bleeding in the intestines. Because of this, in addition to being a screening tool, it is also a “good helper” in diagnosis and even resection. , and it has been developed to add artificial intelligence (AI). In other words, when doctors perform colonoscopy diagnosis, AI technology can also detect the presence of hidden and difficult-to-detect polyps, greatly increasing the chance of detecting colorectal polyps or tumors.

In the past, the error rate of this type of examination was 10%, but now with the assistance of AI and the addition of two-time colonoscopy examination (that is, taking two photos of the large intestine back and forth at the same time), the error rate has been greatly reduced. For this reason, it is now also Promote a point of view, that is, “high quality, white light, high definitions colonoscopy” (high quality, white light, high definitions colonoscopy). If a tumor is found after colonoscopy, computed tomography (CT Scan) and positron emission tomography (PET scan) will be used for further diagnosis.

Are there any restrictions on colonoscopy diagnosis? According to the operating instructions, the procedure can be performed on patients up to the age of 85, and no general anesthesia is required. Before the procedure, the patient must drink 3 liters of purified water to ensure that the intestines and stomach are clean. The diagnosis can be made after 3 to 4 hours. Generally, There is no need to be hospitalized. You can be admitted in the morning and discharged in the evening.

The first stage survival rate is 91%

He said that colorectal cancer is the only cancer that can be prevented. It is in the pre-cancer stage before polyps evolve into tumors. This period can be as long as 8 to 10 years. As long as the polyps can be removed during this period, then the disease will be cured. It is equivalent to eliminating the risk of cancer.

As for the 5-year survival rate after cancer, 91% in the first stage of colorectal cancer, 72% in the second and third stages, but drops sharply to 15% in the fourth stage. Therefore, the sooner you can pass the screening Detecting the presence of polyps is key.

Yan Rongen pointed out that it is helpless that patients with stage 4 colorectal cancer who are diagnosed late in outpatient clinics often have to spend huge medical expenses during the treatment process, and even endure the physical torment of the disease, which is very sad.

For this reason, as a gastroenterologist, he will encourage the public to do a good job in preventing colorectal cancer. Since colorectal cancer tends to occur at younger ages, current guidelines recommend that men and women undergo fecal occult blood screening once a year after the age of 45.

As for colonoscopy, it is recommended to have it done every 5 to 10 years. If some abnormalities are found during the first colonoscopy, doctors usually recommend that the patient undergo another colonoscopy after 3 to 5 years. If If there is no abnormality, it only needs to be inspected again after 10 years.

There are three types of surgeries Plan treatment plan according to patient’s condition

The treatment for colorectal cancer is still focused on surgical resection, radiotherapy (radiotherapy) and chemotherapy (chemotherapy). However, it is not a numerical question of choosing one or two of three. It depends on the patient’s condition to decide the treatment. What type of treatment.

Dr Tan Chih Kiang, clinical oncology consultant, pointed out that many times patients require more than one treatment, that is, surgery plus chemotherapy. In the cancer staging of colorectal cancer, the first, second and even third stages can be classified as early stage, that is, the cancer is still in the intestine and has not yet metastasized. Although the third stage is not very good, It is usually late in the fourth period.

Tumor rupture mistaken for appendicitis

“One of the causes of colorectal cancer is that originally harmless adenomatous polyps or polyps become cancerous. The large intestine is the last part of the human digestive system. It consists of the cecum, colon and rectum. It is composed of a ‘ㄇ’ shape in the abdominal cavity and connects the small intestine and anus. It can be further divided into ascending colon, transverse colon, descending colon, sigmoid colon, rectum and appendix.”

In terms of treatment, we start with the first stage of colon cancer. At this time, the doctor will recommend surgical resection first. In addition to the tumor itself, some surrounding tissues will also be removed. The reason for this is because it is difficult to see with the naked eye alone. To see whether the cancer cells have been completely eliminated, it must be confirmed through further testing. If necessary, part of the lymphoid tissue must be removed for testing or other scans.

“Generally, there are three ways for cancer cells to spread or metastasize, such as traveling beyond the intestines, or through lymphoid tissue and blood. Therefore, doctors will recommend that examinations be performed every 3 months in the first 3 years after surgery, including Endoscopy, because the first three years are the peak period for recurrence, and common tests include colonoscopy, blood test, ultrasound and CT scan.”

He said that for third-stage colon cancer, because the cancer cells have metastasized to lymphoid tissue, even if surgical resection is performed, the probability of recurrence is high, so 3 to 6 months of chemotherapy is generally recommended in order to reduce recurrence. .

As for the second stage, it is more special. At this time, the tumor has touched the intestinal wall or is stuck in the intestine, but has not metastasized to the lymph nodes. The doctor must diagnose whether it is high risk or low risk based on the test report. If it is the latter, then only The first stage of treatment is required, which is surgical resection and continuous observation. If the risk is high, the third stage is required, which is surgery plus chemotherapy.

He said that the tumor size of colon cancer can be as large as 10 centimeters or more, and can even affect peripheral organs such as the bladder, ovaries, uterus, etc. As for whether it will rupture, the chance of rupture is unlikely under normal circumstances, but it is possible and often The patient developed acute abdominal pain and thought it was appendicitis or appendicitis. It was not until he had surgery that he found out that the tumor was ruptured. Judging from the anatomy of the human body, the rectum is a small section of intestine between the large intestine and the anus, about 12 to 15 centimeters. Therefore, if cancer occurs in this part, not only is it difficult to completely remove it with surgery, but the recurrence rate is high and requires surgery. Aftercare is also more complex, so the treatment is different.

“In addition, the location of the tumor in the upper, middle or lower rectum must also be taken into consideration. For example, if the cancer is in the lower rectum, it is close to the sphincter. If the surgery is not careful, it may cause damage to the sphincter and permanent incontinence. Therefore, Generally, radiotherapy and chemotherapy are used to reduce the size of the tumor before surgical removal.”

Robots cost 2 times more

The approach to the first stage of rectal cancer is not much different from that of colon cancer, that is, surgical resection and continuous observation. However, if the tumor in the second stage has not yet touched the intestinal wall, it is feasible to adopt the approach of the first stage, but if the tumor has touched the intestinal wall, it is feasible. If it is a tumor, the doctor will recommend radiotherapy and chemotherapy to shrink the tumor before surgical removal. The purpose is to achieve better and complete removal.

“If it is third-stage rectal cancer that has metastasized to lymphoid tissue, in addition to radiotherapy and chemotherapy before surgery, short-term chemotherapy will also be used after surgical resection to avoid recurrence; there is also a current practice, which is to give it 4 days before surgery. Chemotherapy will be performed until 6 months later, followed by radiotherapy and chemotherapy for 5 weeks, and then surgical resection.”

Although colon cancer and rectal cancer are both classified as colorectal cancer, there are slight differences in treatment between the two. At the same time, different treatment plans, including surgery, must be formulated according to the patient’s condition; currently, surgery is mainly divided into three categories , namely traditional open surgery, laparoscopic surgery and robotic surgery. The latter two are minimally invasive surgeries, which have the advantages of small wounds, less pain and bleeding, and faster recovery. In comparison, robotic surgeries are more expensive, and even Can be more than 2 times higher.

But does higher cost mean treatment will be more effective? “If the condition is complex, such as a large tumor or cancer cells that have eroded into surrounding organs, traditional open surgery will be more suitable. In addition, the choice of surgery also depends on other objective conditions, including manpower and material resources. If necessary, other Specialists (such as urologists) are on hand to provide support, so the choice of surgery must also take relevant factors into consideration.”

Fourth stage radiotherapy improves bone pain

If cancer cells have metastasized to the liver or lungs, radiofrequency (RF), cryotherapy or microwave ablation can also be used, or surgical resection and whole-body stereotactic radiotherapy (Stereotactic Body Radiation Theray, SBRT) can be used. wait.

“Generally, radiotherapy is only used for colon cancer in the fourth stage, mainly to improve the impact of bone pain. Of course, some patients are suitable for immunotherapy, or chemotherapy plus targeted drugs, etc., depending on the situation. The same is true for patients with rectal cancer. In addition to improving bone pain, radiotherapy also has a hemostatic effect. “

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