Nowadays, as people’s living standards continue to improve, the diet structure has also changed, no longer like the previous grandparents, all day coarse vegetables, rare New Year’s Day to eat some brindled vegetables, which is not, the year before a limerick is said: “Every holiday fat three pounds, take a closer look at the three kilograms… …”. Due to the intake of a large amount of high-protein, high-fat, high-calorie foods, dietary fiber intake is insufficient, which will change the environment in the colon. Some studies have shown that the fatty component of the diet exceeds 40% is an important factor in the development of intestinal polyps, and of course, there are chronic inflammatory stimuli, family genetics and other factors.
Medical research has shown that colon polyps are closely related to colon cancer. The cancer rate of adenomatous polyps is high, and the cancer rate of adenomatous polyps with a diameter greater than 50px can be more than 60%. Therefore, the majority of intestinal cancers evolve from intestinal polyps. It is estimated that the time from polyp to carcinoma is 5~15 years. Once it develops into a progressive tumor, the course of the disease will be accelerated significantly, and its treatment effect will be affected by various factors such as tumor size, infiltration and metastasis, etc. Although many patients undergo active treatment and suffer from various pains including surgery and radiotherapy, especially for tumors in the lower rectum, artificial anus is required after surgery, and the quality of life is seriously reduced, some patients’ survival is only extended for a few months, and finally The final result is that both people and money are empty. Our goal is to interrupt the development of polyps before they become cancerous, so that we can effectively control the occurrence of colon cancer.
A new “mirror world” – the sibling of colon polyps
Colon polyp is actually a very common disease and contains many kinds of polyp, generally speaking, the raised lesions growing on the surface of the gastrointestinal mucosa are collectively called “polyps”, but in fact, polyps are a description of the form, which includes “hyperplastic polyps”, “inflammatory polyps”, “inflammatory polyps” and “inflammatory polyps”. “inflammatory polyps”, “juvenile polyps”, “adenomatous polyps”, “familial polyposis”, etc. types.
According to their pathological characteristics, the first three are generally considered benign polyps, which histologically do not have anomalous changes and are therefore not susceptible to cancer; while the latter, especially adenomatous polyps, or “adenomas”, include adenomas, tubular adenomas, villous adenomas, etc. Adenomatous polyps do not usually subside on their own If polyps are found and not treated in time, they will grow and become anomalous with time, and when the anomalies become severe (or high grade intraepithelial neoplasia), they are already precancerous, which we can understand as “standing on the edge of the cliff We can understand that it is “standing on the edge of the cliff”. According to a study in Japan, an adenoma without any intervention but regular checkups often becomes cancerous within 2-10 years, and this time is unpredictable.
Second, the new “mirror world”-predicting the occurrence of intestinal polyps
In order to prevent colon cancer, it is necessary to have a medical examination. But the question arises, which examination is the most effective for intestinal polyps and intestinal cancer? For now, colonoscopy is still the most effective tool. Should we ask everyone to have a colonoscopy? That doesn’t seem realistic, so primary screening is needed.
How can primary screening be performed? Primary screening – the most direct, simple and cost effective test is the “fecal occult blood test”. If a normal person has a negative fecal occult blood test, a positive fecal occult blood test is required, and of course, it may be caused by upper gastrointestinal disease.
Who are the people with high incidence? Generally, people with family history of tumor are considered to be the high-risk group, and the high-risk age is usually after 40 years old. However, we keep detecting colon cancer in young people within 35 years old, what should we do? If there is any change in stool characteristics and bowel habits, we need to have a timely checkup. In addition, the solution of fresh blood stool, also need to pay attention to the bleeding in addition to hemorrhoids, rectal polyps or polyps caused by cancer, there are many long-term solution of bloody stool mistaken for hemorrhoids, or hemorrhoids after surgery, still have bleeding stool, and finally colonoscopy found that it is rectal cancer, can only undergo surgery.
Third, the new “mirror world” – colonoscopy is not so scary
The most effective, intuitive and valuable examination mentioned earlier is colonoscopy. This endoscopic treatment technology, it is like a camera directly into the intestine, controlled by the doctor to complete the entire colon examination. Many patients feel very frightened about colonoscopy, as they are worried about damaging their intestines and fearing pain when a thick tube is inserted and “pounded” in their stomachs.
In fact, due to the improvement of equipment and technology, especially the improvement of single-person colonoscopy technology and the application of painless colonoscopy, colonoscopy is not very painful now. Through colonoscopy, polyps of 3-5mm or more can be detected, and some inflammatory or hyperplastic small polyps can be directly removed during the examination by special biopsy forceps, which can play both a diagnostic and therapeutic role.
However, there are a number of reasons that can affect the detection rate of polyps, namely low-quality diagnostic colonoscopy, low-quality bowel preparation, and the physician’s operating experience. Therefore, it is important to follow a strict diet and bowel preparation prior to the colonoscopy appointment in order to achieve optimal bowel cleansing for easier detection of lesions.
And more advanced equipment is constantly being put into use, along with the use of new technologies that allow even tiny polyps to be detected. It has been proven that due to the widespread use of colonoscopy, increased patient awareness and improved polypectomy techniques, colonoscopic polypectomy has been successful in stopping the development of bowel cancer, and a significant number of patients have benefited from it.
Fourth, the new “mirror world” – colon polypectomy is necessary
Once colon polyps are detected, they need to be treated, and colon polypectomy is an effective way to stop colon cancer. When colon polyps are larger than 5mm or more, they need to be hospitalized for endoscopic polypectomy. For tipped or subtip polyps less than 50px, endoscopic mucosal resection (EMR) can be performed; when polyps exceed this diameter, endoscopic submucosal dissection (ESD) is needed to remove them completely at one time, and the removed tissues will be examined pathologically to determine whether there is a possibility of cancer.
If there is cancer, it will be further confirmed whether there is superficial cancer or deep infiltration. If there is no deep infiltration, we think the treatment can be finished and the patient will be followed up for a long time. Once pathology reveals deep infiltration, it is very important to perform additional surgical procedures to ensure complete removal of the lesion.
Some foreign studies have found that even small polyps have a 3-10% chance of becoming cancerous. And indeed the smallest polyp that we did remove endoscopically that became cancerous was 5 mm in size! Since the EMR method is used to remove not only the lesion but also the normal mucosa surrounding the lesion, a complete and thorough resection is achieved without the need for additional surgical procedures.
In recent years, EMR and ESD techniques can remove larger polyps with no cancerous lesions or only superficial cancerous lesions, and can maintain the intact structure of the colon, with a controlled success rate and complications, reducing the chance of surgery, which is undoubtedly of great benefit to patients. Of course, whether it is a common electrosurgery or EMR or ESD, there is a risk of bleeding and perforation, and hospitalization is usually required. Once delayed bleeding is detected, timely colonoscopic rebleeding is required, and if perforation occurs, timely surgery is needed to repair the intestinal wall.
V. The new “mirror world” – pay attention to regular postoperative follow-up
For patients with multiple polyps and familial polyposis, although the polyps have been removed, but still must be regular follow-up, the density of follow-up with the nature of the pathology of polyps after removal, the number of polyps and the patient’s age has a certain relationship. It is important not to assume that once the polyps are removed, everything will be fine. In fact, there are still some objective limitations and there may be some smaller or hidden polyps that are hidden in some folds of the colon or missed due to poor bowel cleansing.
Therefore, for patients with a history of polyps, according to the situation after the first endoscopic surgery, the treating doctor will decide the frequency and number of years of follow-up visits, usually once a year at first, and if no polyps are found twice in a row, the follow-up period can be extended to once every two years or once every three years for a high standard colonoscopy, so that once tiny polyps are found, they can be treated in time.
Sixth, the new “mirror world” – how to prevent colon polyps and colon cancer
Generally speaking, to prevent the occurrence of diseases, we should pay attention to reasonable diet, proper exercise, regular life, etc. Doing the following points will have a certain preventive effect on the occurrence of colon polyps and even colon cancer.
1, to develop good and healthy habits, eat healthy food, avoid high fat, high protein food, less fried, smoked food, reduce the intake of salt in the diet, less refined food, more coarse grains, increase the dietary fiber in the diet, more vegetables, especially coarse fiber, food containing more fiber, you can properly add yogurt (containing lactic acid bacteria) products, note that not ” beverage”;
2, the habit of regular bowel movements, to avoid the absorption of water in the stool, resulting in dry stool and constipation, stool in the intestinal tract for too long, the intestines will absorb toxins in the stool;
3, appropriate physical exercise, and weight loss, pay attention to maintaining a normal weight, research shows that obesity, is one of the factors that predispose to colon cancer;
4, pay attention to maintain a good mood, good mood can regulate the body’s immune system, reduce the occurrence of tumors, negative mood is not conducive to physical and mental health.