1.High risk group of colorectal cancer?
Positive fecal occult blood test.
History of colorectal cancer in first-degree relatives.
A history of intestinal adenoma in person.
A history of cancer in person.
Meet any 2 of the following 6 items.
Chronic diarrhea, chronic constipation, mucus and blood stool, history of chronic appendicitis or appendectomy, history of chronic cholecystitis or cholecystectomy, and long-term mental depression.
2.What is the prognosis of colorectal cancer patients mainly related to?
The prognosis of newly diagnosed colorectal cancer patients is mainly related to the tumor stage (TNM stage).
Other pathological factors related to prognosis include tumor perforation, obstruction, invasion of nerves or blood vessels, lymphocyte infiltration, the number of lymph node metastases, and the number of lymph nodes in the resected specimen.
3.What are the principles of surgical lymph node dissection for colorectal cancer?
Clearing regional lymph nodes at the root of blood vessels.
Suspected lymph nodes outside the regional lymph nodes should be removed or biopsied.
Consider lateral lymph node dissection only for those with clinical suspicion of lateral lymph node metastasis; routine lateral dissection is not recommended (prone to urinary function and sexual dysfunction)
The number of lymph nodes obtained should be ≥ 12 to ensure the accuracy of tumor staging.
4.The scope of tumor resection for colorectal cancer?
The primary lesion should be resected in its entirety with the lymph nodes in the drainage area to which it belongs.
If the tumor invades the surrounding tissues or organs, it needs to be resected together.
Generally, 5cm of the distal side of the tumor and 15-20cm of the proximal side of the normal intestinal canal should be removed.
5.Can obstructive colon cancer be resected in stage I?
When the right colon cancer is complicated with acute obstruction, right hemicolectomy and stage I anastomosis should be performed as much as possible.
When the right colon cancer cannot be resected locally, terminal ileal and transverse colon anastomosis (internal diversion) can be performed.
Acute obstruction caused by left colon cancer should be resected in stage I as far as possible when conditions permit; internal diversion or transverse colostomy can be performed for left colon cancer that cannot be resected.
6.What is TME/CME standardized resection?
Total mesorectal excision (TME): that is, resection of rectum and perirectal mesentery, complete removal of rectal mesentery to achieve complete clearance of perirectal lymph nodes, which is the standard rectal cancer surgery.
Complete mesocolic excision (CME): complete mesocolic excision is performed in colon cancer surgery.
7.Extreme anal preservation surgery?
Transanal intersphincteric resection (ISR): currently known as extreme anal preservation surgery. The main areas of application include: the lower margin of the mass is within 3-5 cm from the anal verge or 1.5-3.0 cm from the dentate line and does not infiltrate the external anal sphincter, puborectalis and anal levator; the sphincter is in good function; low-grade rectal cancer at T1 and T2 stages, or low-grade rectal cancer at T3 stages in combination with neoadjuvant therapy; pelvic stenosis that prevents transabdominal completion of intestinal anastomosis.
For patients with invasive and low-differentiated adenocarcinoma, extreme anal preservation surgery is not recommended.
8. 5-year survival rate of colorectal cancer surgery?
The 5-year survival rate for stage I patients can reach over 90%.
and slightly more than 10% for stage IV patients.
The average is about 60%.
9.Does neoadjuvant therapy (preoperative radiotherapy and chemotherapy) benefit?
Stage I patients have very little benefit from neoadjuvant therapy because of their very low local recurrence rate (about 3%).
stage III patients may benefit from neoadjuvant therapy, while it is unclear whether stage II patients benefit.
The generally accepted view is that patients with more advanced stage T3 (tumor infiltration of the rectal mesenteric fascia) and stage T4 can benefit from neoadjuvant therapy.
10.Postoperative follow-up of colorectal cancer?
Carcinoembryonic antigen: blood test for carcinoembryonic antigen every 3-6 months for 2 years, then every 6 months for up to 5 years.
Enhanced CT (thorax, abdomen and pelvis): 1 enhanced CT every year for 3-5 years, with more emphasis on those at high risk of recurrence.
colonoscopy (review within 1 year after surgery), those who have not undergone colonoscopy before surgery should be reviewed by colonoscopy 3-6 months after surgery, progressive cancer should be reviewed again in the second year after surgery, non-progressive cancer should be reviewed by colonoscopy again within 3 years after the first review, and every 5 years thereafter; those who have undergone low anterior resection or local resection for rectal cancer can be reviewed by colonoscopy once every 6 months for up to 5 years.
If carcinoembryonic antigen is elevated after surgery, full colonoscopy and CT examination of chest, abdomen and pelvis should be performed, if negative, PET-CT examination or enhanced CT review every 3 months should be performed, and caesarean section should not be blindly explored.