There are many causes of colon cancer, the two main ones are as follows.
Long-term consumption of high-fat and high-protein foods. These foods stay in the large intestine for a long time and are prone to form carcinogenic substances. Therefore, it is recommended to reduce the intake of animal fat and eat more green vegetables and fruits as well as foods rich in fiber and starch. For example, potatoes, cereals, rice, pasta, etc.
Genetic factors: 25% of colon cancers occur in families with a history of colon cancer; the majority of members of some families are prone to polyps, and if they are allowed to develop, the incidence of colon cancer is also 25%. older people over 50 years old should take various measures to prevent colon cancer. This is because 50% of people over the age of 60 will develop colon polyps. Colon cancer is not contagious because cancer cells are not infectious.
What are the common types of colon cancer?
Gross morphological typing
According to the general morphology, colon cancer can be divided into three types: mass type, infiltrative type and ulcerative type.
Mass type: the tumor grows into the intestinal cavity in the shape of hemisphere or spherical bulge, and has a soft texture. And the tumor is large, easy to ulcerate and bleed with secondary infection and necrosis. This type of colon cancer is usually found in the right half of the colon, most of them have higher degree of differentiation, less infiltration and slower growth.
Infiltrative type: The tumor invades around the intestinal wall and grows along the submucosa, with a harder texture, easily causing intestinal lumen narrowing and obstruction. The cells of this type of colon cancer are less differentiated, more malignant, and metastasis occurs earlier. It mostly occurs in the large intestine other than the right half colon.
Ulcerated type: It is the most common type of colon cancer, which is usually found in the left half of the colon and rectum. The tumor grows deep into the intestinal wall and infiltrates outside the intestinal wall, and ulcers can appear at an early stage, with elevated edges and deep bottom, easily bleeding and infected, and easily penetrating the intestinal wall. This type has low cell differentiation and metastasis occurs earlier.
Histological typing
According to histological characteristics, colon cancer can be divided into three types: adenocarcinoma, mucinous carcinoma and undifferentiated carcinoma.
(1) Adenocarcinoma: Most of the colon cancers are adenocarcinomas, and the adenocarcinoma cells are arranged in glandular duct-like or glandular vesicle-like. According to its differentiation degree, it is classified into grade I~IV according to Broder’s method, i.e., low malignant (highly differentiated), moderately malignant (moderately differentiated), highly malignant (poorly differentiated) and undifferentiated carcinoma.
(2) Mucinous carcinoma: cancer cells secrete more mucus, which can be in the extracellular mesenchyme or collected in the cell to squeeze the nucleus toward the edge, and those with more intracellular mucus have poor prognosis.
(3) Undifferentiated carcinoma: The cells of undifferentiated carcinoma are small, round or irregular in shape, and arranged into untidy sheets. It has very low differentiation, strong infiltration, and can easily invade small blood vessels and lymphatic vessels, so the prognosis is very poor.
How many stages of colon cancer are there?
The modified Dukes staging and the TNM staging proposed by UICC are generally used internationally. According to the modified Dukes staging, it can be divided into stage A: cancer is confined to the intestinal wall; stage B: cancer penetrates the intestinal wall and invades the plasma membrane or (and) outside the plasma membrane, but there is no lymph node metastasis; stage C: there is local lymph node metastasis, among which stage C1 is limited to the tumor and parietal lymph nodes, stage C2 is metastasis to the lymph nodes of the mesentery and the root of the mesentery; stage D: there is distant metastasis or abdominal metastasis, or invades the adjacent organs and cannot be removed. D stage: those with distant metastases or abdominal metastases, or those invading adjacent organs that cannot be resected. According to the TNM staging of UICC, colon cancer is divided into four stages according to the depth of tumor invasion, lymph node metastasis and distant metastasis, and there are detailed stages in each stage, which are stage I, IIA-IIC, IIIA-IIIC and IVA-IVB.
How long can I live if I have colon cancer?
The survival time of colon cancer is the best treatment effect among the whole digestive system tumors. According to research and many clinical experiences, the 5-year survival rate of colon cancer after surgery is significantly higher than that of solid malignant tumors such as stomach, lung, liver and esophagus. By analyzing 119,393 colon cancer cases in the SEER (Surveillance, Epidemiology, and End Results) database from 1991 to 2000, we can understand the 5-year survival rates for each stage of colon cancer: 93.2% (stage I), 84.7% (stage IIA), 72.2% (stage IIB), 83.4% (stage IIIA), 64.1% (stage IIIB), and 44.3% (stage IIIB). 44.3% (stage IIIC) and 8.1% (stage IV).
Can young people get colon cancer?
Young people can also get colon cancer, and the younger age of colon cancer is closely related to the change of our lifestyle and unreasonable dietary structure. For example, people pay more and more attention to nutrition intake, less and less crude fiber in food, less vegetables and more meat in food. However, there is a big difference between the feces formed by eating vegetables and meat. The feces formed by vegetables has more fibers, and the feces formed by vegetables has a short residence time in the intestine and less carcinogenic substances; while the feces formed by meat has a long residence time in the intestine, and the metabolites contain more carcinogenic substances, which stimulates the intestinal wall more and more persistently, which may be an important factor for the development of colon cancer.
Secondly, too much consumption of smoked, pickled and fried food can also easily lead to the occurrence of colon cancer, and pesticide contamination in food and unreasonable food additives can also cause the occurrence of colon cancer. In addition, modern transportation is becoming more and more convenient, and people often use cars as a substitute for walking. In addition, sitting in front of a desk or computer for a long time, a lot of smoking and alcohol, long-term untimely meals and staying up late can lead to disorders of the gastrointestinal tract, which is one of the reasons why the prevalence of colon cancer is soaring. Also, smoking, alcohol consumption and obesity are considered to be related to the etiology of colon tumors.
What are the high risk factors for colon cancer? How to prevent colon cancer?
The main risk factors for colon cancer include the following.
Age: Most patients develop the disease after the age of 50.
Family history: If someone has a first-degree relative, such as a parent, who has had colon cancer, the lifetime risk of developing the disease is eight times higher than that of the general population. About one quarter of new cases have a family history of colon cancer.
History of colon disease: Certain colon diseases such as Crohn’s disease or ulcerative colitis may increase the chance of developing colon cancer. Their risk of colon cancer is 30 times higher than that of the general population.
Polyps: Most colorectal cancers develop from small precancerous lesions, which are called polyps. Among them, choroidal adenoma-like polyps are more likely to develop into cancer, with about 25% chance of malignancy; tubular adenoma-like polyps have a malignancy rate of 1-5%.
Genetic features: some familial tumor syndromes, such as hereditary non-polyposis colon cancer, can significantly increase the chance of colorectal cancer. And the time of onset is much younger.
Dietary factors: High saturated animal fat, high animal protein, fiber deficient diet, and calcium deficiency can increase the risk of colon cancer.
The prevention of colon cancer should start from daily life, our habits in life may directly affect the occurrence of colon cancer. So to prevent colon cancer we do the following.
Change dietary habits. We should consume high-fiber foods every day, such as mushrooms, fungus, purple cabbage, buckwheat, sweet potatoes, soybeans, green beans, corn and various fruits, etc., to keep the bowel movement smooth and reduce the contact time between carcinogens in feces and colonic mucosa.
Reduce the intake of fat and animal protein in food, which can reduce the carcinogen production and carcinogenic effect of their decomposition products to reduce the incidence of colon cancer.
Prevention and treatment of schistosomiasis.
Prevention and treatment of precancerous lesions of colon cancer. For colonic adenomatous polyps, especially familial multiple intestinal polyps, the lesions must be removed early. Actively treat chronic colitis.
Giving oral calcium to people with a family history of colon and rectal cancer and a high tendency to develop colon and rectal cancer can lead to a decrease in cancer incidence. Chemoprevention The most applied drugs are currently vitamins A, E and beta-carotene, as well as 4-hpr, and high doses of vitamin C are also commonly used to prevent polyp formation.
Do physical exercise, preferably 30 minutes a day to move your body.
Colon cancer diagnosis
1.Who are prone to colon cancer?
Patients with chronic inflammatory bowel disease (such as ulcerative colitis) have a higher incidence of colon cancer than the general population. During the development of proliferative lesions of inflammation, polyps can often be formed, which can further develop into intestinal cancer; in the case of Crohn’s disease, those with colon and rectal involvement can cause cancerous changes.
The incidence of colon cancer in patients with colon polyps is 5 times higher than that in patients without colon polyps. The incidence of cancer is higher in familial multiple intestinal polyps.
Those with a family history of colon cancer have four times the incidence rate of the general population, indicating that genetic factors may be involved in the development of colon cancer.
2. What are the common symptoms of colon cancer?
Most patients with colon cancer are above middle age, with a median age of 45 years old and about 5% of patients are under 30 years old. The clinical manifestations of colon cancer vary with the size and location of the lesion and the type of pathology. Many patients with early stage colon cancer may have no symptoms clinically, but with the development of the disease and the increasing lesion, a series of common symptoms of colon cancer may arise, such as increased frequency of stool, blood and mucus in stool, abdominal pain, diarrhea or constipation, intestinal obstruction, as well as general weakness, weight loss and anemia.
Symptoms during the course of the disease
Early symptoms: At the earliest stage, there may be abdominal distension, discomfort and dyspepsia-like symptoms, followed by changes in bowel habits, such as increased frequency of constipation, diarrhea or constipation, and abdominal pain before stool. Later on, mucus stool or mucopurulent blood stool can be found.
Toxic symptoms: Due to the blood loss and toxin absorption of tumor ulceration, patients often have symptoms such as anemia, low fever, weakness, emaciation and swelling, among which anemia and emaciation are especially important.
Intestinal obstruction manifestations: incomplete or complete low-level intestinal obstruction symptoms, such as abdominal distension, abdominal pain (distension or colic), constipation or stool closure. Physical examination shows abdominal bulge, intestinal pattern, localized pressure pain, and hyperactive bowel sounds can be heard.
Abdominal mass: It is a mass of tumor body or infiltrated and bonded with omentum and surrounding tissues, hard, irregular in shape, some can have certain mobility with intestinal canal.
Late manifestations: jaundice, ascites, swelling and other signs of liver metastasis, as well as cachexia, anterior rectal concave mass, enlarged supraclavicular lymph nodes and other manifestations of distant tumor spread and metastasis.
Symptoms of colon cancer in different parts
The whole colon is divided into two parts, right hemicolectomy and left hemicolectomy, with the middle of the transverse colon as the boundary, and the clinical manifestations of these two parts have their own characteristics, which are as follows.
Right hemicolectomy The right hemicolectomy lumen is thick and large, and the stool in the intestine is liquid, and most of the cancers in this section of the intestine are ulcerated or cauliflower-shaped cancers that protrude into the intestinal cavity, and there are few circular stenoses, so obstruction does not often occur. However, these carcinomas are often ulcerated and bleeding, with secondary infection and toxin absorption, so they may have clinical manifestations of abdominal pain and discomfort, stool change, abdominal mass, anemia, emaciation or cachexia.
Abdominal pain and discomfort About 75% of patients have abdominal discomfort or vague pain, which is intermittent at first, but later becomes persistent, often located in the right lower abdomen, much like chronic appendicitis attack. If the tumor is located in the hepatic flexure and the stool is dry, colic may also occur, which should be distinguished from chronic cholecystitis. About 50% of the patients have loss of appetite, fullness and belching, nausea and vomiting.
Stool changes Early stool is thin, with pus and blood, and the frequency of defecation increases, which is related to the formation of cancer ulcers. When the size of the tumor increases and affects the passage of feces, diarrhea and constipation may occur alternately. The amount of bleeding is small, and it is not easy to be seen with the naked eye because it mixes well with the stool with the peristaltic movement of the colon, but the occult blood test is often positive.
Abdominal mass More than half of the patients can find abdominal mass at the time of consultation. This mass may be the cancer itself or a mass formed by extra-intestinal infiltration and adhesions. The former is more regular in shape with clear outline; the latter is less regular in shape. The masses are usually hard in texture, with limited movement and pressure pain when secondary infection occurs.
Anemia and cachexia About 30% of patients have anemia due to continuous bleeding from cancer ulceration, weight loss, weakness of limbs, and even general cachexia.
Left hemicolectomy The left hemicolectomy has a thin lumen, and the stool in the intestine becomes dry and hard due to water absorption. Most of the left hemicolectomized colon cancers are infiltrative type, which often cause annular stenosis, so the clinical manifestation is mainly acute and chronic intestinal obstruction. Therefore, the clinical manifestation is mainly acute and chronic intestinal obstruction. The size of the mass is small, and there is less ulceration and bleeding, and there is no toxin absorption, so anemia, emaciation and cachexia are rare, and it is not easy to find the mass.
Abdominal colic is the main manifestation of intestinal obstruction associated with cancer. The obstruction may occur suddenly, with abdominal colic, abdominal distension, hyperactive bowel movement, constipation and obstruction of venting; in chronic obstruction, the manifestation is abdominal distension, paroxysmal abdominal pain, hyperactive bowel sounds, constipation, blood and mucus in stool.
Difficulty in defecation Half of the patients have this symptom, and the constipation becomes more serious as the disease progresses. If the cancer is in a low position, there may also be poor bowel movement and a feeling of urgency.
Blood or mucus in stool As the stool in the left hemicolectomy tends to be formed, blood and mucus do not mix with stool, and fresh blood and mucus can be seen in the stool of about 25% of patients.
3.What tests are needed to confirm the diagnosis of colon cancer?
X-ray examination includes barium meal examination of whole gastrointestinal tract and barium enema examination. The latter is appropriate for patients with colon tumor. The lesion signs may initially appear as stiffness of intestinal wall and mucosal destruction, followed by constant filling defect and narrowing of intestinal lumen. For the detection of smaller lesions, the intestinal cavity can also be injected with gas for barium gas double contrast imaging for better results. For patients with symptoms of colonic obstruction, barium meal examination of the whole gastrointestinal tract is not recommended, because the barium dries up in the colon and is difficult to be discharged, which may aggravate the obstruction.
Colonoscopy Sigmoidoscopy: straight, up to 30 cm long, easy to examine, biopsy under direct vision, suitable for lesions below the sigmoid colon. Fiberoptic colonoscopy: 120-180 centimeters long, can be bent, can observe the whole colon, can perform electrodesection, electrocoagulation and biopsy, and can detect early lesions. This test can be used when the diagnosis is difficult to be confirmed by the aforementioned tests.
B-type ultrasound scan, CT scan and MRI can not directly diagnose colon cancer, but they have certain value in determining the location, size and relationship between cancer and surrounding tissues, lymphatic and liver metastasis.
Serum carcinoembryonic antigen (CEA) is not specific for colon cancer, and its positive rate is not certain. The high value is often related to tumor enlargement, and it can return to normal value more than a month after complete resection of colon tumor, and it can increase a few weeks before recurrence, so it is more significant to determine the prognosis.
a) How to diagnose colon cancer by colonoscopy, CT, ultrasound and MRI?
Colonoscopy Although sigmoidoscopy is 25cm long, 75% of colorectal cancers are located within the scope of sigmoidoscopy. During the microscopy, not only can the cancer be detected, but also its size, location and the extent of local infiltration can be observed. Sigmoidoscopy allows for the removal of tissue for pathologic examination. CT, ultrasound and MRI cannot directly diagnose colon cancer, but they have certain value in determining the location, size, relationship with surrounding tissues, lymphatic and hepatic metastasis of cancer.
b) Does colon cancer necessarily mean occupied colon?
It may be a benign occupying lesion, and further examination is needed to make a definite diagnosis.
c) Which carcinoembryonic antigens can detect colon cancer? Does abnormalities necessarily mean colon cancer?
Carcinoembryonic antigen (CEA) is of little diagnostic value in early stage cases. CEA was first found in the serum of colon cancer patients and was once thought to be a specific immunological manifestation of colon cancer. However, it was later found that CEA is often elevated in the blood of certain benign diseases, especially liver disease, so its specificity is not considered strong. However, CEA can be helpful in predicting prognosis and judging recurrence.
d) What are the conditions that require endoscopy?
Anyone who has abdominal discomfort, abdominal pain, reduced food intake, black stool, vomiting, suspected chronic intestinal disease, which has not been confirmed by various examinations, should undergo colonoscopy to clarify the diagnosis, and those who have intestinal ulcer, intestinal polyp or intestinal tumor found by barium X-ray, but are not sure of the nature, should undergo colonoscopy and biopsy to determine the nature. If there is chronic enteritis, regular colonoscopy is needed. Colon cancer patients, in order to understand the type of tumor, the scope of the lesion, before surgery need to do colonoscopy, in order to determine the surgical program. Regular follow-up examinations are also needed after intestinal surgery in order to observe changes in the condition. As a treatment for intestinal lesions.
e) Is colonoscopy painful? Can a barium meal be used instead?
Some patients are afraid of colonoscopy and ask for X-barium meal instead of colonoscopy. In fact, there are many advantages of colonoscopy compared to X-barium meal. First of all, colonoscopy is performed under direct vision, so that the intestinal mucosa can be seen directly and lesions can be observed directly. Secondly, mucosal biopsy can be taken under colonoscopy, which is necessary to confirm the diagnosis of colon cancer. These findings in colonoscopy can help a lot in the treatment of colon cancer, so X-barium meal examination cannot replace colonoscopy in most cases.
f) Will colonoscopy worsen colon cancer or cause metastasis?
No. The biopsy through colonoscopy will not aggravate colon cancer or cause metastasis. Currently, colonoscopy biopsy is the gold standard for colon cancer diagnosis.
g) What should I do next if the endoscopy result is cancer/not cancer?
If the diagnosis of colon cancer is confirmed by endoscopy, further examination is needed to determine the stage and formulate an appropriate treatment plan. If it is determined to be a benign lesion, different treatment strategies and monitoring protocols can be developed according to the specific situation.
4. What should I do if I have been diagnosed with colon cancer?
After the diagnosis of colon cancer is confirmed, the staging should be further determined, and according to the different staging, appropriate treatment plan should be formulated, using simple surgery or comprehensive treatment. Can rectal cancer surgery cure rectal cancer? What tissues need to be removed in rectal cancer surgery? In terms of rectal cancer treatment, there are three aspects in the broad framework.
Firstly, surgery is still the only means of cure for rectal cancer, that is to say, to eradicate this disease, surgery is the main means.
Secondly, surgery alone is not enough to achieve complete cure for some patients, especially for patients in the middle and late stages, and adjuvant chemotherapy is necessary for some patients.
The third one is radiation therapy, which is mainly used for local radiation therapy for some rectal cancer patients. There are many surgical treatments for rectal cancer, depending on the location of the tumor and the extensiveness of the disease. These surgical methods include local excisional methods such as polypectomy, transanal local excision and transanal microsurgery; and radical transabdominal surgical methods (e.g., low anterior resection, total mesorectal resection with colon-anal anastomosis, or combined abdominoperineal resection.
Transanal local excision may be indicated for selective early cases. Within 8 cm from the anal verge, tumors less than 3 cm, moderately high-differentiated lesions invading less than 30% of the intestinal lumen, and without evidence of regional lymph node metastasis, transanal local excision with negative margins may be performed. Transanal endoscopic microsurgery (TEM) can perform transanal resection of small tumors in the high rectum. Local excision and TEM require full vertical resection of the intestinal wall to the pararectal fat, with negative margins over 3 mm at the base and mucosa, and avoiding resection in pieces. Transabdominal resection should be performed for patients with rectal cancer who do not meet the criteria for local resection. Surgery that preserves organ function, such as maintaining sphincter function, is preferred as much as possible, but this requirement is not met in all cases.
For lesions located in the middle or upper rectum, a low anterior resection (LAR) can be performed to 4-5 cm below the distal margin, followed by colorectal anastomosis and reconstruction. For low rectal cancer, a combined abdominoperineal resection or TME with colo-anal anastomosis is required.
TME also allows for preservation of autonomic function. In patients with intact anal function and complete distal debridement, coloanal anastomosis can be performed after TME. Combined abdominoperineal resection (APR) involves separation and excision of the recto-b junction, rectum, and anal portion, as well as separation of the surrounding mesentery and the rectal mesentery, pelvic soft tissues, and tissues necessary for the creation of the stoma. If complete resection of the tumor with negative margins results in loss of anal sphincter function and fecal incontinence, APR surgery is a necessary option.
What is the approximate cost of rectal cancer surgery?
The hospitalization time for rectal cancer surgery is about half a month. During this period, each patient’s specific situation is different, so the symptomatic treatment is different, the examination items are different, the cost on the day of surgery is different from hospital to hospital and the surgery method chosen is different, so the surgery cost is also different. So this issue varies from person to person. Generally speaking, the cost of surgery is about 20,000~30,000.
What conditions are suitable for rectal cancer surgery?
Radical surgery is the main treatment method for rectal cancer. Any rectal cancer that can be removed without contraindication to surgery should be performed as early as possible.
Is surgery necessary for early stage rectal cancer?
Early rectal cancer diagnosed as long as the conditions allow, all need to be treated surgically. There are many surgical treatment options for rectal cancer, depending on the location of the tumor and the extent of the disease. These include local excisional approaches, such as polypectomy, transanal local excision, and transanal microsurgery; and radical transabdominal approaches (e.g., low anterior resection [LAR], total mesorectal excision with colon-anal anastomosis [TME], or combined abdominoperineal resection [APR]).
What is the appropriate procedure for each type of surgery?
Transanal local excision may be indicated for elective early cases. Within 8 cm from the anal verge, tumors less than 3 cm, moderately high-differentiated lesions invading less than 30% of the intestinal lumen, and without evidence of regional lymph node metastasis, transanal local excision with negative margins may be performed. Transanal endoscopic microsurgery (TEM) can perform transanal resection of small tumors in the high-grade rectum. Local excision and TEM require full vertical resection of the intestinal wall to the pararectal fat, with negative margins over 3 mm at the base and mucosa, and avoiding resection in pieces.
Transabdominal resection should be performed for patients with rectal cancer who do not meet the criteria for local resection. Surgery that preserves organ function, such as maintaining sphincter function, is preferred as much as possible, but this requirement is not met in all cases. For lesions located in the middle or upper rectum, a low anterior resection (LAR) can be performed to 4-5 cm below the distal margin, followed by colorectal anastomosis and reconstruction. For low rectal cancer, a combined abdominoperineal resection or TME and coloanal anastomosis is required.
TME involves resection of the entire mesorectal structure as a “tumor package”, including the associated vascular and lymphatic structures, adipose tissue and mesorectal fascia. In patients with intact anal function and complete distal debridement, a colo-anal anastomosis can be performed after TME. The combined abdominoperineal resection (APR) involves the separation of the recto-basal junction, rectum, and anal portion, as well as the surrounding mesentery and rectal fascia, pelvic soft tissues, and tissues necessary for the creation of the stoma. If complete resection of the tumor with negative margins will result in loss of anal sphincter function and fecal incontinence, APR surgery is a must.
When can rectal cancer be treated with anal preservation?
The distance between the lower edge of the tumor and the anal verge is the main factor that determines whether low rectal cancer can be treated anally. Studies have shown that, except for a few cases with high malignancy or extensive metastasis, there is no significant difference in the postoperative local recurrence rate and survival rate between those with 2cm and 5cm of distal intestinal canal removed for rectal cancer. The safe distance for resection of the distal intestinal canal of rectal cancer, 2cm is sufficient for resection in a non-stretched state. Generally speaking, anal preservation surgery is feasible for tumors that are more than 2cm from the dentate line or 4cm from the anal verge and do not invade the anal sphincter and anal levator muscle.
How to do post-operative artificial anus for rectal cancer?
Artificial anus surgery or enterostomy is a common surgical procedure, which means that the surgeon makes an opening in the abdominal wall for treatment, and then pulls a section of intestine out of the abdominal cavity and fixes the opening on the abdominal wall for excretion of feces, which can be collected in a special plastic bag attached to the opening.
How to take care of the artificial anus after surgery?
Pay attention to dietary hygiene and deployment: pay attention to dietary hygiene and prevent the occurrence of acute gastroenteritis. Since part of the intestinal canal is removed during surgery, the transport tube for feces becomes shorter after surgery, and it takes some time for the body to re-establish the rhythm of defecation after surgery. Therefore, it is important to stick to three meals a day, avoid overeating, and eat more food with high nutrition and less residue. Eat less or no onions, garlic, yams and other irritating smells and flatulent foods to avoid obstruction of the intestinal tube and stoma as well as inconvenience of life and work caused by frequent use of the enterostomy bag. The stool can be formed by regulating the diet.
Protect the skin: The skin around the stoma can be stimulated by feces and intestinal fluid, resulting in dermatitis and even ulcers. Some patients are allergic to the stoma floor, which can also cause dermatitis and thus affect the patient’s quality of life. Therefore, care must be taken to protect the skin around the stoma. The main principle is to keep the skin dry. In addition, some prickly heat powder can be used. If erosion has already occurred, the skin around the stoma can be coated with zinc oxide ointment, etc. If allergy occurs, you can apply some local anti-allergy ointment such as cleansing cream, etc. It is also recommended to switch to another brand of enterostomy bag.
Develop regular defecation habits: Early defecation after artificial anus surgery is often arbitrary, which not only leads to inconvenient care but also affects normal life. You can use the method of colonic irrigation and regular enema, so that regular and repeated stimulation can develop the habit of regular defecation. This method is relatively simple, and patients can do it at home by themselves. It is generally recommended that enemas be given at around 20:00 pm, so as not to interfere with daytime study and work, nor with evening meals and rest.
g) Is it possible to remove rectal cancer that has metastasized to the surrounding lymph nodes?
For rectal cancer with lymph node metastasis, the treatment plan should be determined according to the extent and degree of metastasis. If the lymph node metastasis is limited and considered to be resectable by surgery, surgery can be performed; if the lymph node metastasis is large and considered difficult to be resected by surgery, neoadjuvant treatment can be performed first, and then decide whether to perform surgery according to the treatment effect.
h) Can rectal cancer still be resected if it has metastasized to the liver and other surrounding organs?
Complete surgical resection of liver metastases is still the best method to cure colorectal cancer liver metastases, so all eligible patients should receive surgical treatment at an appropriate time. Indications for surgical resection.
①The primary site of colorectal cancer can be or has been radically resected.
②The liver metastases can be completely (R0) resected according to the anatomical basis of the liver and the extent of the lesions, and sufficient liver function is required to be preserved, with residual liver volume ≥ 50% (simultaneous primary and liver metastases resection) or ≥ 30% (staged primary and liver metastases resection).
(iii) The patient’s systemic condition allowed for the absence of unresectable extrahepatic metastatic lesions. For some patients with unresectable initial liver metastases, the timing of neoadjuvant chemotherapy and surgery should be carefully decided by multidisciplinary discussion to create all opportunities to convert them into resectable lesions. Can we operate again if rectal cancer recurs after partial resection? If rectal cancer recurs after surgery, it can be treated by surgery again.
5.How should the gastrointestinal fistula be treated after rectal cancer resection? How to prevent infection?
The treatment of gastrointestinal fistula after rectal cancer resection mainly includes non-surgical treatment and surgical treatment.
Non-surgical treatment Subclinical fistula with mild symptoms, no signs of peritonitis and anastomosis below the peritoneal reflex line can be treated non-surgically. This includes: Initially, antibiotics may be used to help limit and absorb the inflammation. Ensure unobstructed drainage by applying saline containing gentamicin or metronidazole twice or more daily to flush from the anterior sacral drainage tube without excessive force. For those who recover intestinal function, a liquid diet with less residue can be ordered to promote the recovery of intestinal mucosa and prevent bacterial translocation, while oral stool astringent can be used to make the stool form, and growth inhibitor (Yippu Lemon) can be used as appropriate to reduce the digestive fluid to achieve functional shunt. Supplemented with parenteral intravenous nutrition. Usually the fistula will heal in about 2 weeks.
Surgical treatment The following conditions should be actively prepared for colostomy and diversion of feces.
(1) Significant signs of systemic toxicity, re-increased body temperature 5-7 days after surgery or persistent high fever after surgery, elevated leukocyte and neutrophil ratios in routine blood tests;
(2) Signs of diffuse peritonitis;
(3) The original drainage tube has been removed or dislodged, and there are difficulties in local treatment.
6. How long can rectal cancer live after surgery?
Compared with primary malignant tumors of stomach, esophagus, lung, pancreas and liver, the prognosis of rectal cancer is better and the 5-year survival rate is higher. The 5-year survival rate after radical rectal cancer surgery is reported to be 60%-67% in China. The five-year survival rate of patients with early-stage rectal cancer can be more than 80%, while the five-year survival rate of patients with advanced rectal cancer after radical surgery is lower, only about 30%.