The examination of colorectal polyps is divided into disease detection and pathological diagnosis, which are described as follows.
1.rectal finger examination
This is the most convenient and fast method of detection, but the scope is limited, generally limited to the examination of the lower and middle rectum.
2.Shallow blood test in stool
Most of the polyps rarely show blood in the feces. Stool occult blood test can detect a small amount of bleeding in the intestine, and according to this result, then consider whether to make further examination.
3.Tumor markers
The 58-year-old Liu had already passed menopause but had two uterine fibroids that were still growing slowly, so his doctor asked him to check tumor markers. The result came out, CA199:40.87u/ml, more than 1 times higher than the normal value, and checked twice more in a row, still the same. The doctor asked him to have a colonoscopy, which revealed multiple polyps in the rectum, sigmoid colon and descending colon, as well as polyps in the stomach through gastroscopy. Pathology results, most of them were inflammatory and a few were tubular adenomas. Partial polypectomy was done, and six months later, more polyps were found on reexamination. Currently being treated by herbal medicine.
CEA, CA242, CA199 should be checked, and those with abnormalities should be reviewed 2 times consecutively, and if they are all high, endoscopy should be done.
4.Barium meal enema X-ray examination
For those who are afraid of colonoscopy, this examination method can be used to detect larger and multiple large intestinal polyps and intestinal tumors, and smaller polyps can be easily missed. At the same time, it cannot characterize the disease.
5.Fiber colonoscopy
This is the most important means of intestinal examination at present, and the operation of examination, biopsy and treatment can be completed under the microscope. Combined with intravenous anesthesia, painless colonoscopy makes more patients worried about intestinal diseases happy to choose.
6.Endoscopic staining and magnification of electronic colonoscopy
Under the endoscope, local stain is sprayed and then observed by magnifying colonoscope, which can observe local microstructure, accurately predict adenomatous polyps, whether there is cancer or not, and determine the depth of infiltration of early colon cancer, which has guiding significance for formulating treatment plan.
7.Ultrasound endoscopy
By placing a miniature high-frequency ultrasound probe on the tip of the endoscope, when the endoscope is inserted into the body cavity, while the endoscope directly observes the mucosal lesions of the gastrointestinal tract, the ultrasound under the endoscope can be used to perform real-time scanning, and the histological characteristics of the hierarchical structure of the gastrointestinal tract and the ultrasound images of the surrounding adjacent organs can be obtained, thus further improving the diagnosis of endoscopy and ultrasound. Ultrasound endoscopy can divide the wall of GI tract into five layers, which can determine the depth of tumor infiltration and initially determine the nature of tumor, and can identify whether the bulge of GI tract is caused by submucosal tumor or extramural lesion compression.
8.Laser induced autofluorescence technique
This is a technique for early cancer and precancerous lesion detection. The chemical composition of tumor cells and surrounding normal cells are different, and when irradiated by certain wavelengths of light, their fluorescence broad spectrum is also different, so this principle can be used to diagnose early tumors. This technology started to be applied in clinical practice in the United States in the 1980s, but it was carried out later in China, and there are not many application units so far. However, its safe and non-invasive features will be accepted by more and more people.
9.Simulation of spiral CT endoscopy technology
Using the computer software function, the image data obtained from the spiral CT volume scan is processed in three dimensions to reconstruct a three-dimensional image of the intestine similar to that seen by fiberoptic colonoscopy. This technique can detect intestinal polyps of 2 to 5 mm in size. The advantage is that it is non-invasive, but the disadvantage is that biopsies cannot be taken and it is difficult to detect flat polyp-like lesions.
10.Pathological examination
Pathological diagnosis is not only used to classify colorectal polyps, but also indicates the possibility of cancer. In the pathology report, we often see the description of low-grade intraepithelial neoplasia and high-grade intraepithelial neoplasia, what does this mean?
Low-grade intraepithelial neoplasia refers to polyps with superficial structural and cytological abnormalities limited to the lower half of the mucosal epithelium, corresponding to mild and moderate heterogeneous hyperplasia, and less likely to become cancerous.
High-grade intraepithelial neoplasia refers to structural and cytologic abnormalities extending to the upper part of the epithelium or even the whole layer, corresponding to severe heterogeneous hyperplasia and carcinoma in situ. Those cancers that morphologically lack a basis for infiltration into the submucosa are classified as high-grade intraepithelial neoplasia. High-grade intraepithelial neoplasia has biological characteristics similar to tumor cells and has the potential tendency to develop into tumor cells, but it is still a benign lesion, and its development can be stopped or even reversed with appropriate interventions.
The name high-grade intraepithelial neoplasia is more appropriate than adenocarcinoma in situ, and intramucosal neoplasia is more appropriate than intramucosal adenocarcinoma. The aim is to avoid overtreatment and prevent unnecessary damage to the body that could affect prognosis and quality of survival. In the pathological diagnosis report of ductal adenoma we often see atypical hyperplasia classified into grade I, II and III, the higher the grade, the higher the possibility of carcinoma.