(A) Clinical manifestations.
Early colorectal cancer may have no obvious symptoms, and the following symptoms may appear only when the disease has developed to a certain extent.
1. Change in defecation habit. Xing Nianguo, Department of Anorectal (Hemorrhoid and Fistula), Linyi Central Hospital
2. Change in stool characteristics (thinning, bloody stool, mucus stool, etc.).
3, abdominal pain or abdominal discomfort.
4.Abdominal mass.
5, intestinal obstruction.
6, anemia and systemic symptoms: such as wasting, weakness, low fever.
(B) Physical examination.
1.General condition evaluation, general superficial lymph node condition.
2.Abdominal visual examination and palpation, check for intestinal pattern, intestinal peristaltic waves, abdominal masses.
3.rectal finger examination: all suspected colorectal cancer patients must routinely undergo anorectal finger examination. To understand the size, texture, circumference of the intestinal wall, basal mobility, distance from the anal verge, infiltration of the tumor to the outside of the intestine, and the relationship with the surrounding organs. During finger examination, we must touch carefully to avoid missing diagnosis; touch gently, avoid squeezing, and observe whether the finger stains with blood.
(C) laboratory tests.
1.Blood routine: to know whether there is anemia.
2.Urinary routine: observe whether there is hematuria, combine with urological imaging to understand whether the tumor invades the urinary system.
3.Fecal routine: the presence of red blood cells and pus cells should be noted.
4.Fecal occult blood test: it has important value for the diagnosis of small amount of gastrointestinal bleeding.
(iv) Endoscopic examination.
Proctoscopy and sigmoidoscopy are suitable for colorectal lesions with low lesion location.
Fiberoptic colonoscopy or e-colonoscopy is recommended for all patients with suspected colorectal cancer, with the following exceptions.
1, poor general condition, difficult to tolerate;
2.Acute peritonitis, intestinal perforation, extensive intra-abdominal adhesions and complete intestinal obstruction;
3, perianal or serious intestinal infection, radiation enteritis;
4, women during pregnancy and menstruation.
Before the endoscopy, you must be prepared for the examination before the liquid diet, laxatives, or clean bowel cleansing, so that the intestinal cavity fecal excretion.
The endoscopy report must include: depth of entry, size of the mass, location from the anal verge, morphology, and the extent of local infiltration, and pathological biopsy of suspicious lesions during colonoscopy.
Since the colon canal may be crinkled during examination, there may be errors in the distance from the anus of the mass seen by endoscopy, and it is recommended to combine CT or barium enema to clarify the site of the lesion.
(E) Imaging examination.
1.Colon barium enema examination, especially air-barium double imaging examination is an important means to diagnose colorectal cancer. However, patients suspected to have intestinal obstruction should be selected with caution.
2.B-type ultrasound: ultrasound examination can understand whether the patient has recurrence and metastasis, and has the superiority of convenience and speed.
3.CT examination: The role of CT examination is to clarify the depth of lesion invasion into the intestinal wall, the extent of extra-mural spread and the site of distant metastasis. At present, CT examination of colorectal lesions is recommended for the following aspects.
(1) To provide the staging of colorectal malignancies;
(2) To detect recurrent tumors;
(3) To evaluate the response of tumors to various treatments;
(4) To elucidate the internal structure and clarify the nature of intrinsic and extrinsic compressive lesions in the intestinal wall found by barium enema or endoscopy;
(5) To evaluate the intra-abdominal masses found by barium examination and clarify the origin of the masses and their relationship with the surrounding organs.
4.MRI examination: The indications for MRI examination are the same as those for CT examination. MRI is recommended for the following cases: (1) preoperative staging of rectal cancer; (2) evaluation of liver metastases of colorectal cancer; (3) suspected peritoneal and subhepatic lesions.
5.Transrectal endoluminal ultrasound: endoluminal ultrasound or endoscopic ultrasound is recommended as a routine examination for the diagnosis and staging of middle and low rectal cancer.
6. PET-CT: not recommended for routine use, but can be used as an effective adjuvant examination for metastatic recurrent lesions that cannot be clarified by routine examination.
7. Excretory urography: not recommended for routine preoperative examination, only for patients with large tumors that may invade the urinary tract.
(F) Serum tumor markers.
Colorectal cancer patients must be tested for CEA and CA19-9 before diagnosis, treatment, evaluation of efficacy and follow-up; CA242 and CA72-4 are recommended; AFP is recommended for patients with liver metastases; CA125 is recommended for patients with ovarian metastases.
(vii) Pathological histological examination.
Pathological biopsy to clarify the nature of occupancy is the basis of colorectal cancer treatment. Cases diagnosed as invasive carcinoma on biopsy are treated with standardized colorectal cancer treatment. If the depth of infiltration cannot be determined by biopsy pathology due to the limitation of biopsy sampling, cases diagnosed as high-grade intraepithelial neoplasia, clinicians are advised to determine the treatment plan by integrating other clinical conditions. When recurrent or metastatic colorectal cancer is determined, the K-ras gene status of tumor tissue is detected.
(H) Open abdominal exploration.
In the following cases, open abdominal exploration is recommended.
1.After various diagnostic means, the diagnosis is not clear and colorectal tumor is highly suspected.
2.Intestinal obstruction occurs and conservative treatment is ineffective.
3.Suspected intestinal perforation.
4. Gastrointestinal hemorrhage which is ineffective by conservative treatment.