Basic knowledge of colorectal cancer internal medicine treatment

  The fastest progressing disease in the field of medical oncology is colorectal cancer. At present, the median survival of advanced colorectal cancer through medical treatment has reached more than 20 months, and some clinical trials have even reached 30 months.  I. T3 with high-risk factors in T stage and T4 or cases with lymph node metastasis or distant metastasis should receive postoperative adjuvant chemotherapy.  The standard regimen of adjuvant chemotherapy is platinum oxalate plus 5 fluorouracil drugs.  Currently, there are four effective drugs internationally recognized for chemotherapy of advanced colorectal cancer: platinum oxalate, elitecan, 5-fluorouracil and Siroda. There are two effective targeted therapeutic drugs: one is anti-vascular endothelial growth factor monoclonal antibody (bevacizumab), and the other is anti-epidermal growth factor receptor monoclonal antibody (Epidermol). There is no sufficient basis for other drugs to be used in the treatment of colorectal cancer.  Fourthly, the first chemotherapy should be a combination regimen rather than a single drug regimen, as the situation allows, which is helpful to prolong the patient’s survival.  Fifth, platinum oxalate, elitecan and 5-fluorouracil should be used as much as possible in the course of drug therapy, only in this way can the patient’s survival be prolonged from the perspective of chemotherapy to the maximum.  VI. The order of application of platinum oxalate and elitecan has no effect on the efficacy and survival treatment.  VII. The efficacy of 5 fluorouracil in advanced colorectal cancer is equivalent to that of Siroda, but the toxic side effects are different.  Therefore, active treatment of liver metastases can prolong patients’ survival time; according to statistics, 24-58% of patients survive for more than 5 years after complete resection of liver metastases, and some of them can survive for more than 5 years when they are completely resected again after the first resection. The survival time is more than 5 years.  A few patients with liver metastases can achieve complete remission (complete disappearance of lesions by imaging) by chemotherapy or hepatic artery embolization chemotherapy (radiointerventional therapy), but 70% of patients in this area will have in situ recurrence, so it is currently advocated to ablate the lesions or remove them surgically to prevent recurrence before they disappear completely.  Ten, the current non-surgical minimally invasive treatment means for liver tumors include: physical ablation (radiofrequency, argon helium knife, etc.), chemical ablation (anhydrous ethanol injection, chemotherapeutic drug injection, etc.), and radioactive particle implantation. For small tumors, the efficacy of the above means is equivalent to surgical resection, and the trauma is small. Many patients who cannot tolerate surgery can also receive the above treatments, and for cases with special lesions (located in large blood vessels, bile ducts) or a large number of lesions that cannot be removed surgically, it has its outstanding advantages.  There are only six drugs (classes) used for colorectal cancer treatment, and for patients who are resistant to these drugs, the best supportive treatment is recommended in the current treatment guidelines; if reasonable treatment is provided for these patients who are suitable for minimally invasive treatment, it is possible to prolong their survival.  Given the prominence of local treatment of liver metastases in the comprehensive treatment of colorectal cancer, patients will benefit greatly from choosing a hospital that can provide both standardized drug therapy and sound local minimally invasive treatment.