Colorectal cancer, collectively known as colorectal cancer, is a common malignant tumor of the digestive system and a serious threat to human health. Nowadays, women’s health is getting more and more attention. Due to the unique physiological and anatomical characteristics of women, female colorectal cancer has its own special characteristics in terms of incidence and diagnosis and treatment.
I. Incidence rate of female colorectal cancer in China is increasing and catching up with that of men
The high incidence of colorectal cancer is mainly located in developed countries such as Northwest Europe and North America, while the incidence rate in China is lower. Although the average incidence rate of colorectal cancer worldwide is lower for women than men, the incidence rate of women has been increasing faster in recent years. According to the WHO report, the global new cases of female colorectal cancer are in the 3rd place of female malignant tumors, and the highest incidence of female colorectal cancer is in New Zealand, reaching 42.2/100,000. 1998-2002 domestic survey data show that the incidence of female colorectal cancer in Beijing and Shanghai is close to that of male. In China, colorectal cancer ranks 6th in the incidence of female malignant tumors, and the incidence of female colorectal cancer in China is also on the increase, with the ratio of male to female incidence rising from 1.50:1 in the 1980s to 1.26:1 in the 1990s.
Second, aging and the proportion of right-sided colon cancer patients increased
Recent statistics show that colorectal cancer in China tends to age, and female patients also show this trend. The statistics of Tianjin from 1981 to 2000 show that the median age of female colon cancer incidence is 65 years old. The analysis of the age and location of colorectal cancer in Japan from 1974 to 1994 showed that the proportion of female patients older than 70 years old increased significantly, and the proportion of right-sided colon cancer among all female colon cancers also increased significantly. The incidence of colon cancer in developed countries is equal or even more in women than in men, while men account for the majority of rectal cancer.
The proportion of malignant bowel cancer in young women is higher than that in men
In addition to tubular adenocarcinoma, a common pathological type of colorectal cancer, the literature reports that the proportion of mucinous adenocarcinoma, indolent cell carcinoma and hypofractionated adenocarcinoma and other pathological types with high malignancy in young women is higher than that in young men.
Fourth, smoking, alcohol, obesity and hormones may have a greater impact on women
Like male colorectal cancer, the etiology of female colorectal cancer is also the result of the synergistic effect of multiple unfavorable factors such as dietary factors, genetic factors, precancerous changes, poor lifestyle and some negative events in life.
There are some etiological factors that have a greater impact on female colorectal cancer
Among female colorectal cancer patients, it is found that the age of onset of smokers is 6.3 years earlier than that of women who neither smoke nor drink alcohol, while the corresponding time difference is only 3.7 years in men. Obesity In premenopausal women, obesity (body mass index ≥ 30 kg/m2) increases the risk of colorectal cancer by a factor of 1.
Menstrual status Postmenopausal women have a higher risk of colon cancer than premenopausal women. Progressive adenomas have been reported in the literature to be malignant to colorectal cancer, and are more likely to occur in women, especially young women, than in men, in those who smoke and/or are obese. type 2 diabetes and increased serum glycated hemoglobin levels also increase the risk of colorectal cancer in women.
For patients treated with local radiation therapy for cervical cancer, the risk of subsequent rectal or sigmoid colon cancer increases with the dose of radiation therapy, and the latency period is usually more than 10 years.
Sixth, tumor biological behavior is different from that of male patients
The occurrence of colorectal cancer is a complex multifactorial interaction pathological process. Genetic analysis shows that the occurrence of colorectal cancer involves mutations and loss of multiple genes and loci. The most common histological type of colorectal cancer is tubular adenocarcinoma, which accounts for 66.9%-82.1% of all colorectal cancers. The metastasis of colorectal cancer is mainly lymph node metastasis, which can cause enlargement of lymph nodes at the metastasis site. Bloodstream metastasis often occurs in the late stage, and metastasis to the liver is the most common.
However, based on the differences in physiological conditions of different genders, some tumor biological behaviors of female patients also exhibit gender specificity. Age ≤50 years, poor tumor differentiation and tumor invasion of the plasma layer are three high-risk factors that suggest the possibility of ovarian metastasis. Therefore, in addition to the accurate assessment of tumor differentiation, the number of lymph node metastases and clinical stage, which reflect the malignancy of tumor, we should also pay attention to the different physiological status of female patients, which will help us to correctly assess the condition and prognosis of female patients and guide clinical treatment.
VII. Complex symptoms of female colorectal cancer
Full awareness and comprehensive assessment are needed
Patients with colorectal cancer are usually asymptomatic in early stage, and most of them do not have specificity even if they have symptoms. Early symptoms of colorectal cancer, such as intermittent abdominal pain, constipation or diarrhea, mucus stool, etc., are not specific. Some patients are often misdiagnosed as hemorrhoids, enteritis, dysentery and other diseases that delay treatment.
For female patients, due to the special anatomical structure of female reproductive system, gynecological diseases sometimes interfere with the diagnosis of colorectal cancer, and women with lower abdominal pain or abdominal masses may first consider adnexal tumor or inflammation. Women with lower abdominal pain or abdominal masses may first consider adnexal tumors or inflammation. When symptoms such as blood in stool, abdominal distension, difficult stool, abdominal pain and anemia occur in combination with pregnancy or after pregnancy, they are easily mistaken by doctors and patients as being caused by pregnancy under such special conditions. Therefore, clinicians should fully understand the complexity of female colorectal cancer symptoms and make a comprehensive assessment, while patients should provide a detailed medical history and cooperate with relevant examinations in time to avoid delaying the diagnosis and treatment.
Detailed differences in diagnostic techniques for female colorectal cancer
At present, there are mainly the following methods for the diagnosis of colorectal cancer.
1.rectal anal finger examination. Rectal finger examination is still the most basic and important examination method among a series of preoperative examinations for rectal cancer.
2.Endoscopy. Fiberoptic colonoscopy is the most effective, safe and reliable examination method for the diagnosis of lesions in the large intestine, and most of the early colorectal cancers can be detected by endoscopy.
3.Laboratory examination. Such as fecal occult blood test, hemoglobin test and serum carcinoembryonic antigen test.
4.Imaging and ultrasound examination. Such as CT, magnetic resonance and ultrasound. For female patients, transvaginal ultrasound is also a more ideal examination method because the vagina is adjacent to the rectum. Its scanning field of view is larger than transrectal ultrasound, and it can also make accurate localization diagnosis of intestinal stenosis and high rectal lesions that are limited by transrectal ultrasound, which makes up for the limitations of transrectal ultrasound. In addition, vaginal ultrasound during gynecological examination can also be an important way for early detection of asymptomatic rectal tumors.
The basic treatment principles remain unchanged.
The influence of gender factor is doubtful.
Although some data show that the postoperative survival of female colorectal cancer patients older than 50 years old is longer than that of male, there is no clear evidence that gender has a significant impact on the treatment decision of colorectal cancer patients, so the treatment of female colorectal cancer should still follow the basic principles of colorectal cancer treatment, and different patients should adopt individualized treatment mode due to individual differences.
At present, surgery is still the only radical treatment for colorectal cancer, and most patients can obtain long-term survival after surgical resection. Women with colorectal cancer are prone to ovarian metastasis, and for patients with high-risk factors, prophylactic bilateral oophorectomy should be actively advocated.
In addition, for women, the use of estrogen replacement therapy after menopause can also reduce the incidence of colorectal cancer.
X. Pay attention to colorectal cancer prevention
The development process of colorectal cancer is long and there are many studies related to causative factors. Reasonable diet, good lifestyle behavior, strengthening health education on cancer prevention, vigorously promoting regular screening, early detection and removal of precancerous lesions are all of positive significance for the prevention of colorectal cancer.