Colorectal cancer is indeed one of the most common tumors at present, and the population incidence rate has reached 40/100,000, which means that colorectal cancer occurs in 4 out of every 10,000 people. Since there is no national colorectal cancer screening program in China, and the general public is not sufficiently aware of the prevention of colorectal cancer, more than 85% of colorectal cancers are found to be in the middle and late stages, with poor treatment effect and high treatment cost, and many patients need to undergo “artificial anus” surgery due to the advanced stage of the tumor, which results in poor quality of life after surgery. The quality of life after surgery is poor. Many people don’t know about colorectal cancer and are afraid when they get it! Some people are very nervous even if they don’t have it, and they want to do colonoscopy every day, but in fact, the prevention and treatment of colorectal cancer is not that dangerous!
1.How to conduct screening?
For the general population, it is recommended that people over 40 years old should undergo fecal occult blood examination once a year and full colonoscopy once every 3-5 years to detect early colorectal cancer.
For people with hereditary colorectal cancer family, the screening age for colorectal cancer should be advanced by 5-10 years, that is to say, fecal occult blood examination should be conducted from the age of 30-35.
2.What treatments should I choose after getting colorectal cancer?
For preoperative assessment of stage I and IIA rectal cancer and stage I-III colon cancer, surgery is generally preferred.
For stage IIB rectal cancer, if the tumor is preoperatively staged as T3 or T4, neoadjuvant radiotherapy is recommended before considering surgical treatment.
For stage III rectal cancer, preoperative radiotherapy is recommended, followed by surgery.
For patients with liver or lung metastases, if there is no colon obstruction, intestinal perforation or severe bleeding, neoadjuvant chemotherapy is needed first, and surgical resection is required after the distant metastases have shrunk or transformed into resectable lesions.
3.Under what circumstances do I need to use targeted therapy drugs?
Targeted therapy is an important progress at present. The longest used targeted therapeutic agents in clinical practice are cetuximab, a monoclonal antibody against epidermal growth factor receptor (EGFR), and bevacizumab, a monoclonal antibody against angiogenic factor (VEGF), cetuximab is only effective for K-RAS mutant tumors, therefore, mutation of K-RAS gene is required before treatment. Testing.
Bevacizumab treatment does not require genetic testing, but its use before surgery has an increased risk of surgical bleeding in addition to the risk of hypertension and embolism, so in patients who have used bevacizumab, surgery should preferably be performed after one month of discontinuation.
Targeted drugs can increase the chance of transformation into resectable lesions when used preoperatively for advanced patients with distant metastases, so preoperative adjuvant chemotherapy combined with targeted therapy can improve the efficacy for stage IV colorectal cancer. Of course, for recurrent or advanced colorectal cancer, targeted therapy can also improve the efficacy, increase the chance of radical resection and improve the efficacy.
4.Under what circumstances is stoma surgery (artificial anus) necessary?
Generally speaking, if the tumor is more than 6cm from the anal verge in men and more than 5cm in women, the possibility of preserving the anus is more than 90%, but for colorectal cancer below, the possibility of preserving the anus will decrease, but whether the anus can be preserved or not depends on whether the tumor can be fully released during surgery. If the lower incision margin is more than 2cm, but the anastomosis position is low, in order to reduce the risk of anastomotic leakage after surgery, the surgeon often recommends a temporary “rerouting surgery”. stoma, and then return the anastomosis after 3-6 months when it has completely healed. Whether anal preservation is needed also needs to ensure that the preoperative patient’s anal function is normal. Some older people with poor preoperative anal function are not suitable for low anal preservation surgery, poor postoperative anal function and poor quality of life.
5.In what cases should radiotherapy be performed after surgery? How should the review be conducted?
Patients who did not undergo radiotherapy before surgery, if the postoperative pathology suggests that they are above IIB, they need to undergo postoperative radiotherapy, and the radiotherapy regimen is usually oxaliplatin + 5-Fu or Siroda + oxaliplatin, and if conditions are available, targeted therapy can be given at the same time, and the chemotherapy is usually 4-6 cycles.
After chemotherapy, patients should undergo regular review, generally speaking, CEA and CA199 examination every 6 months, CT examination of chest and abdomen, and colonoscopy within one year; regular review should not be less than 5 years, and after 5 years, the same screening for colorectal cancer as ordinary people.
6.Other treatment methods, there is no evidence to prove their effectiveness?
At present, there are more methods for colorectal cancer treatment, but the mainstream and evidence-supported treatment plan is surgery-based comprehensive treatment. Although some other treatments may have certain efficacy, their exact efficacy still needs further research to achieve precise treatment of colorectal cancer, which can both improve the efficacy and reduce medical costs.