Due to the working relationship, I have met many colorectal cancer patients, most of them are middle-aged and elderly, and their clinical manifestations are different. In order to have a preliminary understanding of colorectal cancer, the performance of colorectal cancer patients at the first diagnosis is reviewed as follows. Blood in stool is the earliest manifestation of colorectal cancer. Due to the influence of the folk saying “nine out of ten hemorrhoids”, some people do not go to formal hospitals for examination even if they have blood in stool, but buy some hemorrhoid medicine and apply it externally, or go to informal medical institutions for treatment, which often misdiagnose rectal cancer as internal hemorrhoids. I met a middle-aged woman in the clinic who had blood in her stool more than a year ago and did not care about it at that time. Half a year ago, she went to a private hospital because of the aggravation of blood in her stool, and the doctor said she had hemorrhoids and then gave her surgery. I gave the patient an anal finger examination, into the finger 8 cm can be palpable a cauliflower-like hard swelling high convex, intestinal lumen narrow, after the diagnosis finger stained with blood smells fishy. The patient’s rectal cancer was already in the middle and late stages. Once a middle-aged man came to the clinic and said that he had watermelon flesh-like bloody material sprayed on his underwear when he was exhausting today, so he asked me to examine him, and the finger examination revealed a bean-sized mass in the anus about 7 cm from the anus, and the pathological diagnosis was rectal cancer. The patient is now more than two years after radical rectal cancer surgery and is still doing well. Tips: Internal hemorrhoids blood in stool mostly appears intermittently, some intervals of several months or years, as long as the stool is smooth blood in stool usually disappears within two weeks, blood in stool is bright red, dripping or shooting blood, blood and stool do not mix. Colorectal cancer blood in stool lasts for a long time, or blood in stool every other day, or pus and mucus stool, when doctors encounter patients with blood in stool, they must do anal finger examination, rectal cancer mostly occurs within 8-10 cm from the anus, which can be touched by finger examination. Once I chatted with a colleague, she said that her stool had become irregular recently, and her stool had become thin, with mucus two to three times a day, and I asked her to check her fecal occult blood three times (within a week), and two times were positive. I also often encounter patients who come to the clinic with diarrhea, abdominal pain, and pus and blood stools, and after colonoscopy, some have ulcerative colitis and some have colon tumors. Tip: Anyone who has a change in bowel habits must first undergo colonoscopy to confirm the diagnosis, otherwise treatment for inflammatory colon disease is often delayed. Some colon cancer is also the result of colonic inflammation or colon polyps malignant transformation. Constipation may also be the result of narrowing of intestinal cavity caused by cancer. Generally, people attach great importance to blood in stool and go to hospital for examination as soon as there are symptoms, fearing to have rectal cancer. When they are constipated, they buy some laxatives and do not go to the hospital for further examination after the symptoms are temporarily relieved. There is an elderly female patient who was constipated half a year ago and often took some laxatives on her own. Now, the old lady has difficulty in defecating, always has the intention to defecate but can’t defecate on the toilet, and sometimes her stool is in sections, but no blood in the stool is found. When I finished examining the patient and told her daughter the clinical diagnosis, her daughter said, “Why was my mother found to have advanced rectal cancer when she did not have blood in her stool, but only had irregular bowel movements and constipation? I explained: if you can’t see blood in the stool with the naked eye, it may be because the amount of bleeding is small, but if the fecal occult blood test is often positive, because the malignant tumor grows faster, the blood supply is not available, the local tissue will bleed and necrosis, and there may be purulent blood discharge in the patient’s stool.
If the tumor increases to a certain degree and becomes obstructive, the stool will become deformed and thin, and the discharge will be difficult. Tip: Constipation is a common clinical symptom and an important cause of many diseases. There are many kinds of toxins in stool, which have serious effects on human body after being absorbed. Constipation is one of the reasons for the development of colorectal cancer, and it is also a manifestation of the narrowing of intestinal cavity due to the increase of tumor. There is an anemic female patient who is only 40 years old, and her hematocrit dropped a year ago, and she was diagnosed as iron deficiency anemia. In order to find the cause, I performed colonoscopy on her and found that there was a tumor in the hepatic region of the colon, which was so large that it was difficult to pass through the colonoscope. The patient reviewed her condition and said that over the past year, she often had left abdominal pain and sometimes right abdominal pain in the form of paroxysmal colic or vague pain, coupled with loss of appetite, fullness and belching, nausea and vomiting, etc. She did not care about the gastrointestinal discomfort because she thought it was caused by taking medicine. Hint: Because of the large intestinal lumen and liquid-like feces in the intestine, most of the cancers in this section of intestine are ulcerated or cauliflower-shaped cancers, which often break down and bleed, with secondary infection and toxin absorption, so the patients mostly come to the clinic with abdominal pain, anemia
Therefore, most patients come to the clinic with abdominal pain, anemia, abdominal masses. There was a patient who was admitted to the hospital with internal medicine disease, and the fecal occult blood test was consistently positive during the routine examination. Hint: fecal occult blood test is a common method for clinical screening whether patients with insignificant symptoms need to undergo further colonoscopy or barium enema. If the test is positive for several times, the patient should be given a colonoscopy or barium enema. In order to make a clear diagnosis