Auntie Li, who lives in Haizhu District, is 62 years old. When she retired a few years ago, Auntie Li thought she wanted to enjoy a few years of good fortune. But what I didn’t expect was that from 2001, Auntie Li kept finding out that she was suffering from malignant diseases. First it was breast cancer, then endometrial cancer. Last year, she was diagnosed with colon cancer. In just a few years, Auntie Li has undergone several major surgeries. What’s more, this year she was found out to have intestinal cancer again. At first, the doctor thought that she was suffering from recurrence and metastasis of colon cancer, and there was no value for surgery. However, Auntie Li refused to give up, so she came to Guangzhou Red Cross Hospital again, and this time the doctor found that it was not colon cancer, but cecum cancer. Although the operation was successful, looking back on her repeated hospitalizations over the past few years, Auntie Li felt very painful: Why do all kinds of cancers love to find me? Is there any connection between these cancers or not? Medical guidance: Liu Shaojie, deputy chief physician of gastrointestinal and oncological surgery of Guangzhou Red Cross Hospital. Experts remind: Don’t take multi-cancer as cancer metastasis. Multiple origins of cancer means multiple primary malignant tumors, including simultaneous cancer and heterochronic cancer. The so-called simultaneous cancer refers to two or more tumors found in the same patient at the same time. By heterochronic cancer, it means that one malignant tumor is found in a patient and another malignant tumor is found some time later. It is important to note that these tumors are not related to each other, and their tissue types, sites and nature are actually not the same. In clinical practice, early-stage multi-originated carcinoma is often mistaken for late-stage cancer recurrence and metastasis, thus missing the time for treatment. As for the cause of multiple origins of cancer, it may be related to genetics. Liu Shaojie said that there are two kinds of genes in human body that fight against each other, one is oncogene and the other is oncogene. Generally, the oncogene is stronger and cancer cannot take root in the body. However, as we grow older and our resistance decreases, the oncogenes may “rise up”. Once oncogenes are stronger than oncogenes, tumors may grow. The elderly are vulnerable to multi-source cancer due to poor health. Older people are the population with high incidence of cancer and are also the high-risk group for the occurrence of multi-infarct cancer because cancer often requires a long latent period. With the increase of age and the decrease of immune system, cancer-causing factors in the elderly will accumulate and eventually lead to the occurrence of cancer. Multi-source cancers that occur in the elderly include breast cancer, colorectal cancer and bladder cancer, the incidence of which can reach 5% to 10%. Liu Shaojie pointed out that multi-source colorectal cancer is not uncommon, and if one is not careful, only one of them may be found during the examination and the other one is overlooked. Like Auntie Li mentioned above, from her case, while colon cancer develops, cecum cancer should be growing at the same time, because bowel cancer grows slowly and it takes 1~1.5 years for the tumor to spread along the intestinal wall. But why was only colon cancer found in the last examination? There may be two reasons for this, one is that colon cancer blocks the way to further exploration by colonoscopy, and the other is that the doctor has already found one tumor and thought he has found the whole cause of the disease, so he gave up further exploration. Adhere to colonoscopy follow-up after colon cancer surgery. Liu Shaojie reminded that colon cancer must not neglect colonoscopy follow-up after surgery. The first follow-up examination should be conducted within six months after surgery, and then once a year for the next two years. If a positive finding is found, it should be insisted once a year to prevent malignant change. If there is no positive finding, it should be followed up once every two years for life. In addition, colonic adenomas, especially villous and mixed adenomas with high cancer rate, should be removed by electrocoagulation once found, and those suspected to be malignant and cannot be removed by electrocoagulation can be removed surgically to reduce the chance of cancer. For some colon cancer patients with combined incomplete obstruction, colonoscopy cannot fully examine the whole course of the large intestine, so doctors should not take it lightly and should not be satisfied with finding one tumor to confirm the diagnosis, but should combine with CT, MRI, air-barium enema and other examinations to exclude the possibility of multi-source colon cancer. Tips: Early signs of cancer: 1. Lumps in any part of the body, such as breast, neck or abdomen, especially those that gradually increase in size. 2.Ulcers on any part of the body, such as tongue, cheek mucosa, skin, etc. without trauma, especially those that do not heal for a long time. 3.Irregular vaginal bleeding or increased discharge (commonly known as leucorrhea) in women of middle age or older. 4.Dullness, burning pain, foreign body sensation or progressive aggravation of dysphagia behind the sternum when eating. 5.Long-term low fever, untreated dry cough or blood in sputum. 6.Long-term indigestion, progressive loss of appetite, and weight loss, and no clear cause is identified. 7.Change in stool habit or blood in stool. 8.Nasal congestion, epistaxis, unilateral headache or with diplopia. 9.Sudden increase of moles or breakage or bleeding, loss of original hairs. 10.In addition, precancerous lesions should also be regarded as early signs. For example, mucosal leukoplakia, chronic skin ulcers, fistulas, proliferative scars (especially those caused by chemical burns), atrophic gastritis and intestinal epithelial hyperplasia, multiple polyps of the rectum, skin keratosis (especially keratosis of the palm of the hand at the size of the fissure), cystic lobular hyperplasia of the breast, cervical erosion, cervical polyps, etc. may develop into cancer. Patient: I just had a checkup at another hospital and said that the sigmoid colon cancer I had last year had recurred and metastasized, and now I have advanced colon cancer. I thought for a long time that it was better to look at another hospital to feel relieved. Doctor: You had sigmoid colon cancer last year, how was it treated? Patient: The lesion was removed cleanly at that time, and the recovery after surgery was fine, so I didn’t think it would metastasize. Doctor: Are the symptoms of the disease the same as last year? Patient: There are still some differences. Last year, I had dark red blood stools for more than two months, and then I went for colonoscopy and found out that it was sigmoid colon cancer. Some time in the middle of this year, I suddenly lost a lot of weight, and had symptoms of anemia and dizziness. Later, I felt a lump in my lower right abdomen, and when I went to the hospital where I was treated, the doctor said that it was advanced colon cancer that had recurred and metastasized in the abdominal cavity, and suggested me to do chemotherapy. After reading Auntie Li’s medical records not long ago, it did look like a recurrence of cancer. In order to be cautious, the doctor decided to check again. From the colonoscopy, there was indeed a tumor in Auntie Li’s intestine, and the tumor was relatively large. However, further PET-CT examination did not reveal any signs of distant metastasis of the cancer and did not look like a late recurrence of colon cancer. In order to further clear the doubts, the doctor gave Auntie Li an open abdominal exploration. This time, it was found that a tumor had grown in the cecum of Auntie Li’s abdomen. However, this cecum cancer is not related to the last colon cancer, although the two locations are only one or twenty centimeters apart, but it is certain that the two tumors are separate. Doctor: Your case is not cancer recurrence, but multi-originated cancer, there is a big difference between the two. After listening to the doctor’s explanation, Auntie Li suddenly realized that she told him that she had been tormented by multi-originated cancer for many years: in 2001, she felt a lump in her left breast, which was later found to be breast cancer and was surgically removed and cured. 2005, after years of amenorrhea, she suddenly had irregular vaginal bleeding, which obviously had nothing to do with her menstrual cycle, and this time she was diagnosed with endometrial cancer, and soon afterwards She underwent an extensive total hysterectomy + double adnexal resection. After that, it was a painful experience to discover colon cancer last year and appendiceal cancer this year. After confirming the “real culprit”, the doctor performed a radical right hemicolectomy on Auntie Li, who recovered well after the operation. It is important to review regularly after bowel cancer surgery.