What to check regularly for rectal cancer

The world is constantly developing, and technology has been greatly improved. The treatment effect of the disease has also been greatly improved, but even so, the 5-year survival rate is still hovering around 60%. Why is this? It turns out that the recurrence rate of colorectal cancer is relatively high, and many patients in my country do not have the awareness of regular follow-up examinations, which leads to the situation that once recurrence occurs, it is difficult to treat.

Most cases of colorectal cancer recurrence are single lesions. If radical resection is performed promptly, the 5-year survival rate of this group of cases can still reach 35%. Therefore, it is recommended that colorectal cancer patients be reexamined every 3 months within 2 years after surgery, and every 6 months thereafter.

It is generally believed that colorectal cancer patients who undergo surgery are very likely to have local recurrence after surgery. Eighty to ninety percent of recurrence cases occur within 2 to 3 years after surgery, and only about 2% of recurrence cases occur after 5 years after surgery. Local recurrence will have symptoms, and when clinical symptoms appear, the tumor has usually developed to the late stage and the opportunity for reoperation has been lost. Therefore, regular examinations are of great significance. Only regular examinations can detect recurrence at an early stage, thereby increasing the success rate of reoperation.

★ Abdominal and pelvic CT scans 4 to 6 weeks after surgery as a control, followed by annual reexaminations within the next 3 years

The use of CT scans after colorectal cancer surgery to understand local recurrence and metastases to distant organs (liver, lungs, etc.), as well as abdominal and pelvic lymph node metastases, has a high accuracy and is now widely accepted.

Under normal circumstances, CT scans are performed once a year, and B-ultrasound examinations are performed once every 6 months. Patients who have the conditions should undergo CT scans within 4 to 6 weeks after surgery as a control for future follow-up examinations. CT scans should be performed every 6 to 8 months within 2 to 3 years after surgery, or when CEA increases. However, in order to distinguish between postoperative changes and recurrences, a CT scan should be performed again 3 months after surgery as comparative data for future follow-up observations.

If B-ultrasound reveals that the abdominal and pelvic lymph nodes are larger than 10 mm, or smaller than 10 mm but clustered together, lymph node metastasis should be considered.

★Review every year within 2 years after colonoscopy. If both negative results are negative, review every 3 years thereafter

Colonoscopy is particularly valuable for observing the anastomosis and should be performed once a year or more. The advantages of fiber colonoscopy after colorectal cancer surgery are: (1) The diagnostic accuracy rate can be as high as 90 to 97 percent, and the positive detection rate is higher than other examination methods; (2) Biopsy can be performed to confirm the diagnosis, which is better than X-ray examination; (3) For postoperative anastomotic stenosis, fiber colonoscopy can determine whether it is a benign scar or a recurrence of the tumor; (4) Colorectal polyps can be removed through fiber colonoscopy.

★Intracavitary ultrasound examination: check once a year after surgery

Hospitals (and patients) with the necessary conditions can perform the examination once a year. This examination is one of the most sensitive methods for determining local recurrence. It can clearly observe the depth of intestinal wall tumor invasion within 25 cm from the anus, and can promptly detect regional lymph node metastasis. For patients who retain the anal sphincter, intracavitary ultrasound examination can be performed through the anus to promptly detect local recurrence lesions. Female patients who undergo Miles surgery can also undergo intracavitary ultrasound examination through the vagina.

★Physical examination: every 3 months within 2 years after surgery, every 6 months from 3rd to 5th year

Medical history and physical examination are conducted once every 3 months, including detailed inquiry into recent medical history. Patients who recover smoothly after surgery may have recurrence if they experience unexplained weight loss, changes in bowel habits, pelvic pain or inner thigh pain in the perineum, unexplained irritating cough, abdominal distension and intestinal bleeding. A comprehensive physical examination should be conducted during the physical examination, including examination of the axillary, supraclavicular and cervical lymph nodes. The abdomen should mainly be examined for the liver and spleen to see if there is an abdominal mass. Digital rectal examination can promptly detect recurrences in the rectum or pelvis. Female patients can undergo pelvic (gynecological) examinations to understand whether there are recurrences (metastasis) of ovarian and pelvic foci.

★Carcinoembryonic antigen (CEA) should be checked every 3 months within 2 years and every year from the 3rd to the 5th year

CEA is one of the most effective methods for monitoring postoperative recurrence or liver metastasis of colorectal cancer. It is usually checked once every three months. The increase of CEA often occurs 4 to 5 months earlier than the clinical symptoms of recurrence. It can not only monitor local recurrence, but also indicate distant metastasis to the liver, lungs, etc.

CEA is also of certain significance in monitoring the efficacy of postoperative treatment. For example, if the serum CEA value of a patient with a high CEA value decreases after chemotherapy, it means that the tumor is sensitive to the chemotherapy drug. If the serum CEA value continues to remain at a high level, it indicates that chemotherapy is ineffective. Serum CEA should be measured every 4 to 6 weeks within 2 years after surgery, and every 6 months after 2 years.

After the above introduction, I believe everyone has a certain understanding of rectal cancer. For patients with rectal cancer, when the body has related abnormal symptoms, they must go to the hospital for relevant examinations and treatment in time. Never give rectal cancer a chance because of carelessness.