Diagnosis and treatment of colon cancer

In clinical practice, colon cancer is a relatively common disease. However, people do not know enough about it and often confuse it with other gastrointestinal diseases, which leads to frequent misdiagnosis. Here we introduce the knowledge about the diagnosis and treatment of colon cancer.

How is colon cancer diagnosed?

(I) X-ray examination

1. Abdominal plain film examination is suitable for cases with acute intestinal obstruction, which can show that the colon above the obstruction site is inflated and swollen.

2. Barium enema examination shows that the intestinal wall at the site of cancer is rigid, with poor distensibility, peristalsis weakened or disappeared at the lesion, irregular or disappeared colonic bag shape, narrow intestinal cavity, disordered, destroyed or disappeared mucosal folds, filling defects, etc. Barium-air double contrast radiography is more helpful in diagnosing pedunculated tumors in the colon.

(II) Carcinoembryonic antigen test

It has little diagnostic value for early cases, but it is helpful in predicting prognosis and judging recurrence.

(III) Sigmoidoscopy and fiber colonoscopy

Although the sigmoidoscope is 25 cm long, 75% of colorectal cancers are within the scope of the sigmoidoscope. Microscopic examination can not only detect cancer, but also observe its size, location and local infiltration range. Through the sigmoidoscope, tissue can be taken for pathological examination. Fiber colonoscopy can provide a higher diagnosis rate and has been widely used in China. Skilled operators can insert the fiber colonoscope into the cecum and terminal ileum, and can also take pictures. It is indeed an ideal examination method.

(IV) Anal digital examination and rectal endoscopy

Check for rectal polyps, rectal cancer, internal hemorrhoids or other lesions for identification.

Treatment of Colon Cancer

【Surgery】

1. Right hemicolectomy is suitable for cancers of the cecum, ascending colon and hepatic flexure of the colon.

2. Left hemicolectomy is suitable for cancers of the descending colon and splenic flexure of the colon.

3. Transverse colectomy is suitable for transverse colon cancer.

4. In addition to resection of the sigmoid colon, sigmoid colon cancer should also be treated with descending colon resection or partial rectal resection.

5. The surgical principle for patients with intestinal obstruction is that if the patient's condition permits, a primary resection and anastomosis can be performed. If the patient's condition is poor, a colostomy can be performed first, and a secondary radical resection can be performed after the condition improves.

6. Principles of surgery when radical surgery is not possible: when the tumor is extensively infiltrated, or is fixed to surrounding tissues and organs and cannot be removed, or the intestinal tract is already obstructed or may be obstructed, a short-circuit surgery or colostomy can be performed. If the tumor has metastasized to distant organs and local tumors can still be removed, local palliative resection can be used to relieve symptoms such as obstruction, chronic blood loss, infection and poisoning.

【Chemotherapeutic drug treatment】

Patients after surgery can generally use chemotherapy for 2 to 3 courses within one to one and a half years. The commonly used drugs are mainly 5-fluorouracil (5-FU), which can also be combined with mitomycin, cyclophosphamide, etc. The total amount of 5-FU can be 7 to 10 grams per course. It can be taken orally or intravenously. It is best to add it to glucose solution for drip infusion, 250 mg each time, once a day or every other day.

If the reaction is severe, such as nausea, loss of appetite, weakness, decreased white blood cell and platelet counts, etc., the dosage can be reduced each time, or the interval can be increased. If bone marrow suppression is obvious, the drug can be stopped in time. The gastrointestinal reaction of oral administration is greater than that of intravenous administration, but the bone marrow suppression reaction is mild. During the medication, supportive treatment must be paid attention to, and drugs that reduce side effects must be used.

Chemotherapy for patients whose cancer cannot be removed can alleviate symptoms and control tumor growth to a certain extent, but the effect is poor and short-lived. If the patient's general condition is poor, the side effects are significant and the condition may be aggravated, so it is not suitable for use.

Immunotherapy

It can improve the patient's anti-tumor ability. It has developed rapidly in recent years. Interferon, interleukin, transfer factor, tumor necrosis factor, etc. have been gradually and widely used. They can not only improve the patient's immune ability, but also cooperate with chemotherapy.

【Chinese medicine treatment】

It can improve symptoms, enhance the body's disease resistance, and reduce the side effects of radiotherapy and chemotherapy. Some Chinese medicines have direct anti-cancer effects, such as Oldenlandia diffusa, Scutellaria barbata, Trichosanthes kirilowii, Solanum nigrum, etc. Ganoderma lucidum preparations can significantly improve the patient's immune function. When taking medicine, you can take both syndrome differentiation and disease differentiation into consideration, and add medicines that clear away heat and detoxify, promote blood circulation, nourish yin and blood, remove phlegm and disperse nodules, and regulate the spleen and stomach.