April 15-21 this year is the 28th National Cancer Prevention and Control Awareness Week, and the theme of this year's Publicity Week is "Cancer Prevention and Control Early Action". In order to help the public advocate healthy life, popularize the relevant knowledge of scientific prevention and treatment of tumors, and improve the health awareness of the masses, on April 14, the China-Japan Friendship Hospital held a press conference and invited experts from the hospital's tumor prevention and control and diagnosis and treatment departments to exchange views. At the meeting, Jie Jianzheng, director of the Department of General Surgery and Colorectal Surgery of China-Japan Friendship Hospital, shared the topics related to the prevention and treatment of colorectal cancer, and explained several issues of common concern to patients.
First of all, Jie Jianzheng shared the incidence of colorectal cancer. Colorectal cancer accounts for the first place in gastrointestinal tumors, according to 2020 data, its incidence ranks third in the world, the mortality rate ranks second, in China, 2020 there are 550,000 cases, the incidence ranks second, the death rate ranks second, the death rate is 280,000 cases, ranking fifth, "This data is equivalent to every minute there is a colorectal cancer patient diagnosed, less than two minutes there is a patient died of colorectal cancer, we have a long way to go in the prevention and treatment of colorectal cancer."
Precision treatment, low-level preservation, rapid rehabilitation, comprehensive care, and health advocacy is the purpose and concept of colorectal surgery in China-Japan Friendship Hospital. Jie Jianzheng introduced the characteristics of the department from 6 aspects.
The first is "minimally invasive". Jie Jianzheng said that most of the surgeries in the department are minimally invasive, accounting for more than 90%. Laparoscopic surgery in the hospital has evolved from the original 2D laparoscope to 3D laparoscopy, and now has advanced technologies such as robotic surgery. In addition, the hospital is also doing natural cavity surgery, surgical specimens are taken out through the natural cavity, there is no incision, both beautiful, fast recovery and.
The second is low-level rectal cancer preservation technology. According to Jie Jianzheng, low/ultra-low rectal cancer has relatively high technical requirements for doctors, and low-level, especially ultra-low-level rectal cancer preservation technology, is the characteristic and advantage of the department, and has been unanimously praised in China.
The third is "colorectal cancer MDT", a multidisciplinary team collaboration model. At present, multidisciplinary team collaboration has become the standard treatment mode of tumor treatment, that is, to bring together experts from oncology-related departments, including internal medicine, surgery, radiology, pathology, etc., to discuss the best treatment methods and means for patients, which is both standardized and individualized, not uniform, and provides patients with the best treatment plan.
The fourth is the "concept of rapid rehabilitation". Jie Jianzheng said that we have cooperated with the Rehabilitation Department to introduce the concept of preoperative rehabilitation, and do a good job in nutritional support, physical training and psychological intervention for patients before surgery or even in outpatient clinics, so that patients have sufficient physical support when doing surgery, can withstand the blow of surgery, reduce postoperative complications, and accelerate postoperative rehabilitation. It turns out that the treatment effect is also very good, shortening the average hospital stay and reducing the financial burden on patients.
The fifth is "ostomy care". Jie Jianzheng said that excellent treatment is inseparable from the nursing team, the department has carried out enterostomy specialist clinics, guiding the outpatient rehabilitation treatment of ostomy patients after discharge, the effect is very good, attracting stoma patients from all over Beijing to come to the clinic, has a certain influence in China, which also reflects the whole process of care for patients.
Sixth, in terms of international exchanges, the China-Japan Friendship Hospital itself is a model of cooperation and friendship between China and Japan, and colorectal surgery has established close contact with relevant departments and major medical centers in Japan as early as 1998, regularly demonstrates and exchanges with surgery, and introduces Japan's advanced laparoscopic gastrointestinal surgery concepts and technologies to China very early. During the epidemic period, the department also did a lot of academic exchanges with Japan online, and held a large number of academic activities and science popularization activities.
Question 1: What causes colorectal cancer? Will it be inherited? How can early screening and prevention be achieved?
Jie Jianzheng: The incidence of colorectal cancer is indeed very high, and 90% of colorectal cancers are gradually developed after the cancer of polyps and adenomas. But the process is relatively long, it is a multi-stage, multi-gene process. Specifically which genes cause it, it has not been clearly studied. Exactly which factors in life can cause colorectal cancer, there are no factors that are very certain, but it may be related to the following factors: First, diet. Now that the diet is Westernized, excessive high-protein, high-fat diet will cause feces to stay in the intestine for a long time, increase the absorption of toxins, and cause cancer. Therefore, we advocate eating more dietary fiber, which can promote the movement of feces in the intestine and excrete toxins. Low-fiber foods are prone to constipation and increase toxin absorption. The second is genetic factors, which also play a certain role in the occurrence of colorectal cancer. In addition, some patients with recurrent intestinal inflammation, such as ulcerative colitis, are also at high risk of colorectal cancer. The above related factors need to be further verified by follow-up studies.
Is colorectal cancer inherited? Genetic factors play a role. Statistically, about 1/3 of colorectal cancer is likely to be related to genetic factors. But only 5-6% of those who can really determine that there are inherited genes are currently known. For example, Lynch syndrome, which accounts for about 3% of colorectal cancer, is an autosomal dominant disorder. There is also familial adenomatous polyposis, which is also a common hereditary colorectal cancer, accounting for about 1% of colorectal cancer. But once it is determined that it is this type of inheritance, the probability of colorectal cancer is very large.
Regarding early screening and prevention, colorectal cancer is a chronic disease and one of the few tumors that can be prevented and treated. Most of it begins to evolve from polyps and adenomas, first the normal mucous membrane becomes a polyp, adenoma hyperplasia, and then cancerous. This evolution takes 5-15 years, giving us plenty of time to discover it. The best means to find it is colonoscopy, and now we advocate that the general population over 40 years old should do colonoscopy screening, do it every 5 years, do a stool occult blood test every year, and if the stool occult blood is positive, go to the colonoscopy immediately. In addition, if there is colorectal cancer or progressive adenoma in the first degree of relatives, colonoscopy is also recommended as soon as possible. For the two hereditary colorectal cancers mentioned above, such as Lynch syndrome, if there is really this genetic gene, it is necessary to start colonoscopy from the age of 20 and check it every two years, because the carcinogenic rate of this cancerous transformation can reach more than 60%. There are also genotypes of familial adenomatous polyposis, sometimes even requiring endoscopy to begin as early as the teens, once a year, because the disease occurs at an earlier age and with a greater probability of colorectal cancer.
Prevention is mainly primary prevention, lifestyle changes, such as not smoking, less alcohol, more exercise, reduce obesity, control diabetes, eat less processed meat in life, eat more dietary fiber.
Question 2: Do low-level rectal cancers have to be diverted after surgery? How to recover after surgery? How long does it take?
Jie Jianzheng: A major feature of our department is the protection of low colorectal cancer, of course, preservation is not necessarily the most important purpose, and the eradication of tumors is the primary goal. Whether low-level rectal cancer should be diverted, divided into the following situations, first of all, if the staging is relatively early, this time it is possible to directly operate, and most of the anus can be saved. However, at this time, a temporary stoma may be done, and it will be put back after half a year after the operation, after which the anus can still defecate normally. More common is the second case, when the patient comes to the low rectal cancer partial stage has been relatively late, this kind of patient if there is still the idea of preservation, we will do preoperative evaluation, through preoperative radiotherapy and chemotherapy, if the tumor shrinks, we will give him preservation surgery. In the third case, the tumor is not sensitive to preoperative radiotherapy and chemotherapy, the treatment effect is not good, if the anus is forcibly protected, it is irresponsible for the patient, in this case the anus cannot be saved, and a permanent stoma should be made. Fourth, for some elderly people or colorectal cancer patients who cannot tolerate surgery or even do not want to operate, if the effect of radiotherapy or chemotherapy is very good, or even to achieve clinical total disappearance, then you can take the strategy of waiting for observation, some patients no longer need surgery, nor do they need to change courses, of course, this is the most ideal situation.
Regarding postoperative rehabilitation, we generally recommend that the patient eat early, help him expel phlegm, get out of bed, walk 50 meters on the first day, move first, and then gradually increase on the second and third days to restore his physical strength and help him cough up sputum. Now our patients can get a basic recovery of physical strength in about six or seven days after surgery, and they can be discharged and go home.
Text/Beijing Youth Daily reporter Jiang Ruojing
Editor/Peng Zhang
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