Cai Sanjun, Chief Physician of Colorectal Surgery, Fudan University Cancer Hospital——

  Colorectal cancer is preventable and treatable (Health Express (stop 41))

  What disease is the most serious cause of death in China?

Tumor.

  According to tumor incidence data released by the National Cancer Center, there were 3.93 million new malignant tumor patients nationwide in 2018, which is equivalent to an average of one person getting cancer every 7.5 minutes, and more than 10,000 people develop malignant tumors every day.

Among them, the incidence of colorectal cancer continues to rise, and the treatment effect is not obvious.

  At the 2020 Tencent Medical ME Conference held not long ago, Cai Sanjun, chief physician of the Department of Colorectal Surgery, Fudan University Cancer Hospital, said that the stage of colorectal cancer at the time of diagnosis has a very large impact on the treatment effect: the 5-year survival rate of first-stage colorectal cancer It can reach 90%, the second phase can reach 80%, and the third phase is about 60%.

However, at the time of actual diagnosis, only 10% of the first-stage bowel cancer is present, and the rate of advanced bowel cancer is relatively high.

  "There is a well-known gastrointestinal oncologist in Shanghai. When he was diagnosed, he was already diagnosed with colon cancer with liver metastases. Although he has undergone the best treatment in China, his survival time is only two years, so early detection is very important. It will have a good effect." Cai Sanjun said that according to the judgment of the World Health Organization, 1/3 of bowel cancer can be prevented, 1/3 of bowel cancer can be cured, and 1/3 of bowel cancer can prolong life and improve survival. quality.

  Do three-level prevention

  Minimize the incidence

  In the face of such a malignant tumor, can it be prevented?

  According to Cai Sanjun, the occurrence and development of colorectal cancer, from normal mucosa to hyperplastic polyps, adenomas, early cancers and advanced cancers, takes about 5 to 10 years, or even longer.

"Such a long period of time has given us an opportunity for early detection, early diagnosis, and early treatment. We should not lose it." He said, "Malignant tumors have the concept of tertiary prevention, and the first level of prevention is causal prevention. The second level is early diagnosis, early treatment, and early detection, and the third level is standard treatment for clinical patients."

  Therefore, the value of primary and secondary prevention is very important.

Primary prevention is mainly lifestyle changes; secondary prevention, screening has played a big role.

"Screening and general surveys can reduce the incidence. Therefore, in the long process of occurrence and development of colorectal cancer, we have the opportunity to detect early through screening and general surveys, and even reduce its incidence." Cai Sanjun said.

  Specifically, first, change lifestyles, reduce high-protein, high-fat, and refined diets, reduce pickled and smoked foods, increase the intake of vegetables, fruits, and whole grains, reduce smoking, excessive drinking, strengthen exercise, and reduce obesity , Appropriate application of drugs such as calcium, selenium, and aspirin.

Second, actively carry out early detection of screening census.

This is the most important means.

Actively treat precancerous lesions and reduce the occurrence of colorectal cancer.

  Just participate in screening

  Will benefit

  Data show that the United States, the United Kingdom and other countries carried out colorectal cancer screenings in the last century.

It is worth noting that they choose different screening methods according to different risk levels and do not use the same method for different risk levels, which will waste a lot of medical resources.

  In 2011, Shanghai initiated colorectal cancer screening for 4 million target populations.

In 2012, Tianjin carried out colorectal cancer screening.

In 2015, Guangdong launched a screening for colorectal cancer.

In 2016, Hong Kong launched screenings for colorectal cancer... These screenings were only carried out in a few large cities, and have not yet been carried out across the country.

  According to Cai Sanjun, there are 7 screening methods for colorectal cancer, including fecal occult blood, sigmoidoscopy, fiber colonoscopy, CT simulation colonoscopy, magnetic resonance simulation colonoscopy, stool DNA analysis and Septin9.

"No research method is superior to other screening methods. As long as you participate in the screening, you will benefit." He said, "When performing colorectal cancer screening, we must pay attention to the age, regional economic status and service capacity of the screening. Support us to carry out screening and be able to benefit."

  Surgical treatment

  Chemotherapy and radiotherapy are effective

  Preventable prevention, can the colorectal cancer that has occurred can be cured?

Cai Sanjun found that many patients will undergo the following processes after the diagnosis is clear.

  First denied, "How could I get a malignant tumor?" Then there was fear and anxiety, "What should I do? What about my family? What about work? What about my future? Why didn't I find it earlier?" Then there was depression. ,Restless.

But through the hospital, it will be accepted gradually.

Cai Sanjun reminded that such a process requires the help of people around.

  Cai Sanjun said that surgical treatment is the most decisive means for the treatment of colorectal cancer.

"It can be said that 85% to 90% of the 5-year survival rate for colorectal cancer treatment is determined by surgery, including laparoscopic surgery, endoscopic surgery, and robotic surgery, which all play a very important role in the treatment of colorectal cancer. Provided a lot of help. He said, "But only relying on surgical treatment is not enough. Medical treatment of tumors can also play a very important role in improving survival, improving quality of life, and prolonging survival time, including chemotherapy.

"

  Many people are afraid when they talk about chemotherapy, feeling that they will lose their hair, feel nauseous, or vomit, and even feel that chemotherapy is not effective.

"In fact, when doctors use chemotherapy, they must have been proven to improve survival and quality of life." Cai Sanjun said that in addition to chemotherapy, there are targeted drug therapy and immunotherapy. These two treatments can improve colorectal therapy. Efficiency is also helpful, but it is currently not doing well in improving survival rates.

  In addition, “radiotherapy is one of the three major methods for the treatment of malignant tumors. It can significantly reduce the local recurrence rate and increase the survival rate in the treatment of advanced rectal cancer. At the same time, it can increase the local control rate in recurrent and metastatic colorectal cancer. , Prolong the survival period and quality of life of patients." Cai Sanjun said.

  Follow the guidelines

  Can get eighty-five points

  Cai Sanjun said that in the treatment of malignant tumors, it is necessary to emphasize standardized treatment, which is to treat according to the diagnosis and treatment guidelines issued by the state.

"If you follow this guideline, you can get the current median level of the world's 5-year survival rate. Simply put, you can score about 85 points in the exam, and combined with some experience and comprehensive treatment, you can reach 90 points." He said.

  In addition, surgery, internal medicine, radiotherapy, endoscopy, pathology, imaging, liver surgery, thoracic surgery and many other disciplines are involved in the treatment of colorectal cancer. Therefore, a good treatment plan must combine everyone’s wisdom and carry out multidisciplinary comprehensive treatment. Ensure that patients get the best treatment effect.

  "Any kind of disease is not like fighting alone in the past." Cai Sanjun said. Multidisciplinary comprehensive treatment means that everyone sits together. According to the patient's condition, after all the diagnosis is completed, a treatment plan is formulated, for example, chemotherapy first. Three times based on the chemotherapy response to decide whether to perform surgery, or to perform chemotherapy three times before surgery. Make a reasonable plan to avoid unnecessary and irregular treatments, which can allow the patient to obtain better results overall.

  Quick question and answer

  Q: At what age should I start screening for colorectal cancer?

  Cai Sanjun: The choice of screening age is mainly determined by the incidence rate.

To put it simply, if you are from 10 to 80 years old, the detection rate may be 3%. If it is 40 to 80 years old, the detection rate may reach 15%.

The money spent was greatly reduced, and the effect was significantly increased.

At present, 50-74 years old is used. Why is it not checked for people over 74 years old?

Although the morbidity rate is high, life expectancy is determined. If you find out at this time, there will be little benefit.

  Q: How should the screening method be selected?

  Cai Sanjun: Among the 7 methods, the simplest and most commonly used is the fecal occult blood test. Basically about 70% can be found through the fecal occult blood test.

The general method is to get a colonoscopy if the stool occult blood test is positive.

  Question: Which foods in your daily diet are related to the incidence of colorectal cancer?

  Cai Sanjun: The most relevant are high-protein and high-fat foods.

Today's dishes are mostly meat.

The proportion of vegetarian dishes should be increased, and the pickled, smoked, and fried dishes should be reduced.

The skewers are obviously not good.

Steamed and cooked is good, and lettuce is good.

  Question: Under what circumstances should I go to the hospital for a stool occult blood test?

  Cai Sanjun: It's generally best to check when you are 50 years old.

You should check if you have symptoms. For example, when you are over 40 years old, your bowel habits have changed. In the past, once a day, now twice and three times a day, you feel unclean. In the past, the stool was quite formed, but now it is often thin.

In addition, some people with mucus and blood need to be seen in time.

  It should be noted that many people say that blood in the stool may be hemorrhoids, but in fact it may be delayed. All people over 40 years old should be checked carefully to exclude tumors when they find that they are uncomfortable.

Unless it is obviously scratched and inflamed, then consider inflammation, and other tumors should be considered first, because the incidence of tumors is too high now.

  Q: Is it healthy to defecate every day?

  Cai Sanjun: It is normal to have a bowel movement once or twice a day.

Of course, many people suffer from constipation.

Constipation is difficult to treat, and 20%-30% of women in their 40s and 50s have constipation.

It is definitely not good to have no bowel movement for two days and three days. I hope to keep the bowel movement smooth through various methods to promote defecation.

  Reporter: Xiong Jian