How to detect colorectal cancer early?Who wants to screen?Experts take stock of new hotspots of colorectal cancer diagnosis and treatment
According to data in my country in 2019, the rough incidence and mortality of colorectal cancer are in the top five in the ranking of all cancers, and research on colorectal cancer has gradually increased.
<!–
->
In the past 2021 Peking Union International Gastrointestinal Institute and the 28th Peking Union Hospital of Beijing Union Hospital, Professor Fang Jingyuan from Renji Hospital, Affiliated to Shanghai Jiaotong University Medical College passed the heavy club published in recent years. The interpretation of the article summarizes the new hotspot of the diagnosis and treatment of colorectal cancer.
Who needs to conduct colorectal cancer screening?
The purpose of colorectal cancer screening is to detect high -risk groups.
The incidence of colorectal cancer in the United States has declined in the past ten years. Very important.
my country’s guide consensus warns high -risk people to meet the following one of the high -risk people who can be considered as colorectal cancer:
1. Poor manure is positive;
2. First -level relatives have a history of colorectal cancer;
3. The history of intestinal adenoma in the past;
4. I have a history of cancer;
5. Change the bowel habits change;
6. It is in line with any two items of the following: chronic diarrhea, chronic constipation, mucus blood, chronic appendicitis or appendic resection, chronic cholecystitis or cholecystectomy, long -term mental depression has alarm signal.
In addition, the Asia -Pacific working group also scores the risk factors of colorectal cancer [1], which is very useful for the high -risk groups that identify colorectal cancer tumors.
A review published in Lancet recently summarized the genetic and environmental factors affecting the incidence of colorectal cancer [2] again, and once again emphasized that smoking, red meat intake, low dietary fiber, obesity and other factors can affect the occurrence of colorectal cancer.
After the two polyps are removed, how often do you review it?
Before explaining this part of the content, Professor Fang Jingyuan first reviewed the definition of related terms. Among them, the more important is the definition of the progressive adenoma, the progress of new creatures, and high -risk adenoma.
The adenoma must have at least one item: the diameter of the adenoma ≥10mm; the tubular fluffy/fluffy tumor; the adenoma is accompanied by a high -grade heteroid hyperplasia.
New creatures in progress need to have at least one of the following: progressive adenoma; colorectal cancer.
High -risk adenoma needs at least one: new creature in progress; 3 or above adenoma.
The monitoring time window after the removal of new creatures such as adenoma in various countries is different. The recommendations of the United States colorectal cancer special work group, the British gastrointestinal disease association, and the Asia -Pacific working group are shown in the figure below [1, 3, 4].
How to detect colorectal cancer early?
In recent years, many new types of blood and feces are used for early discovery and early warning of colorectal cancer, such as LNCRNA and intestinal bacteria in tissue or circulating blood. The team of Professor Fang found that symbiotic achicus in the feces could effectively early warning colorectal cancer, and jointly tested with CEA and FIT, and the early warning value was greater [5].
4 How to accurately predict the treatment and prognosis?
After the colorectal cancer, chemotherapy is less than 40%, and the 5 -year survival rate of drug -resistant people is less than 10%. A study published by Cell Magazine in 2017 shows that the surgical specimen has a high content and recurrence after chemotherapy. Essence
Another study suggests that the internal deformation of colorectal cancer can regulate the chemotherapy resistance of Gascotabin [7]. The results of animal experiments based on animal experiments show that after removing nucleus, the volume of the tumor is significantly reduced [8].
Five establishing new strategies for the first -level prevention of colorectal cancer
The first -level prevention of colorectal cancer includes chemical prevention and endoscopic prevention.
Drugs currently used in the first -level prevention of colorectal cancer are relatively scarce. The results of research based on forward -looking random control tests confirmed that folic acid can significantly reduce the incidence of colorectal adenoma [9], which also established a new method for the prevention of colorectal cancer. Essence
Six emphasis on the prevention of adenoma after removal
Recently published in a multi -center, random, double -blind, and placebo -controlled research results published in Lancet digestion subcumes show that small alkaline hydrochloride can prevent reinstatement after the removal of colorectal adenoma [10].
Other anti -drugs include aspirin and two -septum.
In addition, the intestinal micro ecology may be an important factor in the occurrence of colorectal cancer, so improving environmental factors such as diet and living habits help prevent colorectal tumors.
Seven colorectal cancer Selection of the choice of treatment of drugs after metastasis
After the occurrence of colorectal cancer, patients are no longer suitable for root treatment. For these patients, the treatment method includes traditional Chinese medicine, chemotherapy, targeted therapy and immunotherapy.
It should be noted that if targeted treatment or immunotherapy is proposed, the patient’s lesion tissue needs to perform immune groupization, immune enzyme label or gene sequencing examination, and then start treatment after obtaining the molecular pathological data of the lesion.
Eight clinical issues that cannot be ignored
1 Side of the developed colorectal tumor (LST)
LST has a high detection rate in recent years, and its typography still uses the Paris plan.
2 sawtooth lesions
Sago lesions include proliferative polyps, wide -founded elastic jagged glandular tumors (polyps), traditional jagged glandoma, and hyperplasia. This lesion has the risk of cancer and should attract enough attention.
The main molecular mechanism of traditional adenoma-adenoma-adenocarcinoma is different. Adinel-adenoma was a mutation of APC genes in the early stage, and finally the TP53 mutation, while the sawtoothing pathway was a mutation of BRAF and the occurrence of CPG Island. In the later period The final diagnosis of sawtooth lesions requires histological examinations to confirm. In addition, the colonoscopy is easy to omit serrated lesions. This is because flat samples and side lesions in sawtooth lesions are relatively high.
3 Early Early Early Colorectal Cancer (EOCRC)
EOCRC refers to colorectal cancer that occurs in people less than 50 years old. The incidence of colorectal cancer in the United States is reduced, but the incidence of early colorectal cancer is still rising. This phenomenon is related to excessive emulsifiers, trans fatty acids, acrylamide, nitrite, and A1β-casein in the diet of young American people.
4 Discover the new target intervention: in -depth mechanism research
The CMS molecular type of colorectal cancer has four types. Different types of classification are related to the pathway, lesions and postal treatment of colorectal cancer, but the specific relationship is still not clear. Space.
Professor Fang Jingyuan finally mentioned that the intestinal microcuna is a new target for the diagnosis and treatment of colorectal cancer.
Reference materials:
[1] SUNG, J.J, Et Al., An UPDATED Asia Pacific Consensus Recommendations on COLORECTAL CARANCER Screening.Gut, 2015.64 (1): P.121-32.
[2] DEKKER, E., et al., Colorectal Cancer.lancet, 2019.394 (10207): p.1467-1480.
[3]Gupta，S.，et al.，Recommendations for Follow-Up After Colonoscopy and Polypectomy：A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer.Gastroenterology，2020.158(4)：p.1131-1153 e5 Then, then, then
[4]Rutter，M.D.，et al.，British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines.Gut，2020.69(2)：p.201 -223.
[5] XIE, Y.H., Et Al., Fecal CLostridium Symbiosum for Noninvasive Detection of Early and Advanced Colorectal Cancer: Test and Validation Studies.ebiomedicine, 2017.25 :25 :25 :35 :35 :25 :35 :25 :35 :25 :25: 35 :25 :35 :25 :35 :25: 35 :25 :35 :25: 35 :25 :35 :25 :35 :25: 35 :25 :25 :35 :25 :25: 35 :25 :25: 35 :25 :3,
[6] Yu, T., Et Al., Fusobacterium Nucleatum Promotes Chemoresistance to Colorectal Cancer by Modulating Autophagy.cell, 2017.170 (3): P.548-563 E16.
[7] Geller, L.T., et al., Potential Roletumor Bacteria in MediaTing Tumor Resistance to the Chemotherapeut Drug Gemcitabine.sclence, 2017.357: p.1156-1160.60.60.60.6060.60.60.6060.60.60.60.6060.60.60.6060.60.60.60.
[8] Bullman, S., ET AL., Analysis of Fusobacterium Persistence and Antibiotic Response in Colorectal.Science, 2017.358 (6369): P.1443-1448.
275.
