In recent years, the incidence of colorectal cancer has gradually increased. When many people hear about colorectal cancer, they worry about removing the anus and are afraid of treatment. In fact, the location of the tumor in the intestine is different, and the treatment methods and prognosis are also different.

General lower digestion refers to the range from the ileocecal valve to the anus. It can be roughly divided into four parts, consisting of the cecum, colon (which can be divided into ascending, transverse, descending, and sigmoid colon), rectum, and anus. The main function is to reabsorb the water in the food residues, shape the stool, and store the stool. place. Cancers that occur in the large intestine (cecum and colon) are generally referred to as colorectal cancer. In fact, the tumor grows in different parts of the large intestine, and the treatment methods and prognosis are also different. In the eyes of doctors, colorectal cancer and rectal cancer can even be said to be different cancers.

The total length of the large intestine is about 120-140 cm, showing a door, occupying the four sides of the abdominal cavity. In the past, colorectal cancer mainly occurred in the sigmoid colon, but with the popularization of colonoscopy, because the entire large intestine can be examined, the proportion of tumors found in the right large intestine, that is, the ascending colon, has also increased.

The rectum is a small section of the intestine below the sigmoid colon and above the anus, about 12-15 cm in length, and its main function is to store feces. If the tumor grows within 15 centimeters of the anus, it is called rectal cancer. Because the rectum is closest to the anus and is easy to examine, the risk of finding cancer is relatively high, accounting for about one-third of colorectal cancers.

Rectal cancer treatment, whether the patient retains the anus is a problem

Clinically, the surgical treatment of rectal cancer is more difficult than that of colorectal cancer.

On the one hand, it is related to the location of the anatomy . Unlike colorectal cancer, which is located in the abdominal cavity, rectal cancer is located in the relatively narrow pelvic cavity, and there are many bones next to it. In comparison, the pelvic cavity of men is narrower than that of women, so surgery can be performed. space is limited.

On the other hand, whether to keep the anus needs to be considered. In fact, there is no need to consider this problem in the surgical resection of colon tumors, because the colon is long, but during the operation, in order to clean the tumor, an extra part will be cut at the front and rear ends of the tumor, about 5-10 cm, to ensure the cleaning.

However, for rectal tumors, the length is limited, and patients generally want to preserve the anus, so the cleaning distance is limited, and only about 1 cm more is removed .

Whether to keep the anus or not depends on the location of the tumor and the patient’s thoughts and requirements . All possibilities should be discussed with the doctor. With the current medical methods, if the treating doctor considers that the anus can be preserved, the anus should be preserved as much as possible, but if it is low rectal cancer, that is, For tumors within 5 cm of the anus, the tumor should be cleaned first, and then the question of whether the anus should be preserved should be considered.

Violation of the external sphincter should be an artificial anus

Even if patients with low rectal cancer undergo anal-sparing surgery, because the remaining anal canal is limited, most of them will affect defecation control, but the symptoms are only mild or severe, which is called low anterior resection syndrome. It may be more than ten times a day, and constipation will occur after a few days, which will cause great trouble to life.

Therefore, for patients with rectal cancer, the way of defecation after surgery will definitely change, but the impact will be large or small. It is generally recommended to reduce the amount of bowel movements by adjusting the diet, such as reducing the intake of fiber such as vegetables and fruits. Some patients think that the diet and the uncertainty of defecation will affect their quality of life and choose to have permanent artificial anus. .

However, if the tumor has invaded the external sphincter, most of the time it is not recommended to keep the anus, because the external sphincter is used to control defecation. If the tumor invades the external sphincter, the external sphincter must be removed, and the problem of fecal incontinence will be faced in the future. .

In the case where the tumor has not invaded the external sphincter, there are currently two common surgical methods to preserve the anus: rectal pull-out surgery or intersphincterectomy. The principle is to remove the internal sphincter and preserve the external sphincter and anus.

Obstructive colorectal cancer, possibly with temporary artificial anus

Colorectal cancer patients generally do not need to remove the anus, but sometimes a temporary artificial anus is needed. Surgery to remove the tumor and remove the artificial anus.

Although this artificial anus is only temporary and not permanent, some patients still mind having a fecal bag with them. At this time, another option is to put an artificial stent to make the intestines unobstructed, and then do bowel cleansing and prepare for surgery.

The operation method should be judged according to the patient’s condition and economic ability.

The surgical methods for rectal cancer include traditional laparotomy, laparoscopy and other methods. All of these methods can remove the tumor, but the methods and costs are different. Generally speaking, the less damage and the more advanced some surgical methods are, the more expensive they are. The surgical method may not be suitable for the patient.

Comparing these surgical methods, the biggest advantages of laparoscopy compared with traditional open surgery are smaller wounds, faster recovery, and less pain. However, it is not suitable for every patient. If the tumor cannot be completely removed during the operation, it may be switched to another surgery. Traditional open surgery.

Radiation or chemotherapy before rectal cancer surgery

Unlike other cancers, which are usually treated with radiation therapy or chemotherapy after surgery, rectal cancer is usually performed before surgery, in order to reduce the tumor size, facilitate surgical resection, and facilitate the preservation of the anus. The clinically applicable objects are mainly mid-term rectal cancer patient. As for the need for adjuvant chemotherapy after surgery, there is currently no large-scale clinical trial to prove its effectiveness. In the past, it was based on the effect of colorectal cancer, so rectal cancer was also treated in a controlled manner. For patients whose postoperative pathology report is biased towards poor prognosis, adjuvant chemotherapy is recommended. .

Targeted drug therapy may be considered for advanced patients

For advanced rectal cancer in which the tumor has metastasized, the treatment options are mainly targeted drugs.

At present, there are several kinds of targeted drugs in general use, but the commonly used ones include angiogenesis inhibitors or epidermal growth inhibitors, which are used in combination with chemotherapy in clinical practice. mutation before the use of epidermal growth inhibitor-targeted drugs.

Overall, patients with advanced disease responded to treatment, with an average survival of about 30 months. As for the current popular immunotherapy, the application in colorectal cancer is conditional. It must have the genotype MSI-H, and the use of immunotherapy is effective, but the cost is high and there are not many clinical applications, mainly because of the comparison of eligible patients. few.

How to detect colorectal cancer early?

Colorectal cancer has a long precancerous incubation period, and early detection has a good therapeutic effect. It is recommended that ordinary people do a fecal occult blood test every 2 years. If the test is positive, a colonoscopy can be performed. After the age of 40, try to do a colonoscopy. At present, there are many treatment methods for colorectal cancer, and the 5-year survival rate of early colorectal cancer can even exceed 90% with the cooperation of treatment.