colorectal cancer
Introduction
Introduction to colorectal cancer Colorectal cancer refers to the malignant lesions of the large intestinal mucosa epithelium under the action of various carcinogenic factors such as environment or heredity. The prognosis is poor and the mortality is high. It is one of the common malignant tumors in China. The malignant tumors that occur from the mucosal epithelium are collectively referred to as colorectal cancer and are the most common malignant tumors of the gastrointestinal tract. Those who originate from mesenchymal tissue are called sarcomas, accounting for about 1% of malignant lesions of the large intestine. The 5-year survival rate after surgery is 40% to 60% on average. Early detection, early diagnosis, early treatment, and standardized surgical treatment are still the key to improving the efficacy of colorectal cancer. basic knowledge The proportion of illness: 0.004% Susceptible population: people with genetics and chronic inflammation of the large intestine. Mode of infection: non-infectious Complications: blood in the stool
Cause
Colorectal cancer
The cause is not yet clear and may be related to the following factors.
Genetic factors (20%):
At home and abroad, there are reports of "colorectal cancer family". The death of patients with colorectal cancer in blood relatives is significantly higher than that of the average person. Some colorectal adenomas, such as multiple-family adenomas, are autosomal dominant hereditary diseases with a prevalence of 50% in the family. If left untreated, they may have colorectal cancer after 10 years of age. Recently, some scholars have studied the relationship between tumor suppressor gene and colorectal cancer. It is found that the susceptibility and pathogenesis of colorectal cancer are related to genetic factors.
Colorectal adenoma (15%):
According to local autopsy materials, the incidence of colorectal adenoma is quite consistent with colorectal cancer. It has been estimated that patients with one adenoma have a five-fold higher incidence of colorectal cancer than those without adenoma, and multiple adenomas are twice as likely as single adenomas.
Chronic colorectal inflammation (25%):
It is reported that the epidemiology of bowel cancer is positively related to the prevalence of schistosomiasis. It is generally believed that inflammatory changes in the intestine due to schistosomiasis may cause canceration in some of them. Other chronic inflammations of the intestine may also have cancerous changes, such as ulcerative colitis, which is about 3% to 5% cancerous. Chinese medicine believes that the incidence of colorectal cancer is related to gastrointestinal cold, diet, and exogenous invasion.
Environmental factors (20%):
Studies have shown that among the various environmental factors, the most important dietary factors, the incidence of colorectal cancer has a positive relationship with the high fat consumption in food. In addition, it may also be related to the lack of trace elements and changes in living habits.
Prevention
Colorectal cancer prevention
Colorectal cancer is a malignant tumor that seriously threatens human health. The epidemiological survey data from around the world indicate that colorectal cancer ranks third in all kinds of malignant tumors. In recent years, with the development of the economy, The improvement of the living standards of our people and the incidence of colorectal cancer are increasing year by year. Therefore, the significance of prevention of colorectal cancer is becoming more and more important.
Primary prevention
Reduce, eliminate the pathogenic factors of colorectal cancer, inhibit the cancerous process of normal cells.
1, diet adjustment
Although colorectal cancer has a certain genetic predisposition, most of the sporadic colorectal cancer is closely related to environmental factors, especially dietary factors. Dietary intervention can reduce the incidence of colorectal cancer.
(1) Energy intake
Energy intake is associated with colorectal cancer. Most studies have shown that total energy intake is associated with colorectal cancer risk. Whether the energy consumed is protein, fat or carbohydrate, reducing energy intake may reduce the large intestine. The incidence of cancer.
(2) fat and red meat
The occurrence of colorectal cancer is closely related to animal fat and meat. Studies have shown that women with high fat injection have a 32% increased risk of colorectal cancer compared with low-fat women, while red meat in meat is colorectal cancer. A strong risk factor that occurs, reducing the amount of fat in the food, especially to minimize the brown meat after roasting, contribute to the occurrence of colorectal cancer.
(3) Fruits, vegetables and dietary fiber
Cellulose can increase the amount of feces, dilute the carcinogen in the colon, and absorb bile salts, which can reduce the incidence of colorectal cancer. Therefore, in the usual diet, you should eat as much vegetables, fruits, cellulose, reasonable diet, and reduce the large intestine. The occurrence of cancer.
(4) Vitamins and trace elements
Studies have shown that vitamin A, C, E can make colonic epithelial hyperplasia of adenoma patients into normal, but the current data does not support the use of antioxidant vitamins to prevent colorectal cancer, the relationship between trace elements and colorectal cancer, the current study Not too detailed, folic acid can reduce the incidence of colorectal cancer, but the specific mechanism is not clear.
(5) Dietary anti-carcinogen
Garlic, onion, leeks, leeks, scallions, stalks, stalks, stalks, stalks, stalks, stalks, stalks, stalks, stalks, stalks, stalks Mutations have anti-cancer effects, especially garlic. Studies have shown that garlic is the vegetable with the strongest protective effect and protects people from distal colon cancer.
2, change lifestyle habits
(1) Obesity and exercise
Obesity, especially abdominal obesity, is a risk factor for independent colorectal cancer. Too little physical activity is a risk factor for colorectal cancer. Physical activity can affect colonic motility and facilitate fecal discharge, thus achieving the prevention of colorectal cancer.
(2) Smoking
The relationship between smoking and colorectal cancer is not very positive, but smoking is a risk factor for colorectal adenoma. The current study suggests that smoking is a stimulating factor for colorectal cancer gene production, but it takes about 40 years to function.
(3) Drinking
Alcohol intake is related to colorectal cancer. Alcohol is also a risk factor for colorectal adenoma, but the specific cause is not clear. Reducing alcohol intake is conducive to prevention of colorectal cancer.
(4) Reproductive factors
Hormonal and reproductive factors may affect the occurrence of colorectal cancer. American studies have shown that the incidence of colorectal cancer in single women is higher than that of married women. Some people think that this is related to the effects of hormones on bile acid metabolism.
3, drugs
Many epidemiological studies have shown that long-term use of non-steroidal anti-inflammatory drugs, the incidence of colorectal cancer is reduced, taking 10 to 15 small doses of aspirin per month, can reduce the relative risk of colorectal cancer by 40% to 50%, However, some studies do not support this claim, and the use of non-steroidal anti-inflammatory drugs, the time of administration, and the side effects caused by long-term application are yet to be further studied.
4, treatment of precancerous lesions
Patients with colorectal adenoma, ulcerative colitis, the incidence of colorectal cancer increased significantly, through the census and follow-up, early removal of adenoma, treatment of colitis, can reduce the incidence of colorectal cancer, mortality, especially for family history Through genetic testing, screening high-risk groups and performing colonoscopy is an important aspect of colorectal cancer prevention.
Secondary prevention
Secondary prevention of tumors, ie early detection, early diagnosis, early treatment to prevent or reduce tumor-induced death, the occurrence and development of colorectal cancer is a relatively long process, from precancerous lesions to invasive cancer, it is estimated that 10 For 15 years, this provides an opportunity for censuses to detect early lesions, and census is an important means of secondary prevention.
Tertiary prevention
The third-level prevention is effective treatment for cancer patients to improve the quality of life of patients and prolong the survival period. Currently, surgical treatment is mainly used for patients with colorectal cancer, supplemented by appropriate radiotherapy and chemotherapy, Chinese medicine treatment, and immunotherapy to improve the treatment of colorectal cancer. effect.
Complication
Colorectal cancer complications Complications, blood in the stool
1, blood in the stool
Because the lesion is closer to the anus, the blood color is mostly bright red or dark red, and often the blood is separated. Only when the amount of bleeding is large, the stool is brownish red and jam-like. Among the patients with right colon cancer admitted to the Fudan University Cancer Hospital, 36.5% of these patients with visible blood in the stool.
2, anemia
When long-term chronic blood loss exceeds the compensatory function of the body's hematopoiesis, the patient can develop anemia.
3, tumor obstruction
When the tumor grows to a considerable volume or infiltrates the muscular layer of the intestinal wall, it can cause intestinal stenosis, the intestinal lumen becomes smaller, and the intestinal contents are blocked. Intestinal swelling, loss of body fluids, electrolyte imbalance, infection and toxemia.
4, perforation
Perforation can occur when a cancerous lesion penetrates the intestinal wall with a deep ulcer.
5. Sciatica or obturator neuralgia may also occur when the tumor infiltrates or compresses the sciatic nerve or obturator nerve root (lumbosacral plexus).
Symptom
Colorectal cancer symptoms Common symptoms Loss of blood in the stool, abdominal pain, septic degeneration, thin stools, thinning like pencil constipation, abdominal tenderness, stool, habit, change, large intestine, blackening, planting, dissemination
Early colorectal cancer is not obvious, can be asymptomatic or only vague discomfort, indigestion, occult blood, etc. As the cancer progresses, the symptoms gradually become obvious, manifested as changes in bowel habits, blood in the stool, abdominal pain, abdominal mass, intestinal obstruction and fever, anemia And systemic toxicity symptoms such as weight loss, due to tumor invasion and metastasis can also cause changes in the corresponding organs, colorectal cancer according to its original site and different clinical signs and signs.
1, right colon cancer
The prominent symptoms are abdominal mass, abdominal pain, anemia, some may have mucus or mucus bloody stools, frequent frequency, abdominal distension, intestinal obstruction, etc., but far less common than the left colon, the right colon is wide, and the primary cancer is often found. Increased is very large, ulcer ulcers are more common, many patients can lick and mass in the right abdomen, unless the cancer directly involves the ileocecal valve, generally less intestinal obstruction, because the stool is still semi-fluid in the right colon Therefore, the stool is still semi-fluid and thin in the right colon. Therefore, the bleeding caused by the rubbing of the tumor is less. Most of the bleeding is caused by cancer and necrosis, and the blood and feces are evenly mixed. It is difficult to detect long-term chronic blood loss. Patients often seek medical treatment for anemia. Abdominal pain is also common. It is often caused by pain. It is caused by a mass invading the intestinal wall. Secondary infection of cancerous ulcer can cause local tenderness and systemic toxemia. .
2, left colon cancer
The prominent symptoms are stool habit change, mucus bloody stool or bloody stool, intestinal obstruction, etc., the left colon is narrow, the primary cancer is mostly infiltrated and grows, and the intestinal lumen is narrowed, so constipation is more common, and then the upper intestine is narrowed. Increased effusion, intestinal peristalsis, so diarrhea can occur after constipation, often appear alternately, because the stool into the left colon gradually becomes a paste-like lumps, so the bloody stool caused by fecal friction lesions is more common Patients often seek medical treatment earlier. Anemia caused by long-term chronic blood loss is not as prominent as that of the right colon. The intestinal obstruction caused by intestinal stenosis caused by infiltration of the tumor into the intestinal wall is mostly chronic incompleteness. Patients often have longer-term stools. Poor, paroxysmal abdominal pain, etc., due to lower obstruction, vomiting is not obvious.
3, rectal cancer
The prominent symptoms are blood in the stool, changes in bowel habits and accompanying symptoms caused by advanced cancer infiltration. The site of carcinoma in situ is lower, the fecal mass is harder, and the cancer is easily rubbed by the feces and easily causes bleeding, mostly bright red or dark. Red, mismatched with the formed feces or attached to the surface of the fecal column, misdiagnosed &ldquo&rdquo bleeding, due to lesion stimulation and secondary infection of the mass ulcer, constantly causing defecation reflex, easily misdiagnosed as & quoquo & quoquo / & ldquo enteritis & rdquo, The ring growth of the cancer causes the intestinal lumen to narrow, and the early manifestation is that the fecal column is thinned and the late stage is incomplete obstruction.
4, tumor infiltration and metastasis
Local expansion is the most common form of invasiveness of colorectal cancer. Cancer cells invade surrounding tissues often cause corresponding symptoms, such as rectal cancer invading the sacral plexus and causing persistent pain in the lower abdomen and lumbosacral region, anal incontinence, etc. The rectal examination can be performed in the rectal fossa of the bladder or the rectum of the uterus. The ascites can occur in a wide range of disseminated cells. The early stage cancer can also spread along the lymphatic space around the nerve wall of the intestinal wall, and then the lymphatic vessels are transferred to the lymph nodes. When the cancer cells metastasize to the para-aortic lymph nodes and enter the chyle pool, the left supraclavicular lymph node metastasis can occur through the thoracic duct, causing the lymph nodes to enlarge. There are still a few patients who are blocked by the ascending lymphatic vessels. Cancer cells are retrogradely spread, and numerous diffuse small nodules appear in the perineum. In female patients, tumors can be transferred to both ovaries and cause Kruken-berg's disease. Advanced colorectal cancer can also be transferred to the liver, lungs, bones, etc. via blood. At the office.
Examine
Colorectal cancer examination
I. Laboratory inspection
In addition to blood routine to understand whether patients have anemia, other tests can be performed according to the diagnosis and differential diagnosis. The fecal occult blood test, the detection of colorectal cancer biomarkers, etc. have positive effects on early diagnosis of colorectal cancer. significance.
1, occult blood test
Because colorectal cancer often presents varying degrees of bleeding due to mucosal erosion ulcers, colorectal cancer can be monitored by a simple and convenient occult blood test. The early occult blood test is a chemical coloring method. The commonly used reagents are benzidine or guaiac. In recent years, it has gradually been replaced by a more specific immune occult blood reagent. However, because the occult blood test does not distinguish between cancerous and non-cancerous hemorrhage, it is currently used as a primary screening method for large-scale population colorectal cancer screening. A small number of early cancers can also be false negative results and missed diagnosis.
2, rectal mucus T antigen test
Also known as the galactose oxidase test, it is a simple method for detecting colorectal cancer and precancerous lesions. It can be applied to a special paper film or slide by applying the liquid on the rectal finger, and the galactose oxidase reaction and Schiff Reagent color can be used to determine whether the patient's intestinal mucosa has T antigen expression. It has been tested by clinical and census. The method has high sensitivity and specificity for the detection of colorectal cancer. It is used for screening and immunohistochemistry. Colorectal cancer has complementary effects, but there are also certain false positive and false negative rates.
3. Detection of serum CEA
In most patients with colorectal cancer, serum CEA levels are often elevated, exceeding 50&mug/ml, but the specificity of this test is not strong. In some non-digestive tract tumors and benign lesions, serum levels may also be elevated. In addition, CEA for early colon Cancer and adenomatous polyps are less sensitive, so their use in early colorectal cancer detection is not obvious. In 1982, Magagi et al. used CA19-9 prepared by immunizing mice with human colon cancer cell lines to identify highly cancerous. The specific salivary gangliosides showed that 19% to 49% of colorectal tumors were elevated, but it was more sensitive to gastric and pancreatic bile ducts. As a serological test for colorectal cancer, it was not more sensitive than CEA.
Other tests such as colorectal cancer-associated antigens, determination of avian ammonia decarboxylase and serum sialic acid content, leukocyte adhesion inhibition test, etc., have shown certain effects, but in clinical applications, their specificity and sensitivity need to be further improved. .
2. Endoscopy
It has been widely used in clinical practice, and routine X-ray examination is often available for experienced endoscopists. For patients with highly suspicious colorectal cancer, a full colonoscopy is especially recommended to avoid missed diagnosis. Because the fiberoptic colonoscopy is safe and reliable, it can not only examine the tumor size. , morphology, location, activity, and the ability to remove polyps or early micro-cancer resection, biopsy of suspicious lesions can be directed to the tissue, so it is the most effective means of diagnosis of colorectal cancer, often used as a review in colorectal cancer screening The gold standard for various preliminary screening effects.
Three. X-ray inspection
It can be found that rectal or sigmoidoscopy can not peep the lesions. It is especially suitable for patients with fiberoptic colonoscopy that are difficult to reach the ileocecal area. It is also an effective means for diagnosing colorectal cancer. Generally, barium meal enema examination is performed. The main signs are local mucosal deformation. Abnormal peristalsis, stenosis of the intestine, filling defects, etc., often appear to be difficult for small, especially early-stage cancers less than 2 cm in diameter. The use of dual imaging of gas sputum is helpful for the early detection of cancer.
4. Biopsy and exfoliative cytology
Biopsy is decisive for the determination of colorectal cancer, especially early cancer and polyposis, and differential diagnosis of the disease. It can not only determine the nature of the tumor, the type of histology and the degree of malignancy, but also determine the prognosis, guide clinical treatment, exfoliative cytology. Although the accuracy is high, but the materials are more cumbersome, it is not easy to obtain satisfactory specimens. It is necessary to have experienced cytologists when observing, so there are few clinical applications. At present, it is replaced by endoscopic direct smear for cytological diagnosis. .
V. Other
Such as B-mode ultrasound, CT tomography, magnetic resonance imaging, angiography, lymph node 99mTc isotope scan for clinical colorectal cancer diagnosis, the effect evaluation is different.
Diagnosis
Diagnosis and diagnosis of colorectal cancer
diagnosis
1, medical history
Detailed medical history can often be used to diagnose the diagnosis of colorectal cancer. Anyone with middle age or above who has unexplained weight loss, anemia, changes in bowel habits, mucus, bloody stools, intestinal obstruction, etc. should consider the possibility of colorectal cancer for early detection. Colorectal cancer, for some people with no obvious symptoms but with risk factors for colorectal cancer, such as family history of colorectal cancer, I have suffered from multiple polyposis of the colon, ulcerative colitis, Crohn's disease, chronic schistosomiasis or pelvic radiotherapy. All patients undergoing cholecystectomy should be followed up regularly and reviewed.
2, physical examination
A comprehensive physical examination not only contributes to the correct diagnosis of colorectal cancer, but also can estimate the severity of the disease, the status of cancer invasion and metastasis and as a reference for the formulation of a reasonable treatment plan. Local signs should pay attention to intestinal obstruction, abdominal mass and abdominal tenderness signs. Because most of the colorectal cancer occurs in the rectum and sigmoid colon, rectal examination should be essential. Any patients with blood in the stool, changes in stool habits, stool deformation and other symptoms should be examined by rectal examination, and the anus or rectum should be known during the examination. No stenosis, whether the fingertips are stained with blood, such as touching the mass, should be clear about its location, shape, extent of lesions, basal activity and its relationship with adjacent organs.
3. Early diagnosis of colorectal cancer and evaluation of its population survey
At present, due to the wide application of fiberoptic colonoscopy, endoscopic pathological biopsy has become very simple and easy, so it is not very difficult to diagnose precancerous lesions or early cancer, but early detection of colorectal cancer still faces many obstacles, mainly Early colorectal cancer often has hidden symptoms. The patients who come to see the doctor often have cancer. In addition, there is still no specific laboratory test for early diagnosis of cancer.
Screening for asymptomatic populations or monitoring patients with a family history of colorectal cancer or having precancerous lesions is an important way to detect early cancer. Because cancer diagnosis often depends on fiberoptic colonoscopy and pathological biopsy, any The form of census must consider the workload, economic costs and social endurance. The preliminary screening test to reduce the high-risk population can make up for the deficiency of the application of fiberoptic colonoscopy. Even if the screening efficiency alone, the initial screening test can improve the fiber colonoscopy. The detection effect, for example, in the census of more than 10,000 people, we compared the results of simple sigmoidoscopy and immuno-occult blood-colonoscopy sequential screening, and found that after the initial screening test, the sigmoidoscopy can be used to detect cancer. 0.14% rose to 0.43%.
As a screening test for colorectal cancer, it is not only sensitive and specific, but also simple and economical. Many methods have been tried for the diagnosis of colorectal cancer, but most of them are difficult to meet the above requirements. Because most diagnostic indicators only have a mean difference between colorectal cancer patients and control patients, but they are not specific, it is difficult to establish a diagnostic threshold for cancer, often insensitive to early cancer, from the worldwide colorectal cancer census data In view of the above, the primary screening test currently used for the census is mainly for the occult blood test and the rectal mucus T antigen test developed in recent years. In addition, the use of monoclonal antibodies to detect colorectal cancer-associated antigen in blood or feces is being tested in a small-scale census population.
There are many methods for occult blood test. The method of chemical occult blood test is simple, but it is susceptible to many factors and false positives (such as eating meat, fresh fruits, vegetables, iron, aspirin, etc.) and false negatives (such as feces). For a long time, the hemoglobin in the intestinal cavity is decomposed, taking antioxidants such as vitamin C, etc.), the immunoassay is the second-generation colorectal cancer screening test after the chemical occult blood test. Its outstanding advantage is that it is specific and not affected by food and drugs. The early research was agar immunodiffusion, but we found that the specificity of the method is good, but the sensitivity to cancer detection is not superior to the chemical method. After that, we have compared the reverse indirect hemagglutination test. Immuno-lactility test and SPA synergistic agglutination test, etc., the principle is to coat human hemoglobin antibody on the carrier, and found that SPA immuno-occult blood test can greatly improve the sensitivity and specificity of occult blood detection, we in the 8233 census, 934 positive patients were found, of which 4 cases of colorectal cancer were detected, and 3 cases were early stage cancer. It is worth mentioning that the SPA test is based on the A protein-containing Staphylococci as a carrier, antibody. Remember without purification and complex processing, mining site just a drop of liquid manure and SPA reagent mixing operation, stable results can occur within 1 ~ 3min, and therefore very suitable for the census.
It is worth noting that the occult blood test is based on intestinal bleeding to detect colorectal cancer, so patients with colorectal cancer without bleeding or only intermittent bleeding can be missed, and many intestinal non-neoplastic bleeding can have false positive results. We performed 5 cases of colorectal cancer in more than 3,000 people over 40 years old, including 2 cases of early stage cancer, occult blood test was negative, and more than 97% of occult blood positive patients were non-neoplastic bleeding. In addition, there is still a problem of the right amount of reaction in the immune occult blood reaction. Excessive blood in the fecal fluid or excess hemoglobin molecules may cause a false negative result, which is called a prozone phenomenon.
In order to overcome the deficiencies of occult blood test, in recent years, the United States Shamsuddin et al. based on colorectal cancer and precancerous lesions may appear similar to the expression of T antigen, suggesting the feasibility of rectal mucus galactose oxidase test for screening colorectal cancer (Shams for short) Test), in China, we first verified the screening effect of colorectal cancer and improved it by method, so that it can be used for large-scale population screening. The results showed that the positive rate of colorectal cancer detection was 89.6. %, we used the Shams test in the screening of 3,820 people over 40 years old and compared with the SPA immune occult blood test. The results showed that the positive rate of the former was 9.1%, and the detection rate of the lesion was 12.7%, including 2 cases of early cancer and 28 cases of adenoma, the detection of lesions and SPA test have a significant complementary effect.
Finding a more sensitive and specific colorectal cancer screening test method is one of the important topics in the prevention and treatment of colorectal cancer. Recently, it has been reported that mutations in ras oncogene can be detected from the colorectal cancer feces, but the results of this gene level are applied in clinical practice. It is too early, the current research is mainly to use the existing primary screening test to optimize the census program. The future colorectal cancer screening may no longer be a simple colonoscopy or occult blood-colonoscopy sequential screening, but based on various experiments. The sensitivity, specificity, economy, and the acceptability and social endurance of the subjects, the comprehensive and complementary experimental census tests, thereby improving the screening effect of colorectal cancer.
In addition to early colorectal cancer can be insidious, no symptoms, advanced colorectal cancer often has different degrees of clinical manifestations, at this time as long as vigilance, detailed medical history, serious physical examination, supplemented by laboratory, endoscopy and X-ray Waiting for the check, it is not difficult to make a correct diagnosis.
Differential diagnosis
Colorectal cancer must be differentiated from other intestinal lesions with symptoms such as abdominal mass, abdominal cramps, rectal bleeding or changes in stool habits, including benign tumors of the large intestine or polyps producing lesions such as adenomas, inflammatory polyps, juvenile polyps , intestinal wall lipoma, hemangioma, leiomyomas, etc.; various inflammatory diseases of the large intestine such as ulcerative colitis, Crob's disease, amoebic enteritis, schistosomiasis, intestinal tuberculosis, colonic diverticulitis, appendicitis surrounding inflammation Block, radiation enteritis, sexually transmitted lymphogranuloma, benign rectal, anal canal diseases such as sputum, anal fissure, anal fistula and so on. Others such as intussusception, sigmoid colon fecal storage and rare intestinal endometriosis are also identified. Because the colorectal cancer is not specific, and it overlaps with the clinical manifestations of various diseases of the intestines, it takes more active diagnosis methods in clinical diagnosis, and the diagnostic method is less used. For suspicious patients, detailed examination of the medical history and careful examination, with fiber Colonoscopy or X-ray barium enema and pathological biopsy can often make a definitive diagnosis. Colon cancer should be distinguished from colonic inflammatory diseases, including intestinal tuberculosis, Crohn's disease, ulcerative colitis, schistosomiasis granuloma, and amebic granuloma.
In addition, it should be differentiated from primary liver cancer, biliary tract disease, and appendicitis. Rectal cancer should be differentiated from bacillary dysentery, amoebic dysentery, sputum, schistosomiasis, and chronic colitis.
1, bacterial dysentery
Mainly identified with chronic bacterial dysentery. The patient has abdominal pain, diarrhea, urgency and urgency, mucus pus and bloody stools, increased frequency of bowel movements, and tenderness in the lower left abdomen. If it is chronic bacterial dysentery, there may be an acute attack. In addition to the above symptoms, there is fever, headache, and loss of appetite. The disease has epidemiological characteristics, and the stool is positive for dysentery bacilli. Sigmoid colonoscopy examination of intestinal mucosa in addition to congestion, edema, ulcers, mucosa is granular, may have scars and polyps, take the intestinal mucus purulent secretion for bacterial culture positive rate, the application of , norfloxacin, oxyfluoride Antibacterial drugs such as Shaxing are effective.
2, amoebic dysentery
The patient showed abdominal distension, abdominal pain, diarrhea or urgency, and the stool showed mucus with pus and increased frequency of bowel movements. Chronic type can have weight loss, anemia, the colon is often thick and can be touched, the left and right lower abdomen and upper abdomen often have tenderness, easy to be confused with rectal cancer or colon cancer. However, when the amoebic dysentery is dysentery, there is a stench in the stool. The amoeba can be found in the feces or the trophozoites. Sigmoidoscopy shows a typical scattered ulcer on the normal mucosa. The protozoa can be found by scraping the material from the base of the ulcer for microscopic examination.
3,
It is not uncommon to clinically misdiagnose rectal cancer as a deaf. According to the Shanghai Cancer Hospital, 590 cases of rectal cancer were misdiagnosed as 156 cases, and the misdiagnosis rate was as high as 26.4%. The main reason for misdiagnosis is that the medical history is not well understood and it is not possible to make a fingerprint test. In general, most of the internal hemorrhoids are painless bleeding, which is bright red, not mixed with the stool. With the amount of bleeding, the surface of the stool is bloody, bloody, linear, or even jetted. The stool of patients with rectal cancer is often accompanied by mucus and rectal irritation. Rectal examination or sigmoidoscopy can identify sputum and rectal cancer.
4, intestinal tuberculosis
Intestinal tuberculosis is characterized by right lower quadrant pain, diarrhea, diarrhea, abdominal mass, and symptoms of systemic tuberculosis. Proliferative intestinal tuberculosis, more so that the secret is the main performance. X-ray gastrointestinal barium meal imaging can be distinguished from colorectal cancer. Ulcerative intestinal tuberculosis, tincture in the lesions of the intestines showed signs of irritation, poor filling, while the upper and lower intestines of the lesions were well filled, called X-ray shadow jumping signs. The mucosal folds are rough and the edges of the intestinal wall are irregular and sometimes jagged. Proliferative intestinal tuberculosis showed proliferative stenosis, contraction and deformation of the intestine, showing filling defects, mucosal folds, intestinal wall stiffness and colonic bag disappearance. For a colonoscopy, a biopsy from the lesion can be further confirmed.
5, schistosomiasis
Intestinal lesions of schistosomiasis are more common in the rectum, sigmoid colon and descending colon. The eggs are deposited in the intestinal mucosa to cause local congestion, edema, and necrosis. When the necrotic mucosa falls off, superficial ulcers are formed, clinically manifesting abdominal pain, diarrhea and blood in the stool. Further, connective tissue hyperplasia occurs, and finally the intestinal wall is thickened. In severe cases, intestinal narrowing and granuloma are caused, which should be differentiated from colorectal cancer. However, schistosomiasis in Japan has a certain relationship with colorectal cancer. Therefore, in colonoscopy, tissue biopsy should be performed on the lesion, especially on granulomatous lesions.
6, Crohn's disease
Crohn's disease is a granulomatous inflammatory disease with fibrotic changes and ulcers, which occurs in young adults. Diarrhea is generally light, 3 to 6 times a day, and abdominal pain is mostly in the right lower abdomen. Abdominal pain can be relieved after defecation. About 1/3 of the cases can be rubbed and mass in the right lower abdomen, and there may be anal fistula and abscess around the anus. The barium enema has characteristic changes, showing thickening of the intestinal wall, stiffness, narrowing of the intestinal lumen, disappearance of mucosal folds, thickening, flattening, straightening, and a thin strip of shadow; longitudinal ulcer or transverse fissure ulcer; normal mucosa Congestion, edema, fibrosis, and pseudo-polypoid lesions called pebble signs. Fibrocolonoscopy showed mucosal edema, slightly hyperemia, and pebble-like bulging with round, linear or gully-like ulcers. Patients often have fever, anemia, arthritis and liver disease.
7, ulcerative colitis
UC is a chronic inflammatory disease of the rectum and colon of unknown cause, and more than 95% of cases have rectal involvement. More common in 20 to 50 years old. Clinically, diarrhea, mucus pus and bloody stools, abdominal pain and urgency are the main manifestations, so it is easy to be confused with rectal cancer. Fibrocolonoscopy showed diffuse hyperemia and edema of the mucosa. The surface of the mucosa was granular, often with erosion or shallow ulcers, with mucus and purulent secretions, and severe ulcers. In the later stage, pseudopolyps were seen and the colonic bag disappeared. Gastric sputum double contrast angiography can show large disorder of mucosal folds. When there is ulcer and secretion, the edge of the intestinal wall can be burr-like or serrated. The late intestinal wall is stiff, the intestinal lumen is narrow, the colonic bag disappears, and the pseudopolyps can be formed. Filled with a round or pebbled shape.
8, irritable bowel syndrome
IBS is a disease of intestinal dysfunction, which is related to mental and psychological factors. Abdominal pain, diarrhea, constipation, alternating diarrhea and constipation, and dyspepsia are the main manifestations. However, the general condition was good, and many fecal routines and cultures were negative. There was no positive finding in X-ray irrigation and fiber colonoscopy.
