Check the Kras gene has become the treatment of colorectal cancer approach

Due to advances in molecular biology, found that some liver gene mutation or DNA changes happen many types of drugs can cause different reactions and side effects of the increase or reduction, such as lung epithelial growth factor receptor (EGFR) mutations were generated to target drugs such as Iressa or Tarceva have relatively good efficacy, but the wild-type (EGFR wild type) although there is no effect of mutant, but still has a certain effect, so for the wild-type group also they should not refuse treatment. But since 2006 found that the availability of colorectal cancer in patients with mutations in Kras target for drug treatment is effective, has a very clinical phase of clearance. 

In the EGFR inhibitor cetuximab or Medium panitimumab, KRAS mutation and treatment efficacy have not greatly affected. In other words, when EGFR mutations have used the two target drugs are not curative, that is, whether the combined chemotherapy of their clinical efficacy of cetuximab did not make much difference. Therefore, in the United States and Taiwan also began to study the use of EGFR inhibitors, colorectal cancer is best to first check whether Kras gene mutation, if mutation has suggested that non-use of cetuximab. Kras mutation that accounts for nearly 30 ~ 40% as much as, if prior inspection Kras gene mutations in patients who have no need to use the target treatment can not only reduce the occurrence of side effects can also reduce unnecessary costs, because the cost of expensive drug target , for the people, society and country are a great burden.

For liver metastasis of colorectal cancer patients can not use chemoembolization may extend survival

Colorectal cancer liver are most likely to transfer the place, once the transfer, by chemical treatment such as FOLFOX part of the formula may have the patient can be reduced and surgery and chemotherapy failed surgery should not have some of the patients can use such as radiofrequency tumor ablation methods, can also be used Y90 chemoembolization or embolization, such as radiology. Recently, University Hospital Frankfurt, Germany Wolfgang physician's report, he would colorectal cancer unresectable liver metastasis failed to respond to chemotherapy and 463 patients, average age is 62.5 years old, 67.4% of patients have liver metastasis 5 points, 8% only a transfer point, 14.3% are 3-4 shift points, 10.4 percent have two transfer points. Every four weeks with chemoembolization method, with an average 5.3 times for each person, the use of drugs, including lipiodol, starch microspheres for vascular occlusion at the same time together with mitomycin C, gemcitabine or irinotecan. 463 patients 14.7% of patients have some of remission, 48.2% of patients with stable, 37.1% of patients deteriorated, one-year survival are 62% two years survival was 28%, from the beginning has an average survival of liver metastasis period is 38 months for the embolization was 14 months. With mitomycin C, gemcitabine, or irinotecan survival are the same. No statistical difference, so think Wolfgang chemoembolization for liver metastasis of colorectal cancer patients is not a very good treatment.

The United States Food and Drug Administration approval of Gleevec in Gastrointestinal Stromal Tumor

Intestinal stromal tumors (GIST) is a relatively rare sarcoma, mainly from the deterioration of Cajal cells and long out of mass, previous surgery apart from early detection, there is no better method of treatment. But even surgery, it is still very high relapse rate. Later, American researchers found basic molecular biology of gastrointestinal stromal tumor cell surface of the Kit gene will be abnormal, and abnormal Gleevec itself Kit cancer have curative effects, so the United States Food and Drug Administration approved Gleevec in metastatic or recurrent gastrointestinal stromal tumor patients. As a result of post-surgical gastrointestinal stromal tumor patients, because even if curative surgery, it is still very high relapse rate. Thus the recent gastrointestinal stromal tumors after surgery whether or not Gleevec study also found that patients given Gleevec one year after the relapse rate is lower than the control group, so Gleevec can be used as adjuvant therapy to reduce post-surgical gastrointestinal stromal tumors recurrence.

Treatment of Colorectal Cancer News

Just last year, held in June of Clinical Oncology American Medical Association Council meeting in a discussion like the treatment of colorectal cancer event, from the stages of disease, early colorectal cancer postoperative adjuvant chemotherapy treatment of metastatic colorectal cancer treatment have a wonderful report and the results of these studies may change our future for colorectal cancer treatment modalities. 
Because the United States for chemotherapy of colorectal cancer varies with Taiwan, this article only introduce several important results and personal opinion. At present, commonly used in colorectal cancer drugs, including 5-FU, Leucovorin (LV), Irinotican and oxaliplatin four, at this meeting in a well-known French scholar deGramont report of a response to the second and third period in patients with colorectal cancer postoperative adjuvant chemotherapy of clinical trial (MOSAIC trial) results and found that the oxaliplatin plus 5-FU and LV alone than 5-FU and LV is better, if the results of the United States for another large-scale clinical NSABP C07 trial confirmed, perhaps the future should be the use of oxaliplatin in colorectal cancer postoperative adjuvant chemotherapy. 

Another study (N9741) is more 5-FU + LV + Oxaliplatin (FOLFOX4), 5-FU + LV + Irinotican (IFL), and Irinotican + Oxaliplatin (IROX) three methods of treatment of metastatic colorectal cancer of the efficacy and Living quality, results showed that FOLFOX4 best, and the IFL and IROX in a par between the three aspects of quality of life almost. FOLFOX4 treatment showed N9741 remission rate of up to 40%, while the IFL and IROX 30%, with a median survival of 19.1 months, respectively, three, 14.8 months and 17.0 months. The results showed that FOLFOX4 in metastatic colorectal cancer in first-line treatment is a good choice. However, the study of this group in the IFL used 5-FU + LV injection and more commonly used in Taiwan is different if its conversion to injection of FOLFOX4 or FOLFOX6 injection (which can be referred to as FOLFIRI) may be different results. 

Another clinical trial (EFC4584) confirmed that patients in the IFL after treatment failure, FOLFOX4 than the separate use of oxaliplatin or 5-FU + LV effects better, FOLFOX4 may improve remission rates and improve symptoms, but it was not clear The median survival period of patients was not significantly prolonged. However, due to the FOLFOX4 very obvious improvement in symptoms, it should recommend the use of FOLFOX4. 

In this meeting with two other monoclonal antibodies used in chemotherapy also have a good score, the first study was aimed to Irinotican treatment failure of patients to give monoclonal antibody C225 or C225 plus Irinotican to continue treatment, results showed that its mitigation rates were up to 10% and 22%, but the latter side effect was high. C225 role in epithelial cell growth factor's receptor, which in the treatment of colorectal cancer should be further exploration of the role will be C225 with FOLFOX or FOLFIRI combination is probably the next step to conduct clinical trials. The second study compared this meeting the most noteworthy of a study, the combined use of a blocking angiogenesis monoclonal antibody Bevacizumab (trade name Avastin) and the IFL than IFL alone to treat metastatic colorectal cancer patients, remission rate can be increased to 35 percent from 45 percent, while the median survival time of 15.6 months may be extended to 20.3 months. The use of Avastin patients more prone to high blood pressure, but the available drugs control, the study is the Buddha Cookman (Folkman) physicians in the 1970s initiated blocking tumor blood vessels can starve to death the first time the theory been tested clinically, but the last one study of Avastin for breast cancer have not shown such efficacy, but also with Avastin + IFL and FOLFOX effects will not be more than better, therefore, clinical use of Avastin might have to wait another several large clinical trials, the results can be confirmed.

Laparoscopic surgery less bleeding, fast recovery

Due to the progress of surgery, drugs such as target new development, the current treatment for colorectal cancer is quite progress, but also a good opportunity to heal. 

 Such as watching baseball on television at the scene clearly Khussaiby 

 China Medical University Hospital, director of colorectal surgery Chen understanding that the current treatment of colorectal cancer with surgery, the recent use of laparoscopic surgery, not only less bleeding, fast recovery, but also significantly reduce the number of days of hospitalization, many patients three days after surgery can be discharged. 

 He described laparoscopic surgery as in the television watching the Yankees game than at the scene but also clearly visible pitcher Wang Chien-ming's every move, now the use of laparoscopic surgery can be more easily removed lesions. 

 U.S. Food and Drug Administration (FDA) also confirmed that the use of laparoscopic resection of colorectal cancer surgery, the recurrence rate with the traditional surgery, the survival rate of a considerable. 

 Required medical treatment of metastatic colorectal cancer 

 Liver, lung colorectal cancer is the most vulnerable parts of distant metastases, metastatic colorectal cancer to be the use of medication, Chen-liang said that drug treatment is also good, can also greatly enhance the survival rate, the traditional chemotherapy drugs such as 5-FU have oral, injection two options, as well as drug targets, such as angiogenesis inhibitors and epidermal growth factor inhibitors. 

 Target the treatment of colorectal cancer patients to break through the transfer, not surgery, the survival of the plight of drugs can target cancer cells in a special lock structure, the eradication of cancer cells without harming normal cells, unlike traditional chemotherapy to destroy cancer cells at the same time injury to normal tissue. 

 To angiogenesis inhibitors, its surrounding cancer cells can inhibit angiogenesis, so that cancer cells lose their source of nutrients, the international large-scale study of Phase III clinical trial noted that the combined chemotherapy angiogenesis inhibitors, than the efficacy of chemotherapy alone, survival increased. 

 Chen Liang said that the operations or the use of different drug treatment effect, varies from person to person. Generally speaking, the effectiveness of the drug target good, but very expensive drugs, the U.S. Food and Drug Administration has approved Cancer Center angiogenesis inhibitors (Avastin) to target the treatment of first-line drugs. Due to restrictions on domestic health care, it is in the second-line treatment fails, the third-line treatment benefit.

Early detection of colorectal cancer survival rate of more than 85%

According to 2004 statistics of the Department of Health report showed that colorectal cancer mortality accounted for the third place, the annual number of people suffering from up to 7,500 people, in 2004 the number of deaths for 3898 were the total number of cancer deaths 10.72%. With regard to the treatment of colorectal cancer, although there are several new drugs available, but for the transfer of cancer cells has been the late colorectal cancer patients, the survival rate and no significant progress; On the contrary, for the early was diagnosed with colorectal cancer the early stage patients, the 5-year survival rate can reach 85 ~ high 100 percent, so if early screening, early diagnosis, early treatment and thus would be the best policy. 

 Colorectal cancer caused by the reasons are complex, some genetic factors, some external factors, or both, the interaction of changes within the normal mucosal cells, after a long period of time, evolved into a pre-cancer lesions. Colorectal cancer triggered a number of factors, for example as follows: 

 A family history: 

 General unexpected colorectal cancer, in the foreign literature statistics that pointed out that the family members of a family history of cancer than the rate of colorectal cancer than the general public, such as in the family of a first-class pro-(parents or brothers and sisters ) suffering from colorectal cancer, then his own rate for most people two to four times, if the two first-class pro-patients suffering from colorectal cancer, the increased risk of three to six times. 

 Second, eating and living factors: 

 Most people ignore such an important factor 

 1. Food 

 (1) daily consumption of calories - the daily consumption of fat and calories are two high-risk factor, the incidence of colorectal cancer is about twice the average person. 

 (2) of meat, fat and protein - eating red meat increases colorectal cancer, fried, grilled food will increase the incidence of six times. High-protein intake and cancer-related, a lot of controversy, but in principle, high-protein intake will accelerate the growth of epidermis. 

 (3) of the fat part of red meat, is likely to be tumor promoters, the bacteria in the intestines will help promote the metabolism or carcinogenic substances, caused by intestinal bacteria on the surface of endometrial hyperplasia. 

 (4) fiber - in Africa, the report pointed out that the high fiber diet will reduce the risk of colorectal cancer; in particular, bran, fruits and vegetables. But how in order to prevent the occurrence of colorectal cancer, there are a lot of clinical trials in progress. 

 (5) fruits and vegetables - most of that protection and resistance to the function of colorectal cancer occurrence, especially students, the Green Cross Section of and vegetables, including the antioxidant vitamins (E, C, B, A) and small molecule chemistry etc.. 

 (6) of calcium - in cell culture, there to protect the function of colorectal cancer occurred. 

 2. Living habits 

 Do not exercise, not the activities were considered easy to suffer from colorectal cancer, alcoholism and smoking are also more susceptible to colorectal cancer. According to the report, such as smoking more than 20 boxes each year will increase the intestine polyps, more than 35 boxes of colorectal cancer will increase. 

 3. Non-steroidal, anti-inflammatory drug 

 House attributes to prevent the cancerous polyps are now being investigated. 

 Third, disease syndrome: 

 1. Familial colorectal polyp disease 

 Colorectal cancer accounts for 1 percent of patients, patients can have hundreds of thousands of polyps, if not all of the colorectal resection, all patients will be in about 35 years old when the symptoms in the 45-year-old when there are more than 90% of colorectal cancer patients, and in the 50-year-old, will the incidence of 100 percent. 

 2. Hereditary nonpolyposis colorectal cancer polyps 

 Colorectal cancer accounts for about 3 percent, about 100 polyps, large number of the right or proximal colon, often occurring in middle-aged. Divided into two categories: the beginning of a more flat polyps, but often become malignant after 43-year-old. The second category is often occurred in the large intestine, in the case of stomach, small intestine, bile duct lose, renal pelvis, ureter, bladder, ovary, pancreas, such as skin or where there is such a genetic factor in general people, life will be 80% of the probability of occurrence of large intestine rectum, 40% of endometrial cancer, and 10% in other parts of the cancer, which is a dominant, 80% of the genetic rate, and DNA repair genes. 

 3. Familial colorectal cancer 

 About 20% ~ 30% of colorectal cancer patients, because the genetic family history into the primer, 80% of the patients first discovered polyps of the APC gene mutations. 

 4. Chronic ulcerative colitis 

 Is an unexplained inflammation of the intestinal mucosa, and often occurred in the distal colon or rectum, colitis longer, the greater the chances of malignant tumors appear. 

 5. Has been suffering from colorectal cancer patients

Krestin play the role of adjuvant therapy for colorectal cancer

Colorectal cancer is a common form of cancer in Taiwan each year, many people will suffer from colorectal cancer. So far, the standard treatment of colorectal cancer remains surgical resection, as well as some cases the need to meet the post-operative adjuvant chemotherapy, including traditional 5-Fu/Leucovorin, as well as modern Xeloa, oxaliplatin, such as drugs. As for metastatic patients, then changed to chemical treatment with the drug target. 

 However, in the post-operative adjuvant chemotherapy of which, together with the immunomodulatory drugs, can cause appears to strengthen the effectiveness of the effect, for the prevention of recurrence, as well as the transfer of the remote a certain degree of contribution. Tong General Hospital blood oncology physicians are referred to Chen Yi, and in Japan, the most commonly used immunomodulatory drugs is PSK body Krestin. 

 Krestin is a versicolor mycelium from which the Polysaccharides out, at present, Taiwan is classified in Western medicine, and the Department of Health also approved for use in the treatment of digestive system cancer. Many of Japan's past studies have shown Krestin in complete resection of colorectal cancer after immunochemistry does have the role of adjuvant therapy, but most of the research because the number of subjects is too small, this study design or rigorous enough, so the medical profession there is a certain amount of controversy. 

 In 2006, the famous cancer immunotherapy among medical journals, some scholars through a rigorous comprehensive analysis, will be 1980 to 2004 on Krestin for colorectal cancer after the surgery, whether the immune adjuvant therapy for the role of chemical Research to do a comprehensive analysis. The study found the results, if the intestinal use of rectal cancer after the surgery, adjuvant chemotherapy with the Krestin, will only use than simply supporting the chemical treatment, patients can bring more benefits. For five years in terms of overall survival time were 79 percent and 72.2 percent, the difference between the two have reached statistical significance, but also found that joined the Krestin, can make a patient's risk of the risk of decline in about three-cheng. If the absence of disease on the survival time, five years are as follows: 72.2 percent, respectively, as well as 65.9 percent. 

 Doctors said Chen Yi, and based on research, Krestin is a very good immunomodulatory drugs, will be induced by interferon, IL-immune cells, such as hormones, increase the activity of natural killer cells. If the post-operative chemotherapy, which, coupled with Krestin so, than the individual but to accept chemotherapy, to patients in terms of survival time of the absence of disease or overall survival time, are able to provide substantial help to them.

Colorectal cancer jumped to top 3 killers

"Special Planning" Four years ago, the 22-year-old Ms. Chen found himself when stool bleeding, originally thought it was hemorrhoids attack, did not expect the hospital for an examination before and found that colorectal cancer is the fourth, but has been transferred to the liver After surgery to remove the tumor, combined with chemotherapy, just after 26-year-old birthday Miss Chen, confidence looking forward to the arrival of 30-year-old birthday. 

 Changhua Christian Hospital, director of colorectal surgery, said Dr. Chen-chang, colorectal cancer ranked the top three cancer mortality, such as Ms. Chen on such a young developing colorectal cancer cases, in fact, not many, the average incidence of colorectal cancer age is 50 years old, 6-70-year-old is the peak period of morbidity, family history of genetic percentage is not high, only 15%, mainly, mostly caused by the environment and diet. 

 Dr. Chen-chang said that Japan's research report pointed out that patients with HI regions, high-fat diet and weight bbq, but also, therefore, colorectal patients in other parts of the United States twice, and Taiwan, subject to the influence of western culture, love to eat red meat,bbq , heavy emphasis on taste, and exquisite food, coupled with, vegetables and fiber intake inadequate, resulting in rising cases of colorectal cancer. 

 In addition to eating outside, smoking, drinking, do not love sports, there are overweight people are at high risk of colorectal cancer group, especially in overweight people, colorectal polyps were found for the probability of tumor, is 2 times of ordinary people, but the good news is that overseas studies have shown that breast-feeding women and infants, both the probability of suffering from colorectal cancer are relatively low. 

 Although there is good news, however, the symptoms of colorectal cancer was not obvious, so often neglected. For example, the shape of bowel habits or changes in stool, anemia, has been big but do not come out, or how large the majority does not clean, and even anal bleeding are symptoms of colorectal cancer, but these symptoms, in part, and hemorrhoids sores similar miscarriage of justice is often coupled with the people into a screening rate of only two, wait until after a number of patients to determine the cause, has come late and the delay time for medical treatment, doctor Chen Chang stressed that if they found blood or abdominal pain, always have to have Hospital stool occult blood tests and colonoscopy screening, if there is a family history of persons, should be moved up to the age of 40 for check-ups, if early detection of early treatment, the first phase of the five-year survival rate as high as 90%. 

 If it is determined that suffer from colorectal cancer, it needs not worry too much, said Dr. Chen-chang, the current colorectal cancer therapy are surgery, chemotherapy or the use of target drugs, chemotherapy drugs, including oral or injection, such as Xeloda, Anticancer properly, Europe Lipu, 5FU, such as drug target, Seoul would be moved Shu, stop thinking cancer, in which the drug target for metastatic colorectal cancer patients, had good results, cancer thought to disable in the first IV colorectal cancer patients, as the first line of medication, the patient survival time of up to 29 months, although the drug will target long skin rash, high blood pressure, proteinuria and other side effects, but compared with the drug instead of target is a relatively safe drug.

Tumor grow into cancer

Enteral long polyps to be careful, perfunctory polyps may turn into cancer. Physician reminders, over 50 years of age, have a family history, life is not normal eating habits, overweight high-risk group to undergo regular colonoscopy found polyps to remove, do not Regardless of "income" dependent "cancer." 

 Shutian Clinic physician gastrointestinal Hepatobiliary Division note, intestinal polyp is intraluminal gastrointestinal mucosa, director of the weight, may relapse after resection, as a result of people eating refined, colonoscopy found polyps in an upward trend in the proportion. 

Wang said that intestinal polyps larger than 1 cm, the appearance of a flat-shaped bulge, pathology organizations to villous adenoma, evolve into a higher probability of cancer, according to statistics, if not removed intestinal polyps, 5 years later, there will be the evolution of 2.4% for cancer, 20 years later as much as 24%. If tubular adenoma, villous adenoma polyps mixed type, cancer and even as high as 4 into opportunities. 

 Over 50 years old, have a history of colorectal polyps, colorectal polyps, colorectal cancer family history, smoking, drinking, high fat diet habits, overweight, lack of exercise are intestinal polyps high-risk group, the best regular checks for early removal of polyps and to change bad habits. 

 But changes in bowel habits, there will be blood to be careful too. A 36-year-old woman without family history, nor did the prevalence of obesity, but twice within two weeks of bloody stool, as the stool soft and not easy to remove it hard anal oppression caused by colonoscopy was more than a polyp, that is easy to cancerous tubular villous adenoma must be removed, tracking. 

Wang remind positive fecal occult blood, or other factors rule out the possibility of iron deficiency anemia may be gastrointestinal tumors, inflammation caused by anemia, also require regular screening and found that intestinal polyps must be removed in order to effectively prevent colorectal cancer.

Positive colorectal cancer chemotherapy, he lived well

Colorectal cancer this year, 10 people jumped to No. 2 cancer cause of death, the China Medical University Hospital yesterday to set up a "long intestinal enterovirus" patients will be invited to share cancer patients experience, 50-year-old Xu Guoqing engaged in the real estate industry, he no family history of cancer, in April this year, health screening of colorectal cancer incidence suddenly discovered the first three and transferred to the lymphatic, Xu Guoqing anticancer optimistic "non-cancer patients when their own", and actively undergoing chemotherapy, still radiant. 

 "Intestinal enterovirus long" Yesterday, some patients will be gathered more than 200 patients, patients with one of Xu Guoqing said that he had a bad stomach, intestinal bowel syndrome tendencies, the beginning of this year, "impulse" for gastrointestinal endoscopic examination, the doctor initially observed only ulcer symptoms, but the pathological biopsy to determine risk of colorectal cancer, and spread to the lymph node is already No. 3, June surgery to remove about 20-30 centimeters of ascending colon. 

 Xu Guoqing said that the postoperative dietary restraint, "this did not dare eat it, that can not eat," weighs 80 kilograms before the surgery, after it dropped to 74 kilograms, "the Mirror I was like a terminal cancer patients," he mentality of a switch, not then, when their cancer patients, a normal diet, "in addition to alcohol, I and most people eating the same popular hot drink, hot pot or taboos", body weight increased by 10 kg, gas-color turn for the better. 

 China Medical University Hospital, director of colorectal surgery Chen-liang said that nearly 80 percent of patients suffering from colorectal cancer unexplained, 15% is familial genetic, China currently has a doctor attached to the youngest only 24 years old suffering from colorectal cancer patients, is familial colorectal polyps have genetic disorders, they found blood cancer. 

 Chen understanding,he said that eating vegetables can prevent colorectal cancer that has not yet been confirmed by the medical, the current male and female cancer ratio of almost more attention to his bowel habits, it is best to develop every 2-3 years to check their own expense in order to early detection and early treatment.

How to treat colorectal cancer

The large intestine, colon in the use of which has always existed a number of confusion, to the strict definition of the large intestine is in contrast to the wording of the small intestine, large intestine, including ascending colon, transverse colon, descending colon and sigmoid rectum. However, in day-to-day use of the large intestine semantic equivalent of the colon, do not include the rectum, so often used clinically colorectal Branch, rather than colorectal Branch, which is discussing the lower digestive tract diseases and don'ts. This article referred to colon cancer, mainly occurred in the colon cancer treatment mainly due to cancer treatment has its special place, and another article to discuss. If in this part of colorectal cancer related to colorectal cancer or another direct statement to rectal cancer. 

 And generally speaking the treatment of colorectal cancer There are three main types: surgery, radiation therapy and chemotherapy. General physicians will be based on clinical examination with the results of staging of cancer patients recommended to choose the appropriate treatment, and sometimes take only one, sometimes combined. In addition, some doctors will suggest some ways not yet fully conclusive, such as immunotherapy, chemical prevention and so on. Outlined below: 

 Surgical treatment: 

 Surgical excision has been the main force of the majority of cancer treatment, because only complete resection can be cured only possible, of colorectal cancer is also true. And according to tumor location, to take the surgery will be slightly different way, in addition to intestinal tumor, the usually nearby lymph organization and removed. According to the location of cancer lesions, the common types of surgical resection of the right side of the large intestine, left colectomy, subtotal colectomy, all colorectal resection, high anterior resection, low anterior resection, perineal resection combined with local excision, etc. and so on. As to whether there needs to be done enterostomy fistula, then out of the intestines from the stomach, usually depends on the extent of the tumor and its violations, generally speaking, if lesions in the rectum 78 centimeters or more, then a better chance of not enterostomy fistula. Sometimes due to intra-abdominal infections, or intestinal pressure is required to carry out fistula colostomy. 

 Some of the first zero-phase patients with colorectal cancer, it does not necessarily require laparotomy, the current use of endoscopic surgery can be put into effect, but must be very careful, because the so-called limited to the mucosa of the first zero-phase cancer, or was based on histopathologic diagnosis, according to the appearance of diagnostic errors sometimes, as long as that does not, or biopsy of the report found abnormal, or to open surgery. If lesions in the bottom of the rectum or sigmoid colon, it can conduct ultrasound endoscopy helped found in the mucous membrane lesions on the depth, as surgery or endoscopic removal of the reference. But such sonography of lower digestive tract, not every hospital can afford, the domestic medical institutions did not do a few. 

 And in some terminally ill patients of colorectal cancer is not necessarily acceptable surgery treatment, sometimes only for the treatment of symptoms, when the main purpose of the operation to lift such as intestinal obstruction, massive bleeding and other complications, reduce a patient's discomfort, rather than to seek recovery, but after surgery and sometimes can increase the acceptance of other forms of treatment opportunities. 

 Chemical treatment: 

 Chemical treatment of colorectal cancer can be roughly divided into several major categories, and that is in the treatment of patients can not be the mainstay of chemotherapy, post-operative adjuvant chemotherapy treatment, a new pre-operative adjuvant chemotherapy (Neo-Adjuvant Chemotherpay). 

 In recent years, for the chemical treatment of colorectal cancer, with the understanding of tumor, the usage of drugs in the medical community has a consensus gradually, the current is 5-FU-based, together with other medicines. For more than a decade ago, based on the recommendations the United States, together with the oral Decaris (levamisole), in recent years and replaced by the use of leucovorin (a vitamin), 5-FU to enhance the efficacy and, more recently, the development of high-dose 5-FU continuous injection. As for the direct injection method of mining injection or drip injections, with the first use of 5-FU or other drugs, jury is still out, how long the time interval injection no absolute standard, which has yet to be more research results. There are, however, pointed out that the literature, especially in the second or third phase of patients, chemotherapy can increase the survival rate is true. So as long as circumstances permit, the patient should be accepted chemotherapy. In addition to these drugs, there are also some anti-cancer drugs such as CPT-11, Oxaliplatin, Tomudex, and oral anti-cancer drugs such as UFT, Capecitabine, S-1 are also in development, some drugs in some countries have already listed the use, Some also brought in the near future to begin clinical trials, would like to see better results come out. 

 In addition In addition to the standard chemical treatment, depending on the use of time to develop a different usage, adjuvant (adjuvant) chemotherapy is one example. The reason why there is adjuvant chemotherapy because the eradication of colorectal cancer after surgical excision, perhaps still may have the naked eye can not see a significant shift of a significant, although the organization is in the initial tests, the second or even third period, but perhaps there are a few With the blood of cancer cells have spread out, after a period of time may be recurrence or metastasis. So after the operation to give the chemical anti-cancer drug treatment, to achieve the objective of prevention, it will be called adjuvant chemotherapy. In recent years, countries around the world on the colorectal cancer studies have shown that, of adjuvant chemotherapy in some patients can significantly reduce the surgical treatment of colon cancer recurrence and metastasis of tumors, contribute to the survival rate, and whether lymph cancer metastasis , it is recommended that the need for adjuvant chemotherapy an important basis. Other practices included in the post-operative radiation therapy or chemotherapy before and after the grant and so on. Details behind the article otherwise, including chemotherapy and don'ts and side effects.

Radiation Therapy: 

 Radiation therapy is the use of equipment will be released from radioactive sources or particle cluster radiation exposure in cancer lesions and kill the cancerous cells to achieve the purpose of treatment. Depending on the location of radioactive sources can be divided into large exposure in vitro (External beam radiation therapy) with partial body irradiation (Local radiation therapy or brachytherapy). Its purpose is to prevent the possible transfer microscopy, as well as local recurrence of cancer cell growth, and even tumor metastasis. 

 In fact, radiation therapy for cancer of the lower digestive tract or in the main usefulness of rectal cancer, its sigmoid colon tumor was not above the preferred treatment. Depending on the timing can be divided into the use of adjuvant treatment, including radiation therapy after surgery is aimed at reducing the partial transfer, the organization has violated the vicinity of rectal cancer may also increase the survival rate. In the merits of post-operative irradiation is to remove the lesions before surgery to alleviate the symptoms, and can really understand the actual violations of the scope of cancer cells, but its disadvantage is that after the operation scar and organizations to reduce blood circulation, it will reduce the effectiveness of radiotherapy or chemotherapy. And sometimes lead to retain the anal sphincter damage, caused by difficulties in defecation. Therefore, some violations of the extent of the rectum in patients with more serious, it will take pre-operative radiotherapy, and its advantage is that the tumor has not been removed prior to irradiation, the effect is better, but after irradiation tumor usually reduced, the use of surgical resection of the opportunity to increase. In particular, near the anus of rectal cancer foci in advance of exposure, some patients can sphincter after surgery to relieve a permanent stoma do need. However, the drawback is the pre-operative radiation, making the extent of tumor invasion less doing the right to judge, to increase other forms of treatment difficult. Some physicians also tried in the middle of the implementation of surgery radiation therapy, in the section when such treatment, you need special operating room, can be shielded radiation, but also surgeons, anesthesia, radiation oncology, such as close cooperation only way to do it, not every hospital has such a capacity. The benefits of this treatment is exposure to direct lesions, particularly in violation to the pelvic cavity can not be completely removed the cancer, help to reduce future growth of the tumor and increase survival. Some can not anesthesia for surgery patients, a doctor will recommend mesocaval within the radiation therapy (endocavitary radiotherapy), for local control, some reports indicate there are good results. 

 Colorectal cancer in recent years, radiotherapy in addition to the combined operation, but also with a combination of chemotherapy, and many documents that have a positive significance. As regards the first radiation therapy or chemotherapy, or even coupled with the use of the sequence of surgery, jury is still out, pending more research. As for the recurrence of tumor after surgery, or too much can not be surgically removed tumor, or metastatic sites lead to discomfort, can be given by local irradiation, to reduce the symptoms, when radiation therapy is the so-called palliative treatment as a means. 

 

 Finally, re-emphasized for the treatment of colorectal cancer, of course, not only these types of treatment, but the above-mentioned surgery, chemotherapy, radiotherapy, after all, is the most important force. Patient's attending physician should be most familiar with the condition, and in receiving treatment and doctors should be preceded by a detailed communication and understanding, pre-treatment also need detailed information to check for evaluation. But also recognize there is no 100 percent successful treatment, decided the outcome of the treatment of these many factors, select the type of treatment varies from person to person, depending on the patient's situation should be to select the most appropriate methods of treatment for as long as there is confidence, should be able to achieve the best therapeutic effect.

Colorectal Cancer

Colorectal cancer, including colorectal cancer and colon cancer. Tumor mortality in China, men accounted for the fifth, sixth in women. 

 Colorectal cancer cases in Taiwan and around the world getting more and more a growing tendency, probably due to the popularity of the National Health Education, the National Pharmaceutical increased knowledge, diagnostic equipment and to find more of the progress of cases. 

 Early diagnosis, early detection, early treatment, the five-year survival rate is very high, with a cure rate higher than 75%. Colorectal cancer in Taiwan in terms of gender is similar for men and women, in 75 years for each of about 100,000 men, 11 were female, about 8 colorectal cancer occurred. Regional differences: European and American developed countries the incidence of the largest, followed by developing countries, Africa and Latin America minimum, fewer Asians than Westerners. 50 ~ 60 years the incidence of a maximum of between 20 years of age rarely. The first generation of Japanese immigrants the United States, colorectal cancer mortality is similar to the Japanese mainland, while the second and third generations of Japanese (Japanese) are 2.5 times higher rate. Asia, Europe and the United States Jews and Jews of the incidence of colorectal cancer is different, Europe and the United States about three times the Jews of the Jews in Asia. 

 Colorectal cancer is mainly adenocarcinoma, in the event of parts to 40 percent of the rectosigmoid and descending colon up to 35 percent, and the remaining 8% occurred in the cecum, ascending colon, transverse colon 16%. 

 Etiology 

 The formation of colorectal cancer, and meat, high-fat foods, low-fiber food is closely related to dietary habits. Is generally believed that with the following five factors: 

 Diet: fat, protein, carbohydrates, fresh fruits and vegetables. 

 Micronutrients such as vitamin A, C, D, E, phosphorus, calcium. 

 Serum nutrients, cholesterol, sugar, lipids, urea. 

 Medical quality, body mass index, physical activity index. 

 Living habits, smoking and drinking. 

 Symptoms 

 Symptoms of colorectal cancer are: anal bleeding, change in bowel habits, tenesmus (END stool solution still would like solution), the long-term anemia and weight loss. Late or palpable abdominal mass and swollen lymph glands and so on. 

 Colorectal cancer is rare in the early symptoms may be the only bleeding or abdominal pain, generally the larger the right side of the large intestine lumen and residues into a liquid form, and its symptoms are mainly digestive disorders, loss of appetite, nausea, vomiting, abdominal pain, bloating, anemia, discomfort or pain, while the left side of the large intestine lumen narrow and for the solid residue, and its symptoms stool stained with blood or mucus appearance, occasionally, there would be more blood out with the faeces, stool habits change, long rectal cancer that is obstructive symptoms at any time want to be a sense of stool, and defecation too hard, there is the phenomenon of pain. Generally speaking, patients from the surgical treatment of symptoms, the average has been a waste of time for more than a year. 

 Colorectal adenocarcinoma in the majority, followed by mucinous adenocarcinoma. 

 Diagnosis and Treatment 

 About 55 percent of patients with constipation due to the treatment, because  mucus and treatment accounted for 80 ~ 90%, with blood hematochezia treatment of rectal cancer by about 30%. 

 Early colorectal cancer and intestinal symptoms similar to benign disease. Unexplained recurrent abdominal pain semi stool habits change, or stool blood long, abdominal mass hit. 

 If anemia, fecal occult blood, a vegetarian for three days, for inspection three days, such as three days are positive, consideration should be given the diagnosis of colorectal cancer. 

 Barium enema x-ray accuracy rate of 88.5% ~ 90%.

About the early detection of colorectal cancer?

"With the westernized diet, colorectal cancer has become the main causes of death among the people. However, the majority of clinical colorectal cancer were often diagnosed relatively late, so how early detection of colorectal cancer, it is about caring for everyone! 

   Colorectal cancer risk factors of people throughout his life has been the chance of colorectal cancer is about 5%, mainly occurs in people over the age of 50. Is generally believed that customary high-fat and low-fiber diet has been easier for colorectal cancer, smoking and drinking will also increase the chance of colorectal cancer; more importantly, there is a family history of colorectal cancer, familial polyposis colon and colorectal cancer polyposis patients, colorectal cancer are at high risk. In addition, there are some special diseases such as ulcerative colitis and Crohn's disease is also easy access to colorectal cancer. 

 Common symptoms of colorectal cancer 

 1.anal bleeding. 

 2. Bowel habits change (constipation, diarrhea or both) 

 3. Droppings have smaller 

 4. Bloating, pain and flatulence 

 5. Stool row unclean feeling is intended or there would not have come out 

 6. Unexplained weight loss 

 7. Anemia symptoms such as dizziness, walking will breathe 

 8. Abdominal mass 

 9. Persistent fatigue 

 Colorectal cancer detection method 

 1. Faecal occult blood examination: through fecal examination, cancer can be caused by the naked eye can not see out of the bloodshed screening. 

 2. DRE: more than half of cancer patients can touch the debris. 

 3. Rectum mirror: located in the rectum (end of the large intestine) cancer, rectal examination may be out. 

 4. Colonoscopy: You can see the entire large intestine. 

 5. Lower digestive tract double-contrast photography: The main use of barium and air enema for colorectal X-ray examination. 

 6. Tumor embryonic antigen (CEA): part of colorectal cancer patients with tumor antigen will increase the embryo can be detected through blood. 

 7. PET: the use of nuclear medical examination can detect various types of cancer. 

   Many colorectal polyps are evolved, so early diagnosis of colorectal polyps and cut out to avoid the occurrence of colorectal cancer. The above symptoms should seek medical treatment, as high-risk group and no symptoms, it should also regularly check to the hospital. If early detection of colorectal cancer early treatment, five-year survival rate could reach above 75%. 

   In the catering, the number of intake of high fiber and low fat food, and to reduce smoking, drinking, can prevent the occurrence of colorectal cancer.

Hematochezia is hemorrhoids or colorectal cancer

45-year-old civil servant, Mr. Shen, a hematochezia situation a long time, which he believes is the hemorrhoids caused by a "normal phenomenon", not thought about it before medical treatment. 

 3 years ago, Mr. Shen's mother was hospitalized,at that time in order to balance work and care for mothers, lack of sleep, mental and physical exhaustion, there are times when even bowel bleeding, medical care after the doctor to assess the hemorrhoids deterioration is also concerned about the possible length of the "bad "In addition to open ointment to him, and further arrangements for the large intestine barium X-ray examination. No abnormal test results, Mr. Shen on time after the symptoms of drug-coated also improved a lot. 

 Before the end of the story. Last year, Mr. Shen bleeding recurrence of the situation, this time accompanied by abdominal pain, stool shape significant changes (to become thin and small, in some cases, transparent mucus), but he depends on its findings two years ago, normal, and there was no family history , care about the warning issued by the body. 

 Until the later one of his classmates get colon cancer, and his symptoms exactly the same, he was alert to the situation was serious, to the hospital to make colonoscopy. 

 Inspection process is successful, doctors will be skillfully colonoscopy from the anus into to, first quickly pushed to the end of the large intestine, and then slowly back to doing the carpet-like inspection. Mr. Shen did not play anesthesia, clearly heard the doctor said: "At present, very good and found no polyps or tumors." He said he had a little uneasy heart release . Did not expect that after a few minutes, the doctor looked dignified manner, pointing to the screen, "There is a tumor biopsy to see is good or bad." Mr. Shen in shock, mind blank. 

 Biopsy results showed that malignant tumors, but also because it was found later, is already the third phase of colorectal cancer, which is transferred to the lymphatic cancer, five-year survival rate of about 40 ~ 50%. Although the heart to do the worst, the news announcement, Mr. Shen is still at unacceptable repeatedly ask: "Why me?" Shen wife is panic-stricken, more than tears.

As the tumor 5 centimeters big, doctors first radiotherapy plus electrotherapy, so to 3 cm tumor removed after surgery, then chemotherapy. It is very difficult by the side effects of chemotherapy, treatments have not ended, Mr. Shen decided to give up the chemotherapy, but fortunately the disease has been controlled, and now every three months in addition to regular back-up care in daily life are now reunited with the normal track. And the life down and let him re-examine their own lives and the establishment of a new eating habits, do not dare to overlook physical distress signal. 

 However, it was not clear, why not check out before the anomaly? Doctor to assess, 3 years ago it was a massive hemorrhage, intestines should have polyps may be barium X-ray inspection errors (with the concentration of well or according to well), the impact of the doctor's interpretation. The doctor said that if the colonoscopy was again confirmed that perhaps will be able to early detection, replacing toss later. 

 Many patients with hemorrhoids, as Mr. Shen, the symptoms that hematochezia only cause it to "tolerance" of non-medical treatment, ignored bleeding may also be a precursor of colorectal cancer, colorectal Linkou Chang Gung Memorial Hospital physician Zhang Jian Rong pointed out. 

 Mackay Memorial Hospital colorectal surgeons said Liu Jianguo, some people even after a doctor refuses to face the truth, convinced that he was just hemorrhoids is not cancer, hemorrhoids turn up (doctors in order to tie up band hemorrhoids, about 8 ~ 10 days due to necrosis of hemorrhoids organizations and off), food prescriptions, self-purchase of medicines, delays in treatment time. 

 Almost all colorectal Physicians are met various medical treatment of hemorrhoids has not improved, after further examination found that colorectal cancer patients. Yang Lie singer because hematochezia, diarrhea unbearable the first time for medical treatment, it was misdiagnosed as hemorrhoids attack, for a second hospital was diagnosed with colorectal cancer.

Difficult to judge patients, doctors often misdiagnosed. Well, how in the end the difference between what is hemorrhoids, or colorectal cancer do? 

 Chang Chung-Rong said that in general to do preliminary color bleeding judge hemorrhoids bleeding red color is due to defecation vein bleeding caused by forced extrusion; and colorectal cancer partial color bleeding is to attack cancer cells, causing damage to normal tissue, blood leaving some time in the intestines with feces. 

 But be careful, if the tumor location near the anus if it will emit red color, it depends on whether the merger of other symptoms such as abdominal pain, diarrhea, stool shape change (thin, small or faceless justice), or anemia, it is best to check quickly for medical treatment. 

 Found that the higher survival rates sooner 

 Early detection of colorectal cancer can be treated early, in addition to alert symptoms, regular screening is a more active approach to combat. 90% of colorectal polyps grow by more than change comes cancerous process would take about 5 to 10 years. No early symptoms, the patient found that the abnormal, the most is the second, three or even the end of early screening, removal of polyps is an important line of defense to prevent cancer. 

 However, Taiwan's screening rate is relatively low, showing the alertness of the people is not high. According to a 2005 national survey found that people over the age of 50 into a screening rate of only 2. 

 As a result, colorectal cancer has been discovered too late, the National Health Council in 2004 analysis of 29 hospitals, 6463 new cases found, II and III of the ratio of more than half of the three patients, and found that the rate of early colorectal cancer less than a percent , which is lower than the United States improvements.

"Should think of ways to raise public awareness of colorectal cancer, especially high-risk group," is also chairman of colorectal surgery Chung-Rong Changchien loudly. 

 There are tuna fish maw, please carefully 

 The latest national survey found that waist size (an indicator of metabolic syndrome) and the great relationship between colorectal cancer. National Taiwan University Hospital hepatobiliary gastrointestinal mode analysis of general practitioners Kin Hospital Center, nearly 5,000 people attending the information found that people suffering from metabolic syndrome with multiple colorectal polyps disease risk is generally 2 to 3 times. As to why there is correlation between the two requires further study. 

 Other high-risk groups include: 

 People over the age of 50: singer Yang, writer Chang Hsiao-feng, director Edward Yang, President of Hong Kong artists Zhu Ding, both before and after the 50-year-old disease. 

 American Cancer Society recommended that the general public once a year after the age of 50 fecal occult blood examination, once every 5 years Sigmoidoscopy examination or barium X-ray ultrasound examination every 10 years a whole colonoscopy. Die doctors stressed in particular that 75% of patients with colorectal cancer is not family history, early detection is therefore particularly important. 

 Have a family history: one parent suffering from colorectal cancer, children's chances of ordinary people suffering from the 2 to 4 times, such as both parents have, then an increased risk 3 to 6 times. 

 Colorectal many general practitioners found that the recent trend of younger, 50 years of age more and more patients, so Mackay Memorial Hospital Dr. Liu Jianguo appeal to have a family history of those who should be granted early in the 40-year-old started to accept colonoscopy.

Personal history: has won, including colorectal cancer, chronic inflammation of colitis such as ulcerative colitis and Crohn's disease, adenomatous polyps. There is a history of colorectal cancer, the recurrence rate of up to five-cheng, it is best to track every three months once every six months after two years, five years after the inspections each year; and adenomatous polyps, the polyps removed after every 3-year follow-up time; As for chronic inflammatory colitis patients, the proposed 8 years after onset to start screening. 

 ‧ well-known U.S. anchor Katie Couric's husband is due to colon cancer, died at age 42. Katie two years ago to do a colonoscopy, and inspection process in the television broadcast, causing a lot of reverberations screening rate for a short period of time the United States increased by 20%. 

 Singer Yang cancer is restored, are also involved in charity performances, called on people from his own experience, early screening, awareness of symptoms, maintain a healthy lifestyle is the only way to prevent colorectal cancer.