Colorectal cancer treatment, so far, the most effective treatment of colorectal cancer is surgical removal of method.
(A) of the surgical treatment
Colorectal cancer treatment is the main purposes of radical resection, minimal effect of other ways. Who should not strive for radical resection for palliative or less like surgery.
1. Surgery contraindication
poor general condition, despite preoperative treatment were not correct; with serious heart and lung liver and kidney disorders, can not tolerate surgery; had multiple distant metastases. However, if only the isolated lung, liver, bone metastasis, and primary tumor resection but also can still be palliative resection, hepatic effect 2-3 weeks after surgery, child surgery lobectomy or osteotomy.
2. Preoperative
Preoperative preparation including treatment with the incidence of preoperative ; to correct water and electrolyte disturbance, and anemia; control diet; bowel preparation, there are reports better with the whole gut lavage, is not restricted diet before surgery, no oral antibiotics only in the beginning of the operation intramuscular or intravenous injection of antibiotics once; vaginal preparations: married women for vaginal cancer patients are also prepared two days before surgery with 1% per day. The Bromogeramine douching.
3. Operation Selection
Clinical often based on tumor location, invasion and metastasis lesions range, is associated with intestinal obstruction, etc., combined with the general condition of the patient determine the scope of surgical and sewing in addition. DukesA, B, C of the patient should be thoroughly z DukesD radical surgery for palliative resection of patients should focus (including primary and metastatic lesions), can not be removed will be considered or colostomy match paint desolate surgery. Yuan incomplete obstruction or only mild obstruction, can be used for a surgery to remove a significant obstruction or condition does not allow for a phased removal may consider surgery.
Associated with obstruction of colon cancer, treatment, attention: cases of acute complete obstruction, should be completed within a short preoperative preparation, surgery to remove the obstruction as soon as possible. As for surgery, or stage one completed, the patient should be specific circumstances. Decided to stage surgery, first as a colostomy thin, thin parts should be made part of the proximal obstruction, and as close to the tumor at the time of radical operation for two and made a thin bowel resection.
1) Radical surgery
Basic principles: at least 5'""'-' 10cm away from the tumor together with the primary tumor, mesenteric and regional lymph nodes be removed; to prevent cancer cell proliferation and local plant: first in the tumor, the lower intestine with a cloth band ligation, then the ligation veins, arteries, and then removed. Gentle surgery operations, the application sharp separation, less blunt dissection, as far as possible without direct contact with the tumor. on the basis of the radical cancer, saving as much as possible (especially dirty gate function).
Colon cancer resection: right hemicolectomy, for swollen right colon cancer (including the cecum, ascending colon and liver cancer song). transverse colon resection, for the middle transverse colon tumor. left colon resection for colon splenic flexure and descending colon tumors. sigmoid resection for sigmoid colon, the lower the cancer.
Rectal cancer: total mesorectal excision (total mesorectal excision, TME) is a British doctor BillHeald made in 1982. After twenty years of practice, proof of TME can effectively reduce the middle and lower rectal cancer local recurrence rate to 3% -7%, and can improve survival. Compared with traditional surgical methods, TME more emphasis on the surrounding space under direct vision along the sharp separation of the rectum, complete resection of the mesorectum to protect the pelvic plexus. Therefore, TME has been used as the middle and lower rectal cancer surgery principles of the standards. TME's operation principle is: space under direct vision carried out in Russia before the sharp separation; to maintain the integrity of the visceral pelvic fascia, non-destructive; tumor excision of distal mesorectum not less Scm, bowel resection at least remote from the tumor 2cm. Who can not meet the above requirements, are not called total mesorectal excision.
According to the site of rectal cancer, the choice of different procedures: complete resection of the rectum and permanent dirty tube dirty door manual operation. Dirty abdominal rectal tube, resection (Miles operation) for embryo duct carcinoma, carcinoma of the lower rectum (the lower edge of foci 6-7 cm from the edge of the dirty door below). bowel control functions to retain rectal resection. Paul dirty surgical resection should follow the principle, not reduced by 5-year survival rate, or increase the local recurrence rate, but also improve the patient's quality of life. Paul used dirty surgical procedures: low anterior resection (abdominal rectal resection, Dixon surgery). Rectal cancer confined to the past (foci edge of the lower edge of the door from the Rainbow 12-15cm), with recent research found that the downward infiltration of rectal cancer rarely exceeds 3cm, so request away from the tumor margin to the lower edge of 3cm. Recent wide application of stapling rectum, so that part of the margin of 6-7cm from the anus after excision of rectal cancer can be successfully ultralow anastomosis, and expand the indications of the previous resection and improve the security Wang rate. Pulling out rectal resection (Bacon patients) or colonic anastomosis dirty tube (Park surgery).
For middle rectal tumors (cancer focus away from the lower edge of the door edge 6 -12 cm dirty person). Because of these two surgical removal of all the rectum and sphincter of defecation reflex, affect postoperative Wang door function. Thus, the present improved implementation of the majority, that reservations sphincter function of the gradual recovery after the door is dirty.
On rectal cancer to keep the door or not, there are many arguments Wang, there are many ways to improve, but are still not satisfied. To improve the efficacy of radical surgery, physicians have taken many measures, such as expanding the scope of operation, "do not touch isolation technique" (no-touch isolation technic), "Second View" (second look), preoperative, intraoperative, postoperative chemotherapy and radiotherapy.
Rousselot's better is proposed S-FU chemotherapy intestine, simple, and there is a certain effect. Concrete steps are: laparotomy decided to radical resection can be used in colon cancer far from the tumor of the proximal margin of about 8-10cm with a cloth belt encircling bowel, such as cancer, pre-slit rainbow door closed during operation ligation of the lower sigmoid colon: a tube with 5 F z and then blind eyelashes C5-FU) 30mg/kg body weight, into the tumor where the colon lumen. 2_7 minutes after the ligation, cut off the supply of arteriovenous bowel cancer. Followed by conventional surgical procedures to complete the operation. 1,2 d after operation, daily intravenous 5 – FU10mg/kg weight. This method has been reported to increase DukesC radical resection of colorectal cancer patients.
2) palliative surgery
Although we can not fight for radical resection of the lesions should also facilitate the chemotherapy and other treatment and improve symptoms.
3) Less-like operation
Short (Go to) surgery, colon surgery, etc. can be made thin lifting obstruction, Confucianism artery ligation can reduce the cancer bleeding.
4. Surgery
5-year survival rate of radical resection of colon cancer is about 70%, 50% of rectal cancer. But better early and late less effective. A 5-year postoperative survival rate of 90%, B and C of the period of only 50% and 30%. Cancer Hospital, Sun Yat-sen information, right colon cancer resection 5 and 10 year surviva
l rates were 73.6% and 65.3%, left colon cancer were 70.9% and 64.5%; cancer were 58.9% and 49.9%.
(B) chemotherapy
Used for surgery, postoperative adjuvant therapy, also used in patients with advanced inoperable. Beijing drug commonly used fluoride wow kneeling C5-FU, FT-207, UFT, etc.), mitomycin CMMC), urinary nitrite month (such as CCNU, _1e – CC) L-, etc.). In recent years research and development of new drugs: Xeloda CXeloda), oxalic acid lead COxaliplatin), CPT CIrinotecan), C225, and Avastin and other clinical treatment of advanced colorectal cancer proved to have a certain effect: the majority of unsolicited in the treatment of colorectal cancer is combined with chemotherapy or add a regulator. 5 – FU + Levamisole (L-Mi lag) solutions that can improve the E of early postoperative effects of colon cancer; 5-FU ten Leucovorin (folic acid, hydrogen awake, CF) program, is the newer and more effective treatment programs, oxalic acid added to the lead or CPT 5-FU/CF, the effect has increased, survival also improved. Therefore, the two currently recommended (Oxaliplatin ten 5-FU/CF the FOLFOX program, Irinote-can 5-FU/CF or FOLFIRI ten programs) can be used for first-line treatment. Oral Xeloda due to convenience, efficacy 5-FU/CF programs similar to the characteristics of low bone marrow toxicity, application of Xeloda in recent years to replace lead 5-FU/CF combined with oxalic acid (XELOX or CAPOX) or combined with CPT (XELIRI or CAPIRD the treatment of advanced colorectal cancer. The treatment of advanced colorectal cancer 57.1% effective rate ranging from 46 %'"'-'. C225 and Avastin is a molecular target for new drugs, are monoclonal antibodies. C225 by competitive binding epidermal growth factor receptor (EGFR), inhibiting activation of tyrosine kinases play an anti-tumor effect. The combination of Avastin and in and through the vascular epithelial growth factor (VEGF) activity, resulting in anti-angiogenic effect. both in advanced colorectal cancer depth study of the effect needs further confirmed.
(C) Radiation Therapy
Radical surgery for rectal cancer before and after treatment or surgery aimed at strengthening local control and reduce local recurrence and improve survival. Radiotherapy alone 5-year survival rate of 5% -10%. Dose 40-60Gy / 4-6 weeks. For local recurrence and distant metastasis (such as bone, liver, lung, brain metastasis), selective use of radiotherapy also in order to alleviate the symptoms (such as pain, etc.), to extend life.
(D) of hyperthermia combined with chemotherapy (hot chemotherapy) or radiation (heat radiation)
Treatment of unresectable advanced or recurrent rectal cancer. According to the study, 42 C hyperthermia combined with chemotherapy or radiotherapy has obvious synergies, growth of cancer cells remaining after treatment, the slow reduction of mitotic index and decreased reproductive capacity, generous tail of the patients to alleviate pain, control of lesion development.
(E) traditional Chinese medicine
According to the specific circumstances of the patient, syndrome differentiation. Chinese herbs have preferred flavescens, diffusa, Pteris grass, vine pear roots, expanding wood, grass Rumex; second choice of a word son, SFAS, Patrinia, government rice, Atractylodes, wild vines. Three commonly used prescription for a living cooked yellow Decoction.
(Vi) biological treatment
Biological treatment of colorectal cancer at the exploratory stage, the clinical application: cytokines such as IFN, TNF, IL-2, LAK cells and so; monoclonal antibodies, such as the C225, etc.; immune effector cells such as tumor infiltrating lymphocytes (TIL ), lymphokine-activated killer cells (LAK), cytokine-induced killer cells (CIK), cytotoxic lymphocytes (CTL), NK cells. immune stimulating agents such as BCG, OK-432, protein vaccines, tumor cell vaccines, dendritic cell vaccine. gene drugs, such as 63 gene, E1-B adenovirus and so on. The method of treatment of uncertain efficacy of colorectal cancer, gene therapy is also still in the experimental research stage. Has been used successfully in the wild-type gene family of 53 colorectal cancer cell line in vitro transfection, so the growth was inhibited, showing the families of 53 anti-cancer gene in colorectal cancer treatment potential value.
(G) Integrated treatment
Treatment of colorectal cancer, with surgery, radiotherapy, chemotherapy, Chinese medicine or immunotherapy, is expected to improve efficacy, in some cases, applications can be considered frozen, coagulation and other methods.
Colorectal cancer and gastric cancer, lung cancer, liver cancer, esophageal cancer, adenocarcinoma and other malignant tumors compared to film, the prognosis is good. Prognostic factors of colorectal cancer are many, foremost among which is early or late stage of disease, DukesA of 5-year survival rate after radical operation for more than 90%, but Dukes'C period of only about 30%. Another major source of lymph node metastasis, in the event of regional lymph node or distant lymph node metastasis, the prognosis is poor. Others such as age, disease duration, tumor size, number of perimeter wall invasion, pathological type and degree of differentiation, immune status and treatment and so have an impact on prognosis. As the popularity of anti-cancer knowledge, modern means of detection and treatment methods continue to improve, can improve the cure rate colon cancer.