Text/Hong
The cure rate of early colorectal cancer is extremely high. If it can be found early, the prognosis will be excellent, and the occurrence of colorectal cancer is closely related to polyps. If polyps are found and removed early, the possibility of further canceration will be avoided and the occurrence of colorectal cancer will be effectively prevented. Unless it is a very large polyp, it may bleed. Otherwise, early polyps will not have obvious symptoms. Most patients found polyps in the intestine during health examination.
Polyps are not cut, and the risk of cancer is high.
According to statistics, if polyps are not removed, 2.4% will develop into cancer after 5 years, 8% after 10 years, and 24% will develop into colorectal cancer after 20 years.
Chen Guanyang, director of the Department of Gastroenterology, Renai Hospital, Taipei United Hospital, pointed out that since more than 90% of colorectal cancer is transformed from polyps, once polyps are found, most of them will be directly removed. Unless the doctor can confirm that the polyp is benign from its appearance and location, such as inflammation or cell proliferation, it will usually be directly removed.
Different types of polyps have different chances of developing into cancer in the future. If the doctor judges that it is adenoma, because it is a precursor of cancer, if it is detected, it should be removed to avoid further development of cancer in the future.
According to the position, determine the resection method.
According to the shape and other characteristics of polyps, the method of polypectomy is selected. When removing polyps, not only the size of polyps and their basal parts is determined, but also the removal method. Polyps with different appearances will also affect the safety of the operation.
◎ Small polyp: It can be taken out directly with slicing forceps.
◎ Large polyp with rhizome appearance: it can be covered with a net first, and then removed with an electric knife.
◎ Large flat polyp: A substance similar to hyaluronic acid is injected into the submucosa to make the flat polyp swell out, and then it is removed by endoscopic submucosal polypectomy.
Chen Guanyang pointed out that if the bottom of the polyp is wider, the risk of resection is higher; If the polyp is a stem-like polyp like a mushroom, the safety of resection is higher; If it is a flat polyp, it is not easy to be found. Before resection, it should be inflated with drugs, which will not only take a long time to remove, but also make the wound bigger. If the polyp has invaded the submucosa, even the muscle layer, and is malignant, it may not be removed cleanly due to the use of endoscope, and the surgeon will need further treatment to evaluate the necessity of removing part of the large intestine and lymph nodes.
Painless colonoscopy relieves discomfort
The action of removing the polyp itself will not bring pain to the patient, but after all, if the polyp needs to be removed, the instrument will run in the intestine for a long time, which will really make the patient feel uncomfortable when the colonoscopy is pushed or turned. In addition, air will be injected during the inspection. Once the examination time is prolonged, the discomfort of abdominal distension will become more obvious. Generally, more experienced doctors will pump air while doing it to make patients feel more comfortable. Some people will choose painless colonoscopy with anesthesia because they are afraid of pain, but polyps can be removed with or without anesthesia during colonoscopy.
If polyps need to be removed during colonoscopy, the whole examination time will be lengthened, and the required time will vary according to the size and location of polyps. Some polyps are located at the bend of the liver or spleen, and it takes longer to deal with the turning position. If there are many flat polyps or polyps, it will take longer.
In the past, large or flat polyps could not be removed by colonoscopy, and even required surgical laparotomy or laparoscopic surgery. The patient needs general anesthesia and hospitalization. At present, endoscopic surgery of large intestine will treat the wound with hemostatic clips after resection to reduce bleeding and wound rupture without hospitalization.
After colonoscopy and polypectomy, because there is still residual gas in the intestine, it is necessary to walk a little after resection to facilitate exhaust. Although hemostasis will be given after resection, excessive force may still cause bleeding, so it is not suitable for strenuous exercise. In addition, if there are patients taking anticoagulants, it is recommended to stop taking them first; Because there is a wound in the intestine, you should avoid eating raw food for a few days after operation to avoid infection.
If you don't change your eating habits, polyps will grow again.
Some patients think that the polyp was obviously removed when it was found last time. Why did you find polyps this time? Because the occurrence of colorectal polyps is closely related to heredity, diet and defecation habits, it is still possible to recur after resection. However, Chen Guanyang pointed out that the probability of recurrence of polyps in the same part is actually not high, but polyps in other parts are still possible. It has been pointed out that more than 20% patients will still find new polyps after polypectomy.
Although there are still a few patients with colorectal cancer who have not passed polyp examination, but are directly caused by mucosal lesions, as high as 90% of colorectal cancer is transferred from polyps. Polyps can be regarded as precancerous lesions of colorectal cancer. As long as it is treated as soon as it is found, it can prevent it from developing into colorectal cancer in the future.
To prevent polyps, we should start with regular examination.
The research team of the German Cancer Research Center and the University of Heidelberg conducted a follow-up survey of more than 400 patients with colorectal polyps for 10 years, and found that about13 patients later developed colorectal cancer. The results show that people who have not been followed up by colonoscopy within 5 years after finding colorectal polyps, or who have not completely removed colorectal polyps, are more likely to develop colorectal cancer. The study found that people who did not receive colonoscopy follow-up within 5 years were three times more likely to develop cancer than those who received regular follow-up, while those who did not remove colorectal polyps were five times more likely to develop cancer than those who removed polyps cleanly.
Chen Guanyang pointed out that it takes about 5 to 10 years for polyps to turn into malignant tumors. Because polyps can be regarded as the manifestation of precancerous lesions, in the United States, due to the limitation of medical environment, it is suggested that if polyps are not found in the examination, they can be examined again after 10 years. However, the medical environment in Taiwan Province Province is relatively friendly, and it is generally suggested that it can be shortened to five years, that is, it needs to be checked again. After all, there are folds in the large intestine, some small polyps may not be easy to see, or the patient's defecation is not clean in advance, and the residual feces in the intestine may cover some small polyps or flat polyps, forming a dead angle for examination.
If a large polyp is found in the examination, and it is a villous adenoma, it is recommended to have/kloc-0 examination every year for the first 2 or 3 years after resection. If no polyp is found in 2 or 3 years, the frequency of examination can be extended to 3 years 1 examination. If the polyp is less than 1 cm, it is a benign strip adenoma, which can be checked again after 2 ~ 3 years. If no polyp is found, it can be checked after 5 to 10 years.
Those with family history should be examined early.
Because polyps and colorectal cancer often have family history, those with family history should be examined earlier. It is generally recommended that the examination age of colorectal cancer should start at the age of 50, and those with family history may need to be examined earlier. The patient's age is the youngest age in the family who was diagnosed with the disease, which is 10 years earlier. For example, my mother was diagnosed with colorectal cancer at the age of 60, and my brother was diagnosed with colorectal cancer at the age of 55. It is recommended that my family undergo colonoscopy from the age of 45 to confirm whether there are polyps.
Chen Guanyang emphasized that 10 years is advanced because it takes about 5 10 years for polyps to develop into cancer.
366