What caused one elderly patient with colon cancer to recover after surgery while the other died from an infection?

According to a latest cancer statistics report released by the National Cancer Center, in 2020, there were 4.57 million new cancer cases in my country, of which 820,000 were lung cancer, ranking first, followed by 560,000 colorectal cancer. At the same time, the number of cancer deaths in China in 2020 was 3 million, with the top five being lung cancer (710,000), liver cancer (390,000), gastric cancer (370,000), esophageal cancer (300,000), and colorectal cancer (290,000). Professor Song Chunfang, doctoral supervisor at Harbin Medical University, honorary dean of Hongsen Hospital of Harbin Medical University in Sanya, and chief expert in general surgery, pointed out in an interview with the media that in recent years, like other malignant tumors, the prevalence of colorectal cancer has also shown a "rising tide" trend, and all age groups are not immune. Among them, the elderly are more likely to be "dragged down" by colorectal cancer, and must be highly vigilant.

Professor Song Chunfang pointed out that there are often no special symptoms in the early stage of colon cancer, which are mostly manifested as increased bowel movements, diarrhea, constipation, blood, pus or mucus in the stool. Many people, especially the elderly, believe that it is normal to have abnormal bowel movements due to irregular work and rest, high pressure in life, or because of old age and physical weakness, poor gastrointestinal function, so they often turn a blind eye to these problems. In fact, whether the above symptoms can be given due attention and whether they go to the hospital for diagnosis and screening in time often determines whether colon cancer patients can be cured, and the difference in prognosis is also huge.

A typical case of positive and negative In early March this year, the General Surgery Department of Hongsen Hospital of Harbin Medical University in Sanya successively received two elderly patients with colon cancer, and the final diagnosis and treatment results were very different. Among them, 76-year-old Aunt Li went to the hospital for diagnosis and treatment quickly because of "abdominal distension and pain accompanied by cessation of gas and defecation for 3 days". After examination, she was diagnosed with complete intestinal obstruction, and the possibility of descending colon cancer was not ruled out. After non-surgical treatment, the condition did not improve, and the abdominal distension and pain worsened. After in-depth discussion by Dean Song and the team of Director of General Surgery Ran Qihua and with the consent of the family, Aunt Li underwent laparotomy and exploratory surgery. As a result, a huge tumor was found at the junction of the descending colon and the sigmoid colon during the operation. After finding the lesion, the doctor performed a radical resection of colon cancer on her. After the operation, the old man recovered well and was discharged soon.

Grandpa Wang, who was in his 80s, had chills and high fever the day before he was hospitalized, but he didn't take it seriously. Later, he came to Sanya Hongsen Hospital because of "severe abdominal pain and reduced flatulence and defecation for 5 days". When he was admitted to the hospital, Grandpa Wang had unbearable abdominal pain, accompanied by septic shock and diffuse peritonitis. After a detailed examination by the medical team, active anti-shock and emergency surgery, fecal water and fecal odor gushed out after the patient's peritoneum was cut; the expert team quickly explored and found colon cancer at the junction of the descending colon and the sigmoid colon, extremely dilated colon, high intestinal tension, intestinal wall ischemia, long segment necrosis with perforation, small intestine embedded in the pelvic cavity causing compression ischemia and necrosis, and a large amount of feces entered the abdominal cavity, resulting in peritonitis and septic shock. During the operation, the colon tumor, necrotic segments of the colon and small intestine were quickly removed, and an ostomy was performed. Unfortunately, due to the delay in the elderly's medical treatment, the degree of postoperative infection was too severe and combined with multiple organ failure, and he died.

Professor Song Chunfang commented that nowadays, my country's medical technology level is very high, and the age of the elderly is no longer a limiting factor for surgery. Effective control of preoperative complications, perioperative monitoring and treatment can effectively reduce the incidence of postoperative complications and surgical deaths, allowing the elderly to enjoy a "second spring" after surgery. The key to the problem is that when gastrointestinal symptoms are found, you must see a doctor as soon as possible, and you cannot delay for a long time and delay the best time for surgery.

Colon cancer starts from the tip of a leaf. Colon cancer is considered to occur "silently". Most of them develop silently in the body from nothing to something, from small to large, and after multiple evolutions, it takes about 10-15 years. There are also 30% of colon cancers that do not evolve into adenomas, but directly appear in the form of cancer nests. Professor Song Chunfang explained that the normal epithelial cells of the colon evolve into hyperplastic microadenomas, and after three stages of early, middle and late adenomas, they are finally determined as cancer, and infiltrate and metastasize over time. In clinical practice, the mystery of the cause of colon cancer has not yet been solved, but its related high-risk factors are gradually being recognized by people, such as adenomas and hamartomatous polyps, inflammatory bowel disease, family history, excessive fat, protein intake, lack of dietary fiber, as well as age, obesity, smoking, etc.

Data shows that the incidence of colon cancer is rising worldwide and has surpassed that of rectal cancer. In my country, the most common disease is found in people aged 41-65, and the proportion of elderly people aged 75 and above in large and medium-sized cities who suffer from colorectal cancer is soaring, accounting for more than 30% of the total number of surgeries. At present, the mortality rate of colon cancer remains at a high level. Early detection and early intervention can improve the cure rate and reduce the mortality rate.

Analyzing the common factors that cause colon cancer, Professor Song summarized the following three points: First, patients cannot control their diet and have an unreasonable diet. They consume high-sugar, high-fat, high-protein, low-fiber foods for a long time. Second, the early symptoms of colon cancer are not obvious. People often turn a blind eye to potential clues, or take some digestive medicine on their own, and no longer pay attention to the problem after solving the surface problem. Third, they do not have enough knowledge about colon cancer and have never undergone regular colonoscopy screening, which causes hidden dangers to turn into serious diseases.

Early diagnosis and early treatment can defeat cancer. In fact, if you want to identify colon cancer early, the best way is to have a fiber colonoscopy, which can remove precancerous adenoma lesions in time. According to the summary of the guidelines by experts, the following groups should be listed as high-risk groups for colorectal cancer, namely: those with positive fecal occult blood, first-degree relatives with a history of colorectal cancer, a history of colitis polyps, a history of cancer, and changes in bowel habits. These groups must be closely observed and paid special attention to.

Professor Song Chunfang has worked in the general surgery department for 58 years and has accumulated a lot of experience in diagnosis and treatment. According to his suggestion, people with a family history of polyposis should undergo their first colonoscopy at around 30 years old, and have a colonoscopy every 1-3 years depending on the situation; people with a family history of colon cancer can undergo their first colonoscopy at around 40 years old, and those with polyps and resection should have a reexamination every 1-2 years, and those without polyps should have a reexamination every 3 years; people without a family history of colon cancer can undergo their first colonoscopy between the ages of 45-50, and those with polyps and resection should have a reexamination every 1-2 years, and those without polyps can have a reexamination every 3 years. Compared with foreign countries, the cost of colonoscopy in my country is relatively low, and it is recommended that the above people go to regular hospitals for colonoscopy examinations regularly.

Professor Song introduced that the current treatment for colon cancer is still mainly surgical resection. Due to the rapid development of clinical technology, especially the rapid development of medical equipment such as laparoscopes and robots, radiotherapy and chemotherapy, biotechnology, and the formation of multidisciplinary joint diagnosis and treatment models, most patients with advanced tumors, including colorectal cancer, can be effectively treated, and their survival time and quality of life have been significantly improved.

Professor Song Chunfang finally reminded that in daily life, people over 40 years old with abnormal changes in bowel habits and shape, people with a family history of colorectal cancer, people after treatment of colorectal adenoma, patients with long-term ulcerative colitis and people over 50 years old should undergo regular physical examinations and colonoscopy to truly achieve early detection, early diagnosis and early treatment, and nip in the bud in the bud. At the same time, pay attention to prevention, strengthen physical exercise, avoid obesity, and promote healthy diet, which are all effective means to prevent gastrointestinal tumors.