The risk of colorectal cancer in the elderly continues to increase. Experts remind: It is crucial to change these bad habits

As the living standards of Chinese people gradually improve, their eating habits have gradually become westernized, with an increasing intake of high-calorie, low-fiber foods. Coupled with their daily "life of luxury" and lack of exercise, the incidence of colorectal cancer, a "rich disease" related to lifestyle, has increased year by year.

As of the end of 2020, the incidence of colorectal cancer ranked among the top three in my country, and the mortality rate ranked fifth. Survey data show that the incidence and age of colorectal cancer in China are currently showing a "double upward" trend. Starting at the age of 55, the risk of colorectal cancer continues to rise, generally reaching a peak in the 80-84 age group. Taking Shanghai as an example, more than half of colorectal cancer cases are people over 70 years old; and among patients over 75 years old, colorectal cancer continues to rise at a rate of 3.91% per year.

The incidence of colorectal cancer in the elderly is hidden. In an interview with reporters, Huang Rui, a member of the Tumor Metastasis Professional Committee of the Chinese Anti-Cancer Association and a professor of colorectal tumor surgery at the Second Affiliated Hospital of Harbin Medical University, pointed out that the elderly are themselves susceptible to cancer, and their incidence of malignant tumors is significantly higher than that of other groups. As the proportion of the elderly population increases, the number of new malignant tumors and long-term survivors will also "rise with the tide", which poses a severe challenge to the allocation of medical resources, especially for the elderly to meet their specialized diagnosis, treatment, rehabilitation and care needs. At the same time, clinicians are required to continuously improve medical standards, strive for early detection and early treatment, so that elderly colorectal cancer patients have long-term survival rates and better quality of life after surgery.

Professor Huang said that due to the decline of physiological functions and slow reactions of elderly patients, colorectal tumors grow slowly and early symptoms lack specificity. Most elderly patients do not show obvious initial clinical manifestations, and are often in the middle and late stages when they seek medical treatment. Generally speaking, the common first symptoms of colorectal cancer patients are changes in bowel habits and bloody and mucous stools, followed by intestinal obstruction, abdominal mass, abdominal pain, bloating, diarrhea, etc.; with age, the incidence of abdominal mass and intestinal obstruction in elderly colorectal cancer patients also increases, so we must be particularly vigilant against these "clues".

Early clinical symptoms should not be ignored. According to foreign reports, the tumors of patients with colon cancer over the age of 75 are mostly located in the right colon, and the incidence of proximal colon cancer is more significant in patients over the age of 75. However, research data in my country show that the incidence of colorectal cancer in the elderly is still the highest in the rectum and sigmoid colon, followed by the right colon, transverse colon, and descending colon. Related studies also show that the size of colorectal tumors in the elderly is concentrated around 2-5 cm, followed by those larger than 5 cm, and there are fewer cases of tumors smaller than 2 cm. At the same time, the ulcer type is more common clinically, followed by the protrusion type; the infiltrative type and other types are relatively rare.

In response to the above situation, Professor Huang reminded that for elderly patients with mild digestive tract symptoms, the medical history should be carefully inquired and the physical examination should be serious. If bloody stools, mucus and bloody stools, or changes in bowel habits occur, outpatient and clinical doctors should attach great importance to them and give corresponding examinations in time, including digital rectal examination, full colonoscopy, abdominal CT, etc., to avoid missed diagnosis and misdiagnosis; at the same time, efforts should be made to increase popular science education to let the public understand and recognize colorectal cancer, and see a doctor in time if there are any abnormal conditions.

Professor Huang Rui pointed out that the proportion of elderly patients with colorectal cancer in stages I to II is relatively high, and they are mainly moderately and highly differentiated adenocarcinomas, indicating that their malignancy is relatively low and there is a good prognosis, which provides favorable conditions for radical resection and better efficacy to a certain extent. At present, my country's medical technology and level are very high. The age of the elderly is no longer a limiting factor for surgery. Effective control of preoperative complications and 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.

Changing bad habits is crucial. So, how can we avoid the invasion of colorectal cancer? Professor Huang warned that from the perspective of lifestyle, prevention of colorectal cancer must be "controlling your mouth and moving your legs". These two points are crucial because genetic susceptibility genes cannot be modified. But it can be prevented by changing unhealthy lifestyles. According to the Global Aging and Adult Health Research Report, among the elderly population in my country, the smoking rate of those aged 70-79 is 30.6%, the drinking rate is 18.8%, the proportion of insufficient intake of fruits and vegetables is 41.8% (higher for those over 80 years old, at 58.0%), the overweight rate is 29.0%, and the obesity rate is 5.4%. These factors are mostly caused by the lifelong living habits of the elderly. They must quit smoking and limit alcohol, lose weight, control blood sugar, and consume more fresh fruits and vegetables.

Among them, we should eat more vegetables rich in vitamin C, such as cabbage, spinach, celery and broccoli, and often eat pitaya, kiwi, orange and other fruits that are good for bowel movements, so as to effectively reduce the contact time between carcinogens in feces and intestinal mucosa and prevent the occurrence of colorectal cancer. Professor Huang also warned that spicy, raw, cold, sour and astringent foods should be avoided in life; high-fat, high-protein, low-fiber and smoked, fried and pickled foods should also be avoided to avoid increasing the burden on the gastrointestinal tract and prevent nitrite from entering the human body to form carcinogens.

In daily life, preventing constipation can effectively reduce the risk of colon cancer. Therefore, many people use laxatives to solve the problem of difficulty in defecation. This practice is also undesirable. "Medicine is three-point poison." Although laxatives can help promote gastrointestinal motility and facilitate defecation, long-term abuse can cause abnormal gastrointestinal motility and destroy the normal intestinal flora. At the same time, it will cause dependence on laxatives. Once the drug is stopped, it will lead to more severe constipation. Professor Huang pointed out that laxatives can only be used in special constipation or obstruction, or before gastrointestinal endoscopy. They are temporary emergency drugs and cannot be taken at will.

Finally, Professor Huang Rui suggested that elderly friends must enhance their awareness of regular physical examinations. After people are over 50, if conditions permit, they should try to have a comprehensive physical examination every year. In particular, they should have a colonoscopy screening every two years or so to facilitate timely treatment if rectal polyps or precancerous lesions are found.

Brief introduction of Chief Physician Huang Rui

Chief physician of the Department of Colorectal Tumor Surgery (General Surgery Ward 9), the Second Affiliated Hospital of Harbin Medical University, Doctor of Medicine, postdoctoral fellow, and master's supervisor.

Actively carry out minimally invasive treatment of digestive tract tumors, master open laparotomy for colorectal cancer, da Vinci robot surgery for colorectal cancer, total laparoscopic surgery, TEM surgery for rectal cancer, NOSES surgery for radical resection of colorectal cancer with specimens taken from natural cavity, etc. Advocate the concept of multidisciplinary comprehensive treatment, which has greatly improved the treatment effect and survival rate of patients with colorectal tumors.