How to prevent recurrence of colorectal cancer ? How to treat recurrence of colorectal cancer after surgery ?
Colorectal cancer is a common malignant tumor, including colon and rectal cancer. The incidence of colorectal cancer from high to low is the rectum, sigmoid colon, ascending colon, descending colon, and transverse colon. In recent years, there has been a trend toward the proximal (right colon).
If colorectal cancer is detected early, it can usually be cured.
5-year survival rate for colorectal cancer
According to US ASCO official website data, the 5-year survival rate of colorectal cancer patients is 65%. However, the survival rate of colorectal cancer may vary depending on a number of factors, especially the stage.
For colon cancer, the overall 5-year survival rate is 64%. 5-year survival rate for localized colon cancer is 90%; 5-year survival rate is 71% for metastasis to surrounding tissues or organs and / or regional lymph nodes; 5-year survival rate is 14% for colon cancer that has occurred distant .
For rectal cancer, the overall 5-year survival rate is 67%. The 5-year survival rate for localized rectal cancer is 89%; the 5-year survival rate is 70% for metastases to surrounding tissues or organs and / or regional lymph nodes. If distant metastases occur in rectal cancer, the 5-year survival rate is 15%.
The current treatments for colorectal cancer include surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy. Surgery is the preferred way to cure colorectal cancer. But Vicki, a cancer-free home editor, learned that about 60% to 80% of patients with rectal cancer will relapse within 2 years after surgery.
How to effectively prevent recurrence of colorectal cancer ?
Improve lifestyle
Quit alcohol, quit alcohol, quit alcohol, important things are said three times, you must quit alcohol. Also, don’t smoke, don’t overwork, and stay happy.
Appropriate exercise, 2-3 months after surgery, you can do gentle exercises, such as walking, and gradually increase from 15 minutes to 40 minutes; you can also exercise qigong, Tai Chi, radio exercises and other gentle exercises.
Special attention should be paid to the diet, do not eat moldy food, barbecue, bacon, tofu and other foods containing nitrite, and do not eat traditional Chinese medicine and health products.
The postoperative diet is mainly light, and the intake of high-quality protein such as egg white and lean meat is appropriately increased. The postoperative diet generally transitions from water, porridge, milk, steamed eggs, fish, lean meat to ordinary diet.
Try to eat easily digestible foods, avoid greasy, spicy, irritating, hard, sticky and other foods, eat a balanced diet, eat fewer meals, and should not be full.
Regular consumption of nuts such as cashews, hazelnuts, walnuts, almonds, and walnuts can reduce the recurrence rate of bowel cancer.
Postoperative care recommendations for colorectal cancer
The suture is completed 7-10 days after colon cancer. Elderly patients or patients with certain complications can appropriately extend the time of stitch removal. After stitch removal, they must pay attention to the cleanliness of the wound to avoid infection.
After the suture is removed, the dressing and abdominal bands should continue to be tightened during the wound healing until the surgical incision is completely healed, which takes about half a month.
The skin puller should be removed at least 10 days after the operation. The wound should be kept as clean and dry as possible to reduce sweating. You can take a shower, but you cannot rub the wound.
It is normal to have numbness around the wound after surgery, which will disappear after a while.
It is normal for wounds to exudate. A small amount can be used for local disinfection. Replace the dressing on the surface. However, if the amount of exudate is large and severe redness, swelling and pain occur, you should contact your doctor in time to treat the wound.
When the surgical incision is about to grow, it will feel itchy, commonly known as “long meat”. At this time, avoid scratching, do not get water, and avoid infection.
The wound is beyond the healing period, but it still does not grow well. You need to find a professional surgeon to handle it, change the medicine in time, clean the wound, and treat the infection. At the same time, pay attention to controlling blood sugar and strengthening nutrition.
Anal wounds usually take a month to heal. After healing, you can slowly practice squatting, 3-5 minutes each time, once in the morning and afternoon.
If the wound heals well, you can take a shower 7-14 days after removing the suture. You can use a body wash or soap, but avoid the wound.
Periodic review
According to statistics, the recurrence and metastasis rate of postoperative colon cancer in China is as high as 50%, and more than 90% of the recurrence and metastasis occur in 2-3 years after operation, and the recurrence rate is lower after 5 years. Therefore, surgery is not a one-time operation, and you must insist on regular review after surgery.
Patients with bowel cancer are most likely to have relapses within 3 years after surgery. During this period, the number of re-examinations should be relatively frequent; after 3 years, the re-examination interval can be appropriately extended.
Generally, it is reviewed every 3 months within 1 year after surgery; it is reviewed semi-annually in the first 2-3 years; and every 4-5 years. Specific review time also needs to find their own doctor to determine.
During the review, the items to be checked include:
Blood tests: blood routine, liver and kidney function, tumor markers (CEA, etc.);
Imaging examination: B-ultrasound, chest radiograph
Colonoscopy: performed 3 months after surgery to determine the healing of the surgical anastomosis and observe the polyps in other parts.
How to treat colon cancer recurrence after surgery ?
Secondary surgery
The most ideal method for recurrence of colorectal cancer patients after surgery is to remove the recurrent lesions to achieve the goal of radical cure. The first thing to do is to see if a second surgical resection can be performed. If the surgical criteria are met, the tumor can be surgically removed.
If there are multiple lesions, the invasion area is relatively large, or the distant metastases, if reoperation is prone to danger, and in the case that the surgical benefit is not guaranteed, other treatment methods can be selected.
Medication used in colon cancer treatment
Colon cancer chemotherapy drugs
Common chemotherapeutics are 5-fluorouracil, irinotecan, oxaliplatin, calcium folinate, capecitabine, tigio (S-1), and TAS-102 (trifluridine / tipiracil).
However, chemotherapy for colon cancer is usually a combination of several chemotherapeutics, and the common combination methods are:
1.FOLFOX (fluorouracil, calcium folinate, oxaliplatin)
2.FOLFIRI (fluorouracil, calcium folinate, irinotecan)
3.CAPEOX (Capecitabine, Oxaliplatin)
4.FOLFOXIRI (fluorouracil, calcium folinate, irinotecan, oxaliplatin)
Colon cancer targeting drugs and immune drugs
1. KRAS / NRAS / BRAF wild-type targeted drugs: cetuximab or panitumumab (commonly used in left colon cancer)
2. Anti-angiogenesis inhibitors: bevacizumab or ramonizumab or ziv aflibercept
3. BRAF V600E targeted drugs: dalafenib + trimetinib; connetinib + bimetinib
4. NTRK fusion targeting drugs: Larotinib; Emtricinib
5.MSI-H (dMMR) PD-1: Paimumab; Navumab ± Ipilimumab
6.HER2-positive targeted drug: Trastuzumab + (Pertuzumab or Lapatinib)
In addition to surgery and radiotherapy for advanced colon cancer, systemic medication is an indispensable treatment stage. Fir
st-line treatment refers to the stage of first treatment with anticancer drugs, also called initial treatment. There are many choices for the first-line treatment of advanced colon cancer, usually based on chemotherapy.
However, the patient’s condition and physical condition must be distinguished. After a series of examinations, patients can be divided into two categories: patients who are suitable for high-intensity treatment and those who are not.
Drug selection for high-intensity treatment of colorectal cancer patients
Divided into three categories:
First-line solutions with oxaliplatin
First-line solutions with irinotecan
(1) First-line plan containing oxaliplatin
FOLFOX ± bevacizumab
CAPEOX ± Bevacizumab
FOLFOX + (cetuximab or panitumumab) (only for KRAS / NRAS / BRAF wild-type left colon cancer)
(B) the first-line plan containing irinotecan
FOLFIRI ± bevacizumab or
FOLFIRI + (cetuximab or panitumumab) (only for KRAS / NRAS / BRAF wild-type left colon cancer)
(III) First-line plan containing oxaliplatin + irinotecan
FOLFOXIRI ± Bevacizumab
Drug selection not suitable for high-intensity treatment in colorectal cancer
First-line medication options
1. Infusion of 5-fluorouracil + calcium folinate ± bevacizumab or
2.Capecitabine ± Bevacizumab
3. Cetuximab or panitumumab) (Class 2B evidence, only for KRAS / NRAS / BRAF wild-type left colon cancer)
4. Navumab or Paimumab (only for dMMR / MSI-H)
5. Nivolumab + Ipilimumab (type 2B evidence, only applicable to dMMR / MSI-H)
6. Trastuzumab + (Pertuzumab or Lapatinib) (for tumors with HER2 amplification and RAS wild type)
1) After the above treatments, the functional status does not improve, and the best supportive treatment (palliative care) is selected;
2) After the above treatments, the functional state improves, and a high-strength initial plan can be considered.
Last medication choice in colorectal cancer
Rigfini
Trifluorothymidine + tipiracil
Best supportive care (palliative care)
References:
https://www.cancer.net/cancer-types/colorectal-cancer/statistics
https://zhuanlan.zhihu.com/p/42575420
https://www.nccn.org/professionals/physician_gls/default.aspx
