In Poland, colorectal cancer (colon cancer) is one of the most common but quite late detected cancers. As a result, the effectiveness of treating the disease is low, recurrences often occur, and the percentage of people after surgery that survive for more than 5 years does not exceed 25%. This state of affairs results from the lack of popularity and easy access to screening.
Requirement of vigilance after colon cancer surgery
The risk of recurrence of the disease concerns especially persons who have been diagnosed with cancer in the second and third stage of the disease and have undergone radical surgical treatment. This means for those people and their medical supervision the requirement of high vigilance and constant monitoring of health. Early diagnosis of recurrence of colon cancer may allow another tumor resection, second-line chemotherapy, radiotherapy - in other words, provide the patient with another chance to heal and prolong life.
OPERATION - WHICH CHANGE FOR TREATMENT?
Some people believe that even after a successful colon cancer surgery, a relapse is a programmed verdict. Is it true? No, you can not think like that. However, the recurrence risk is significant. Statistical data from, for example, the USA shows that after treatment with available methods (radical resection, chemotherapy, radiotherapy) - in 35-40% of patients in stage II or III, after some time relapse in the form of local recurrence or metastasis (dissemination) to other organs and organs).
How long can the disease come back?
Most recurrences of colorectal cancer occur within 5 years, but most often they occur within 3 years after surgery.
Can you determine the effect of the severity of colon cancer (at the time of starting treatment) on life expectancy?
There are often 4 stages of colorectal cancer. The severity of the disease measured at these stages is the most important prognostic factor. For example, we give in the table / below / - a statistical summary showing what percentage of people in various stages of cancer survive after treatment for more than 5 years.
The degree of advancement of bowel cancer at the time of treatment. The percentage of people who survive thanks to the treatment of cancer for more than 5 years
I ° the first 70% of patients
II ° second 63% of patients
III ° third 46% of patients
IV ° fourth 12% of patients
HAZEL SYMPTOMS - CONTROL TESTS
What methods allow early diagnosis of recurrence of colon cancer?
Possible applications include: carcinoembryonic antigen (CEA), colonoscopy, chest radiographs, liver function tests, complete blood counts, occult blood stool tests, ultrasonography and computed tomography.
What may be the first signs of relapse?
At the outset, it should be emphasized that this is about the detection of cancer recurrence in the asymptomatic phase, that is when the patient does not have anorectal bleeding, he does not get feverish, he has no pains or no abdominal tumor. The detection of recurrence in the early, asymptomatic phase is more promising when it comes to the chances of successful treatment than in the phase of clinical symptoms.
What can be the recurrence location of colon cancer?
The most frequent localization of recurrence of colorectal carcinoma is metastasis to the liver; or into the lungs, bypassing the liver. There are also frequent local recurrences in the large intestine, ie in its basal part - the colon and the final one - the rectum.
How to detect early symptoms of liver metastases?
In patients at high risk, i.e. in stage II or stage III of colorectal cancer, recurrence of disease in the form of liver metastases can be detected by systematically (every 3 months) abdominal ultrasound. The determination of CEA concentration (so-calledcarcinoembryonic antigen) in blood serum. (eg American oncology standards provide for tests - every 2-3 months for 2 years after surgery). The finding of increased CEA concentration, confirmed by a control study, justifies the further search for metastases, but it is not yet an indication for treatment.
THE RECOGNITION RECOGNIZE
What is the role of the patient's direct examination in the diagnosis of the metastases - e.g. physical and physical examination.
This is the basic and the most important part of every medical check in oncological patients. Unfortunately, we are often forgotten by the fascination with modern diagnostic technology. Subject study (i.e. interview collected from the patient) and so-called physical examination (ie a direct medical examination of the patient), allow gathering information necessary for the doctor to plan further diagnostics. Without this information, the doctor would be groping. For example, if a patient admits that he has been observing blood in his stool for some time, it is obvious that he must be referred to a colonoscopy. When you complain about a dry cough, you need to urgently perform a chest X-ray, but if you notice that it has slightly yellowish sclera (the so-called eye protein), it can be a sign of jaundice caused by liver metastases. In this case, it is necessary to determine the level of blubiard in the serum and perform ultrasound of the abdominal cavity.
This examination should be carried out every 3-6 months for the first three years and then every year.
When are the radiographs of the chest intentional?
This test should be performed routinely during any comprehensive medical check-up after surgery (ie, for example in the first two years - every three months.) In addition, this test should be performed in any situation where an increased concentration of CEA marker or other symptoms suggestive of metastasis are found. to the lungs (eg cough, hemoptysis).
What role for the early detection of recurrence of colorectal cancer is attributed to such
methods like:liver function tests, occult blood stool examination, computed tomography?
Nowadays it is more and more often accepted that to monitor the early symptoms of recurrence, the abovementioned direct subjective and physical examination, laboratory tests (including biochemical liver and peripheral blood count) of abdominal ultrasound, chest radiographs (if necessary) are sufficient. Carcinoembryonic antigen (CEA), and above all colonoscopy of the large intestine. The advantages of the latter method allow to avoid the need for routine computed tomography. On the other hand, periodic examination of stool for occult blood is indicated when the patient has difficult access to a colonoscopy. In addition, it is a good screening test that allows you to select from the population a group of people who need to be colonoscopically (a positive result of faecal occult blood stool testing may be an early sign of cancer).
COLONOSCOPIC CONTROL TESTS
Many years of colonoscopy experience prove that this is the best method not only for screening but also for the early detection of local recurrence of colorectal cancer.
What is the role of colonoscopy in the perioperative period?
Recall that colonoscopy is usually used in the perioperative period - before and after surgery. Thanks to this, it can be unequivocally determined whether, apart from the operated cancerous lesion, the large intestine is free from polyps and other tumor centers.
What role does this test method play in post-operative audits?
After colon cancer surgery - world standards recommend performing a colonoscopy at least once a year during the 5 years after surgery. After this period, the study may be performed for 3-5 years, which is a sufficient frequency for the early detection of new polyps or cancer foci. In patients with adenomatous polyps, a follow-up colonoscopy is recommended according to the WHO guidelines.
What is the control procedure for patients with stage II and stage III who have not undergone irradiation?
Patients after rectal cancer surgery who were not subjected to irradiation for medical reasons or not to consent were usually offered periodically to perform proctosigmoidoscopy (ie, endoscopic examination of the rectum and sigmoid colon - the final sections of the large intestine), whereas in patients undergoing radiotherapy this examination is not necessary - a colonoscopy may be sufficient, eg at a frequency of 3-5 years.
What do we know about the progress in so-called non-invasive colon monitoring?
With hope, for example, the development of imaging techniques, known as virtual colonoscopy, is observed. This method consists in the reproduction of two- and three-dimensional images of the intestine's interior, resulting from the computer processing of data obtained using the so-called spiral tomography. The test itself is short, safe, well tolerated by patients. A problem may be inadequate preparation of the colon for the test - a factor that causes false positive results, i.e. recognizing cancer, even though it is absent.
Another innovative technique is the use of a microcamera closed in a capsule about 1 cm in size, which the patient swallows. The device passes through the entire gastrointestinal tract, taking every few tens of seconds the picture, which is then sent via radio to a special recorder (the patient wears it on the belt). After expelling the camera, frame by frame, you can see the entire alimentary canal of the patient from the inside.
Edited by MA Edward Ozga Michalski;
Konsult. bow. med. Tomasz Sarosiek - oncologist
