| BackgroundColorectal cancer(CRC),including colon cancer and rectal cancer,is one of the most common digestive tract malignant tumor.The incidence,prevalence and mortality of CRC is still on the rise worldwide with the development of the social society,the improvement of living conditions,and more westernized life style.A great deal of statistics had confirmed that the CRC is a common cause of cancer death(with the total survival rate is about 50%),seriously threated the human health.Colorectal cancer(CRC)is a multifactorial disease,and its occurrence is the result of the interacting of genetic and environmental factors.Ecological studies,secular trend studies,and migration studies have shown that environmental factors including lifestyle are likely to be important determinants of colorectal cancer risk.Some risk factors for colorectal cancer including overweight and obesity,low physical activity and type 2 diabetes are linked to insulin resistance.Family history was independent risk factors for disease progression of CRC.The age of CRC onset is mainly middle-and old-aged patients,male patients is more than females.CRC mainly develops in the distal colon and rectum,The site of CRC site a trend of the proximal colon these years.Pathological diagnosis is the most reliable method of CRC diagnosis,and the pathological type of CRC is given priority to the ulcer type,and protrude type is in second place.With the difference CRC parts and disease stages,the clinical manifestations is different.The clinical manifestations of the CRC is bowel habit change,abdominal pain,weight loss,thinner or strip stool,abdominal mass,anemia,etc.The mortality of CRC had declined with early detection and treatment level of progress in the past two decades.There is evidence that regular line of fecal occult blood test(FOBT),sigmoidoscopy(FS),and a colonoscopy,can reduce the incidence of CRC and/or mortality.There is evidence that regularly fecal occult blood test(FOBT),sigmoidoscopy(FS),or colonoscopy examination,could reduce the incidence and/or mortalityof CRC.Tumor markers is quite sensitivity and specificity in the CRC diagnosis.TNM classification system is still the most effective clinical method that affect the prognosis of patients with CRC.At present,the 5-year survival rate of TNM stage I patients is 96%,and the 5-year survival rate of TNM stage IV patients is 8%.Surgical treatment is still the one of the main treatments of colorectal cancer,and the surgical treatment for CRC is follow the principle of individualization.For early cancer disease confined to the mucosal layer,endoscopic stripping resection can reach the purpose of healing.Advanced colorectal cancer could take radical resection if on surgery taboo,and the overall 5-year survival rate was 50%～60%.Recent years many international scholars adopted a series of comprehensive treatments on the basis of colorectal cancer surgery,including chemotherapy,radiotherapy and so on,had greatly improved the survival of CRC patients,especially the middle-or late-staged patients.At present,the chemotherapy mainly including FOLFOX and FOLFIRI which is based on 5-FU + folic acid(LV)is the classic treatment of colorectal cancer.According to NCCN colorectal cancer treatment guidelines,stage II colon cancer can be benefit from adjuvant chemotherapy;Patients who are with high risk of stage II and above stage II must take adjuvant chemotherapy.The treatment of advanced colorectal cancer have a great breakthrough with the targeted drugs appeared.Radiation therapy(radiation)includes adjuvant therapy and palliative care is mainly used for cases in stage Ⅱ～Ⅲ.Those relatively shallow and early ranged lesions could take radical radiotherapy treatment.And palliative radiotherapy mainly used for late colorectal cancer,tumor invasion to surrounding,and with obviously pain,secretions and bleeding,etc.The based diagnosis and clinical treatment of colorectal cancer is a systems engineering.Although the diagnosis and treatment of colorectal cancer had made great progress,but still faces many problems.Early discovery,early diagnosis and early treatment is needed in order to improve the diagnosis and cure rates of CRC.,And change bad life habits and take CRC census work is also important.Part one:Clinical epidemiological characteristics of colorectal cancerObjective:To provide a reference for CRC prevention and cure,through realizing the realationship between the general risk factors,sex and age of the onset,and understanding the clinical characteristics of CRC.Methods:Cases that confirmed colorectal cancer pathologically in Nanfang Hospital i between 1.1.2000 and 31.12.2007 were enrolled in this study.507 cases of advanced colorectal cancer in stage II,III,IV were included in the study while stage I cases were excluded from the study.Refer to hospital medical records,detailed record patients’ past history,system review and personal history,and telephone or visited these patients,understanding cases epidemic history.Measurement data used the way of mean±standard deviation.The age difference between male group and female group compared with the one-way ANOVA.The relationship between the general risk factors and the onset age were compared with the multiple logist regression.The clinical manifestations of the CRC ratio can be used to calculate.Findings:(1)the onset ages of CRC mainly middle-and old-aged cases,the average onset age was(58.80 ± 13.49),the incidence of male patients was higher than female patients,with the incidence ratio of 1.61:1;(2)High blood pressure,alcohol consumption,family history of tumor,liver cyst,chronic cholecystitis has remarkable effects ononset age for CRC patients(X2 = 84.405,P = 84.405),as a risk factor for CRC with an earlier morbidity age;(3)The mainly onset of CRC is distal colon and rectum with a common general types of ulcer;(4)The symptoms of early is not typical and easily lead to disease progression;The most common clinical symptoms include,abdominal pain(63.7%),bowel habit change(51.3%)and weight loss(36.7%);Conclusions:CRC is a multifactor disease.We need to strengthen the primary prevention,especially for high-risk groups,to increase screening,and to reduce the incidence of CRC,so as to improve the prognosis of patients with CRC.Part two:Therapeutic and prognosis of advanced colorectal cancerObjective:Research on correlation between treatment and prognosis of CRC cases.Methods:Cases that confirmed colorectal cancer pathologically in Nanfang Hospital i between 1.1.2000 and 31.12.2007 were enrolled in this study.507 cases of advanced colorectal cancer in stage Ⅱ,Ⅲ,Ⅳ were included in the study while stage Ⅰcases were excluded from the study.All the cases were followed up until August 30,2012.5 patients lost follow because the death time was not clear.The rest of the 502 patients’ living status and survival time were evaluated.The differences between surgical group and non-surgical group,chemoterapy group and non-chemoterapy group used log-rank method;The survival of CRC cases with different TNM staging compared with K-M method.Findings:Surgery is the main treatment of CRC,can obviously prolong the CRC survival time(P<0.001,X2= 84.79);The median survial-time of surgery and non-surgical group is 67.067 months and 9.067 months,respectively;(2)adjuvant chemotherapy can increase survival time of CRC(P<0.001,X2 = 24.278);The median survialtime of chemotherapy group and non-chemotherapy group is 67.900 months and 31.500 months,respectively;(3)the treatment combination of surgery and chemotherapy is the most beneficial,median survival time for groups of surgery plus chemotherapy,surgery alone,chemotherapy alone,neither surgery or chemotherapy were 69.050 months and 59.100 months,15.233 months and 8.308 months,respectively;(4)TNM stage had a significant effect on the prognosis of patients,the higher the TNM staging,the worse prognosis(X2=366.683,P<0.001).Conclusions:Early diagnosis of CRC,and take individualized,comprehensive therapies combined surgery,chemotherapy can improve the prognosis of CRC.Part three:Therapeutic and prognosis of multiple primary colorectal cancerObjective:To investigate the clinical features and prognosis of multiple primary colorectal carcinoma(MPCC).Methods:Among 1462 patients with colorectal cancer admitted to our department from January 2000 to December 2007,39 patients with MPCC were identified based on the Warran and Gates MPC diagnosis criteria.Age of onset,5 years of survival rate,lesion location and therapeutic method were analyzed retrospectively.Results:(1)The incidence of MPCC was 2.67%(39/1462).18 cases of them were patients with synchronous carcinomas(SC)and 21 cases were diagnosed as metachronous carcinomas(MC).(2)Most tumors were located in the left colon and rectum.The average age of onset were(61.02±13.94),and the overall 5-year survival rate was 61.76%.Patients presented with metachronous carcinomas had a better prognosis than those with synchronous carcinomas.(3)The 5-year survival rate of 3 early staged cases as TNM stages I was 100%after radical surgery.30 advanced cases underwent radical surgery combined with adjuvant chemotherapy,the 1-,3-and 5-year survival rates of which were 93.33%,83.33%,73.33%respectively.The 1-,3-year survival rate of 3 advanced cases who underwent palliative surgery and adjuvant chemotherapy were 66.67%and 0.The 1-,3-year survival rate of the other 3 advanced cases who underwent palliative chemotherapy were 66.67%and 0.Conclusion:Early diagnosis and effective treatment can help to prolong the survival span of MPC patients.Surgery,chemotherapy is beneficial to the patients with advanced MPCC in improving survival and prognosis. |
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