Abdominal "air-cluster-like" mass

Introduction Abdominal "gas-like" mass is a symptom of colon cancer. Colon cancer is more common in middle-aged and elderly people, and the majority of men aged 30-69 are more than women. Early symptoms are not obvious. Common symptoms in patients with advanced disease include abdominal pain and gastrointestinal irritation, abdominal mass, bowel habits and fecal trait changes, symptoms caused by anemia and chronic toxin absorption, and intestinal perforation. The social development status, lifestyle and dietary structure are closely related to colon cancer, and there are phenomena suggesting that there may be differences in the environment and genetic factors affecting the incidence of colon cancer in different parts and age groups.

Cause

Some colon cancer epidemiological studies have shown that social development status, lifestyle and dietary structure are closely related to colon cancer, and there are phenomena suggesting that there may be differences in the environment and genetic factors affecting the incidence of colon cancer in different parts and age groups. Environment (especially diet), genetics, physical activity, occupation, etc., are possible etiological factors affecting the incidence of colon cancer.

1. Diet:

Epidemiological studies have shown that 70% to 90% of cancer incidence is related to environmental factors and lifestyle, and 40% to 60% of environmental factors are related to diet and nutrition to some extent, so diet in the onset of cancer Factors are seen as extremely important factors.

(1) Mechanism of action of high fat, high protein and low cellulose: can be summarized as follows:

1 affects intestinal lipid metabolism, high-fat diet increases 7a-dehydroxylation enzyme activity, leading to increased formation of secondary bile acids, while cellulose has the opposite effect, and inhibits reabsorption, dilution and adsorption, chelation Lowering the deoxycholic acid concentration in the intestine increases the solid phase material in the feces and promotes excretion; some dietary factors (such as calcium ions) can lower the levels of intestinal ionized fatty acids and free bile acids, both of which are on the intestinal epithelium It has a damaging effect; it inhibits the degradation of intestinal cholesterol. Milk, lactose and galactose have the effect of inhibiting the redox effect of cholane.

2 Cellulose also has the effect of changing the intestinal flora, affecting the structure and function of intestinal mucosa, affecting the growth rate of mucosal epithelial cells, mediating the pH of the intestine, and strengthening the mucosal barrier through mucin to reduce intestinal toxic substances to the intestine. Injury of the epithelium;

3 high fat and some carbohydrates can increase intestinal enzyme activity (such as glucuronidase, ornithine dehydrogenase, nitroreductase, azooxygenase, lipoxygenase, cyclooxygenase) to promote carcinogenesis The production of substances and auxiliary cancers.

4 The effect of biological macromolecular activity. When the cytoplasm is acidified, DNA synthesis is inhibited and the cell cycle is prolonged.

(2) Vitamins: Case-control studies have shown that carotene, vitamin B2, vitamin C, and vitamin E are all associated with a reduction in the relative risk of colon cancer, and are dose-response. Vitamin D and calcium have a protective effect.

(3) Onion and garlic: The protective effect of onion and garlic on the body has been widely recognized, and the inhibition of tumor growth on this type of food has been confirmed many times in the experiment. Garlic oil can significantly reduce colonic mucosal cell damage caused by dimethyl cholestyramine, and can reduce the colon cancer induction rate of mice by 75%. According to the case-control study, the risk of colon cancer in high-intake garlic foods was 74% in the low-intake group.

(4) Salt and preserved food: The relationship between salt content and gastric cancer, colon cancer, and rectal cancer. In the high salt intake group, the relative risk of the three cancers increased, and the case-control study suggested weekly intake. The excess risk of colon cancer in three or more preserved foods was 2.2 times (P<0.01) for less than one time, 2.1 times for left colon cancer, and 1.8 times for right colon cancer. The explanation for this risk factor may be related to the carcinogens produced during the food pickling process, and high salt intake may be a concomitant state.

(5) Tea: Tea polyphenols are a strong antioxidant that inhibits the carcinogenic effects of carcinogens. According to the case-control study, the risk of rectal cancer in drinking tea (green tea or black tea) more than 3 times per week was 75% of that of less than one, but not related to the colon cancer group. In the past 10 years, the study suggests that there is a significant negative correlation between tea drinking and the risk of colon cancer, but there are also reports of the opposite. Because of the small number of studies on the protective effect of tea drinking on colon cancer prevention, it is difficult to evaluate the role of tea drinking in the pathogenesis of human colon cancer. The relationship between coffee and colon cancer is still difficult to determine.

(6) Trace elements and minerals:

1 Selenium: The mortality rate of various cancers (including colon cancer) is negatively correlated with local dietary selenium intake and soil selenium content. It is speculated that selenium and potassium are associated with a low risk of colon cancer. However, it is believed that these factors may be just some accompanying factors, and do not directly affect the risk of colon cancer in the population.

2 Calcium: Animal experiments have shown that calcium can improve the toxic effects of deoxycholic acid on intestinal epithelium. Some scholars believe that the increase of the concentration of bile acids and free fatty acids in the intestine can promote the occurrence of colon cancer, and calcium can be combined with them to form insoluble saponified compounds, so that their effects on intestinal epithelial stimulation and toxicity are alleviated. Some epidemiological studies have also suggested that calcium intake can prevent the development of colon cancer.

2. Occupational and physical activity:

Insulated asbestos production workers are more common in colon cancer patients, and animal experiments have shown that swallowing asbestos fibers can penetrate the intestinal mucosa. In addition, the metal industry, cotton yarn or textile industry and leather manufacturing. It has been confirmed that in the production process of plastics, synthetic fibers and rubber, a compound which is often used - acrylonitrile has a role in inducing the stomach, central nervous system and breast tumors, and textile workers exposed to the substance, lung cancer and colon The incidence of cancer is high. Despite this, colon cancer is generally not considered an occupational disease.

In the analysis of occupational physical activity, it is found that the risk of colon cancer in long-term or frequent sitting is 1.4 times that of some major physical activity, and it is more closely related to cecal cancer. As a result of case-control studies, moderate-intensity physical activity has a protective effect against colon cancer, especially colon cancer.

3. Genetics: It is estimated that genetic factors may play an important role in at least 20% to 30% of colon cancer patients, 1% of which are familial polyposis and 5% of hereditary polypoid-free colon cancer syndrome patient. 80% to 100% of patients with hereditary familial polyposis may develop malignant tumors after 59 years of age. In addition, patients with familial colonic polyposis have a majority of left colon cancer, while patients with hereditary nonpolyposis often have right colon cancer.

Through the case-control pedigree survey of the whole population (1328 cases of colon cancer probands and 1451 population control families), the results showed that the prevalence of colon cancer in the first-degree relatives of different proband groups was significantly higher than that of the second-degree relatives. The age at diagnosis of colon cancer proband is related to the risk of colon cancer in the first-degree relatives. The younger the proband is, the greater the relative risk of colon cancer in the first-degree relatives of the family, the first-degree relatives of the colon cancer 40 years old. The relative risk is six times that of the >55 age group. Family members (first-degree relatives) with a family history of colon cancer, especially those with a colon cancer age of 40 years or younger, should be given high priority.

4. Disease:

(1) Intestinal inflammation and polyps: chronic intestinal inflammation and polyps, adenomas and patients with extensive ulcerative colitis for more than 10 years: the risk of developing colon cancer is several times higher than that of the general population. Patients with ulcerative colitis with severe dysplasia have a 50% chance of developing colon cancer. Clearly, patients with ulcerative colitis are at higher risk of developing colon cancer than the general population. The data in China suggest that the risk of colon cancer in patients with onset of disease for more than 5 years is 2.6 times higher than that of the general population, but not closely related to rectal cancer. For patients with limited and intermittent lesions, the risk of colon cancer is small.

Crohn's disease is also a chronic inflammatory disease that invades the small intestine and sometimes the colon. A growing body of evidence suggests that Crohn's disease is associated with colon and small bowel adenocarcinoma, but to a lesser extent than ulcerative colitis.

(2) Schistosomiasis: According to the retrospective investigation of cancer deaths in Zhejiang Province from 1974 to 1976 and the survey data of Chinese malignant tumors from 1975 to 1978 and the Chinese schistosomiasis atlas, the relationship between schistosomiasis endemic areas and colon cancer incidence and mortality was discussed. Relevance. There is a very significant correlation between the incidence of schistosomiasis and the mortality rate of colon cancer in 12 counties and autonomous regions in southern China and 10 counties in Jiaxing, Zhejiang Province. It is suggested that in areas where schistosomiasis is seriously endemic in China, schistosomiasis may be associated with high incidence of colon cancer. However, there is little evidence from epidemiological studies about colon cancer and schistosomiasis. For example, in Jiashan County, Zhejiang Province, which is increasingly controlled by schistosomiasis, the mortality rate of colon cancer and the incidence of schistosomiasis in this area have been the highest in China, and the infection rate of schistosomiasis has decreased significantly. However, according to recent survey results, epidemiological and pathological studies of colon polyp carcinogenesis also suggest that polyp carcinogenesis has nothing to do with the presence or absence of schistosomiasis eggs in polyps. In addition, the results of the colon cancer screening conducted in the above two regions do not support schistosomiasis as a risk factor for colon cancer. In the case-control study, no history of schistosomiasis was found to correlate with colon cancer.

(3) cholecystectomy: In recent years, there are more than 20 literatures in China about the relationship between cholecystectomy and colon cancer. Some of these studies have shown that after cholecystectomy can increase the risk of colon cancer, especially proximal colon cancer. Men have an increased risk of colon cancer after cholecystectomy; in contrast, women have a lower risk of developing rectal cancer after the procedure. There are also views that the effect of cholecystectomy on female colon cancer is greater than that of men.

It is generally believed that the occurrence of tumors is the result of a combination of factors, and colon cancer is no exception. Colon cancer, as a disease closely related to the lifestyle of Western society, is closely related to its etiology, and it is considered that the role of dietary factors is the most important. The etiology of high fat, high protein, high calorie and lack of cellulose intake is still dominant, and most of the results are consistent with this model.

Other carcinogenic factors have relatively weak effects, such as disease factors, genetic factors, and occupational factors. It can be considered that the carcinogenic process of colon cancer is based on the role of dietary factors, combined with the results of multiple links of other factors. With the deepening of etiology and the penetration of multidisciplinary, there is now a new understanding of the carcinogenic mechanism of colon cancer. In the field of epidemiology, modern technology is more widely used, and some factors that are not consistent with previous results are more deeply understood, and the possible causes of epidemiological results will be further clarified.

an examination

Related inspection

Laparoscopic abdominal CT

1. Abdominal mass: Abdominal mass refers to the abnormal mass that can be touched during abdominal examination. Common causes include swelling of organs, swelling of hollow organs, tissue hyperplasia, inflammatory adhesions, and benign and malignant tumors.

2, upper abdominal mass and bloating: a mass in the upper abdomen refers to the abnormal mass that can be touched during abdominal examination. Bloating is the swelling of the abdomen or discomfort. The two symptoms appear together with problems with the heart, liver, and pancreas.

Differential diagnosis

Diagnosis: The basic premise of colon cancer treatment is to have a comprehensive and correct tumor diagnosis. The diagnosis of tumor is based on the comprehensive medical history, physical examination, and related equipment examination. The general preoperative diagnosis mainly includes the tumor condition and other conditions of the whole body.

1. Tumor situation:

(1) Location diagnosis of tumors: that is, to identify the site where the tumor exists, to understand the relationship between the tumor and adjacent tissues and organs, and whether there is distant metastasis.

1 Anatomical part of the tumor: clinically, the anatomical part of the tumor should be clearly defined. We can determine it by the following various positioning diagnostic techniques: A. Physical examination of the lumps is a simple and effective method, but pay attention to the partial freeness. Large transverse colon and sigmoid colon tumors may not be in a conventional position, causing misjudgment. BB super, CT, MRI can determine the presence or absence of the mass and the location of the mass, but sometimes the tumor is small, the above examination can not be judged. C. Fiber colonoscopy In addition to the rectum, the positioning function of other parts is unreliable, mainly due to the non-linear relationship between the colonoscope and the intestine, the intestine can be elongated or nested, often in clinical practice. It can be seen that there is a huge difference between colonoscopy and surgery, which makes surgery difficult. D. The best localization diagnosis method for colon tumor is barium enema examination, which can give us the most intuitive and accurate tumor site, and also give us the length and tightness of the intestine, help us to determine the surgical incision selection and resection of the intestine. range.

2 The relationship between tumor and surrounding tissue structure: In addition to clarifying the anatomy of the tumor, it is very important to understand the relationship between the tumor and surrounding tissues and organs, especially the relationship with important organs and large blood vessels. The relationship between the general colon and surrounding tissues is not Too close, only when the tumor is large, it can invade other organs. The main ones have large ileocecal tumors that invade the iliac vessels and ureters; the colonic liver cancer invades the duodenum and the head of the pancreas; and the colon cancer invades the ureter. Knowing the relationship between the tumor and the surrounding tissue before surgery has certain value for the judgment of preoperative resection and the notification of the patient and family.

3 distant metastasis of the tumor: for malignant tumors, in addition to the situation of the primary tumor is very important, the situation of metastases is more important, because with the metastases, the entire treatment plan will undergo major changes, so carefully before surgery Check for possible metastases is a routine preoperative examination. For colon cancer, pelvic floor metastasis, retroperitoneal lymph nodes, liver, and lung are common sites of metastasis and should be routinely examined. For rare bones, brains, and adrenal glands, it is determined according to clinical symptoms whether or not to perform brain CT and bone scan.

(2) Qualitative diagnosis of tumors: The qualitative diagnosis of diseases requires the following questions to be clarified:

1 disease is not a tumor;

2 is a malignant tumor or a benign tumor;

3 is which type of malignant tumor, which type. The first two determine the scope of surgery and surgery; the latter will determine the way the surgery is performed.

Although physical examination, B-ultrasound, CT, MRI, endoscopy can be a preliminary qualitative diagnosis, the qualitative diagnosis of colon cancer depends on histopathological diagnosis.

It should be noted that malignant tumors that can be diagnosed clinically are sometimes not necessarily malignant. Some authors have reported cases of preoperative pathological examination of colorectal cancer repeated 8 times (including fiberoptic colonoscopy, sigmoidoscopy, and anal biopsy). This is related to the size of the tissue biopsy site and the size of the tissue block. Therefore, when clinically suspected malignant tumors must be repeatedly checked, do not arbitrarily give up the examination, delaying the diagnosis and treatment of the disease. In the clinical treatment of colon cancer, there are several requirements for preoperative pathology: for colon cancer and colon cancer that can certainly retain the anus, the current pathology can be uncertain, but there must be a clear lesion and reach a certain level. The size of the rectal cancer, which cannot clearly preserve the anus, must have a pathological diagnosis before surgery.

(3) Quantitative diagnosis of tumors: Quantitative diagnosis of tumors can be broadly divided into two aspects:

1 The size of the tumor. There are two representations: the maximum vertical diameter representation of the tumor and the representation of the tumor invading the circumference of the intestine. The former is mostly used for larger tumors. Generally, the maximum diameter of the tumor is multiplied by its maximum vertical diameter, expressed in centimeters. The latter is mostly used for small and small tumors, which are still limited to the extent of the intestine. The clinical use of tumors accounts for the extent of the intestinal canal. To indicate, for example, 1/2 circle; 2 the volume or weight of the tumor, the volume and weight of the tumor are less applied to intestinal cancer, and the method is mostly used for larger solid tumors, such as soft tissue tumors.

(4) Preoperative staging of tumor: The preoperative staging of colon cancer is the same as other tumors, and there is a problem of accuracy of staging. Generally, according to the above tumor location, qualitative and quantitative, a preoperative staging can be given. This staging is often quite different from postoperative staging. Current research has shown that clinical guidance for colon cancer preoperative staging is of little significance, but preoperative staging is significant for WHO stage II or III, which has invaded the intestinal wall or has metastatic lymph nodes in the middle and lower rectal cancer. Can guide neoadjuvant radiotherapy and chemotherapy.

2. Diagnosis and management of systemic non-neoplastic diseases: In the treatment of tumor diseases, the understanding and treatment of the health of other tissues and organs throughout the body is also an important basis for the development of treatment plans.

(1) Examination of the state of the body: The tumor is a disease that increases with age, and most patients are older than 50 years old. Most of them have some chronic diseases, such as cardiovascular and cerebrovascular diseases, respiratory diseases, liver and kidney system diseases, and diabetes. Shi Yingqiang reported that a group of elderly colon cancer patients, 66% have various types of chronic diseases. The authors emphasize that a comprehensive physical examination should be performed on any patient with cancer, including: conventional electrocardiogram, chest X-ray, liver and kidney function, blood routine, coagulation function, infectious disease, and diabetes-related tests. For symptomatic or check-up situations, further examinations such as echocardiography, cardiac function, lung function, EEG, and bone marrow function should be performed.

(2) Examination of diabetes: Diabetes is closely related to colon cancer. In the general population over 60 years old, the incidence of diabetes is 42.7%. Because diabetes has the same pathogenic factors as colon cancer, such as high protein, high fat, high calorie, low cellulose, and less exercise, the incidence of diabetes in colon cancer patients is significantly higher than that in the general population. Mo Shanzhen's study of colon cancer and gastric cancer admitted in 1993-1994 showed that the detection rate of diabetes in colon cancer was 17.6%, while the detection rate of diabetes in gastric cancer was only 6.3% (P<0.025), which was significantly higher than normal. crowd. Due to the disorder of glucose metabolism in diabetes itself and the stress response under the operating state, the healing of the anastomosis of the operation can be delayed, the anti-infective ability can be reduced, and the postoperative complications can be increased. Therefore, it is very important to detect diabetic patients before surgery. Most hospitals use diabetes history and fasting blood glucose to check for diabetes, but Mo Shanzhen research suggests that only 14.3% of patients can be detected by diabetes history; 37.1% of patients can be detected by fasting blood glucose; glucose tolerance test is the most reliable For the detection method, it is best to perform a routine glucose tolerance test before the anastomosis operation. In the glucose tolerance test, some patients have the following 1 or 2 abnormalities, although they can not be diagnosed as diabetes, but also suggest that the patient has abnormal glucose metabolism. In the case of surgical stress, it is also necessary to pay attention to the detection or application of insulin to control blood sugar.

1WHO Diabetes Diagnostic Criteria (1998): A. Diabetes Mellitus Symptoms Symptoms + Random Blood Glucose 11.1mmol/L; or B. Fasting Blood Glucose 7.0mmol/L; or C.OGTT 2h Postprandial Blood Glucose 11.1mmol/L.

2 fasting blood glucose 6.1 ~ <7.0mmol / L, or 2h postprandial blood glucose 7.8 to <11.0mmol / L for impaired glucose tolerance.

3 The symptoms are not typical and need to be confirmed again on another day. For asymptomatic patients, there must be 2 abnormal blood glucose to diagnose.

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