Thin stool that looks like a pencil

Introduction The bloating of patients with colon cancer is obvious, and the stool becomes thin like a pencil. Colon cancer is a common malignant tumor of the digestive tract, accounting for the second place in the gastrointestinal tumor. The predilection site is the rectum and the junction of the rectum and the sigmoid colon, accounting for 60%. The incidence is more than 40 years old, the ratio of male to female is 2:1. 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.

Cause

Causes

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.

Dietary factors: 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 in tumors Dietary factors in the onset are seen as extremely important factors.

The 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 and 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.

an examination

Symptom

(1) abdominal pain and digestive tract irritation symptoms: Most patients have varying degrees of abdominal pain and abdominal discomfort, such as abdominal pain, right abdominal fullness, nausea, vomiting and loss of appetite. Symptoms often worsen after eating, sometimes accompanied by intermittent diarrhea or constipation, easily associated with chronic appendicitis common in the lower right abdomen, ileocecal tuberculosis, ileocecal segmental enteritis or lymphoma. Colonic hepatic squamous cell carcinoma can be characterized by paroxysmal cramps in the right upper quadrant, similar to chronic cholecystitis. It is generally believed that the pain of the right colon cancer is often reflected to the upper part of the umbilicus, and the pain of the left colon cancer is often reflected to the lower part of the umbilicus. If the cancerous tumor penetrates the intestinal wall to cause local inflammatory adhesions, or forms a local abscess after chronic perforation, the pain site is the site where the cancer is located.

(2) Abdominal mass: generally irregular shape, hard texture, nodular surface. There is a certain degree of mobility and tender tenderness in the early stage of transverse colon and sigmoid colon cancer. If the ascending or descending colon cancer has penetrated the intestinal wall and adheres to the surrounding organs, the chronic perforation forms an abscess or pierces the adjacent organs to form the internal hemorrhoids, the mass is more fixed, the edge is unclear, and the tenderness is obvious.

(3) Defecation habits and fecal trait changes: the result of ulceration and secondary infection for cancer necrosis. As the toxin stimulates the bowel to change the bowel habits, the number of bowel movements increases or decreases, sometimes diarrhea and constipation alternate, there may be abdominal cramps before defecation, and then relieved. If the location of the cancer is low or located in the rectum, there may be rectal irritation such as anal pain, poor bowel movements or urgency. Feces often do not form, mixed with mucus, pus and blood, sometimes blood is often misdiagnosed as dysentery, enteritis, hemorrhoids and so on.

(4) Anemia and chronic toxin absorption symptoms: The surface necrosis of the cancer can form a persistent small amount of oozing, and the mixing of blood and feces is not easy to attract the attention of the patient. However, anemia, weight loss, weakness, and weight loss can occur due to chronic blood loss, toxin absorption, and malnutrition. Late patients have edema, hepatomegaly, ascites, hypoproteinemia, cachexia and other phenomena. If the cancer penetrates the stomach and the bladder forms internal hemorrhoids, the corresponding symptoms may also appear.

(5) Intestinal obstruction and intestinal perforation: due to intestinal blockage, intestinal tube itself narrowing or adhesion outside the intestinal cavity, compression. Most manifested as incomplete intestinal obstruction with slow progression. Early patients with obstruction may have chronic abdominal pain with bloating and constipation, but they can still eat and have severe symptoms after eating. Symptoms can be alleviated after treatment with laxatives, colon cleansing, and traditional Chinese medicine. After a long period of recurrent episodes, the obstruction gradually becomes complete. Some patients appear in the form of acute intestinal obstruction, and more than half of the acute colonic obstruction in the elderly is caused by colon cancer. When the colon is completely obstructed, the ileocecal valve blocks the colon contents from flowing back to the ileum to form a closed intestinal obstruction. The colon from the cecum to the obstruction can be extremely inflated, the intra-intestinal pressure is constantly increasing, and rapidly develops into strangulated intestinal obstruction, and even intestinal necrosis, causing secondary peritonitis. Some patients have atypical symptoms and are difficult to preoperative. Clear diagnosis. Cancers located in the cecum, transverse colon, and sigmoid colon can cause intussusception when the peristalsis is severe.

Colon cancer patients do not necessarily have the above-mentioned typical symptoms, and their clinical manifestations are related to the location of the cancer, the type of pathology, and the length of the disease. The colon can be divided into left and right halves by the spleen of the colon. The two halves are different from embryonic origin, blood supply, anatomical and physiological functions, intestinal contents and common cancer types. There are significant differences in diagnostic methods, surgical methods, and prognosis.

The right colon colon originates from the midgut and the intestine is large, and the contents of the intestine are liquid. One of the main functions is to absorb water. The cancer is mostly mass or ulcer type. The surface is easily bleeding, and the toxin produced by the secondary infection is easily absorb. The three main symptoms are the symptoms of right anterior abdominal and digestive tract irritation, abdominal mass, anemia, and chronic toxin absorption, and less chance of intestinal obstruction.

The left colon embryo originates from the hindgut, the intestinal lumen is fine, and the contents of the intestine are solid. The main function is to store and discharge the feces. The cancer is mostly infiltrated and easy to cause the intestinal lumen to be narrowed. The three main symptoms are common bowel habits, bloody stools and intestinal obstruction. Intestinal obstruction can be manifested as a sudden onset of acute complete obstruction, but most of them are chronic incomplete obstruction, abdominal distension is obvious, the stool becomes thin like a pencil, and the progressive progression of symptoms eventually develops into complete obstruction. Of course, this distinction is not absolute, and sometimes there are only one or two clinical manifestations.

2. Signs

The physical examination can vary depending on the course of the disease. Early patients may have no positive signs; those with longer course of disease may have a bump in the abdomen, and may also have signs of weight loss, anemia, and intestinal obstruction. If the patient has intermittent "a gas-like" mass in the abdomen, accompanied by colic and bowel sounds, the possibility of colon intussusception caused by colon cancer should be considered. If the left supraclavicular lymphadenopathy, hepatomegaly, ascites, jaundice or pelvic mass are found to be late manifestations. There are tenderness in the liver, lung and bone metastases.

Rectal examination is a non-negligible examination method. It is generally known that there are polyps, lumps, and ulcers within 8 cm from the anus. Low sigmoid colon cancer can be accessed through abdominal and rectal double diagnosis. At the same time, attention should be paid to the presence or absence of metastatic mass in the pelvic cavity. Female patients can be diagnosed in the abdomen, rectum, and vagina.

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 condition

(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: 1 whether the disease is 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, and 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 treatment of systemic non-neoplastic diseases. In the treatment of tumor diseases, understanding and handling the health status of other tissues and organs throughout the body is also an important basis for formulating 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, and 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.

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.

Differential diagnosis

Differential diagnosis of stools that resemble a pencil:

1. Idiopathic ulcerative colitis: accounting for 15% of misdiagnosed cases. Colon cancer, especially papillary carcinoma or cauliflower-like carcinoma of the left colon, when the disease progresses to a certain extent, symptoms such as diarrhea, mucus, pus and bloody stools, increased frequency of bowel movements, abdominal distension, abdominal pain, weight loss, anemia, etc. are often accompanied. Infected people may still have symptoms such as fever and other symptoms, which are similar to the symptoms of idiopathic ulcerative colitis. When X-ray is checked, there are similarities between the two. Therefore, it is easy to cause misdiagnosis in the clinic, especially for young patients, and the presence of tumors is less thought.

2. Appendicitis: About 10% of misdiagnosed cases. The ileocecal cancer is often diagnosed as appendicitis due to local pain and tenderness. Especially in advanced ileocecal cancer, local necrosis and infection often occur, clinical manifestations of elevated body temperature, increased white blood cell count, local tenderness or touch of the mass, often diagnosed as appendix abscess, and conservative treatment. After a period of treatment, the tumor does not shrink or even enlarge, and the tumor is considered. In general, the appendix abscess has a serious history of the disease, and there is inflammation, which can be obviously improved after short-term treatment. Such as cancer and appendicitis coexist or due to cancer caused by appendix obstruction caused by appendicitis, although the treatment has improved, but will not be thorough, continue to increase after stopping the drug to be further examined and diagnosed. Surgical exploration should be performed promptly when highly suspected.

3. Intestinal tuberculosis: Intestinal tuberculosis is more common in China, and its predilection sites are at the end of the ileum, the cecum and the ascending colon. The most common clinical symptoms include abdominal pain, abdominal mass, diarrhea, and constipation, which are more common in colon cancer patients. In particular, proliferative intestinal tuberculosis has many similarities with colon cancer, such as low fever, anemia, weight loss, fatigue, and local swelling. However, the systemic symptoms of intestinal tuberculosis are more obvious, manifested as low fever or irregular fever in the afternoon, night sweats, weight loss and fatigue. Therefore, when these symptoms appear clinically, especially when diarrhea is the first diagnosis, it is often easy to consider from the perspective of common diseases and frequently-occurring diseases. About 1% of patients misdiagnosed colon cancer as intestinal tuberculosis before surgery. There was a special change in the blood picture, and the blood sedimentation was fast. The tuberculin test was strongly positive. A combination of medical history, age, and general performance can generally confirm the diagnosis.

4. Colon polyps: Colon polyps are common benign tumors, most of which occur in the sigmoid colon. The main symptoms are blood in the stool, blood is blood, not confused with feces, and some patients may have pus and bloody stools. X-ray examination showed a filling defect. If the pathological examination of the fiberoptic colonoscopy is not performed, the polypoid colon cancer can be misdiagnosed as colon polyps. Adenomas and polyps are the most common benign tumors and tumor-like lesions of the colon. There are significant differences in histology: adenomas can develop cancer, and polyps do not turn into cancer. Both can be single or multiple. In the X-ray gas double examination, the round or oval filling defect is smooth and sharp. In the intestinal lumen, if the pedicle can move up and down, the contour of the colon is not changed, and there is a small amount in the vicinity of the adenoma or polyp. The tincture forms a circular shadow that contrasts sharply with the gas. Fibrous colonoscopy and biopsy for pathological examination are the most effective methods of identification.

5. Schistosomiasis granuloma: more common in epidemic areas, more common in southern China, with the development of schistosomiasis prevention and control after liberation, it is now rare. Intestinal schistosomiasis is the deposition of schistosomiasis eggs under the intestinal mucosa, causing large chronic inflammatory granuloma in the early stage. In the late stage, the colonic fibrous tissue proliferates, and adheres to the surrounding tissues to form an inflammatory mass, and the colonic mucosa continuously forms ulcers and scars. Polypoid hyperplasia can be formed due to ulcer repair of tissue hyperplasia. A small number of cases can be cancerous, and colon cancer and intestinal schistosomiasis in the endemic areas account for 48.3% to 73.9%, indicating that schistosomiasis is closely related to colon cancer. Therefore, patients with intestinal schistosomiasis who have lived in epidemic areas or have lived in endemic areas have been diagnosed for the past and are more likely to be associated with colon cancer or cancer. In addition to X-ray and fiberoptic colonoscopy and biopsy, combined with the history of schistosomiasis infection, the examination of eggs in feces, all contribute to the identification of intestinal cancer caused by colon cancer and schistosomiasis.

6. Amoebic granulomatosis: In the formation of amoebic granuloma, according to the location of the colon, the corresponding abdomen may have a mass or intestinal obstruction. Amoebic trophozoites and cysts can be found during stool examination. X-ray examinations of 30% to 40% of patients may have positive findings, and polyps on the mucosa. Amoebic granulomas are multiple, often producing large unilateral marginal defects or circular incisions on the intestine.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.