How to assess your risks, prevent and detect?
Risk factors
The main risk factor for cancer colorectal is age-related. At the time of diagnosis, the average age is around 70. On the other hand, this cancer is more common in countries developed countries whose diet is rich in animal fats. Even though food is an essential parameter in the onset of colorectal cancer, it is difficult to determine what changes to the diet that may reduce the risk.
There are other risks associated with genetics. The cumulative risk of developing cancer colorectal is close to 3.5%. This risk is multiplied by two to three in subjects whose a first-degree relative (father, mother, brother, or sister) has developed colon cancer, or of the rectum, and by four to five if two parents in the first degree have developed this same illness.
The importance of screening
The importance of screening Colorectal cancer is usually preceded by of a benign lesion: a polyp (vision macroscopic), an adenoma (vision microscopic). This lesion precedes the onset of cancer in a decade or so. It manifests itself in particular by bleeding in the stool. It’s on this the observation that the strategy of recently introduced mass screening in France.
In people at risk, it is the colonoscopy, which is the true way of screening. It allows, through an examination of inside the colon, to detect lesions precancerous. These can be safely removed during the examination. It is recommended to a subject where one of the parents has developed colorectal cancer from undergoing an colonoscopy from the age of 45 years, and this examination must be renewed every five years. The Hemoccult® test is used in the mass screening. It is not suitable for individuals with digestive symptoms. Indeed, the test, although very specific, is not very sensitive. The subjects who test negative cannot be insured of the absence of cancer. However, in terms of public health, this test, without causing of unnecessary examinations, reduces by 30%. mortality from colon cancer in the people who submit to screening.
Colonoscopy
The first step in colonoscopy is to cleanse the intestine by absorbing a product specific. In a second step, a endoscopy allows examination of the inside of the colon by means of a flexible tube. The whole of the examination, conducted under anaesthesia, lasts for a Fifteen minutes.
Surgery, chemotherapy, radiotherapy: what treatments, for whom?
A sneaky disease
Because it develops in a way insidious, cancer is perceived by the population as a sneaky disease. The starting point is still a malfunction cell phone. One of the first difficulties for health professionals is to carry out the detection in the most efficient way precocious. To the extent that the determinants of cancer can be observed in the intimacy scale cell phone, arbitration cannot be carried out …that after the pathological examination… Diagnosing cancer involves the observation of cancer cells under the microscope. No other examination, either. modernity, cannot replace the need for a observation under a microscope. Endoscopy is not able to replace the virtual microscope. Indeed, there is no way to determine the nature of a polyp that has been observed during an endoscopy.
Centrifugal development of the disease Another insidious aspect of cancer is the disease is centrifugal: in the least favorable, it is progressing from an epicenter to the whole body. This centrifugal evolution can continue without give clear signs. Let it evolve a primary tumour can lead to a infiltration of the colon and, for reasons related to cellular intimacy, the presence of cells cancer in the blood and lymph. During the second phase of the extension of the tumor, the lymph nodes are affected. Usually, the nodes are located in periphery of the primary tumor. It is again, in this case, a locoregional disease. Third stage of evolution centrifugal, the cancer cells are able to colonize through the bloodstream… organs unrelated to the colon. It’s a… especially the case of the liver. After hatching at the cellular level, the tumor primary is visible on endoscopy. The second phase (involvement of peripheral lymph nodes) can only be detected by an examination at the microscope. When the disease is disseminated – the general public uses the term generalized” – therapists can’t “generalize” – therapists can’t plus treat it in a curative manner. It is therefore necessary for the patient to learn to living with the disease.
Depending on the stage of the disease the actions implemented by the company. the therapists, although they are identical, do not have the same objectives. In the case of early diagnosis, the treatment must lead to a cure. In the In the case of a disseminated disease, the treatment must allow the patient to cohabitate with his or her illness.
The indispensable recourse to surgery
It is necessary to use surgery to different stages of the disease. Indeed, the surgery remains an essential tool in the framework for the treatment of colon cancer. The colon is located in the lower part of the colon. the abdomen, the pelvis, which is home to others organs (prostate, uterus) as well as a reservoir (rectum). The anus is a canal that makes communicate the rectum and the outside of the body (the rectum is part of the colon). In the of the lower rectum, a sphincter makes it possible to ensure control of the expulsion of excrement. As long as the tumor is far enough away from the sphincter, he’s possible to cut a part of the colon and to using an anastomosis (bonding between the two healthy ends, once the game tumor removed). In the case of rectum, the situation is more complex. Up to about 15 years from now, in more than half of the years of the cases, rectal cancer surgeries demanded the sacrifice of the sphincter and the putting on in place of a pocket. The progress of the surgery now make it possible to anastomoses very close to the sphincter. Thus the proportion of rectal cancers requiring an abdominal-perineal amputation is diminishing.
The use of surgery is also necessary for the treatment of metastases, including liver metastases. The liver surgery over the past twenty years, the In recent years, significant progress has been made. It is now possible to metastasize hepatic in good conditions. The survival gains are real. The surgery of hepatic metastases has recently been seen with a technical competitor: the radiofrequency.
Anticancer (cytotoxic) drugs All anti-cancer drugs aim to “break” the DNA in the cells. The action of these drugs is carried out at at the expense of all the cells dividing. In addition to the cells that divide in such a way anarchic, they affect normal cells. That’s why chemotherapy causes undesirable side effects. Disorders are explained in particular by the fact that the digestive in the small intestine, of the numerous dividing cells. On the other hand, the blood cells manufactured in the marrow, have very active kinetics. Thus the chemotherapies, do they result in significant low blood cell count. Chemotherapy can be recommended in two distinct situations: – an early-diagnosed disease and operated on in which positive nodes have were found on the operating room (cytotoxic drug treatment preventing the risk of metastases). The duration of this treatment is determined – it does not exceed six months; – a disseminated disease. In this case, the The duration of the treatment is indefinite.
Radiotherapy
Experts agree that the radiotherapy is not indicated in case of colon cancer. On the other hand, it is useful for treatment of rectal cancer.
Innovative treatments for who, for when?
The different ways of research
Cancer research is very diversified. Teams are dedicated to basic research (research on causes a tumor cell to occur, differentiation between tumour cells and normal cells). The research is also supported by the industry pharmaceutical. Indeed, the progress drug-related findings cancer are, in part, the result of the work of the research organizations laboratories pharmaceuticals. Finally, clinical research is intended to benefit certain patients in a regulated framework, progress therapeutic. Clinical research is is carried out in different phases of development of the drug. In a first, the team is trying to determine whether or not the medication may be effective and if it is can be tolerated (phase 1). In a second time, depending on the pathology being studied, it is will need to observe the effectiveness of a medicine or a combination of drugs (phase 2). Finally, studies of phase 3 consists of gathering patients homogenous in terms of their disease, and to draw lots. One half will suffer the reference treatment (the best in the current state of knowledge) while the other half will know an alternative therapeutic. At the end of the observation, it will be possible to determine the therapeutic attitude the most effective. Thus a standard therapeutic can be questioned.
Research and delay
The delay between phase 1 and phase 3 can reach 15 to 20 years of age. Admittedly, the research is not progressing at the rate of the public’s expectation. The public is hoping for a immediate availability to as many of the latest therapeutic advances as possible. It is yet necessary to respect a set of rules. Whatever they are, drugs cause side effects. It would not acceptable to trivialize them until you have verified that such side effects are controllable. This is particularly the case in preventive situation. No one could admit the use of treatments whose disadvantages would outweigh the benefits.
Treatments
Over the past ten years, it has been probably for colorectal cancer that therapeutic advances in tumor pathology have been the greatest. This can be explained by a better control of the use and association of conventional drugs and by progress in the collaboration of the different interveners (surgeons, chemotherapists, etc.), anatomical pathologists, radiologists). Finally, it is in this area that the therapeutics seem to give the most positive results. promising. In the field of cancer colorectal, two therapeutic classes are well-established. The first is the EGF receptor inhibitors (epidermal growth factor receptor). The EGF-receptor is a factor more frequently present in the surface of the tumor cells than on the surface of the tumor cells normal cells. When this receptor is stimulated, it leads to a proliferation of the cell. Different drugs are now able to block the EGF-receiver.
Another approach aims to dry up the blood vessels that feed the tumor. Indeed, it is not impossible to coexist with a malignant tumor that would have become unable to develop. A tumor does not can only develop with an input of oxygen and blood to the cells that make up the constitute. Tumors are capable of secrete a substance (VEGF – Vascular endothelial growth factor) which, based on the existing vessels, contributes to the creation of new ships. So the tumor is organizing its own bloodstream. The inhibition of the creation of such a network would deprive the tumor of any form of supply. Products about to become available allow for such action. The studies therapeutic interventions have shown that the promising results in a difficult situation, especially in the case of cancers colorectal. Their effects, in situation preventive, should be even better.