tumors of the colon and rectum, are a major cause of morbidity and cancer mortality in all western countries with high development technology. In Italy, an estimated incidence of 35 to 40,000 new cases a year die from the disease every year about 18,000 people, with a higher mortality rate in central and northern Europe, the lowest in the south and islands. Over the past decades in Italy, as in much of Europe, the mortality trends were more favorable for women and the ratio of mortality between sexes (M / F) for bowel cancer is increased systematically from 1.2 in the 50s until reaching 1.5 in the 90s. Surgical treatment of colon - rectum remains a challenge, despite the undeniable progress occurred over the years and the important acquisitions that have had a forte incremento nel corso dell’ultimo ventennio, grazie a diversi fattori: Il progredire delle conoscenze sulle modalità di diffusione del cancro del retto.
L’asportazione totale del mesoretto ( T.M.E. ) che ha ridotto drasticamente il tasso di recidive locali, aumentando quindi, la sopravvivenza.
Purtroppo però, la sensibilizzazione del cittadino,in Italia, verso il problema della "Prevenzione" è davvero poco stimolata. Vuoi perchè i sintomi iniziali della malattia neoplastica del colon-retto, sono spesso sovrapponibili alla più diffusa malattia emorroidaria (sanguinamento) con conseguente sottostima degli eventi, vuoi perchè in Italia non si è mai sviluppata una cultura Colonproctologica,per which often fails to identify the national professional, in charge of anorectal diseases and medical treatment are left to "counter" and therefore easy to find and to think you can solve his illness. To all this we must also add the inner fear of the citizen to undergo endoscopy, experienced as a deeply traumatic moment, and for the method of bowel preparation (use of strong laxatives) but also, for fear of having to suffer excruciating pain during the execution of the method, but unfortunately we must also emphasize to the clogging of the waiting lists of centers of Digestive Endoscopy often with infinite time before the exam.
However, is now difficult to understand at a / a patient who has completed the 50th year of age, the occult blood stool test, visit the Colon-proctology and endoscopy or Vitual traditional tools are useful and effective for:
1) Lowering the incidence rates of cancer in advanced stage
2) Increasing consensus through Section 1, the survival rates in patients with colorectal cancer, thanks to their early identification and treatment.
If the theme is cultural, then the disclosure of this baggage must be institutions, how much more widespread in the area, investing professionals at various levels:
general practitioner -> Specialist in colo-proctology -> specialist in digestive endoscopy. The chain has, however, the weak point:
1) The failure to inform the public on prevention campaigns in the area.
2) The user's underestimation of symptoms such as bleeding that you always back in the automatic haemorrhoids.
3) failure to notify the general practitioner of symptoms
4) the lack of knowledge of professionals (colorectal proctologist? "This unknown")
5) the long waiting lists to perform endoscopic examinations.
Needless to add, that this list could, or rather, it is incomplete, but whatever the cause Unfortunately, the effect is the same: The ratirdo diagnostic and increasing rates of neoplastic disease in an advanced stage.
If I really aim, I'd be the first to congratulate me, so I hope to be able once and for all delivered to clarify that the blood from the anus NOT 'PHYSIOLOGICAL EVER! It 'a symptom of a disorder, such as haemorrhoids, which is the red herring of the kind of thinking that, = Blood Hemorrhoids -> NO PROBLEM!
NO! it is not.
in Anglo culture is colon-proctology well established, thanks to the fact that talking about hemorrhoids is not as outrageous as in Italy. The first British patients to sign whatever it is, the challenge facing the specialist and correction of hemorrhoidal disease if present.
correction of hemorrhoidal disease, has a dual effect:
1) correct the disease
2) cut considerably the causes of bleeding, thus prompting the patient to an early focus on the symptom and then to the cause!
such as the following example, a cancer of the colon, which stenotizza (not occluded), the light organ, which was manifested by bleeding and reduction of serum iron (iron) and that the patient back to the old 20-year haemorrhoids.
that nobody believes that this is only a coincidence, in the case histories of patients to have these random archives full. It 'obvious that the aim of prevention is to resolve these cases.
Needless to say, the detection of polypoid lesions, as in this image of a virtual colonoscopy, are the overwhelming majority, but it is unclear that this lesion and its degenerate two are the result of the previous .
policy identification and remediation of the colon by means of endoscopic polypectomy is the very instrument through which to break down the growth rates of Cancer of the colon and rectum. Wanting
then draw conclusions that we have to say: The
occult blood stool is:
The first step toward identifying asymptomatic patients at risk of developing cancer
That alone does not however represent a good nothing if not followed by the Colon-proctology Visit which aims to identify anorectal diseases in the patient and that alone is able to identify 50% of cancers of the rectum.
It must be said that 50% Mother House colon rectal cancer develops within the first 5 cm of the rectum from the anal margin, or the terminal portion of the rectum which then connects to the anus.
So it is understandable that, EDAR or anorectal exploration performed by experienced operators allow the detection or exclusion of a considerable portion of those tumors with a higher incidence of development and which are those of the terminal rectum or rectum low!
This also means that, early detection of cancer at an early stage in this anatomical region defined, then preventing the implementation of interventions such as demolition amputation abdomino-perineal "Miles Intervention" which includes the packaging of ' preternatural anus or permanent colostomy, said in a nutshell " the bag in the belly .
Why is it okay to say that the anterior resection of the rectum, showed the same effect dell'amputaione abdomino-perineal resection in the treatment of rectal cancer or low subperitoneal, but only if the disease is locally advanced.
To then return to the topic of the post in question, occult blood, and visit proctological pancolonscopia are the means by which we prevent and / or diagnosis.
But the positivity of occult blood cancer mean?
NO! means that there is a leak blood, which could be caused by various diseases including cancer, colorectal cancer, but not exclusively.
But if you suffer from hemorrhoids and I have tested the blood in the stool, the visit and the colonoscopy and is not nothing I can avoid surgery for hemorrhoids?
The choice is personal, it can cope with his hemorrhoidal disease course, but remember that the occult blood test would become increasingly DISTORTION both good thanks to hemorrhoidal bleeding that is not only eye-catching of the blood in the cup! but also the "hidden" from gavocciolo of micro-cracks.
E 'useful to the cancer markers in asymptomatic patients as a test of prevention?
NO! Oncology markers have no role in the prevention of disease! Are indicators that should be used and interpreted in the follow-up of patients with a history of cancer alone and have no role.
Which intervention for rectal cancer?
Surgical options for rectal cancer defined as "low" may be different:
Therefore, it is essential to perform a proper pre-operative Staging (Eco trans-rectal, endoanal MRI) and a proper evaluation of the clinical and general the patient, and only then, implement the most effective therapeutic option in respect of oncological radicality and quality of life of patients. Today, the indication for abdomino-perineal amputation have changed in the past, it reserves this treatment in cases of sphincter infiltration structures, documented by surveys of staging or in the case of incontinence, where the packaging of a permanent colostomy is certainly more appropriate view dysfunction of the base. The introduction of mechanical
suturatici in colorectal surgery Fain et al. in the mid 70's, has allowed conservation work in a larger number of patients. E 'in the early nineteenth century, the first documented attempt to pack with a mechanical device, the intestinal continuity. The succession of efforts in creating an instrument mechanic, act for that purpose, culminating in the availability of all the operating rooms of the globe principals reliable. Spurred on by these technologies, in compliance with the radical cancer, many surgeons have made resection of the rectum with preservation of sphincter function and packaging of low and ultra low anastomosis, especially in patients with cancer of the lower third of the rectum.
a result, the number of abdominal-perineal amputation has been gradually reduced.
studies last thirty years have definitely made it clear that at the same level, grading and biological characteristics, the RA and the App are equivalent in terms of results, because the recurrence is closely related to an inadequate removal of tissue periviscerale the rectum or mesorectum. The
suturatici have certainly set the pace, because they have made possible the packaging of colo-rectal anastomosis significantly lower and safer than they were, where possible and would result in the hands of a few surgeons, the manual anastomosis.
But all this technical and cultural effort which is essential for the treatment of neoplastic disease alone would be little without a culture of cancer prevention.
I must say that the efforts being made in surgery and medicine and will have many.
But it must be stressed that the citizen is too often ill-informed.
E 'to praise the work done by national associations for the fight against cancer prevention campaigns that disseminate the area through the work of volunteers, but tuuto is not enough.
should be realized that the only way to stop a disease that unfortunately affects INEVITABLY a slice of the population, is the use of the tool of prevention.
correction of hemorrhoidal disease, has a dual effect:
1) correct the disease
2) cut considerably the causes of bleeding, thus prompting the patient to an early focus on the symptom and then to the cause!
such as the following example, a cancer of the colon, which stenotizza (not occluded), the light organ, which was manifested by bleeding and reduction of serum iron (iron) and that the patient back to the old 20-year haemorrhoids. that nobody believes that this is only a coincidence, in the case histories of patients to have these random archives full. It 'obvious that the aim of prevention is to resolve these cases.
Needless to say, the detection of polypoid lesions, as in this image of a virtual colonoscopy, are the overwhelming majority, but it is unclear that this lesion and its degenerate two are the result of the previous . policy identification and remediation of the colon by means of endoscopic polypectomy is the very instrument through which to break down the growth rates of Cancer of the colon and rectum. Wanting
then draw conclusions that we have to say: The
occult blood stool is:
The first step toward identifying asymptomatic patients at risk of developing cancer
That alone does not however represent a good nothing if not followed by the Colon-proctology Visit which aims to identify anorectal diseases in the patient and that alone is able to identify 50% of cancers of the rectum.
It must be said that 50% Mother House colon rectal cancer develops within the first 5 cm of the rectum from the anal margin, or the terminal portion of the rectum which then connects to the anus.
So it is understandable that, EDAR or anorectal exploration performed by experienced operators allow the detection or exclusion of a considerable portion of those tumors with a higher incidence of development and which are those of the terminal rectum or rectum low!
This also means that, early detection of cancer at an early stage in this anatomical region defined, then preventing the implementation of interventions such as demolition amputation abdomino-perineal "Miles Intervention" which includes the packaging of ' preternatural anus or permanent colostomy, said in a nutshell " the bag in the belly .
Why is it okay to say that the anterior resection of the rectum, showed the same effect dell'amputaione abdomino-perineal resection in the treatment of rectal cancer or low subperitoneal, but only if the disease is locally advanced.
To then return to the topic of the post in question, occult blood, and visit proctological pancolonscopia are the means by which we prevent and / or diagnosis.
But the positivity of occult blood cancer mean?
NO! means that there is a leak blood, which could be caused by various diseases including cancer, colorectal cancer, but not exclusively.
But if you suffer from hemorrhoids and I have tested the blood in the stool, the visit and the colonoscopy and is not nothing I can avoid surgery for hemorrhoids?
The choice is personal, it can cope with his hemorrhoidal disease course, but remember that the occult blood test would become increasingly DISTORTION both good thanks to hemorrhoidal bleeding that is not only eye-catching of the blood in the cup! but also the "hidden" from gavocciolo of micro-cracks.
E 'useful to the cancer markers in asymptomatic patients as a test of prevention?
NO! Oncology markers have no role in the prevention of disease! Are indicators that should be used and interpreted in the follow-up of patients with a history of cancer alone and have no role.
Which intervention for rectal cancer?
Surgical options for rectal cancer defined as "low" may be different:
Therefore, it is essential to perform a proper pre-operative Staging (Eco trans-rectal, endoanal MRI) and a proper evaluation of the clinical and general the patient, and only then, implement the most effective therapeutic option in respect of oncological radicality and quality of life of patients. Today, the indication for abdomino-perineal amputation have changed in the past, it reserves this treatment in cases of sphincter infiltration structures, documented by surveys of staging or in the case of incontinence, where the packaging of a permanent colostomy is certainly more appropriate view dysfunction of the base. The introduction of mechanical
suturatici in colorectal surgery Fain et al. in the mid 70's, has allowed conservation work in a larger number of patients. E 'in the early nineteenth century, the first documented attempt to pack with a mechanical device, the intestinal continuity. The succession of efforts in creating an instrument mechanic, act for that purpose, culminating in the availability of all the operating rooms of the globe principals reliable. Spurred on by these technologies, in compliance with the radical cancer, many surgeons have made resection of the rectum with preservation of sphincter function and packaging of low and ultra low anastomosis, especially in patients with cancer of the lower third of the rectum.
a result, the number of abdominal-perineal amputation has been gradually reduced.
studies last thirty years have definitely made it clear that at the same level, grading and biological characteristics, the RA and the App are equivalent in terms of results, because the recurrence is closely related to an inadequate removal of tissue periviscerale the rectum or mesorectum. The
suturatici have certainly set the pace, because they have made possible the packaging of colo-rectal anastomosis significantly lower and safer than they were, where possible and would result in the hands of a few surgeons, the manual anastomosis.
But all this technical and cultural effort which is essential for the treatment of neoplastic disease alone would be little without a culture of cancer prevention.
I must say that the efforts being made in surgery and medicine and will have many.
But it must be stressed that the citizen is too often ill-informed.
E 'to praise the work done by national associations for the fight against cancer prevention campaigns that disseminate the area through the work of volunteers, but tuuto is not enough.
should be realized that the only way to stop a disease that unfortunately affects INEVITABLY a slice of the population, is the use of the tool of prevention.
But the treatment of rectal cancer is surgery alone?
Yes, the surgery is in place which ensure the 50% median survival in patients with this tumor and is not essential that the surgical can be a variable. Colon-Rectal Surgery was established by a process of training is essential and indispensable. In countries like the USA, there have long been the unit of JRC (colorectal surgery) that address both the benign neoplastic disease. In Italy, this training and technical and cultural knowledge should be provided within the course of specialist training. From 8 years about national reference centers and clinical scientific research institutes (IRCS) have, with great effort, inaugurated the training through the Masters, where many surgeons " at their expense" were able to increase their cultural and technical confronting reality even abroad. The approach surgery is the son of a correct staging of the disease. In cases of locally advanced disease, surgery is delegated after the use of chemo-radiotherapy. Who have shown good efficacy in reducing not Neoadjuvant local recurrence, but able to implement the Down-SIZE namely the reduction of the disease locally, and then can not be reserved for patients demolition operations.
There has been innovation in surgical technique?
Surgical Innovation indeed coincides with the best biological knowledge of the disease cancer. The biggest step forward The concept was mesorectum was brought to the fore in 1982 when Heald, Husband and Ryall have a job where it was first described the technique of excision of the mesorectum performed on five patients with distal rectal cancer (TEM). Heald, in the light of his experience, he proposed to carry out the removal of the block structure in the surgical treatment of middle and distal rectal cancer, due to the fact that after such treatment, the rate of local recurrence detected amounted to only 5 %. Rectum and mesorectum are therefore an 'linfovascolare precise amount that must be excised en bloc without creating discontinuity in the mesorectal fascia in order to perform a radical excision oncologically. Irisultati obtained from Heald through the total mesorectum excision (TME) with survival rates in 5 years (87% versus 60% reported in world literature) and very low rates of locoregional recurrence of 3.7% at 4 years versus 30 % of the scientific community. (Hida)
bag in the belly (vehicle or ileostomy) is still necessary or not?
Firstly I should clarify two major aspects:
UNFORTUNATELY, not all patients can undergo a sphincter-conserving surgery and then have a candidatiad radical surgery and amputation abdomino perineal colostomy permanent. The reason is that even today! Some patients come to the observation of the surgeon too late in the disease.
For patients candidates for surgery conservative "anterior resection of rectum" packaging "Temporary " of Ileostomy or colostomy (depends on the school) turns out to be a duty.
So in conclusion how to defeat the cancer of the rectum:
few years ago discussing with a colleague, looking for a way to create an acronym to describe briefly the three golden rules to be disclosed.
After so much I married rimurginare " APC" that bed so it seems say nothing!
A = Attention
careful what we eat the diet that must always be balanced attention to obesity, attention to the high protein intake of alcohol and tobacco to the low consumption of fruits and vegetables.
P = Prevention
prevention starts at age 50 even though Personally I do not agree with the application of statistics in this age group, since their thirties and forties were my patients. But strictly speaking, we use the Prevention of course first! Of course, such as pattern change (sudden constipation and diarrhea), bleeding, rectal pain, family history of cancer! is worth emphasizing that if the family the father or the mother developed a colonic neoplasm children must turn on the light bulb! and attention to themselves the problem. The fecal occult blood test is quick! and useful! Contact your proctologist is not an option! Ask a colonoscopy at age 50 is not going to the gallows!
C = Caring for the Care
prorpio aspect is a priority! heal the body but is not? Care identifies a number of behaviors that should be well considered. Unfortunately, when you get sick, the logic is displaced by fear! And 'that's when everyone is susceptible.
Cure is now possible. The surgery has become by demolitiva a conservativa, la medicina oncologica ha nuove terapie meno invalidanti che agiscono a livelli sempre più selettivi e senza i reliquati di un tempo, senza cioè quel disconfort tipico dei sintomi legati ai trattamenti antiblastici. La radioterapia ha affinato sempre più le metodiche risparmiando sempre di più il tessuto sano a scapito di quello malato.
Gli anni che verranno saranno sicuramente ricolmi di grandi novità e speranze per la cura dei tumori. Noi oggi però dobbiamo sforzarci nel far comprendere ai sani che il tumore si può prevenire ed ai malati che di tumore si può guarire.
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