[EBS 명의] SUB 증상없는 대장암, 내시경으로 발견한다

[EBS 명의] SUB 증상없는 대장암, 내시경으로 발견한다


In the operating room, even the most unfaltering doctor sometimes spend minutes agonizing. The cancer cells on the peritoneum are found two years after the surgery. The late discovery of the cancer made it to transfer to the peritoneum, which became a sticking point in the full recovery. [Dr. Kim Seonhan/ Colorectal surgeon]
During the surgery, cancer spread to peritoneum the cancer cells are seen here and there which weren’t detectable at the scan. So it’s the hardest to treat. [Cancer mortality in South Korea (2017) – lung cancer 22.8%, liver cancer 13.6%, colorectal cancer 11.1%, stomach cancer 10.2%, pancreatic cancer 7.3%]
The treatment for cancer is constantly developing. Nevertheless, the number of colorectal cancer deaths are still high. [Survival rate of colorectal cancer per stage 2012 – 2016]
[1st stage – early 2nd stage: 95.3%; late 2nd stage – 3rd stage: 81.8%; 4th stage: 20%]
Colorectal cancer, in particular, does not show any symptoms, which makes it harder to detect in the earlier stages, and is easier to spread to other tissues. [Dr. Kim Seonhan/ Colorectal surgeon]
Colonoscopy is the only way to detect colorectal cancer in the early stage. There are a lot of researches being conducted (to detect colorectal cancer earlier) There are methods like blood tests, or stool test detecting cancer related genes, being developed But they are not the established tests yet, For now, colonoscopy is the only test to detect colorectal cancer. That’s because it can detect polyps. Most colorectal cancer starts from polyps, So if you detect them earlier, you can eliminate cancer from its seed. If we detected polyps through colonoscopy, can we stop worrying about it? How to discover the cancer earlier, and to treat it fully, Let’s talk about it with Dr. Kim. [Colorectal cancer with no symptoms, detectable with colonoscopy] The accurate cause of polyps are still unknown. If you are prone to developing polups You should be aware of it, and receive colonoscopy every two or three years. [How does polyps develop into cancer?]
Polyps are small bumps in the colon that look like warts, developing anywhere in the colon. It takes an average of 5 years for polyps to develop into cancer. So that’s why polyps are called the seed of colorectal cancer. Healthy and smooth tissues grow abnormally into polyps [Benign]
In a few years, the cancer cells are developed, which progresses to early colon cancer. [Malignant]
And if they pass through the mucous membrane, it turns into progressive colon cancer. [Dr. Kim Seonhan/ Colorectal surgeon]
About 60%, two-thirds of the polyps slowly grow with time, Which are called adenomatous polyps, And they have the properties to develop into cancer as they grow. And the other 30-40% of them either disappears with time Or just stay as the same size as they are. However, which one grows with time, Or which one stays or disappears, Some of them are distinguishable, but quite a lot of them are not. So if you discover polyps, you’d rather get rid of them. If the polyps are visible (through the colonoscopy) Five out of seven are completely removed But two of them, which look like cancer, still remains. Today, Dr. Kim Seonhan, with Dr. Keum Bora, a gastrointestinal surgeon, is going to make a final decision whether to remove them with simpler procedures or operate a surgery. If given the choice, everyone would choose simple procedures over surgery. Then what would be the criteria to determine whether to choose the surgery or simple medical procedures? [Determining between surgery and procedures]
Determining between surgery and procedures, the criteria are the polyps’ size, location, and depth. The most important factor is depth. [Mucosa / Submucosa / Muscularis Externa / Serosa]
If it permeates underneath the mucosa to the submucosa, it requires surgery. [Dr. Kim Seonhan/ Colorectal surgeon]
The most important criteria is depth. Whether it permeated through submucosa, which is within 1mm deep, Or if the permeation exceeds 3mm, or is it in the middle. That determines if it requires a simple treatment (with colonoscopy) or remove it through surgery, The reason why the depth is the standard criteria of determination is that, the deeper they get, The more probable it may spread to the lymph glands. It’s the season for the national medical checkup again. It’s available throughout the year, But because of our hectic life, the end of the year is the only time you are reminded of it. Especially, Koreans should have the gastric cancer, breast cancer, and colon cancer screened, Because we are more vulnerable to them, as well as with higher mortality. But there is a test which makes you hesitate, even if you know it’s helpful. [The cancer screening rate in 2018 – Gastric cancer 72.8%, Breast cancer 63.1%]
There are more than half who got their cancer screened among those who are eligible for the national cancer screening. However, [Colorectal cancer 58.4%]
the screening rate for colorectal cancer is far low. Even though Korea has the highest colorectal cancer incidence. Why is that? [“Bowel clearing” and diet control for Colonoscopy]
[52% were not qualified]
To clear your bowel right, it’s important to take medication as indicated, But the most important thing is the diet control. [Limited food before the test: Kimchi, seasoned vegetables, multi-grain rice, fruits with seeds]
You should avoid the specified foods, and it’s better to have some soft porridge the day before the test. [Dr. Kim Seonhan/ Colorectal surgeon]
There’s only one purpose for the bowel clearing. It’s to get rid of all the stool So you should be ready 2 or 3 days ahead of the colonoscopy, with limited intake of food. And there are types of food which sticks on the intestine walls, even with the same clearing. Avoid those, and wake up early in the morning, And get your intestine cleared, and get your colonoscopy early, And start the rest of your day. That’s the tip. [Polyps and colonoscopy]
The colonoscopy starts from the anus. The camera is inserted to the point where the small intestine and the large intestine meets, And the colonoscopy proceeds with the camera being removed. If polyps are detected, they should be removed with the colonoscopy, For that, the chemical that detaches polyps from the intestine walls is inserted, And it’s detached with the endoscope. When the polyps are not deeply attached on the intestine walls, they’re removable with the endoscope, But when they are larger, harder, and if they have permeated through the submucosa, or the muscle layers, will have to be removed with surgery. The 95% of colorectal cancer develops from the adenomatous polyps, So, to prevent cancer, all polyps should be removed, even they are small. [Dr. Kim Seonhan/ Colorectal surgeon]
When we look at the colonoscopy images from the hospital, It was already visible from the colonoscopy that they proceeded to cancer, so it was already impossible to remove them with endoscopy. And it’s large, too. And there’s the ulcer, which means that it’s a little deeper rooted, So we will incise the intestine today, And this part is the part we inserted pigments. So we will incise both of them, the cancer tissues and the cancer cells where the polyps are found. But the removed polyps were really small, so we inserted pigments there the last time with the colonoscopy. We marked the areas where it should be removed So we will remove the part of the intestine where it’s pigmented and connect the rest, through a laparoscopic surgery. And finally, we need to check the cut tissues with a microscope. [The laparoscopic surgery of the early sigmoid colon cancer]
They will perform a laparoscopic surgery, Two cancer tissues marked with pigments earlier before the surgery through colonoscopy, And all the roots of lymphatic glands where the cancer may spread. If the incised intestine is connected back with the circular stapler, that’s the end of the surgery. [Dr. Kim Seonhan/ Colorectal surgeon]
The patient had a lot of polyps detected through the colonoscopy. So we removed them all, But there were cancer tissues in the sigmoid colon, where it’s irremovable with the endoscopy, And a little apart from there, over the sigmoid colon, we removed the polyp with the endoscopy, But through the microscope, we found that the cancer cells could be present in the cut surface of the polyp, so we incised the sigmoid colon And removed the lymphatic glands where the cancer could spread And the rest of the intestine was connected. And then we should examine the cut tissue with a microscope. Depending on the result, the treatment plan will vary. If we don’t find any cancer spread to lymphatic glands, the treatments ends with the surgery. And all the patient needs is regular checkups. If there is even one cancer cell spread into lymphatic glands, The patient would require 6 months of cancer treatment. We should see how it comes out. In the national medical checkup, colonoscopy is included when the eligibles reach 50. But when you have the family history, when should you start your first colonoscopy? [Dr. Kim Seonhan/ Colorectal surgeon]
Those who have colon cancer patients in their families belongs to the high risk group. If the patients are their parents or siblings, they belong to the highest risk group. If you have someone who has colon cancer in your family, You will ask: When should I start to receive regular colonoscopy? Do I start in my 20’s? Or 30’s? When is it better to start receiving colonoscopy? If you have someone who was diagnosed with the colon cancer in you family, whether your siblings or parents, If you start 5 years earlier than the family member’s age of detection, then there’s not much risk.

Leave a Reply

Your email address will not be published. Required fields are marked *