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结肠癌的病因、症状与治疗

Colon Cancer: Causes, Symptoms and Treatments
结肠癌的病因、症状与治疗
1149字
2019-10-12 14:56
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Colon cancer, also known as colorectal cancer, is the second-leading cause of cancer deaths in both men and women. According to the Centers for Disease Control (CDC), 51,783 Americans died from colon cancer in 2011 (the most recent year for available data). The disease affects slightly more men than women, and risk increases with age.

结肠癌,又称结直肠癌,是男性和女性癌症死亡的第二大原因。根据美国疾病控制中心与预防中心的数据,2011年(有可用数据的最近年份)有51,783名美国人死于结肠癌。这种疾病对男性的影响略大于女性,风险会随着年龄的增长而增加。

"Colon cancer is a growth in the colon that usually arises from a polyp. Sometimes the polyps look like stalks of cauliflower, sometimes they're flat," said Dr. Richard Goldberg, the physician-in-chief and a professor of medicine at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute. "When they spread that's when [people] have life-threatening issues."

“结肠癌是结肠里的一种细胞生长,通常由息肉引起。有时息肉看起来像花椰菜茎,有时是平的。”俄亥俄州立大学综合癌症中心– 亚瑟G. 詹姆斯肿瘤医院医院 和理查德J. 尚兰研究所主任医师与医学教授理查德·戈德堡博士说,“当息肉扩散时,(人们)就会面临危及生命的问题。”

Causes

病因

Excluding very rare types, colon cancer develops in the cells lining the inside of the colon and/or rectum. The colon, or large intestine, is a curving structure that continues the digestion of food from the small intestine, absorbs liquid out of the stool and carries it down to the rectum for elimination. 

除了非常罕见的类型以外,结肠癌是在结肠和/或直肠内壁的细胞中发生的。结肠(或大肠)是一个弯曲的结构,它继续消化从小肠而来的食物,吸收粪便中的液体,并把它带到直肠进行排泄。

While there is no specific cause of colon cancer, certain factors can increase risk of developing the disease. These factors include genetics, diet and health. Individuals with a family history of colon cancer, especially if more than one relative has had the disease, are at increased risk. Also, two genetic syndromes, familial adenomatous polyposis and Lynch syndrome, have been associated with colon cancer.

虽然结肠癌没有特定的起因,但某些因素会增加罹患结肠癌的风险。这些因素包括遗传、饮食和健康状况。有结肠癌家族史的人,尤其是如果有一个以上的亲属患结肠癌,面临的风险更大。此外,家族性腺瘤性/息肉病和林奇综合征这两种遗传疾病也与结肠癌有关。

A diet rich in fat and red meat may increase disease risk. Colon cancer is rare in countries where red meat is less common on the menu. For instance, "Colon cancer is quite rare in Japan, although it's becoming more common as their diet becomes Westernized," Goldberg said.

富含脂肪和红肉的饮食可能会增加患病风险。在食用红肉较少的国家,结肠癌相对罕见。例如,“结肠癌在日本相当罕见,不过随着他们的饮食变得西化,结肠癌变常见了。”戈德堡说。

First-generation Japanese immigrants who move to Hawaii notice an uptick in colon cancer rates, and "after a generation, the immigrants adopt the incidence of their adopted country," Goldberg said. 

在移居夏威夷的第一代日本移民中,结肠癌发病率有所上升,“经过一代人的时间,这些移民沿袭了他们所移民国家的结肠癌发病率。”戈德堡说。

In addition, heavy alcohol use as well as smoking may contribute to a colon cancer diagnosis. Health factors such as obesity, diabetes and lack of exercise are associated with increased risk. Moreover, inflammatory disease such as other types of cancer or conditions such as ulcerative colitis can increase the likelihood of developing colon cancer.

此外,大量饮酒和吸烟也可能引发结肠癌。肥胖、糖尿病和缺乏锻炼等健康因素与患病风险增加有关。同时,炎症性疾病,如其他类型的癌症,或溃疡性结肠炎等疾病可能增加罹患结肠癌的概率。

These risk factors, however, do not guarantee a diagnosis of colon cancer. As with many cancers, colon cancer develops from the complex interplay of many factors, and no two individuals are the same.

然而,这些风险因素并不一定会导致结肠癌的诊断结果。与许多癌症一样,结肠癌是由许多因素的复杂作用发展而来的,没有两个病例是相同的。

Colon polyps are small growths on the inside lining of the colon or rectum. Most colon cancers begin as polyps.

Colon polyps are small growths on the inside lining of the colon or rectum. Most colon cancers begin as polyps.

结肠息肉是结肠或直肠内壁上的小型增生物。多数结肠癌由息肉发展而来。

(Image credit: Ross Toro, MyHealthNewsDaily)

图片来源:My Health News Daily Ross Toro

Symptoms & screens

症状与筛查

Symptoms that may indicate the presence of cancer cells in the colon or rectum include blood in bowel movements, weight loss, stomach pains and constipation or diarrhea. Often, individuals will not experience any symptoms of colon cancer until it has become advanced. For this reason, the U.S. Preventive Services Task Force recommends that all individuals ages 50 to 75 undergo routine screening. African Americans, who have an increased risk, are advised to begin screening at age 45, according to the American College of Gastroenterology.

表明结肠或直肠中可能存在癌细胞的症状包括粪便中带血、体重减轻、胃痛、便秘或腹泻。通常情况下,在晚期之前,患者不会出现任何结肠癌相关症状。因此,美国预防医学工作组建议所有年龄在50到75岁之间的人都要进行定期筛查。据美国胃肠病学院介绍,非裔美国人患大肠癌风险更高,建议他们在45岁时开始筛查。

"One of the bad things about colon cancer is that it often doesn’t cause symptoms until it's gotten pretty advanced," Goldberg said. "And that's why we recommend that people have screenings."

“结肠癌的一个问题是,它往往在病情相当严重之前不会引起症状。”戈德堡说,“这就是我们建议人们进行筛查的原因。”

Colon cancer screening tests include an at-home stool test, called high-sensitivity fecal occult blood testing (FOBT); a flexible sigmoidoscopy (Flex Sig); and a colonoscopy. The FOBT checks stool samples for blood cells, and should be done annually, the CDC reports. 

结肠癌筛查包括一种称为高敏感性粪便潜血试验(FOBT)的家用粪便试验;软管式乙状结肠镜检查;结肠镜检查。美国疾病控制与预防中心报告称,FOBT检查粪便样本中的血细胞,应该每年检查一次。

Both a Flex Sig and a colonoscopy involve the insertion of a thin tube into the rectum and/or colon to check for cancerous tissue. In a Flex Sig, a doctor can look at the bottom third of the colon, unlike a colonoscopy, which includes an examination of the entire colon. 

软管式乙状结肠镜检查与结肠镜检查都需要在直肠和/或结肠插入一根细管来检查癌组织。在软管式乙状结肠镜检查中,医生可以查看结肠的底部三分之一,这与结肠镜检查不同,结肠镜检查包括对整个结肠的检查。

People receiving a Flex Sig are asked to take an enema to clear out the bottom of their colon before the procedure, Goldberg said. It typically doesn’t require sedation. 

戈德堡说,接受软管式乙状结肠镜检查的患者被要求在手术前先灌肠以清理结肠底部。 通常不需要施予镇静剂。

For a colonoscopy, people are asked to stay on a clear liquid diet and drink a medicine, such as GoLytely, that will clear their bowels a day or so before the procedure. Colonoscopies are generally done under anesthesia, and patients, who are typically groggy after the procedure, often don't return to work that day and will need a ride home. 

结肠镜检查要求患者保持清流质饮食,并服用一种药物,如聚乙二醇(GoLytely),可以在手术前一天左右清理肠道。结肠镜检查通常在麻醉下进行,患者在检查后通常会感到昏昏欲睡,当天无法恢复工作,需要乘车回家。

During a colonoscopy, doctors use a colonoscope, a thin six-foot tube with a light on its end. The colonoscope allows doctors to blow air into the colon, which helps find tumors that may be hiding behind the colon's many wrinkles and folds, Goldberg said. Doctors can also take a biopsy or remove suspicious polyps during the colonoscopy. 

在结肠镜检查中,医生使用结肠镜,即一根末端装有照明灯的约1.8米长的细管。戈德堡表示,进行结肠镜检查时,医生会将空气通入结肠,这有助于发现隐藏在结肠众多皱褶后面的肿瘤。医生也可以在结肠镜检查时进行活检或摘除可疑息肉。

Screening exams are so effective that undertaking these tests could prevent 60 percent of colon cancer deaths, according to CDC estimates.

根据美国疾病控制与预防中心的估计,筛检非常有效,进行这些检查可以预防60%的结肠癌死亡。

Treatment

治疗

If a diagnosis of colon cancer is made, treatment is determined by the stage of the disease. In other words, earlier stages in which the cancer is small and localized may require less intervention. Typically, surgery can effectively remove small tumors and chemotherapy is prescribed to kill any remaining cells. Chemotherapy drugs commonly used for colon cancer include irinotecan, oxaliplatin, capacitabine and 5-fluorouracil.

如果确诊为结肠癌,治疗方法取决于疾病的发展阶段。换句话说,早期癌症病灶小而且出现在局部,需要的干预较少。通常情况下,手术可以有效地切除小型的肿瘤,化疗则可以杀死剩余的癌细胞。结肠癌常用的化疗药物有伊立替康、奥沙利铂、卡培他滨和5-氟尿嘧啶。

More advanced cancers in which the disease has metastasized, or spread, throughout larger areas of the colon or to other parts of the body may require removal of whole sections of the large intestine. Often, the remaining colon can be reconnected to the rectum, but if the cancer has also reached the rectum, a colostomy may be needed. In this procedure, a surgeon creates an opening in the abdomen and attaches a colostomy "bag." Waste collects in the bag instead of passing through the rectum. Chemotherapy and radiation are then prescribed to kill remaining cancer cells, and control as much as possible the spread of the disease.

较晚期的癌症,如果癌细胞已经转移或扩散到整个结肠或身体的其他部位,可能需要切除整个大肠。通常情况下剩余的结肠可以重新与直肠接上,但如果癌细胞已经扩散到直肠,可能需要施行结肠造口术。手术过程中,外科医生在腹部开一个口,然后接上一个结肠造口“袋子”。粪便在造口袋里聚集,不再通过直肠。然后通过化疗和放疗杀死剩余的癌细胞,并尽可能地控制癌细胞的扩散。

Alternative treatment

替代疗法

Although there is no scientific evidence to show that alternative treatments can treat or cure colon cancer, certain therapies can improve the quality of life of cancer patients. 

虽然没有科学证据表明替代疗法可以治疗或治愈结肠癌,但某些疗法可以改善癌症患者的生活质量。

"Living successfully with a life-threatening disease like this takes resources other than medical resources," Goldberg said.

“带着这种危及生命的疾病生存需要医疗资源以外的其他资源。”戈德堡说。

Activities such as art, dance and music can shift focus away from the disease and the treatment process, and help reduce stress. In addition, exercise and meditation can improve mood and appetite. In fact, daily exercise can improve life outcomes for people with localized colon cancer, according to a 2013 study in the International Journal of Cancer.

艺术、舞蹈和音乐等活动可以转移人们对疾病和治疗过程的注意力,并有助于减轻压力。此外,运动和冥想可以改善情绪和食欲。事实上,根据《国际癌症期刊》2013年的一项研究,每天锻炼可以改善局部结肠癌患者的生活。

Support groups are also a helpful resource for coping with colon cancer. Information on local groups can be found through organizations including the Colon Cancer Alliance, Cancer Care and the American Cancer Society.

支持团体也是应对结肠癌的有效资源。可以通过结肠直肠癌联盟、癌症护理和美国癌症协会等组织找到有关当地团体的信息。

With additional reporting by Amber Angelle, My Health News Daily Contributor

My Health News Daily供稿人Amber Angelle补充报道

Follow Laura Geggel on Twitter @LauraGeggel and Google+. Follow Live Science @livescience, Facebook & Google+.

欢迎关注Laura Geggel的推特@LauraGeggel和Google+。关注Live Science 的推特@livescience、Facebook和Google+。

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