Pele follows the World Cup in the hospice ward. How can colorectal cancer be treated at the end of the day?
The hospital re-evaluated the effect of chemotherapy and accepted some pain relief measures. The basic therapy for advanced patients is the use of chemical drugs, so chemotherapy is destined to not cure cancer. at present, two-drug / three-drug combination chemotherapy and targeted therapy can increase the total survival time of colorectal cancer patients to nearly 20 months. International authoritative treatment guidelines recommend chemotherapy as the first choice for patients with advanced colorectal cancer. The three pillar basic drugs for colorectal cancer chemotherapy are fluorouracil (5-Fu, capecitabine), irinotecan and oxaliplatin. The main adverse reactions of these three kinds of drugs are myelosuppression, nausea and vomiting, neurotoxicity and delayed diarrhea. Most patients can tolerate the side effects of chemotherapy, and doctors will adjust the dose of chemotherapy according to the side effects of the patients. More accurate chemotherapy kills mitotic cells with no difference compared with chemotherapy.
At a time when the World Cup is in full swing and fans at home and abroad are enjoying it, Brazil's "ball king" Pele, who is terminally ill, is concerned about the game even if he is transferred to the hospice ward.
A few days ago, 82-year-old Bailey was admitted to hospital because of "respiratory tract infection" and "heart failure". Since he was diagnosed with colorectal tumor at the end of August 2021, his condition has been repeated, and the hospital has re-evaluated the effectiveness of his chemotherapy and concluded that he is no longer responsive to chemotherapy. After consulting him himself, he was finally transferred to the "hospice palliative care" ward to receive some pain relief measures.
In the future, Pele will enjoy the last World Cup in the deathbed ward and spend the rest of his life peacefully. I wish him good health and all the best.
Colorectal cancer currently ranks fourth in the incidence of malignant tumors in China, the vast majority of patients are found in the middle and late stages, losing the opportunity for surgery, although some patients have experienced surgery, but the tumor is still irresistible progression or recurrence. So, at this stage, what else can patients do?
Chemotherapy: the basic treatment for advanced patients
Chemotherapy is the use of chemicals to kill cells that are in the stage of division. Because cancer cells divide actively, they are most vulnerable to drugs, but at the same time, many normal cells in the body are dividing, and it is certain that some cancer cells are not dividing, so chemotherapy is doomed to not cure cancer, and there must be great adverse reactions. such as nausea, vomiting, hair loss, decreased immunity and so on.
People talk about the causes of discoloration of "cancer". One of the reasons is the side effects of chemotherapy. However, with the development of chemotherapeutic drugs, the current two-drug / three-drug combination chemotherapy and targeted therapy can increase the total survival time of colorectal cancer patients to nearly 20 months. Therefore, international authoritative treatment guidelines recommend chemotherapy as the first choice for patients with advanced colorectal cancer.
The three pillar basic drugs for colorectal cancer chemotherapy are fluorouracil (5-Fu, capecitabine), irinotecan and oxaliplatin. The main adverse reactions of these three kinds of drugs are myelosuppression, nausea and vomiting, neurotoxicity and delayed diarrhea. Generally speaking, most patients are able to tolerate the side effects of chemotherapy, which are not as terrible as they think. In addition, the doctor will also adjust the dose of chemotherapy according to the side effects of the patient.
Targeted therapy: more accurate chemotherapy
Compared with the undifferentiated killing of mitotic cells in chemotherapy, targeted drugs can more accurately attack cells with a certain type of characteristics, so they can accurately kill cancer with less side effects. However, due to the rapid mutation of cancer cells, targeted therapy is not a panacea.
At present, for colorectal cancer, a number of targeted therapeutic drugs have been approved for clinical use by the State Food and Drug Administration, among which the most widely used and most widely used include anti-EGFR therapy of siliximab, panizumab and anti-VEGF bevacizumab and so on.
Large clinical trials show that as a first-line / second-line therapy, targeted therapy combined with chemotherapy can significantly prolong the total survival time of patients, even more than 30 months. Therefore, international authoritative guidelines recommend targeted therapy combined with chemotherapy as first-line treatment. Clinically, it is also found that in the first / second line treatment of advanced colon cancer, targeted therapy can not be used alone, but must be combined with chemotherapy and anti-tumor therapy. In other words, targeted therapy has played an icing on the cake, but it can not completely replace chemotherapy for the time being.
Immunotherapy: there is a chance to cure
Cancer cells can inhibit human immune cells, making it unable to effectively destroy cancer cells. Immunosuppressants can reactivate immune cells and achieve the purpose of suppressing cancer cells, so end-stage colorectal cancer can be enhanced by combined immunosuppressants on the basis of chemotherapy and targeted therapy.
There is a pathological type of colorectal cancer called mismatch repair gene defect, which is caused by a mismatch of a genome and forms cancer cells, accounting for about 15% of colorectal cancer. In August 2021, FDA approved the launch of a new drug called DOSTARLIMAB. Previous clinical studies showed that among the 12 patients tested with the drug, all cancers and cancer cells disappeared after half a year (once every three weeks), lasting for 25 months, and the side effects were very mild, such as mild dermatitis, rash, fatigue and so on.
Of course, this drug also has shortcomings, that is, it is only effective for patients with mismatched genes, and the number of trials is relatively small, the follow-up time is relatively short, less than two years, and the cost is relatively high, which costs 0000 for six months of treatment.
At present, there is no such drug in China, so we can only buy it in the United States if necessary. If we have the opportunity, we can also see if there is any participation in relevant clinical trials.
Surgery: can also be used at a later stage
Many people believe that patients with advanced malignant tumors have lost the opportunity for surgery. Clinically, some patients with advanced colorectal cancer, even if there has been metastasis, but after chemotherapy, the focus is reduced, can also be treated by surgery, postoperative adjuvant chemotherapy, can also achieve the effect of long-term survival.
What kind of terminal patients have the hope of long-term survival? This situation mainly exists in patients with metastatic lesions of the liver or lung and patients whose primary lesions can be completely resected by surgery. However, the judgment and treatment of the specific situation requires the joint efforts of a team of experienced experts.
Local treatment: in order to better control tumor
In addition to a full-scale attack, for some suitable patients, we can consider using a variety of local treatment methods to make breakthroughs, so as to disintegrate the tumor army. These local treatments mainly include transcatheter arterial chemoembolization, radiofrequency ablation, cryotherapy, radiotherapy and so on.
After local radiofrequency ablation was performed in some patients with advanced colorectal cancer with liver metastasis, the liver metastasis could be well controlled and the total survival time was significantly improved.
Palliative care: spend your last days in peace
Palliative treatment is active treatment and care for patients with poor response to treatment, mainly to control pain and related symptoms, reduce psychological discomfort, and win the best quality of life for patients and their families, rather than prolonging life.
Under the stimulation of tumor, surgery, radiotherapy, chemotherapy and other stimuli, the body resistance of patients is declining day by day, at the same time, physical and mental pain and psychological burden continue to accumulate, many patients no longer want to be tortured, especially when there is no progress in treatment. At this time, we can choose palliative treatment to minimize the pain of patients, choose traditional Chinese medicine with little side effects, exercise, eat reasonably, assist patients in excretion, turn over regularly for patients who have been bedridden for a long time, massage for patients, etc., so that patients can spend the last moments of life comfortably and painlessly.
If palliative treatment is chosen, the family members can accompany and care for the patient more and help him through the final stage. At the same time, can guide patients to express their own demands and inner thoughts, targeted psychological counseling, patient comfort. When communicating, you should be friendly and soft-spoken, and avoid mentioning sensitive topics.
The length of life is important, but the quality of life and the dignity of life are also very valuable. Birth, aging, sickness and death is a necessary course of life. There are always some situations that are beyond the reach of medicine. We should enjoy a good time at the final stage of life without leaving any regrets. Appeasement is not simply "waiting to die"! # Cancer # # Pele # # World Cup #