Smooth muscle tumors of the large intestine

　　Colonic smooth muscle sarcoma mostly originates from the固有muscle layer of the intestinal wall, with a small number originating from the mucosal muscle layer and vascular smooth muscle. The size of the tumor varies, with large ones reaching tens of centimeters and small ones less than 1cm. Grossly, it is divided into 4 types:

　　1. The intraluminal type, also known as the submucosal type, is characterized by tumor tissue protruding into the lumen, mainly growing beneath the mucosa.

　　2. The extramural type, also known as the subserosal type, is characterized by the main growth of tumor tissue outside the intestinal wall.

　　3. The mixed type tumor grows simultaneously towards the intestinal lumen and the outside of the intestinal wall within the intestinal wall, often presenting as dumbbell-shaped.

　　4. The intramural type, also known as the constrictive type, is characterized by tumor tissue growing along the intestinal wall, often involving the entire circumference of the intestinal wall, leading to narrowing of the intestinal lumen.

　　The pathological and histological types can be divided into well-differentiated sarcoma and poorly differentiated sarcoma according to the degree of differentiation. At present, most scholars believe that the malignancy of smooth muscle sarcoma increases with the increase of nuclear division. In addition to local infiltration of adjacent organs and tissues, hematogenous dissemination is the main route of metastasis, and lymph node metastasis is rare.

　　In addition to general symptoms, colonic smooth muscle sarcoma can also lead to other diseases. When the tumor invades the mucosal layer, it may cause hematochezia or mucous hematochezia. When the tumor grows too large, it may cause difficulty in defecation or intestinal obstruction.

　　Colonic smooth muscle sarcoma often has no specific clinical manifestations. In the early stages, it may only present general symptoms of the digestive system, such as abdominal discomfort and abdominal pain. When the tumor invades the mucosal layer, it may cause hematochezia or mucous hematochezia. When the tumor grows too large, it may cause difficulty in defecation or intestinal obstruction.

　　Prevent the occurrence of colonic smooth muscle sarcoma, pay attention to the following in daily life:

　　1. Maintain a positive attitude towards stress, balance work and rest, and avoid overexertion. It is evident that stress is an important trigger for cancer. Traditional Chinese medicine believes that stress can lead to overexertion and body weakness, causing a decline in immune function, endocrine disorders, and metabolic disturbances within the body, leading to the deposition of acidic substances. Stress can also lead to mental tension, causing Qi stagnation and blood stasis, or internal invasion of toxic fire.

　　2. Strengthen physical exercise to enhance physical fitness, and expose yourself to sunlight more often. Excessive sweating can help expel acidic substances from the body through sweat, preventing the formation of an acidic body type.

　　3. It is important to maintain a regular lifestyle, as irregular habits such as staying up all night to sing karaoke, play Mahjong, or not returning home at night can exacerbate acidification of the body, making it more susceptible to cancer. It is advisable to develop good habits to maintain an alkaline体质 and keep various types of cancer at bay.

　　Colonic smooth muscle tumors require pathological biopsy, as the tumor originates from the smooth muscle layer, it is necessary to reach a certain depth during sampling, and multiple sampling should be done. Sometimes, it is very difficult to distinguish between benign and malignant tumors. In addition, the following should also be done:

　　1. Rectal examination:Since colonic smooth muscle tumors often occur in the rectum, this examination is of great significance for providing diagnostic clues. It is often possible to palpate round or elliptical masses, which are tough like rubber, poorly mobile, with smooth mucosa. When the mucosa is invaded and ulcers appear, it is difficult to distinguish from cancer.

　　2. Barium double-contrast imaging examination:The main manifestations are filling defects, luminal stenosis, mostly without mucosal changes. When the tumor invades the mucosa, shadowing may appear, which is difficult to distinguish from ulcerative cancer.

　　3. Fiberoptic colonoscopy examination:Visible submucosal mass changes, intestinal cavity presents extrinsic compression changes.

　　4. Rectal cavity ultrasound and abdominal/pelvic CT scan:It is helpful for the diagnosis of this disease and has a certain significance for determining the surgical method.

　　Patients with colonic smooth muscle tumors should avoid excessive intake of saturated fats (pork, beef, mutton), and appropriately increase the intake of protein, vegetables, and fruits; those with a family history of heredity should strengthen monitoring and follow-up.

　　Surgical treatment is the main treatment method for colonic smooth muscle tumors, often using radical resection. For cases of recurrence and metastasis, active surgical treatment should also be adopted. This disease is insensitive to chemotherapy and radiotherapy, and for those with large tumors or those who cannot be operated on or have recurred multiple times, CVAD chemotherapy can be used, but according to literature reports, there is no significant efficacy. The suggestions proposed by Randleman in 1989 for the treatment of anal and rectal smooth muscle tumors can be used as a reference for clinical treatment:

　　1. Tumor diameter

　　2. For those with a diameter ≥ 2.5cm and infiltration of the intestinal wall, it is best to undergo radical abdominal perineal resection, low anterior resection, or pelvic organ resection.

　　3. Radiotherapy and chemotherapy should not be used as the routine treatment methods for this disease.