Malignant lymphoma of the large intestine

　　The etiology of colorectal malignant lymphoma is unknown and may be related to radiation, chemical carcinogenesis, toxins, and other factors.

　　1, Virus

　　EB virus infection leads to immune function suppression, activation of oncogenes, and malignant proliferation of B lymphocytes.

　　2, Immune suppression

　　The occurrence of lymphoma is related to immune suppression. Immunosuppressive drugs also have an impact on the occurrence of lymphoma.

　　3, Environmental factors

　　Factors such as insecticides, pesticides, drugs, paint, atomic bomb radiation, receiving radiotherapy and chemotherapy, congenital immune deficiency disease, and other factors can all lead to a higher incidence of lymphoma than the normal population.

　　Colorectal malignant lymphoma often invades surrounding tissues and organs, such as the bladder and prostate, and adjacent tissues, causing frequent urination, urgency, and difficulty in urination. It can also involve the pre-sacral plexus, causing sacral and lumbar pain. It can also metastasize to distant organs such as the liver, causing liver enlargement, ascites, and even cachexia. In the late stage, it can be complicated by intussusception, intestinal obstruction, and symptoms and signs of involvement of other organs.

　　Common clinical symptoms include nausea, vomiting, weight loss, abdominal pain, abdominal mass, changes in defecation habits, hematochezia, intestinal obstruction, intussusception, and intestinal perforation leading to acute peritonitis. A few patients may delay treatment due to the lack of obvious early symptoms. Clinically, it can be divided into three types:

　　1, Diffuse type

　　Predominantly infiltrative, with diffuse thickening and hardening of the intestinal wall, the affected intestinal segment loses luster, the intestinal lumen becomes narrow, peristalsis disappears, and thickened folds can be seen within the mucosa, or it can also present as a diffuse nodular change, with surface erosion or superficial ulcers, similar to infiltrative cancer, with a large range of involvement.

　　2, Polypoid type

　　The mass presents with a broad base, smooth surface, or nodular polypoid mass, and can also present as multiple hemispherical polyps, similar to benign lymphoid polyps, with a smooth surface, white color, local infiltration and thickening, disappearance of the colon pouch crescent fold, local rigidity, and disappearance of peristalsis.

　　3, Ulcerative type

　　It can present with malignant ulcer characteristics, or it can also be manifested as benign ulcer, with flat and superficial ulcers, white fur on the surface, and flat edges. There is a type of extraintestinal mass, which grows from the inside to the outside of the intestinal lumen, and the mass can compress the intestinal lumen, causing it to become narrow, with a normal mucosal surface.

　　Due to the fact that the definite etiology of colorectal malignant lymphoma has not been fully discovered, there is no effective preventive measure for this disease. Early detection and early treatment are the key to the prevention and treatment of this disease. Reducing environmental pollution, maintaining good living habits, treating certain chronic inflammatory diseases of the body in a timely manner, and improving the body's immune function may not only reduce the incidence of lymphoma but also are common principles for reducing the incidence of other malignant tumors.

　　The main method for diagnosing this disease is fiberoptic colonoscopy, with a high positive rate. In patients highly suspected of malignant lesions under the endoscope, biopsy pathology sometimes shows inflammatory cell infiltration, but no tumor cells are seen. This may be related to factors such as shallow sampling, small tissue size, and tissue compression during tissue clamping. Colorectal malignant lymphoma has certain characteristics in histology. When taking biopsies, in addition to sampling the mucosa, the submucosal tissue should also be sampled.

　　It is recommended to eat more vegetables rich in dietary fiber in the diet, such as celery, chives, cabbage, radish, and other green leafy vegetables. Vegetables rich in dietary fiber can stimulate peristalsis, increase defecation frequency, and remove carcinogenic and toxic substances from feces. If the colorectal malignant lymphoma protrudes into the intestinal lumen and the luminal diameter narrows, the intake of dietary fiber should be controlled because excessive intake of dietary fiber can cause intestinal obstruction. At this time, easy-to-digest, soft semi-liquid foods such as millet congee, thick lotus root powder soup, rice gruel, corn gruel, egg custard, and tofu pudding should be given, as these foods can reduce the stimulation to the intestines, pass through the intestinal lumen smoothly, and prevent the occurrence of intestinal obstruction.

　　The comprehensive treatment plan for colorectal malignant lymphoma should mainly adopt surgery and systemic chemotherapy.

　　1. Systemic combined chemotherapy after radical resection or tumor resection of the colon, plus early multi-drug chemotherapy (chemotherapy).

　　2. For patients with extensive lesions, palliative colectomy followed by systemic chemotherapy. Common chemotherapy regimens include: CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), R-CHOP (Rituximab + CHOP), MACOP, etc.

　　3. Lymphoma has a high sensitivity to radiotherapy and is suitable for the treatment of localized lesions and regional lymph nodes. Radiotherapy is limited by complications after radiotherapy of the small and large intestines. Therefore, it is suitable for patients with localized lesions.