Rectal adenoma

　　Researchers at the University of Washington reported at the Digestive Disease Week in 2006 that the risk of developing colorectal adenomas in women with type 2 diabetes is 80% higher than that in non-diabetic women. Compared with non-obese, non-diabetic women, diabetes combined with obesity can increase the risk of colorectal adenomas and adenomas found at more advanced stages by more than twice.

　　Dr. Jill E. Elwing and her colleagues conducted a study on 100 female patients with type 2 diabetes and 500 non-diabetic women who underwent colonoscopy screening. The average age of the diabetic group was 60 years old, 41% were Caucasian, and 10% had a first-degree relative with colorectal cancer. The average body mass index was 34.4, and 29% used insulin. The hormone status of the non-diabetic control group was quite similar. The average age was 59 years old, 68% were Caucasian, and the average BMI was 28.5, with 7% having a first-degree relative with colorectal cancer.

　　Any adenoma or advanced adenoma that is villous or tubular villous and has a diameter greater than 1cm, or any highly dysplastic lesion, meets the definition of adenoma in this study. The incidence rate of adenoma in diabetic women is 37%, and 24% in non-diabetic women, so the probability is 1.80. The incidence rate of advanced adenoma in diabetic women is 14%, and 6% in non-diabetic women, with a probability of 2.4. Compared with non-obese, non-diabetic women, the probability of any adenoma and advanced adenoma in obese diabetic women is 2.6 and 3.5, respectively.

　　Dr. Elwing pointed out: 'Estrogen is believed to affect the growth rate of colorectal cancer, so we controlled the estrogen status.' As for the possible reasons for connecting diabetes and colorectal adenomas, hyperinsulinemia may be the cause. Insulin itself is a growth factor. It may have a direct promoting effect on tumor formation or act indirectly through growth factor-1.

　　Rectal adenoma refers to protruding hyperplastic lesions on the surface of the rectal mucosa into the intestinal lumen, including adenomas (including villous adenomas), juvenile polyps, inflammatory polyps, and polyposis, etc. There are currently no reports of complications.

   　Generally, there are no obvious symptoms in the early stage, and patients come to the hospital mostly through physical examination or the formation of ulcers and infections due to cancer formation, etc. The general symptoms include:

　　1. Direct stimulation symptoms, changes in defecation habits, a feeling of descent at the anus, incomplete defecation, and the desire to defecate again after defecation.

　　2. Symptoms of intestinal lumen narrowing caused by tumor, abdominal pain, abdominal distension, and loud bowel sounds.

　　3. Ulceration and infection of cancer caused by tumor formation, bloody mucus in stool, and some with purulent stool.

　　Rectal adenoma refers to protruding hyperplastic lesions on the surface of the rectal mucosa into the intestinal lumen, including adenomas (including villous adenomas), juvenile polyps, inflammatory polyps, and polyposis, etc. There is currently no effective preventive measures, and early detection and diagnosis are the key to the prevention and treatment of the disease.

　　1. Digital rectal examinationDigital rectal examination is very important and can detect adenomas in the rectum and part of the sigmoid colon. If the tumor is smooth, mobile, round, soft, and elastic, it often suggests a tubular adenoma. If the tumor is not smooth, lobulated, flat, or broad-based, soft in texture, it often suggests a villous adenoma. If the tumor texture is uneven, fixed, locally nodular, and accompanied by ulcers on the surface, it suggests the possibility of malignancy.

　　2. Fecal occult blood test (FOB)Those with a family history of colorectal tumors or changes in bowel habits should undergo fecal occult blood test for initial screening. If positive, further X-ray air-barium double-contrast imaging and endoscopic examination should be performed to exclude colorectal adenomas and other gastrointestinal lesions.

　　3. Radiological examinationThe oral barium enema examination is observed after 3 to 6 hours of barium contrast reaching the colon. This examination method has limitations. The missed diagnosis rate of colorectal adenomas with a diameter less than 1 cm can reach 80% or more in routine barium enema examination, while the missed diagnosis rate of those with a diameter greater than 1 cm is between 20% and 50%. Even with air-barium double-contrast imaging, the missed diagnosis rate of adenomas with a diameter greater than 1 cm is still between 10% and 30%, and can only show about 70% of larger lesions. The most easily missed sites are the sigmoid colon and cecum. Barium enema shows poor display of the size, surface morphology, and relationship with the colorectal mucosa of adenomas, and its detection rate is also affected by the examiner's experience and technical level. However, barium enema can be used as a supplement for those who have not completed the entire colorectal examination with colonoscopy, and sometimes even detect lesions that cannot be detected by colonoscopy. For patients with an older age, poor general condition, and unable to tolerate colonoscopy, the value of X-ray air-barium double-contrast imaging should not be ignored. The combined use of barium enema and colonoscopy can improve the detection rate of colorectal adenomas.

　　4. Endoscopic examination: The past commonly used rigid sigmoidoscopy equipment was simple, inexpensive, and easy to master, but due to its inability to inflate and the pushing effect on the intestinal tract, the actual observed intestinal cavity distance was shorter than the length of the scope, so it was gradually replaced. Fiberoptic colonoscopy can examine the entire colon and rectum, which is helpful for the location, histological diagnosis, and to some extent, treatment of colonic and rectal adenomas, so it is widely used. Although this method occasionally has complications such as bleeding or perforation, it is still safe if the technique is skilled.

　　1. Eat more than 5 kinds of fruits and vegetables every day. Long-term consumption of fruits and vegetables can reduce the chance of developing tumors by 50% or more. Eating more spinach and broccoli can help avoid colorectal cancer.

　　2. Drink more tea appropriately. Regardless of which type of tea, it is a natural plant containing a variety of antioxidants. Tea can achieve 20 times the antioxidant effect of vitamin E, because the oxidative stress caused by oxidation is the main cause of aging and tumors in the human body.

　　3. Limit meat intake. Generally, people who consume high-fat foods tend to have higher body weight and do not like to eat fruits and vegetables, and have a higher chance of developing tumors than the general population. Therefore, the American Cancer Society recommends that people choose low-fat foods, especially to limit animal fats.

　　Transanal endoscopic microsurgery is a minimally invasive surgery that can be used to remove benign tumors and selectively malignant tumors. A study was completed by 6 centers in Italy to evaluate transanal endoscopic microsurgery for the resection of rectal adenomas.

　　Except for benign tumors and selectively malignant tumors. A study involving 6 centers in Italy was completed to evaluate the surgical complications, mortality rate, and local recurrence rate of transanal endoscopic microsurgery for the resection of rectal adenomas. The results show that transanal endoscopic resection is effective in treating rectal adenomas.