Prevention and treatment of traditional Chinese medicine for elderly patients with colorectal cancer

Jia Wang, Zhu Yang, Feng-Xi Long, Jin-Lin Wu, Ting Yu, Xian-Man Wei, Xun Liu, Dong-Xin Tang

Prevention and treatment of traditional Chinese medicine for elderly patients with colorectal cancer

Jia Wang1, 3, Zhu Yang1, 3, Feng-Xi Long1, 3, Jin-Lin Wu1, 3, Ting Yu1, 3, Xian-Man Wei1, 3, Xun Liu1, 3, Dong-Xin Tang2, 3, *

1Guizhou University of Traditional Chinese Medicine, Guiyang, China.2First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China.3Tumor Inheritance and Scientific and Technological Innovation Talents Base of Traditional Chinese Medicine in Guizhou Province, Guiyang, China.

As China's population ages, the incidence of colorectal cancer in the elderly has increased. At present, colorectal cancer depends on surgery, radiotherapy and chemotherapy. Due to the characteristics of the elderly, postoperative recovery is slow, prone to postoperative complications and difficult to tolerate radiotherapy and chemotherapy have become the main problem hindering the disease. Based on the theory of prevention, the use of drugs from the perspective of constitution and etiology can prevent the occurrence of colorectal cancer in the elderly. Traditional Chinese medicine (TCM) combined with radiotherapy and chemotherapy can alleviate adverse reactions and improve treatment efficacy. TCM with surgical treatment can reduce the occurrence of postoperative complications and promote postoperative recovery. For patients with advanced colorectal cancer, TCM can play a role in fighting cancer and improving the quality of life of patients. For patients in stable phase, TCM can prevent tumor recurrence and metastasis.

Traditional Chinese medicine, Colorectal cancer, Elderly, Physique, Etiology, Western medicine treatment

As a special treatment method for malignant tumors in China, TCM can play an advantage in the prevention and treatment of colorectal cancer in the elderly. The idea of “prevention before disease” is applied to the prevention of colorectal cancer in the elderly.

Introduction

According to the International Agency for Research on Cancer, in 2012, there were about 1.36 million new cases of colorectal cancer worldwide, second only to lung cancer and breast cancer, ranking third in the world, and 69,000 deaths, third only to lung cancer, liver cancer and stomach cancer, ranking fourth in malignant tumors. In 2015, the incidence of colorectal cancer in China reached 23.03/100,000, and the mortality rate reached 11.11/100,000. The incidence rate and mortality rate showed an increase [2]. As China's population ages, the incidence of elderly patients with colorectal cancer will gradually increase. Surgery, radiotherapy and chemotherapy are the main methods for the treatment of intestinal cancer, but the physical response of the elderly is slower than that of young people. In the early stage of the tumor, there is a lack of typical clinical symptoms, and some patients often miss the best timing of surgery [3]. Older patients feel dull, and some patients have habitual constipation and hemorrhoids, so it is easy to be misdiagnosed [4]. The elderly patients are insufficient in vital energy and often accompanied by diseases, so most of them are difficult to tolerate systemic chemotherapy. In addition, the elderly patients recover slowly, due to anesthesia, mental factors and surgical stress, abdominal surgery can cause patients with varying degrees of gastrointestinal dysfunction [5]. Therefore, it is particularly important to select appropriate treatment for elderly patients with advanced intestinal cancer. In addition, due to personal constitution and etiology, the elderly patients with adenomatous polyposis and inflammatory bowel disease are prone to canceration, while the elderly patients with traditional Chinese medicine (TCM) syndrome differentiation and treatment can prevent the canceration of such diseases.

Traditional Chinese medicine to prevent elderly colorectal cancer

Huangdineijing (An ancient book of China, B.C. 220~211, Han Dynasty) said that "The sage will not wait until the disease occurs before going to treatment, but to treat the disease before it happens. Just as it is not waiting for the chaos to go to governance, but to govern before it happens." This shows that TCM emphasizes the treatment before the onset of disease in order to prevent the occurrence and development of disease, which is the thought of pre-treatment of disease in TCM. Applying the theory of preventive treatment to the prevention and treatment of malignant tumors is similar to the three-level prevention of modern oncology. Jinguiyaolue (An ancient book of China, about 205 AD, Eastern Han Dynasty) said, "If people can be prudent, do not let evil spirits dried up meridians. There is no reason for disease to come into its fungus if there is no body left to fail. "This is the theory of disease prevention in TCM. Precancerous lesions of colorectal cancer include adenomatous polyposis, dysplasia associated with inflammatory bowel disease, and distorted crypt foci. It has been confirmed that patients with dysplasia are pathological changes closely related to colorectal malignant tumors [6], so how It is very important to prevent cancer of such diseases.

Physique and prevention of colorectal cancer

With the decline of the functional activities of the internal organs, the physical characteristics of the elderly also change correspondingly. The constitution types of the elderly are mostly biased constitution, such as Qi deficiency, phlegm dampness and Yang deficiency. Studies have shown that yang deficiency and old age are risk factors for high-risk people with colorectal cancer, and yang deficiency is also a risk factor for colorectal cancer and precancerous lesions such as adenomatous polyps [8-10]. In addition, under the guidance of the theory of "Preventive Treatment of Diseases", TCM can effectively alleviate the clinical symptoms of patients with adenomatous polyps and effectively reduce its recurrence [11]. Therefore, the combination of constitutional identification and colorectal cancer screening, as the key screening target for the above high-risk groups, intervention and regulation of its biased constitution, is conducive to the prevention of colorectal cancer.

Etiology and prevention of colorectal cancer

The incidence of colorectal polyps tends to increase with the increase of age. The most common TCM symptoms of villous adenomatous polyps and cancerous polyps with higher malignancy are spleen-kidney Yang deficiency, and spleen-kidney Yang deficiency mainly occurs in elderly patients, followed by spleen deficiency and dampness, spleen weakness, liver-spleen disorder [12]. Therefore, it is necessary to treat different specific causes. The main pathogenesis of precancerous lesions of colorectal cancer is accumulation of intestinal toxins due to long-term accumulation of phlegm. Clinical treatment should be based on the principle of "eliminating phlegm and dredging Fu organs". In clinic,andare often used to clear up phlegm and turbidity.andto release visceral toxins [13].

Traditional Chinese medicine to treat elderly colorectal cancer

At present, the main treatment methods for colorectal cancer are surgery and radiotherapy and chemotherapy, and elderly patients often suffer from postoperative complications and intolerance to radiotherapy and chemotherapy due to poor physical function. Both Chinese and Western medicine can provide a more optimal treatment plan for elderly colorectal cancer, and can combine Chinese and Western medicine to supplement the therapeutic effect. Older patients have a slower body reaction, so most patients with colon cancer have been diagnosed with advanced tumors and cannot be treated with radical surgery. In addition, elderly patients have poor physical function and often cannot tolerate radiotherapy or chemotherapy, or when patients are resistant to chemotherapy, traditional Chinese medicine can be used as an alternative treatment to exert anti-tumor effects.

Combine with radiotherapy and chemotherapy to improve efficiency and reduce toxicity

Radiotherapy and chemotherapy are important treatments for patients with advanced colorectal cancer, but elderly patients with colorectal cancer are often difficult to tolerate, and serious side effects after radiotherapy and chemotherapy will affect the quality of life of patients. Modern medical research shows that Chinese herbal compound [For example, Yiqi Jianpi compound prescription:. Or Yiqi Jianpi anti-cancer compound prescription: on the basis of the previous prescription, add. Or Fuzheng Jiedu Quyu compound prescription:] combined with chemotherapy can reduce the adverse reactions of chemotherapy, and can also reverse the multi-drug resistance and sensitization of colorectal cancer [14,15]. Studies have shown that Jianpi Yiqi Jiedu decoction combined with FOLFOX6 regimen in the treatment of advanced colorectal cancer can increase short-term efficacy, improve quality of life, and reduce adverse reactions [16]. Huachansu Capsule is effective for the treatment of qi and yin deficiency caused by radiotherapy for rectal cancer, and can improve the immune function of patients [17]. Compared with XELOX chemotherapy alone, the combination of TCM and XELOX chemotherapy in elderly patients with colorectal cancer can improve the quality of life, improve the appetite of patients, and reduce the leukopenia caused by chemotherapy [18]. Thermosensitive moxibustion can effectively alleviate chemotherapy-related gastrointestinal reactions and hand numbness reactions in patients with colorectal cancer [19]. It can be seen that TCM compound, Chinese patent medicine, and TCM external treatment assisted radiotherapy and chemotherapy can not only reduce side effects, but also increase clinical efficacy, thereby exerting the effect of increasing efficiency and reducing toxicity.

Combined with surgery to promote postoperative recovery

Surgery is the preferred treatment for early colorectal cancer. Postoperative gastric motility usually recovers within 24 to 48 hours, while colonic motility usually recovers within 48 to 72 hours [20]. The elderly patients recover slowly after operation, are prone to complications such as gastrointestinal dysfunction after abdominal surgery, and often make temporary gastrointestinal dysfunction develop into postoperative intestinal obstruction. Current treatment mainly includes gastrointestinal decompression, intravenous infusion, parenteral nutrition, and simple exercise gradually out of bed activities [21-22]. Long-term gastrointestinal dysfunction can lead to malnutrition, and studies have shown that malnutrition in colorectal cancer significantly affects postoperative mortality and length of hospital stay [23]. Studies have shown that Chinese herbal compound can relieve pain, improve symptoms and improve the quality of life for patients with intestinal paralysis after colorectal cancer surgery [24]. For patients with colorectal cancer surgery, acupoint acupuncture and external application of traditional Chinese medicine can improve the curative effect and reduce postoperative adverse reactions [25]. TCM fumigation and washing in patients with abnormal bowel movement after rectal cancer can significantly improve their clinical symptoms [26]. Patients with postoperative chemotherapy for rectal cancer plus TCM enema can reduce the occurrence of postoperative complications, enable patients to better control bowel movements, improve their quality of life and short-term efficacy [27]. Therefore, It can be seen that the combined treatment of TCM can promote the recovery of gastrointestinal function in patients with postoperative intestinal cancer and reduce the incidence of postoperative complications in elderly patients.

Treatment of advanced colorectal cancer in the elderly with traditional Chinese medicine and prevention of recurrence and metastasis

For elderly patients with advanced colorectal cancer, it is impossible to undergo surgical treatment, in addition, elderly patients are difficult to tolerate radiotherapy and chemotherapy, or patients are resistant to chemotherapy, targeted therapy and other drugs, TCM can be used as an alternative treatment to play an anti-cancer role. At present,, a flower of seven leaves,andare often used for the treatment of colorectal cancer. On this basis, elderly patients often use the product of strengthening the body. When treating malignant tumors in TCM, we should first diagnose the disease as malignant tumors according to the pathological results. After defining the specific types of cancer, we should carry out syndrome differentiation and treatment by collecting four diagnostic data. Malignant tumors are prone to recurrence and metastasis, so on the basis of syndrome differentiation and treatment, Fuzheng anti-cancer drugs should be added to regulate the overall situation of patients and prevent recurrence and metastasis of tumors. Colorectal cancer is prone to liver metastasis and lymphatic metastasis. For stable elderly patients with colorectal cancer, TCM based on the idea of strengthening the body and eliminating pathogens to prevent colorectal cancer metastasis. Most of the elderly patients are deficient in positive qi, and their own positive Qi can not inhibit the recurrence and metastasis of malignant tumors. At this time, they should take both supplements and remedies. The treatment should be based on strengthening the body, supplemented by anti-cancer and eliminating pathogens.

Conclusion

As a special treatment method for malignant tumors in China, TCM can play an advantage in the prevention and treatment of colorectal cancer in the elderly. The idea of “prevention before disease” is applied to the prevention of colorectal cancer in the elderly. Screening and preventive treatment for high-risk groups through physiology and etiology, which is conducive to early detection of colorectal cancer and greatly reducing the risk of colorectal cancer. Prevalence the idea of "Prevention of deterioration of illness " is applied to elderly patients with colorectal cancer. It can prevent recurrence and metastasis and increase survival rate by strengthening the body and removing pathogens. As a supplementary treatment, TCM combined with surgery, radiotherapy and chemotherapy for elderly patients with colorectal cancer can reduce postoperative complications, promote postoperative recovery, reduce adverse reactions of radiotherapy and chemotherapy, and enhance the therapeutic effect. For patients with advanced and convalescent patients, TCM can be used as an alternative treatment in elderly patients with colorectal cancer, thereby playing a role in anti-tumor, improving quality of life, preventing tumor recurrence and metastasis. TCM provides new treatments for elderly patients with colorectal cancer and provides new treatment ideas for malignant tumors. After years of clinical observation and modern medical research, TCM as a special treatment method in China, can play many roles in the prevention and treatment of malignant tumor diseases, but for now, its mechanism of action needs to continue to explore.

1. International agency for research on cancer. colorectal cancer estimated incidence, mortality and prevalence worldwide in 2012.

2. National health and family planning commission of the people's republic of China. Regulations for diagnosis and treatment of colorectal cancer (2015 edition). Chin J Practical Surgery 2015, 53: 881-894.

3. Arifi S, Elmesbahi O, Amarti RA. Primary signet ring cell carcinoma of the colon and rectum. Bulletin Du Cancer 2015, 102: 880-888.

4. Garba SA, Han JY, Zhao ZX,Survival analysis of surgical treatment for advanced colorectal cancer. J Tongji Univer (Med Sci) 2016, 37: 107-113.

5. Vather R, Trivedi S, Bissett I. Defining Postoperative ileus: results of a systematic review and global survey. J Gastrointestinal Surgery 2013, 17: 962-972.

6. Li P, Wang YJ, Chen GY,Screening and diagnosis and treatment of early colorectal cancer and precancerous lesions in China. Chin J Practical Internal Med 2015, 35: 211-227.

7. Zhang H, Wang SS. Investigation on physical fitness of elderly residents and related factors of common biased constitution. World J Integr Tradit Western Med 2012, 7: 972-974, 997.

8. Zhao MM, Zeng BZ, Du M,Logistic regression analysis of colorectal cancer and TCM constitution and related risk factors. Chin J Integr Tradit Western Med 2019, 39: 23-27.

9. Shen L, Weng XL, Cao JC,Study on the distribution of TCM constitution types based on early screening of colorectal cancer. China J Tradit Chin Med Pharmacy 2015, 30: 2914-2916.

10. Liu Y, Feng YX, Yan SM,Study on the relationship between pathological types of colorectal polyps and TCM constitution. Chin J Integr Tradit Western Med Digestion 2014, 22: 291-293.

11. Zhang BP, Zhao XY, Liu G. Traditional Chinese medicine intervention study of adenomatous colorectal polyps based on the theory of “treatment of disease”. Chin General Practice 2012, 15: 2718-2720.

12. Xue J, Lin YF, Liu Y,Relationship between the occurrence and biological characteristics of colon polyps and TCM syndromes. Chin J Integr Tradit Western Med Digestion 2011, 19: 88-91.

13. Liu W, Jiao JP, Zhou YQ,Analysis of precancerous lesions of colorectal cancer from the treatment of phlegm and blood stasis - Professor Wei Pinkang's experience in clinical practice. Academic J Shanghai Univer Tradit Chin Med 2014, 28: 1-3.

14. Tang GY, Yin DF. Experimental study on the effects of Yiqi Jianpi anticancer method on microvessel density and apoptosis in colorectal cancer tissues. World J Integr Tradit Western Med 2016, 11: 601-604.

15. Liu XY, Zhao XM, Zhang GX,Effect of Fuzheng Jiedu Quyu Recipe on postoperative chemotherapy and attenuation of colorectal cancer. Chin J Surgery Integr Tradit Western Med 2016, 22: 150-156.

16. Zhu FY, Wang B, Ai Y,Clinical study of Jianpi Yiqi Jiedu Decoction combined with chemotherapy in the treatment of advanced colorectal cancer. Modern J Integr Tradit Chin Western Med 2016, 25: 261-263.

17. Ma HF. Effect of Huachansu Capsule on the efficacy of qi and yin deficiency syndrome in patients with rectal cancer after radiotherapy and its effect on immune function. Chin J Integr Tradit Western Med Digestion 2014, 22: 185-188.

18. Yao Q, Zhang YL, Deng JL,Clinical observation of traditional Chinese medicine compound combined with XELOX regimen in the treatment of elderly patients with advanced colorectal cancer. Modern J Integr Tradit Chin Western Med 2017, 26: 3399-3401.

19. Li ZP, Zheng Z, Wang LJ,. Efficacy evaluation of heat-sensitive moxibustion for improving symptomatic group of patients with colorectal cancer chemotherapy. Chin Acupunc Moxibustion 2015, 35: 1010-1013.

20. Story SK, Chamberlain RS. A comprehensive review of evidence-based strategies to prevent and treat postoperative ileus. Digestive Surgery 2009, 26: 265.

21. Tan Y, Ye Z, Tian H,Efficacy and safety of auricular point acupressure treatment for gastrointestinal dysfunction after laparoscopic cholecystectomy: study protocol for a randomized controlled trial. Trials 2016, 17: 280.

22. Meng ZQ, Garcia MK, Chiang JS,Electro-acupuncture to prevent prolonged postoperative ileus: a randomized clinical trial. World J Gastroenterology 2010, 16: 104-111.

23. Hu WH, Cajas-Monson LC, Eisenstein S,Preoperative malnutrition assessments as predictors of postoperative mortality and morbidity in colorectal cancer: an analysis of ACS-NSQIP. Nutrition J 2015, 14: 1-6.

24. Zou XX. Treatment of 46 cases of intestinal paralysis after colorectal cancer with integrated traditional Chinese and western medicine. Henan Tradit Chin Med 2016, 36: 655-657.

25. Hao L, Xu YL, Hao X,Clinical application of TCM syndrome differentiation and external treatment of traditional Chinese medicine before and after operation in patients with colorectal cancer. Chin Archives Tradit Chin Med 2016, 34: 2276-2278.

26. Zheng CF, Zhong GY. Treatment of 45 cases of bowel movement abnormality after rectal cancer treatment with traditional Chinese medicine fumigation and washing. Clinical J Chin Med 2013, 5: 58-59.

27. Fan KF. Clinical analysis of self-made Chinese medicine enema for patients with Dixon. Clinical J Chin Med 2013, 5: 72-73.

*Correspondence:Dong-Xin Tang, First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China. Tumor Inheritance and Scientific and Technological Innovation Talents Base of Traditional Chinese Medicine in Guizhou Province, Guiyang, China. Email: tangdongxin@sina.com

TCM, Traditional Chinese medicine.

The authors declare that there is no conflict of interests regarding the publication of this paper.

10.12032/TMRIM201903016

Wang J, Yang Z, Long FX,Prevention and treatment of traditional Chinese medicine for elderly patients with colorectal cancer. TMR Integrative Medicine 2019, 3: e19016.

Chang Liu