关于结肠癌，你需要知道的几件事
What to Know About Colon Cancer
PAM BELLUCK
2020年8月31日
In the wake of Chadwick Boseman’s death from colon cancer at age 43, many people have questions about the disease, especially about the risk of colon cancer in younger people. Here’s what is known and what experts recommend.
43岁的查德维克·博斯曼(Chadwick Boseman)因结肠癌病逝后，许多人对这种疾病产生了疑问，尤其是年轻人患结肠癌的风险。以下是已知情况和专家建议。
Doesn’t colon cancer mostly affect older people?
结肠癌不是主要影响老年人吗？
Although the majority of cases are found in older people, there has been an increase in cases in younger people in recent years.
虽然大多数病例发生在老年人身上，但近年来年轻病例有所增加。
Among people over 65, rates of colorectal cancer, which includes tumors in the rectum or the colon, have actually been declining, probably because of more regular screening. Nonetheless, it is the second-leading cause of cancer deaths in the United States for men and women combined, and cases have been rising by about 2 percent annually in recent years in people under 50, according to a recent report by the American Cancer Society.
在65岁以上人群中，结肠直肠癌（包括直肠或结肠肿瘤）的发病率其实一直在下降，这可能是因为有了更多的定期筛查。不过，根据美国癌症协会(American Cancer Society)最近的一份报告，它是美国所有男性和女性的第二大癌症死因，近年来，50岁以下人群的病例以每年约2%的速度增长。
Experts aren’t sure exactly why. For some patients, obesity, diabetes, smoking or a family history of cancer may play a role, but not all people who develop colorectal cancer have these risk factors.
专家们还不确定确切原因。对一些患者来说，肥胖、糖尿病、吸烟或有癌症家族史可能是原因，但并不是所有患结肠直肠癌的人都有这些危险因素。
“The bottom line is we just don’t know,” said Dr. Robin B. Mendelsohn, co-director of the Center for Young Onset Colorectal Cancer at Memorial Sloan Kettering Cancer Center, which was opened in 2018 to treat younger patients and study the reasons for their diagnoses. She and her colleagues are exploring whether diet, medications like antibiotics, and the microbiome — which have all changed significantly for generations born in the 1960s and later — might be contributing to the cancer in younger people.
“总的来说我们确实不知道，”斯隆·凯特琳癌症中心(Memorial Sloan Kettering Cancer Center)青年结直肠癌中心的联合主任罗宾·B·门德尔松博士(Robin B. Mendelsohn)说，这一机构于2018年开业，专门治疗较年轻的患者，并研究他们的确诊原因。她和同事们正在探究饮食、抗生素等药物以及微生物群——对上世纪60年代以后出生的世代来说，这些因素都发生了显著变化——是否是年轻人患病的可能因素。
When is screening recommended?
建议什么时候进行筛查？
Everybody should begin getting screenings at age 45, the American Cancer Society and other expert groups recommend. But people with a family history of colon cancer should start getting tested at age 40, or at 10 years younger than the age at which their family member was diagnosed, whichever is sooner.
美国癌症协会和其他专家小组建议，每个人都应该在45岁开始接受筛查。但有结肠癌家族史的人应该在40岁开始，或者在比其被诊断出结肠癌的家族成员年龄小10岁的时候开始检查，以更早的那个时间为准。
Dr. Mendelsohn recommends early screening also for people with a history of inflammatory bowel disease, like ulcerative colitis or Crohn’s disease, and for people who have previously received radiation in their abdomen or pelvis.
门德尔松建议对有炎症性肠病（如溃疡性结肠炎或克罗恩病）病史的人，以及曾接受过腹腔和盆腔放疗的人进行早期筛查。
Screenings can be done with various tests on stool samples or with imaging-based tests like colonoscopies. The risks from these tests are relatively small. The prep for a colonoscopy, drinking liquid to cleanse the colon the day before, can be uncomfortable. But the advantage of a colonoscopy is that if it reveals polyps that might be precancerous, they can be removed during the test, said Dr. Mohamed E. Salem, an associate professor of medicine at the Levine Cancer Institute at Atrium Health in Charlotte, N.C.
筛查可以通过对粪便样本进行各种测试，也可以通过结肠镜检查等基于成像的测试。这些测试的风险相对较小。结肠镜检查的准备工作包括，在前一天饮用清洁结肠的液体，可能会让人不适。但结肠镜检查的优势在于，如果发现有可能是癌前病变的息肉，就可以在检查期间将其切除，北卡罗来纳州夏洛特市心房健康(Atrium Health)莱文癌症研究所(Levine Cancer Institute)的医学副教授穆罕默德·E·萨利姆博士(Dr. Mohamed E. Salem)说。
“It makes a huge difference when you detect cancer early versus late,” he said.
“癌症发现的早晚是有很大差别的，”他说。
“The five-year survival rate for young people for early-stage disease is 94 percent,” said Rebecca L. Siegel, the scientific director of surveillance research at the American Cancer Society. For people with late stages of the disease, the survival rate can be as low as 20 percent, she said. Early diagnosis, Ms. Siegel said, is “the difference between life and death.”
“青年早期结肠癌的五年生存率是94%，”美国癌症协会的监测研究科学主任丽贝卡·L·西格尔(Rebecca L. Siegel)说。该病晚期患者的存活率可能低至20%，她说。西格尔表示，早期诊断意味着“生与死的差别”。
Mr. Boseman learned in 2016 that he had Stage 3 colon cancer, according to an Instagram post announcing his death. Dr. Mendelsohn said that patients with Stage 3 “have an approximate 60 percent to 80 percent chance of cure,” depending on a number of factors, including whether the cancer is responsive to chemotherapy.
据Instagram上宣布他逝世的帖子表示，博斯曼在2016年得知自己患上了三期结肠癌。门德尔松称，三期患者有大约60%到80%的治愈机会，这取决于许多因素，包括癌症是否对化疗有反应。
Are there racial disparities in the risk of colon cancer?
结肠癌风险是否存在种族差异？
Yes. According to the recent American Cancer Society report, rates of colorectal cancer are higher among Black people. From 2012 to 2016, the rate of new cases in non-Hispanic Black people was 45.7 per 100,000, about 20 percent higher than the rate among non-Hispanic white people and 50 percent higher than the rate among Asian-Americans and Pacific Islanders. Alaska Natives had the highest rate: 89 per 100,000.
存在。根据美国癌症协会最近的报告，黑人患结直肠癌的概率更高。2012年至2016年，非西班牙裔黑人的新发病率为每10万人中有45.7人，比非西班牙裔白人高出约20%，比亚裔和太平洋岛民高出50%。阿拉斯加原住民的新发病率最高：每10万人中有89人。
Ms. Siegel also said that at any age, “African-Americans are 40 percent more likely to die from colorectal cancer. It’s because of later-stage diagnosis, it’s because of systemic racism and all that this population has been dealing with for hundreds of years.”
西格尔也表示，在任何年龄段，“非裔美国人死于结直肠癌的可能性都要高出40%。这是由于晚期诊断、系统性种族歧视和这一群体数百年来一直在面对的各种困难。”
What symptoms should prompt someone to see a doctor for possible colon cancer?
出现什么症状应该就医诊断可能的结肠癌？
Common symptoms include bloody stool or bleeding from the rectum, doctors say. Other symptoms can include constipation or diarrhea, a change in bowel habits, dark sticky feces, feeling anemic, abdominal pain or cramps, nausea, vomiting or unexplained weight loss.
医生表示，常见的症状包括大便带血或直肠出血。其他症状包括便秘或腹泻、排便习惯改变、粪便黑色粘稠、感觉贫血、腹痛或痉挛、恶心、呕吐或不明原因的体重下降。
“If you feel something, you have to say something,” Dr. Salem said. “Don’t put it off because you’re busy or because you’re a young person or because you have too much on your plate.”
“如果你感觉到什么不对，一定要说出来，”萨利姆说。“不要因为你很忙，或是你还年轻，或是你还有太多事情要做而推迟。”
Are younger people less likely to receive a diagnosis early, and are they less likely to discuss their disease?
年轻人是否较不容易得到早期诊断？他们是否更不愿意讨论自己的疾病？
Unfortunately, yes. The average time from symptoms to diagnosis for people under 50 is 271 days, Dr. Siegel said, compared with 29 days for people 50 and older.
很不幸，是的。西格尔说，50岁以下群体从出现症状到诊断的平均时间是271天，相比之下，50岁及以上群体的平均时间是29天。
“Both doctors and these young folks are not thinking they have cancer,” she said. “Part of that is screening, but it’s not all screening. Young patients have symptoms, sometimes for years. For one thing, they’re much less likely to have health insurance than older people, and so they have less money. And they’re thinking, ‘I’m a 30-year-old, what could be wrong with me — it’s going to go away.’”
“医生和这些年轻人都不认为他们得了癌症，”她说。“部分原因是筛查，但筛查不是全部。年轻患者会出现症状，有时持续好几年。一方面，比起年长者他们更可能没有医保，所以钱也更少。而他们还想着，‘我才30岁，能有什么问题——症状会消失的。’”
Also, she said, “There’s the embarrassment factor. ‘I’m bleeding from the rectum.’”
她也说，“还有尴尬的因素。‘我的直肠在流血呢。’”
Dr. Salem said that “there is a lot of shame somehow. Nobody likes to have bleeding, especially from their butt. Especially young people; they don’t like to discuss this or disclose this information. That’s understandable. But it’s our obligation to change that culture. It’s OK to talk about your pain in that area, or your bleeding, or your constipation, or your diarrhea.”
萨利姆说，“不知何故会有很多羞耻。没有人喜欢流血，尤其是在屁股里。特别是年轻人，他们不喜欢讨论这个或是透露这些信息。这也可以理解。但改变这种文化是我们的义务。谈论你那个部位的疼痛、流血、便秘、腹泻都是可以的。”
Doctors also need to get better at flagging a younger person’s symptoms as possible colorectal cancer, experts said.
专家说，医生们还需要更好地警告年轻人的症状存在结肠直肠癌的可能。
“Anytime patients are 75 years old and have rectal bleeding, we say ‘Make sure and get checked out for colon cancer,’” Dr. Salem said. “When younger people have rectal bleeding, sometimes we say ‘Oh, that’s hemorrhoids or stress from working too much.’ Those symptoms go on for many, many months or years, and now it’s not Stage 1 anymore, it’s Stage 3 or 4.”
“任何一位75岁的患者有直肠出血，我们说‘一定要做结肠癌检查，’”萨利姆说。“当年轻人有直肠出血时，有时我们会说，‘哦，那是痔疮或者工作太多造成的压力。’那些症状会持续好几个月甚至几年，结果就不再是一期，而变成三或四期了。”
Once they receive a diagnosis, doctors said, younger people should not feel ashamed.
医生们说，年轻人一旦被确诊，不应该感到羞耻。
“Increasing awareness and reducing stigma, all of this information could be saving lives now,” Dr. Siegel said. “Keeping a secret is not the way to go.”
“提高意识，减少污名，所有这些信息都可以拯救当下的生命，”西格尔说。“当成秘密来保守不是解决的办法。”
