Click on the blue text to follow us "Blood in stool, diarrhea, and abdominal pain" - these symptoms should never be ignored. What you may think is just an occasional bout of diarrhea could actually be an early sign of rectal cancer. Rectal cancer, as a type of colorectal cancer, often presents with subtle early symptoms, leading to many patients being diagnosed with advanced disease upon confirmation.
According to the latest data on the disease burden of malignant tumors in China released by the National Cancer Center (NCC) in February 2024, an estimated 4,824,700 new cases of malignant tumors were reported nationwide in 2022, with lung cancer ranking first in incidence among malignant tumors, followed by colorectal cancer (517,100 cases, 10.7%). [1] Colorectal cancer, also known as large intestine cancer, generally includes rectal cancer and colon cancer. The rectum, a segment of the intestinal tract at the end, is approximately 12-15 centimeters long and is a high-risk area for cancer development in all intestinal tracts.
Ms. Zhang sought medical attention in February 2020 due to an increase in bowel movements and blood present in her stool. ►Enteroscopy: At the junction of the rectum and the sigmoid colon, approximately 18cm into the scope, an ulcerative infiltrative lesion was visible, with obvious surface erosion, irregular raised edges, easy bleeding upon contact, slightly narrowed lumen, and a tough biopsy texture. ►Pathology: High-grade intraepithelial neoplasia with carcinogenesis in the mucosal glandular epithelium. On February 27, 2020, a radical resection of rectal cancer was performed. ►Postoperative pathology: 1. (Rectal) adenocarcinoma, grade II, ulcerative type, approximately 3.1cm x 2.5cm x 1cm in size, with cancer tissue invading the subserosal fat tissue, and visible vascular invasion. 2. No cancer tissue involvement was found in both rings of the (anastomotic) specimen. 3. Mesenteric lymph nodes (+) 8/22. 4. AJCC PTNM staging (8th Ed, 2017): PT4N2. 5. Immunohistochemical results: PMS2 (+), MSH2 (+), MSIH6 (+), MLH1 (+). Postoperative chemotherapy for 12 cycles. ►On July 15, 2021, tumor markers: CEA and CA19-9 increased. MR: Compared with the film on April 19, 2021: mass in the left lobe IV segment of the liver, unclear boundary, edge enhancement, about 38*22mm, possible metastasis. On July 28, 2021, liver metastasis focal surgery, postoperative temozolomide chemotherapy.
Staging and Grading of Rectal Cancer
● The commonly used staging system for rectal cancer is TNM staging, with stages I, II, III, and IV.
● Clinical TNM staging is mainly based on the number of regional lymph node metastases, the extent of the primary lesion, and the presence or absence of distant metastasis.
● T indicates the extent of the primary lesion of rectal cancer, clinically classified as T0 (no rectal cancer lesion), Tis (carcinoma in situ), T1 (involvement of the submucosal layer), T2 (involvement of the muscular layer), T3 (involvement of the adventitia), and T4 (involvement of perirectal tissues).
N represents the status of regional lymph node metastasis. It is classified according to the number of lymph node metastases: N0 (no lymph node metastasis), N1 (1-3 lymph node metastases), and N2 (4 or more lymph node metastases).
M indicates the presence or absence of distant metastasis. It is classified as M0 (no distant metastasis) and M1 (distant metastasis).
● Based on the degree of infiltration, staging can be divided into five stages: Stage I involves tumors that are limited to the mucosa and submucosa without lymph node metastasis. Stage II involves tumors that have invaded the muscularis propria without lymph node metastasis. Stage III involves tumors that have invaded the subserosa or perirectal tissues with lymph node metastasis. Stage IV involves tumors with distant organ metastasis, commonly to the liver, bones, and lungs.
Stage III is a watershed stage for tumors, with a high risk of recurrence and metastasis.
Professor Zhang Minghui, an immunology expert from Tsinghua University, explains the characteristics of Stage III tumors.
Ms. Zhang was diagnosed with rectal cancer in February 2020, and the postoperative pathology showed PT4N2, indicating a Stage III tumor.
Tumor staging is one of the most important factors affecting prognosis. Stage III is a watershed and a stage that is prone to recurrence and metastasis. Stage III rectal cancer refers to cancer that has invaded the serosal layer or surrounding tissues of the rectum, with lymph node metastasis, and belongs to the middle to late stage of rectal cancer. The treatment is difficult and the prognosis is relatively poor. If the patient is older, in poor physical condition, or has other illnesses, it may increase the difficulty and risk of treatment. In July 2021, Ms. Zhang underwent surgery for a liver metastasis focal lesion. Within just over a year, Ms. Zhang's condition relapsed and metastasized, progressing to stage IV. Stage IV rectal cancer is characterized by distant metastasis and has a relatively poor prognosis, requiring a comprehensive treatment strategy.
vNKT immunotherapy breaks the survival dilemma of advanced colorectal cancer
After learning about the characteristics of advanced rectal cancer, Ms. Zhang promptly contacted Professor Zhang Minghui's team at Lehe New Medicine to discuss vNKT cell therapy. The vNKT immune cell subpopulation discovered by Zhang Minghui's team at Tsinghua Universitypossesses both the nonspecific recognition function of NK cells and the specific recognition function of CD8+T cells,so the dual anti-tumor effect of vNKT cells can rapidly kill tumor cells. It not only directly kills cancer cells but also kills inhibitory immune cells (Myeloid-derived suppressor cells, MDSCs are a heterogeneous group of cells derived from the bone marrow, capable of significantly inhibiting immune cell responses and negatively regulating immune responses.),regulating the microenvironment within cancer tissues,providing new hope for the treatment of solid tumors. At the same time, vNKT cells are collected from the immune cells of healthy individuals, cultured and expanded, and then infused back into patients, making it easier to achieve treatment.
After a comprehensive understanding of Ms. Zhang's condition, the Lehexin Medical team provided a second diagnosis and treatment suggestion:
1. Ms. Zhang underwent radical resection for rectal cancer, and the postoperative pathology revealed risk factors such as vascular tumor thrombus and lymph node metastasis. The risk of postoperative recurrence is high, and adjuvant chemotherapy was administered postoperatively to control the disease progression as much as possible.
2. Despite undergoing 12 cycles of postoperative chemotherapy, Ms. Zhang still developed liver metastasis, indicating a high malignancy of the cancer cells.
3. After surgery and chemotherapy, the tumor burden was reduced to some extent, but there is still a risk of progression. It is recommended to undergo vNKT cell therapy to enhance the body's immunity and control tumor development.
According to the second diagnosis and treatment suggestion, Ms. Zhang began to undergo vNKT cell therapy on September 23, 2021, with a treatment regimen of 2 courses per month. During the treatment, Ms. Zhang's condition remained stable, and multiple follow-up examinations showed that the lesion remained stable. Therefore, in January 2022, the treatment regimen was adjusted to 1 course per month, and so far, 33 courses have been completed (as of April 19, 2024).
Pelvic imaging: 2021-12 pelvic MRI showed postoperative changes of rectal cancer without obvious signs of recurrence or metastasis. Follow-up MRI from 2022-2 to 2024-4 showed no changes compared to previous findings.
Chest imaging: The imaging on December 1, 2021, showed bilateral subpleural nodules, which remained unchanged during follow-up examinations from February 2022 to June 2022, suggesting a benign nature. No abnormalities were observed during follow-up examinations from February 2023 to April 2024. Re-examination is recommended.
Abdominal imaging: The imaging on December 2021, showed postoperative changes in the left lobe of the liver, a small cyst in the right lobe of the liver, and no other significant abnormalities. Follow-up examinations from February 2022 to April 2024 showed no changes. 
In July 2021, CEA, CA199, CA242, and CA50 levels were significantly elevated, but returned to normal range during the follow-up examination in August. During the cell therapy, CEA, CA19-9, CA242, and CA50 levels were within the normal range. From January 2022 to July 2022, the level of CA72-4 was intermittently higher than that in November 2021, and continued monitoring is required.
After vNKT cell therapy, Ms. Zhang's condition improved significantly. Her imaging follow-up results showed no abnormal signals. Ms. Zhang felt more energetic than before and was able to carry out physical labor, such as moving heavy shopping bags or luggage (over 5kg, such as a 5-liter barrel of cooking oil), for 8 minutes (approximately 800 meters), with good sleep quality. She had no problems with normal daily life and work.
Conclusion and Commentary
The early detection and treatment of cancer are crucial. Regular physical examinations and paying attention to abnormal bodily signals can facilitate early diagnosis. For patients in the middle and late stages, postoperative preventive treatment and active treatment after recurrence and metastasis are equally important. In the early stage, Ms. Zhang underwent radical surgery to remove the primary lesion, but she still experienced recurrence and metastasis in the short term. Later, even though the tumor progressed to stage IV, Ms. Zhang effectively controlled the disease and improved her quality of life through the active use of vNKT cell immunotherapy, breaking the survival dilemma of advanced intestinal cancer!
Reference source: [1] Zheng RS, Chen R, Han BF, Wang SM, Li L, Sun KX, Zeng HM, Wei WW, He J. [Cancer Incidence and Mortality in China, 2022]. Chinese Journal of Cancer. March 23, 2024; 46(3):221-231. Chinese. doi:10.3760/cma.j.cn112152-20240119-00035. PMID: 38468501.
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Written by: Liu Fengmei
Reviewed by: Qiao Jiacheng, Wang Ying, Gao Chen
Edited/typeset by: Zhang Jiao
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