Tumor of the colon symptoms and treatment. Colon cancer: symptoms. Stages and methods of treatment of colon cancer

In most cases, cancer colon determined rather late. The disease is detected after the patient has tumor metastases and damage to other organs and tissues. Discovered on early stages developing colon cancer increases the chances of a cure.

In the Yusupov hospital, thanks to modern equipment, highly qualified doctors using innovative techniques will be able to alleviate serious condition the patient and prolong the life of the patient.

Colon cancer symptoms

The colon is a segment of the large intestine. The main functions of the colon are secretion, absorption and evacuation of intestinal contents. The colon has the most great length. It consists of the ascending, descending, transverse and sigmoid colon, has a hepatic flexure, a splenic flexure. Colon cancer is one of the most common malignant diseases in developed countries, the population of which consumes excess amount animal fats, a lot of meat and very little fresh vegetables and fruits.

Symptoms of the disease become more pronounced as the tumor grows and intoxication of the body. Regional lymph nodes are located along the iliac, middle colon, right colon, left colon, inferior mesenteric, and superior rectal arteries. Various methods are used to detect early stages of colon cancer:

• colonoscopy;
• biopsy. Histological examination;
• x-ray examination;
• sigmoidoscopy;
• other methods.

The clinical picture in the case of tumor growth is quite clear, it is diverse, depending on the location, shape of the tumor, and various aggravating circumstances. Left-sided colon cancer is characterized by rapid narrowing of the intestinal lumen, the development of its obstruction. Right-sided colon cancer is characterized by anemia, intense abdominal pain. In the early stages of colon cancer, the symptoms are similar to various diseases of the gastrointestinal tract, which often does not allow timely diagnosis. correct diagnosis. Symptoms of colon cancer include:

• belching
• non-systematic vomiting;
• heaviness in the abdomen after eating;
• nausea;
• flatulence;
• pain in the abdomen;
• constipation or diarrhea;
• change in the nature of the chair, its shape;
• feeling of discomfort incomplete emptying intestines;
• iron deficiency anemia.

Often, colon cancer is accompanied by the addition of an infection and the development of an inflammatory process in the tumor. Pain in the abdomen may resemble pain in acute appendicitis, fever often rises, blood tests show an increase in ESR and leukocytosis. All these symptoms often lead to medical error. Early manifestations of colon cancer are intestinal discomfort, the symptoms of which are often attributed to diseases of the gallbladder, liver, and pancreas. Constipation in colon cancer is not treatable, which becomes an important symptom of the development of cancer. Left-sided colon cancer is much more likely to be accompanied by intestinal disorders than right-sided cancer.

Constipation in colon cancer can be replaced by diarrhea, bloating, belching and rumbling in the abdomen. This condition may be disturbing. long time. The appointment of a diet, treatment of intestinal disorders does not bring results. Most severe symptoms with bloating and constipation, characteristic of rectosigmoid colon cancer, appear in the early stages of cancer development.

Intestinal obstruction in colon cancer is an indicator of late manifestation of cancer, more common in left-sided cancer. The right section of the intestine has a large diameter, a thin wall, the right section contains fluid - obstruction of this section occurs in the later stages of cancer, in the last turn. The left part of the intestine has a smaller diameter, it contains soft stool, with the growth of the tumor, the intestinal lumen narrows and the lumen becomes blocked with feces - intestinal obstruction develops.

With the right-sided form of cancer, patients often find the tumor themselves during palpation of the abdomen. Bloody issues in colon cancer, they are more often observed in exophytic types of tumors, begin with the decay of the tumor, and are late manifestations of malignant formation.

Colon cancer: survival

In the absence of metastases in regional lymph nodes, the survival of patients over 5 years is about 60%. In the presence of metastases in regional lymph nodes, only about 25% of patients live more than 5 years.

Cancer of the ascending colon: symptoms

Cancer of the ascending colon is characterized by severe pain syndrome. Pain in the abdomen is also very disturbing in cancer of the caecum. This symptom is one of the signs of cancer of these parts of the colon.

Cancer of the splenic flexure of the colon

Due to its anatomical location, cancer of the splenic flexure of the colon is poorly determined by palpation. Cancer of the hepatic flexure of the colon is also poorly defined. Most often, the examination is carried out in a standing or half-sitting position. Such a study at primary examination of the patient allows you to get information about the presence, size of the tumor and the location of its localization.

Cancer of the transverse colon: symptoms

Cancer of the transverse colon develops less frequently than cancer of the sigmoid or caecum. With a growing tumor of the transverse colon, the right colon, middle, left colon and lower mesenteric lymph nodes are affected. Symptoms of transverse colon cancer are loss of appetite, a feeling of heaviness in the upper abdomen, belching, and vomiting. These symptoms often characterize cancer. right side transverse colon.

To timely determine the clinical stage of the development of the disease, the start of treatment for colon cancer, the following actions should be taken:

• anamnesis collected;
• a physical examination was performed. Many tumors are detected by palpation abdominal cavity;
• total colonoscopy with biopsy. With the help of colonoscopy, the size of the tumor, its location is determined, the risk of complications is assessed, and a biopsy is performed;
• irrigoscopy. It is performed when it is impossible to conduct a colonoscopy;
• Ultrasound of the abdominal cavity, retroperitoneal space with contrast (intravenous);
• x-ray chest;
• analysis for oncomarkers, clinical and biochemical blood tests, analysis of tumor biological material for the KRAS mutation;
• CT scan of the abdominal cavity with intravenous contrast. It is performed if an operation on the liver is planned due to damage to the organ by metastases;
• osteoscintigraphy. Carried out in cases of suspected injury skeletal system metastases;
• PET-CT 2 - if metastases are suspected.

When a patient is being prepared for surgical treatment, additional studies are carried out on the state of the cardiovascular system, respiratory function, blood clotting, and urine. The patient receives advice from an endocrinologist, neuropathologist, cardiologist and other specialists.

The main treatment for this disease is surgery. The affected area of ​​the colon is resected along with the mesentery, and the lymph nodes are also removed. If cancer of the ascending colon is found, treatment is by right-sided hemicolectomy. The tumor of the caecum is removed by the same method. The surgeon removes the lymphatic apparatus, the entire right half of the colon, including a third of the transverse colon, ascending colon, caecum, and the hepatic flexure.

Chemotherapy for colon cancer

Colorectal cancer ranks third among malignant diseases. Chemotherapy is used for various purposes - to reduce the tumor before surgery, stop its growth, destroy cancer cells, metastases. Colorectal cancer is a tumor that is quite resistant to cytostatics. Chemotherapy for colon cancer is prescribed by a doctor depending on the size of the tumor and the presence of metastases, and is carried out in courses.

Chemotherapy in the treatment of colon cancer has its own characteristics - drugs such as oxaliplatin, irinotecan, cetuximab are not used because of their ineffectiveness after surgery. A group of these drugs, together with a fluoropyramide duet, is used for treatment before surgery and receive nice results– the life expectancy of patients increases. Chemotherapy for colon cancer with tumor metastasis is palliative.

Unresectable colon cancer is characterized by the germination of the tumor in the bone structures, the main vessels. An assessment is made of the possibility of removing the tumor; if surgical intervention is not possible, palliative treatment (chemotherapy) is used, with intestinal obstruction, bypass ileostomies, colostomies, and anastomoses are formed.

Colon cancer most often metastasizes to regional lymph nodes not immediately, but after a long time after tumor development. The tumor often grows into neighboring tissues and organs without metastasizing to the regional lymph nodes. Colon cancer is generalized, with penetrating metastases to the lungs, the liver requires consultation of a thoracic surgeon, a hepatologist surgeon. During surgery on the liver, radiofrequency ablation is additionally used (with its help, metastases are removed), radiation exposure. Chemotherapy in this case is used as an experimental method, it can lead to liver damage, as well as to the difficulty of finding some "disappeared" metastases.

Initially resectable metastatic lesions are removed surgically followed by palliative chemotherapy. Also, as a treatment, systemic chemotherapy is performed before surgery to remove metastases, after surgery, chemotherapy treatment is continued.

Colon cancer of the 2nd and 3rd stages of development is treated with a surgical operation. Adjuvant chemotherapy is performed in the presence of metastases in regional lymph nodes, with tumor invasion serous membrane and in other cases.

Locally advanced and resectable colon cancer is operated on taking into account the localization of the tumor and its local spread. With the defeat of regional lymph nodes, germination of the tumor of the serous membrane, adjuvant chemotherapy is performed.

With the potential for the development of tumor foci from metastases, the most active chemotherapy is used. After several cycles of chemotherapy, the state of metastases and the removal of foci are assessed. After surgery, adjuvant chemotherapy is used.

Colon cancer with concomitant severe pathology is operated on only after a consultation of doctors who calculate all the risks associated with the operation. Most patients undergo palliative medicinal treatment and symptomatic treatment. The patient can form an unloading intestinal stroma, stent the tumor.

An important role in the treatment of colon cancer is played by radiation therapy, which is used together with drug therapy, chemotherapy. All difficult cases are considered at a consultation of doctors, where a treatment strategy is developed. Chemotherapy for stage 2 colon cancer, in case of its microsatellite instability, is not recommended. In this case, treatment with fluoropyrimidines is ineffective.

Surgical treatment in planned and emergency cases does not differ. If the tumor is localized in the region of the ascending colon, caecum, proximal third of the transverse colon, hepatic flexure, a primary anastomosis is formed. If the tumor is located in the left sections of the colon, Hartmann and Mikulich operations are performed. After decompression of the colon, a primary anastomosis is formed.

Where to go for colon cancer?

In the Yusupov hospital, colon cancer treatment is carried out with the help of modern equipment and highly qualified oncologists. Innovative techniques help to alleviate the serious condition of the patient and prolong the life of the patient. To undergo the diagnosis and treatment of the disease, you should sign up for a consultation or call by phone. The medical coordinator of the center will answer all your questions.

Bibliography

• ICD-10 (International Classification of Diseases)
• Yusupov hospital
• Cherenkov V. G. Clinical Oncology. - 3rd ed. - M.: Medical book, 2010. - 434 p. - ISBN 978-5-91894-002-0.
• Shirokorad V. I., Makhson A. N., Yadykov O. A. Status of oncourological care in Moscow // Oncourology. - 2013. - No. 4. - S. 10-13.
• Volosyanko M. I. Traditional and natural methods of prevention and treatment of cancer, Aquarium, 1994
• John Niederhuber, James Armitage, James Doroshow, Michael Kastan, Joel Tepper Abeloff's Clinical Oncology - 5th Edition, eMEDICAL BOOKS, 2013

Colon cancer treatment prices

*The information on the site is for informational purposes only. All materials and prices posted on the site are not a public offer, determined by the provisions of Art. 437 of the Civil Code of the Russian Federation. For exact information, please contact the clinic staff or visit our clinic. List of rendered paid services listed in the price list of the Yusupov hospital.

*The information on the site is for informational purposes only. All materials and prices posted on the site are not a public offer, determined by the provisions of Art. 437 of the Civil Code of the Russian Federation. For exact information, please contact the clinic staff or visit our clinic.

Thus, malignancy in diffuse polyposis occurs in almost 100% of cases.

Some authors attribute the increase in cases of colorectal carcinomas in developed countries to an increase in the dietary content of meat and animal fat, especially beef and pork, and a decrease in fiber. There has been a sharp decline in cases among vegetarians. There is a high frequency of colonorectal carcinomas among workers in asbestos industries and sawmills.

Most often, cancerous tumors develop in the places of the bends of the colon, i.e., in places of stagnation of feces, which makes it possible to consider chronic constipation as one of the predisposing factors. They also play a role chronic colitis and, most importantly, polyposis of the colon.

The favorite localization of cancer is the caecum, the hepatic flexure, the splenic angle and the sigmoid colon. Approximately 40% are affected by the caecum and 25% by the sigmoid. In cancer that occurs against the background of polyposis, multiple foci of tumor development are not uncommon (double and triple localization).

In colon cancer, exophytic (growing inside the intestine) delimited forms, endophytic infiltrating and mixed forms are distinguished.

According to the histological structure, cancers emanating from the glandular epithelium of the intestinal mucosa are defined as adenocarcinomas, solid and colloid cancers, rarely the tumor has the structure of cricoid, undifferentiated or squamous cell carcinoma.

Clinical symptoms vary depending on the location of the tumor. The clinical picture of colon cancer in the early stages does not manifest itself in any way. vivid symptoms, although a thorough examination of the patient can reveal a change general well-being, decreased ability to work, decreased appetite. Weight loss in colon cancer is rare, on the contrary, patients may even gain weight.

In the future, a number of signs of intestinal disorders appear: rumbling and transfusion in the intestines, diarrhea and constipation, periodic cramping or constant dull pain in the abdomen, not associated with eating. With the developed narrowing of the intestinal lumen by a cancerous tumor, one-sided uneven abdominal distension occurs. Cancer of the right colon causes anemia due to slow chronic blood loss.

In the future, the symptoms of the disease increase, in severe cases intestinal obstruction, bleeding, inflammatory complications (abscess, phlegmon, peritonitis) are observed.

When examining a patient, no external signs are determined, and only with a significant size of the tumor or in thin patients can it be felt through the abdominal wall.

An important role in the diagnosis belongs to X-ray examination. With the current level of knowledge and examination methods, the radiologist manages to detect a cancerous lesion of the colon even in the absence of clear clinical signs. The study is carried out using a contrast suspension of barium, given both through the mouth and administered with an enema. In some cases, the relief of the intestinal mucosa is additionally studied against the background of air introduced into its lumen. At the same time, a filling defect is detected with exophytic (tumors protruding into the lumen of the intestine) or areas of narrowing with an irregular mucosal relief and uneven corroded contours.

For cancer distal departments, i.e., damage to the sigmoid colon, the necessary research methods also include sigmoidoscopy and colonoscopy, in which the intestinal mucosa is examined with the eye and, having detected a tumor, a biopsy is performed.

The selection of patients for examination is carried out after analysis clinical symptoms, obtaining the results of a stool test for the presence of blood, determining the carcinoembryonic antigen in the blood.

Ultrasound tomography (ultrasound) is performed to exclude liver metastases. Laparoscopy (endoscopic examination of the abdominal cavity) is indicated to exclude the generalization of the malignant process.

Radical treatment of colon cancer is possible only surgical method. The options for operations are different depending on the level of the location of the tumor: in case of cancer of the blind, ascending and hepatic flexure of the intestine, the entire right half of it is removed, creating an anastomosis between the ileum and the transverse colon (right-sided hemicolectomy). In case of cancer of the transverse colon, its resection is performed with the restoration of patency by the anastomosis between the remaining segments; in case of cancer of the splenic angle and descending section, the entire left half of the large intestine with an anastomosis between the transverse colon and sigmoid colon is removed (left-sided hemicolectomy); finally, in case of cancer of the sigmoid colon, it is resected. There are a number of modifications of these operations, which we will not dwell on.

Preparing patients for surgery and consists in a thorough cleansing of the intestines. 3-4 days before the operation, patients are transferred to a light slag-free diet, excluding bread, potatoes and other vegetables from the diet. In two days the patient receives Castor oil and repeated enemas, including the night before surgery. Prophylactically within 2-3 days, a course of antibiotics and sulfamids is carried out.

After the operation, in addition to general measures to combat postoperative shock, dehydration and intoxication, the patient is prescribed vaseline oil 30 g twice a day. This mild laxative will prevent the formation of dense feces that could injure the fistula suture line. From the 2nd day, drinking is allowed, and then light liquid food, gradually expanding the diet, and after the first normal stool patients are transferred to a general diet.

With inoperable, advanced forms of colon cancer, palliative operations have to be performed - the imposition of bypass anastomoses or a fecal fistula to prevent the possible development of acute intestinal obstruction when the intestine is blocked by a tumor. In addition to palliative operations, a course of chemotherapy is carried out.

Colon cancer recurrences are rarely observed, only as a result of a non-radical operation performed and in the absence of distant metastases, repeated operations are resorted to.

Colon cancer metastasizes through the lymphatic tract, affecting the lymph nodes of the mesentery, and then a group of nodes along the way. abdominal aorta. Hematogenous metastases most often occur in the liver. When the tumor grows into the serous cover of the intestine, dissemination of the process along the peritoneum may occur, accompanied by ascites.

In colon cancer, the prognosis depends on the stage of the process, but in the absence of metastases to the lymph nodes, it is relatively favorable, because almost half of the patients receive a permanent cure.

Patients at risk are subject to dispensary observation. Prevention of colon cancer mainly comes down to the timely radical treatment of intestinal polyposis, as well as the correct treatment of colitis in order to prevent its transition to a chronic form.

An important preventive measure is the normalization of nutrition, a decrease in the content of meat products in the diet, and the fight against constipation.

Since a decrease in the risk of colon cancer in smokers has been observed, some authors recommend starting smoking after 60 years of age as a preventive measure. But smoking (especially cigarettes!) can cause other health problems, so the NICOTER program of the ONKONET System is currently the ideal solution to the problem.

Symptoms of transverse colon cancer: treatment and prognosis

The colon is the longest part of the large intestine. If visualized, it resembles a slightly distorted letter "P". The rectum completes the P-shaped intestine.

This organ does not take part in the digestive tract, but absorbs liquid, electrolytes that enter the body during a meal. The chyme or liquid content of the small intestine that has entered the colon, turned into feces, exits into the rectum. The length of the colon is one and a half meters and is divided into four sectors:

• Ascending colon - 24 cm;
• Transverse - 56 cm;
• Descending colon - 22 cm;
• Sigmoid - 47 cm.

Colon cancer is one of the most common diseases in developed countries and is in second place among oncological pathologies of the gastrointestinal tract. The United States and Canada are recognized as leaders in the number of patients with colon tumor. A high percentage of cases in Europe, Japan, Australia, but residents of other Asian countries and African countries rarely suffer from this pathology. The disease most often affects people aged 65 and over.

The reasons

A malignant tumor is located on the walls of the colon and, when growing, is able to completely block the intestinal lumen, which is 5-8 cm in diameter.

The reasons, cancer-causing colon have many factors, both pathogenetic and etiological. Pathology can be formed due to:

• Precancerous diseases left to chance - ulcerative nonspecific colitis, diffuse polyposis, diverticulosis, Crohn's disease, hereditary polyposis, adenoma.
• Improper nutrition - refined carbohydrates, animal fats, proteins.
• Obesity.
• Age category over 50 years old.
• Chronic constipation against the background of senile atony.
• Increased content of endogenous carcinogen in the contents of the intestine.
• Permanent damage to the folds of the intestine by feces.
• Sedentary lifestyle.

Important! Vegetarians are much less prone to oncology than lovers of meat food, and in particular fatty beef, pork.

Classification

Colon cancer is divided into three forms:

• Endophytic tumor. With this type of pathology, the neoplasm does not have clear boundaries, it is localized in the intestinal walls on the left side. The tumor can be ulcerative-infiltrative, circular-structuring and infiltrating.
• Exophytic formation has the form of polyps, nodules or villous - papillary. This type of tumor appears in the lumen of the intestine on the right side.
• Combined or mixed.

By international classification colon cancer is divided into types, which determines the analysis of the cellular structure.

• Adenocarcinoma is poorly differentiated, moderately differentiated and highly differentiated. It develops from epithelial cells.
• Mucosal adenocarcinoma is a colloidal, mucoid, and mucinous carcinoma. Formed in the glandular epithelium of the intestinal mucosa.
• Ring-shaped - cellular or mucocellular cancer. Tumor cells are separately located blisters.
• Colloidal cancer.
• Glandular-squamous and squamous. The tumor was formed from epithelial cells - glandular flat and flat.
• Undifferentiated carcinoma consists of a medullary-trabecular constitution.

Colon cancer differs in the location of the tumor, the degree of damage to tissues and organs, and the severity of the course. The clinical picture of the disease has six forms:

1. enterocolitic;
2. dyspeptic;
3. obstructive;
4. toxic-anemic;
5. atypical or tumor;
6. pseudo-inflammatory.

A malignant formation can be located anywhere in the intestinal section. More than 50% of patients suffer from oncology of the rectum and sigmoid colon, all other tumors appear in the zone of the right flexure or the hepatic angle of the colon, in the cells of the ascending and transverse and descending sections, as well as in the area of ​​the splenic flexure.

Cancer of the ascending colon Cancer of the ascending colon, in 18% of cases, its symptoms resemble other diseases. Signs characteristic of this pathology:

• pain syndrome, localized in different zones - in the groin, right hypochondrium, upper abdomen and the entire abdomen, iliac region on the right side.
• violations in the work of the intestines - diarrhea, constipation, or their alternation.
• increased intestinal peristalsis, manifested in the form of strong rumbling, bloating, bloating.
• the color of stool is stained in dark color due to the admixture of blood, the presence of pus and mucus in it.
• the presence of a dense, infiltrate with an uneven surface.

Important! Ascending cancer is characterized by late appearance of metastases. Because of this, tumors large sizes are considered operable.

If metastasis occurs in the lymph nodes and atypical cells remain in them for a long time, then the removal of the lymph nodes along with the mesentery will help stop the growth of the tumor throughout the patient's body.

Oncology of the descending department

The tumor of the colon of its descending section is 5% of other data of anomalies. Due to the fact that the lumen of the descending colon has a small diameter, and the feces have a semi-solid consistency, one of the main signs of oncology is the constant alternation frequent stool and constipation.

For cancer of the descending department is also characteristic:

• complete or partial intestinal obstruction, accompanied by paroxysmal pain in the peritoneum;
• the presence of blood in the feces.

Malignant formation of hepatic angulation and flexure

Cancer of the hepatic flexure of the colon narrows the intestinal lumen, causing obstruction. In its symptoms, the pathology is similar to a cancerous tumor of the ascending colon. Bleeding caused by organ damage leads to anemia.

The neoplasm in the place where the hepatic angle is located looks like a decaying tumor that has grown into duodenum. With this arrangement of cancer, the appendix, cholecystitis, adnexitis and gastric and duodenal ulcers are stimulated. Such a malignant formation leads to the appearance of a colonic fistula, intestinal obstruction.

Neoplasm of the transverse colon

Cancer of the transverse colon is characterized by severe pain. This is due to spastic contraction of the intestine, at the time of pushing the feces through the narrow intestinal lumen in the area of ​​the tumor. The inflammation caused by the decay of the formation aggravates the process of cleansing the body. On the initial stage, until the tumor penetrates beyond the walls of the intestine, pain rarely appears, and the tumor is palpated.

Tumors of this type make up 9% of the total number of colon cancers.

Signs of transverse colon cancer are as follows:

• rapidly developing intestinal obstruction;
• frequent belching;
• heaviness in the upper abdomen;
• sudden weight loss due to constant nausea and attacks of vomiting;
• bloating and rumbling of the abdomen is chronic;
• flatulence;
• constipation and diarrhea;
• secretion of mucus, blood, pus at the time of defecation;
• the patient's condition deteriorated sharply, the skin is pale, developed weakness and fatigue from a slight load.

Cancer of the splenic flexure of the colon

This pathology occurs in % of patients with bowel cancer. Painful sensations, if this is a splenic type of pathology, are combined with an unreasonable rise in body temperature, muscle tension in the anterior and left walls of the peritoneum, and leukocytosis.

Fecal masses accumulate above the location of the neoplasm, which causes the process of decay, fermentation, stool retention, gases, bloating, nausea and vomiting. The composition of the intestinal flora changes.

Forms

The main forms and symptoms of colon cancer:

• Toxico-anemic causes anemia, fatigue, pallor of the skin, weakness.
• Dyspeptic is caused by nausea, belching, vomiting, aversion to food, a feeling of heaviness and bloating, which is accompanied by pain.
• Obturation has leading signs - intestinal obstruction. In connection with partial obstruction of the feces, there is bloating and rumbling of the abdomen, a feeling of fullness, cramping pains, difficulty in passing gases, feces. Reducing the lumen of the intestine requires emergency surgical intervention.
• Enterocolitic form that causes problems with the intestines - bursting, rumbling, bloating, diarrhea, constipation. All this is accompanied by pain and the presence of blood, mucus in the feces.
• Pseudo-inflammatory with an increase in body temperature, the presence of pain, an increase in ESR, leukocytes in the blood.
• The tumor-like form does not have any certain symptoms, but the tumor can be palpated during examination.

Complication

Colon cancer has severe consequences if the patient has not received proper and timely treatment.

1. Intestinal obstruction affects 15% of patients. This complication occurs due to the growth of the tumor in the left side of the colon.
2. Phlegmon, abscesses and other purulent-inflammatory processes occur in 10% of patients with this type of cancer. The formation of abscesses is inherent in the neoplasm of the ascending department.
3. Perforation of the intestinal walls is observed only in 2% of patients, but with a small rate, this complication ends in death. Rupture of the walls of the intestine occurs due to the collapse of the tumor and ulceration. Such anomalies lead to the fact that the contents of the intestine enter the abdominal cavity and peritonitis occurs. Intestinal masses caught in fiber cause phlegmon and abscesses of the retroperitoneal zone.
4. Penetration cancerous tumor into hollow organs leads to the appearance of fistulas - entero-vesical and enterovaginal.

stages

All oncological diseases have four stages of development of the disease and the initial - zero.

• Stage 0 - the mucous membrane is damaged, but there are no infiltrations, metastases, lymph nodes are unchanged.
• Stage 1 - a small tumor appears in the submucosa and mucosa of the intestine, metastasis is not observed.
• Stage 2 - the neoplasm blocked the intestinal lumen by 1/3. There is no germination in neighboring organs. Single metastases appeared in the lymph nodes.
• Stage 3 - the circumference of the intestine is half closed by the tumor. It sprouted beyond its location and affected nearby organs. There are metastases in the lymph nodes.
• Stage 4 - the tumor has a size of more than five centimeters, has penetrated into other organs. Metastasis occurs throughout the body.

Symptoms

The main symptoms of colon cancer are as follows:

• the presence of blood in the stool;
• intestinal upset in the form of non-systematic diarrhea occurring at different times without the participation of food taken;
• undulating, girdle pain in the abdomen.

Similar symptoms may be associated with other pathologies that are not related to oncology.

• stomach ulcer;
• ulcerative enterocolitis;
• haemorrhoids;
• severe food poisoning;
• exotic food;
• stress.

For example, the most common cause of blood in the stool is hemorrhoids. This is due to the fact that hemorrhoids burst at the time of passage of feces.

Important! As people age, they need to look out for a number of signs that indicate they have colon cancer.

Certain symptoms include:

Free legal advice:

• going to the toilet more than four times a day;
• after eating any food, abdominal pain develops;
• loss of appetite, aversion to food, lethargy, pallor, cold sweat;
• comes out of the mouth bad smell, and belching is accompanied by a putrid odor;
• feeling that in anus is, something superfluous, which in the future begins to hang outside the anus;
• vomiting after and before meals.

Early stage colon tumors almost always go unnoticed because there are no or only mild symptoms.

Important! Modern people and the elderly are accustomed to the fact that they have a breakdown, malaise, and digestive disorders. But for the prevention of cancer after 60 years, it is necessary to undergo annual examinations, and especially for cancer of the intestines and colon. This disease ranks second worldwide in terms of the number of deaths. The first is lung cancer.

Diagnostics

Diagnosis of oncology of the colon, as well as bowel cancer, is carried out using comprehensive examination- clinical, endoscopic, radiological and laboratory.

• The clinical study consists of taking an anamnesis, talking with the patient, performing palpation and percussion of the abdominal cavity, examining the rectum with a finger through the anus.
• X-ray examination includes irrigography, irrigoscopy and plain radiography of the abdominal organs.
• Endoscopic diagnostics is carried out using sigmoidoscopy, laparoscopy, at the time of the procedure, material is taken for biopsy and fibrocolonoscopy.
• Laboratory diagnostics consists in a coagulogram, general analysis blood, the study of fecal masses for the presence of occult blood and analysis for tumor markers.
• additional diagnostics is the conduct of computed tomography, magnetic resonance imaging and ultrasound.

Differential diagnosis of cancer allows you to identify what the tumor is - benign education, polyps, tuberculous lesions of the intestine, or it is a colon sarcoma.

If on palpation of the right iliac region a tumor has been identified, it may represent an appendicular infiltrate or a disordered connection of the tissues surrounding the inflamed appendix.

Treatment

In order for the prognosis for a patient with ROK to be good, treatment must be comprehensive.

Colon tumors are treated with surgery followed by chemotherapy and radiation exposure. The doctor will draw up a therapy regimen that will take into account the type of tumor, the stage of the process, the location, the presence of metastases, general state and age of the patient, as well as concomitant diseases, which he was told by the patient's medical history.

Before the operation, the patient must follow a slag-free diet. 2 days before the procedure, he is given cleansing enemas and prescribed to drink castor oil. Potatoes, all vegetables, bread are excluded from the diet. AT preventive purposes prescribe antibiotics and sulfa drugs.

Immediately before surgery, the patient is repeatedly cleansed of the intestines with laxatives or an orthograde bowel lavage is performed using a probe with an isotonic solution.

Treatment of the disease without the presence of complications in the form of obstruction, intestinal rupture and metastases is carried out by radical operations with the removal of the affected areas of the intestine with the mesentery and lymph nodes.

In the presence of a neoplasm in the colon on the right, a right-sided hemicolonectomy is performed. During this operation, the blind, ascending, third of the transverse colon and 10 cm of the ileum in the terminal section are removed. Simultaneously with them, resection of nearby lymph nodes is performed. After everything necessary has been removed, the connection of the small and large intestine or anastomosis is performed.

If the tumor has affected the colon on the left side, then a left-sided hemicolonectomy is prescribed. Perform an anastomosis and remove:

• 1/3 of the transverse colon;
• descending colon;
• part of the sigmoid;
• mesentery;
• lymph nodes.

If the tumor is small in the center of the transverse section, then it is removed, as is the omentum with lymph nodes. The tumor located at the bottom of the sigmoid colon and in the center is excised with lymph nodes and mesentery. Next, the large intestine is connected to the small intestine.

When a tumor affects other organs and tissues, all affected areas are removed with the help of an operation. Palliative therapy is started when the cancer is advanced and if the tumor is inoperable.

At the time of the operation, bypass anastomoses are made to the sections of the intestine, between which there is a fecal fistula. This is necessary to exclude acute intestinal obstruction. If it is necessary to completely turn off the intestine, then the adductor and efferent loops of the intestine are sutured between the anastomosis and the fistula, and then the fistula with the part of the intestine turned off is removed. Such an operation is necessary in the presence of multiple fistulas and a transient deterioration of the patient's condition.

Chemotherapy is prescribed to rule out adverse effects. Radiation exposure is carried out three weeks after tumor removal. Both methods of therapy have many side effects - nausea, vomiting, hair loss, skin rash, damage to the intestinal mucosa, lack of appetite.

For the first day after surgery, the patient spends medical measures to eliminate dehydration, intoxication and shock. The next day, the patient can start taking water, liquid and soft food. Further, the patient's diet is gradually expanded. He is prescribed the use of the following dishes:

Important! In order to prevent the occurrence of constipation, the patient is given vaseline oil. It helps to gently cleanse the intestines, without traumatizing the postoperative sutures.

Forecast

Patients diagnosed with colon cancer need to know that the prognosis for them will be worsened by complications, side effects. Fatal outcomes after removal of a tumor of the colon is 6-8%. If left untreated and if the disease is advanced, the mortality rate is 100%.

Survival for 5 years:

• after the operation - 50%.
• In the presence of a tumor that did not affect the submucosa - 100%.
• In the absence of metastasis to the lymph nodes - 80%.
• In the presence of metastases in the liver and lymph nodes - 40%.

Payr's syndrome: what is the splenic angle of the large intestine to blame for?

Problems may arise in the inflection of the colon in the left hypochondrium, leading to a characteristic symptom complex - Payr's syndrome

Payr's syndrome, or splenic angle syndrome

The German surgeon, professor at the University Hospital in Greifswald, Erwin Payr, described the clinic of the disease, which is caused by narrowing of the large intestine in the area of ​​​​its inflection at the junction of the transverse to the descending colon. This symptom complex was manifested by cramping pain in the left hypochondrium, associated with impaired patency of intestinal contents and gases in the region of the splenic flexure of the colon. Subsequently, this disease (more precisely, the syndrome) was named after the scientist who discovered it - Payr's syndrome. One of the sphincters located just below the splenic flexure is named after this surgeon.

Studies show that about 46% of cases of chronic colostasis are associated with Payr's syndrome. So the problem is quite common. Lack of awareness of doctors in this disease leads to the fact that patients are treated for a long time for other diagnoses.

Patients with pain in the left hypochondrium are often treated for completely different diagnoses.

Symptoms that are observed in the syndrome of the splenic angle

1. Pain in the abdomen. This is the most common symptom of Payr's syndrome. The pain is usually localized in the left hypochondrium. Sometimes abdominal pain in localization resembles heart attack. The pain is described by patients as severe and lasts for several minutes. These pains can recur several times over several weeks and months. Quite characteristic is the increase in pain with physical activity and after a heavy meal. Many patients report an increase in pain intensity with age.

And although a number of authors attribute Payr's syndrome to the clinical variant of irritable bowel syndrome (IBS, Irritable Bowel Syndrome), there are still studies confirming the presence of inflammatory changes in the histological examination of the intestinal wall.

2. Constipation. Delayed stool is noted by most of the patients. The duration of constipation can be up to 5 days. Obviously, the intensity of the pain syndrome also depends on the duration of constipation.

3. Ileocecal reflux. Due to overstretching of the colon, there may be a reflux of the contents of the colon into the small intestine - colonic reflux. Casting can also be of a congenital nature: with a congenital anomaly of the ileocecal valve and its insufficiency. When colonic contents enter the small intestine (due to a significant difference in the composition and amount of microflora), an inflammatory process occurs. The so-called reflux ileitis. Therefore, pain can be observed in the right abdomen.

4. Nausea and vomiting. The reasons for the mechanism are reflex.

5. Fever, headache, irritability. And if a systemic reaction, an increase in temperature is enough rare symptom, then irritability and headache are constant companions of a patient with Payr's syndrome. With chronic pain and stress, try to stay calm ... Plus nervous exhaustion added toxicity.

Causes of Payr's syndrome

Pain and discomfort in gastrointestinal tract have many different causes, pain in the splenic angle is no different here. Here are a number of reasons:

1. Pronounced bending of the colon in the splenic angle. May be due to coloptosis (low position of the transverse colon). Coloptosis can be congenital anomaly(eg, a long transverse colon) may also occur in overweight patients. In general, coloptosis is often observed in obese people. Why is the large intestine also called Intestinum Crassum in honor of the commander Mark Licinius Crassus (who suppressed the uprising of Spartacus), a very full man.

The long transverse colon results in a very strong kink in the splenic angulation

2. Accumulation of gases. This is believed to be the most common cause of flexural splenic syndrome and is due to excess gas in the large intestine. In order for the patient to get rid of discomfort, it is necessary to reduce gas formation and improve gas discharge.

2. Bloating. Here it is more due to neighboring organs, for example, the stomach. Excessive gas formation can be caused by poor digestion of food in the stomach and small intestine. Or due to the so-called aerophagy - swallowing air. This is a fairly common cause of colic in newborns (aerophagia when screaming and crying). This can occur when drinking quickly, chewing gum, breathing through the mouth.

3. Inflammatory bowel disease (ulcerative colitis and Crohn's disease). With these diseases, the intestinal mucosa is quite affected.

4. food poisoning. Most often caused by various bacterial agents (salmonella, staphylococcus, clostridia, pathogenic strains of Escherichia coli).

5. Postoperative period. Against the background of postoperative paresis (functional weakening of peristalsis). This can lead to pain in the left hypochondrium.

6. Various obstacles. It is usually cancer of the descending colon.

7. Functional weakening of peristalsis in peritonitis.

8. Intestinal obstruction.

9. Changing the composition of the diet. presence in the diet a large number short-chain carbohydrates: they can hold water in the intestinal lumen and increase fermentation processes. Examples: apples, prunes, Brussels sprouts, sweet cherry. Foods that increase flatulence: potatoes, soybeans, peas, broccoli, alcohol.

Diagnosis of Payr's syndrome

Now there is no single diagnostic procedure, which can accurately identify and confirm Payr's syndrome.

1. Collection of anamnesis. Like a student medical history. A characteristic "sketch" in the future diagnosis can be sketched after a detailed questioning of the patient: how, where and what worries. It is necessary to identify the relationship of pain with the position of the body, food intake, movement. How and under what circumstances the symptoms appeared. Need information about comorbidities. Therefore, questioning the patient has always been and will be in the first place.

2. Inspection. Palpation can determine the localization of abdominal pain, its nature and intensity. Sometimes with percussion in the region of the splenic angle, in the left hypochondrium there may be a characteristic "drum" sound.

3. Irrigography. No, not a colonoscopy. Yet for the recognition of Payra's disease is a decisive method. it X-ray method diagnostics using barium sulfate as a contrast agent. The barium suspension is diluted with saline in a ratio of 1 to 3 and injected into the rectum (the intestine is previously cleaned with laxatives) under the control of an x-ray screen. At the same time, they pay attention to the shape and position of the large intestine (and the method is quite clear). Pictures are taken in the supine position (with a full colon) and standing - after emptying. Attention is focused on the bend of the colon in the splenic angle.

4. Colonoscopy. With this method, it is possible to identify a number of diseases that lead to a violation of the passage of intestinal contents (including adenocarcinoma of the colon).

5. Computed tomography and magnetic resonance imaging of the abdominal cavity.

Treatment of Payr's syndrome

1. Diet correction. Actually, this is the first recommendation that is given to a patient with this problem. Foods that promote flatulence should be avoided. Foods high in fat, starch and sugar should be limited. It is recommended to increase the amount of fiber in the diet. Food should be fractional, in small portions.

2. Normalization of the chair. If the diet does not give proper treatment, then mild laxatives are recommended.

3. Avoiding swallowing air. In addition to not chewing gum or drinking soda, doctors advise taking prebiotic supplements before meals and chewing food thoroughly.

4. Medicines. For Payra's disease, apply:

Antacids. Reduce bloating.

Antispasmodics. Given to reduce abdominal pain.

Antihistamines. Some are used to relieve pain and intestinal spasm

Metoclopramide. Improves peristalsis and relieves abdominal pain.

5. Physiotherapy. The pain syndrome is removed by electrophoresis with novocaine on the anterior abdominal wall, diathermy on the lumbar region. good effect gives medical gymnastics.

Indications for surgery in Payr's syndrome

Persistent pain syndrome that is not relieved by medication, as well as a clinic of partial intestinal obstruction

Progression of disease symptoms despite adequate conservative therapy.

Surgical treatment of Payr's syndrome is reduced to two operations: resection of the transverse colon or omission of the splenic angle by dissection of the colon-splenic and colon-phrenic ligaments. In the latter case, laparoscopic techniques have shown themselves well.

Prognosis of splenic angle syndrome

The prognosis at the initial stages and with appropriate treatment is favorable. The effect of surgery is good, but there is a risk of complications of surgery. I remind you: do not self-medicate. Seek help from a doctor.

The colon is the largest section of the large intestine in terms of length and area. Digestion, absorption of dietary fibers and elements takes place in it. What could not be digested is formed into feces and comes out.

Colon cancer is a malignant lesion of one or more of its departments with a progressive course, metastasis, dysfunction and various complications.

In the anatomy of the intestine, independent sections and bends are distinguished.

The departments include:

• Ascending part.

Located in the right side of the abdomen. It is a continuation of the caecum.

• Cross section.

It occupies the upper floor of the abdominal cavity. It is projected in the supra-umbilical region, follows the ascending section.

• descending part.

Lies in the left half of the abdomen, serves as a continuation of the transverse segment, is the final section of the colon. It ends with a transition to the sigmoid colon.

Between the parts there are bends:

• Hepatic flexure of the colon.

It is located under the liver, on the right, in the upper right quadrant of the abdominal wall. Lies between the end of the ascending part and the beginning of the transverse. There the organ has a certain extension.

• Splenic flexure.

Located on the left, in the upper left quadrant. Extends between the end of the transverse section and the beginning of the descending section, borders on the spleen.

Classification

There are several classification criteria. Depending on the type of tissues and cells from which the tumor is formed, there are:

• epithelial cancer.

Formed from epithelial type tissues. It is the most common form. Responds well to chemotherapy treatment.

• Adenocarcinoma.

It is dominated by mutation and degeneration of glandular elements. It is in second place in terms of prevalence. Tends to progress rapidly. Not always treatable with chemotherapy.

• Mucous cancer.

Formed from mucus-producing cells and mucous membranes. It is not so common, about 10% of all types.

• Ring cell carcinoma.

It is put only on the basis of a study of biopsy specimens under a microscope. In cells, the nuclei are of huge size, they resemble a ring in shape, hence the name. Aggressive tumor, has a severe course.

• undifferentiated carcinoma.

It is almost impossible to determine the neglected form, the type of cells. Poorly treatable, has a poor prognosis.

Depending on the form, progression and extent of the lesion, the stages are distinguished:

• Stage 0 is precancerous.

The first atypical cells begin to form, there are no complaints or symptoms yet. May be manifested by mucosal hyperemia. It responds well to treatment, the prognosis of recovery is close to 100%.

• Stage 1

True cancer, the most initial and light in the flow. Characterized small tumor, on the mucous layer, without germination in depth, does not give metastases.

It may not manifest itself clinically, so it is not often diagnosed. With timely detection and treatment, the prognosis is good, the cure rate is 90%.

• Stage 2

The tumor takes on a larger size, the submucosal layer is affected, without metastasis, early symptoms appear. Pain syndrome, dyspeptic symptoms may disturb, it is well treated. The survival rate for stage 2 cancer is 70-90%.

• Stage 3

The tumor is large, grows into the deep layers. Blocks more than half of the intestinal lumen. It has metastases and lesions of the lymph nodes.

Symptoms are expressed: pain at the site of localization, obstruction, constipation, asthenovegetative syndrome. It is not always treatable, the prognosis is moderately favorable. The five-year survival rate is 30-50%.

• Stage 4

The heaviest and most neglected. Extensive damage to the organ, obstruction of the lumen. Multiple distant metastases and lesions of the lymph nodes.

Complications in the form of intestinal obstruction, bleeding, infectious processes. The prognosis is not favorable, it is practically not amenable to treatment. The three-year survival rate is up to 20%.

The first symptoms of colon cancer

Symptoms do not always occur in the early stages. They usually develop in the later stages. This complicates the tactics of treatment and prognosis.

• Feeling of discomfort at the site of the tumor or pain syndrome.

It can form in the left or right side of the abdomen. All envy from the localization of the malignant focus. At first, the pain is periodic, muffled. Then it becomes a nagging constant. Not related to eating.

• Constipation is a common symptom.

A person cannot empty his intestines for 3-4 days, sometimes for weeks. At the same time, the stomach is greatly swollen.

• Flatulence.

The phenomenon of abundant gas formation and swelling of intestinal loops. It may be the only sign of pathology.

• Feces with pathological impurities.

First mucus joins, then pus. At extreme degrees, streaks of blood or obvious bleeding appear, this is a formidable sign, if it appears, immediately consult a doctor.

• Loss of appetite.

Associated with a violation of the digestive functions of the intestine.

• Rapid weight loss.

Caused by tumor blockage of the lumen of the colon:

• Paleness of the skin, followed by increasing jaundice.
• General weakness, malaise, chronic fatigue.
• Dyspeptic phenomena: nausea, vomiting, diarrheal syndrome.
• Persistent and prolonged increase in body temperature.

When joining complications, the following symptoms may appear:

• Suppuration of the tumor, purulent fusion. Comes with sharp pains.
• Accession secondary infection. Clinic of septic lesions.
• Bleeding internal hidden and external obvious.
• Rupture of the intestinal wall. Causes a state of shock, loss of consciousness, to whom.
• Wall perforation.

Symptoms of liver damage

In colon cancer, the first organ that suffers from metastatic lesions is the liver. Most often this occurs when the primary focus is localized in the hepatic flexure.

The tumor itself can grow into the capsule and parenchyma of the liver. What characterizes this phenomenon:

• The patient will report general malaise.

Suffering from insomnia, anxiety, decreased performance.

• An important syndrome is jaundice.

In bright yellow the sclera are stained, the mucous membranes are visible, and then the whole skin. The jaundice is constant and does not go away.

• Skin itching.

A sign of cholestatic lesions and congestion of bile, joins at stages 3-4:

• Dull pain in right hypochondrium.
• Discoloration of feces. It becomes almost white.
• Urine acquires a dark color, becomes the color of beer.
• Skin rashes, hemorrhages.
• Edema syndrome.

First, edema appears on the limbs, then in the abdominal cavity. ascites is formed.

• Portal hypertension syndrome is a persistent increase in blood pressure numbers.
• Varicose veins of the esophagus with subsequent bleeding from them.

Symptoms in women

Due to the peculiarities reproductive system and anatomical and physiological nuances, the symptoms of colon cancer in women may differ.

Due to a different innervation, pain can spread not only at the site of the focus, but also in the lower abdomen, inguinal zones.

In case of violations menstrual cycle, not associated with hormonal disruptions or pregnancy, in some women, menstruation becomes profuse, resembling uterine bleeding.

The main signs in women:

• An increase in the size of the abdomen as during pregnancy.
• Soreness and hardening of the inguinal lymph nodes.
• Hormonal failures, endocrinopathy.
• Sudden mood swings, brittle nails, severe hair loss.

Cancer of the hepatic flexure of the colon

Occurs relatively infrequently, localized in the upper right half of the abdomen. The tumor progresses moderately, the liver is often involved in the process, as it borders on the department.

What are the symptoms of cancer:

• Pain of diffuse dull nature.

It spreads in the right hypochondrium, in the umbilical region on the right. It can give to the navel, epigastrium, back, lower back.

• Jaundice.

Early development of icterus of the sclera, skin, visible mucous membranes. Jaundice is not eliminated by drugs.

• The presence of hemorrhages on the skin of the extremities.
• Obstructive intestinal obstruction. The patient is unable to empty the bowels.
• The presence of ascites, edematous syndrome.
• At grade 4, an expansion of the veins is formed on the skin of the abdominal wall.
• In extreme cases, a coma, hepatic encephalopathy is formed.

Pathology is treated in a combined way: a combination operational methods and chemotherapy. The prognosis for cancer of the hepatic flexure depends on the stage. At 1-2 degrees, it is treated well, not for a long time.

Survival after surgery is 80-90%. At 3-4 degrees, the prognosis is doubtful, more in an unfavorable direction.

Cancer of the splenic flexure of the colon

The percentage of its prevalence is not high. It rarely appears as an independent focus, it is a metastatic lesion from other parts of the intestine, while the spleen is involved in the process.

Symptoms:

• Dull pain in the left hypochondrium, to the left of the umbilicus. Irradiation in left shoulder blade, collarbone, epigastric region
• Severe nausea, frequent vomiting.
• Nose, gum bleeding.
• The appearance of multiple bruises on the skin of the body.
• Frequent diarrhea.
• Intestinal obstruction may be associated.
• Lemon jaundice.

Treatment requires special attention, as a delicate organ is involved - the spleen. At the first stage, courses of chemotherapy drugs are prescribed, followed by operational access, the entire area with the affected lymph nodes is removed.

The prognosis for cancer of the splenic flexure of the colon is uncertain. If there is no germination in the spleen, then the survival rate is high, in other cases there is a high risk of death.

Symptoms of cancer of the ascending colon

For cancer of this department of the organ, the entire general symptoms. Highlight individual points:

• Pain of a aching nature is spread throughout the right side of the abdomen, from the very bottom to the chest. It intensifies a couple of hours after eating, when the intestinal loops are stretched.
• Intestinal obstruction appears early. Such patients with an acute attack get to the hospital as a matter of urgency.
• Loss of appetite, sudden weight loss.
• Prolonged constipation.
• Weakness, dizziness, nausea.

Prognosis of Survival in Ascending Colon Cancer

The prognosis for this form is related to the degree. The early stages are actively amenable to chemotherapy. Then the affected area is removed by performing an anastomosis. The survival rate is high, over five years 70%, 3-5 years - 90%.

In the later stages, due to metastatic spread and complications, treatment is complicated. Five-year survival is up to 40%, 3-year - up to 50%. This is why early diagnosis is so important.

Symptoms and prognosis in transverse colon cancer

Pathology is common among all oncological lesions of the intestine. It has symptoms characteristic of the entire colon.

• Pain in the injured area. Patients note soreness of a dull or acute nature from above the navel, it increases a couple of hours after eating.
• Asthenovegetative manifestations.
• Alternating constipation and diarrhea.
• Vomiting of food eaten the day before.
• Nausea.
• Formation of difficulty in the passage of the food bolus through the intestines.
• Heartburn.
• Persistent fever.

The prognosis for the disease is associated with early diagnosis. The earlier the disease is detected, the greater the chance of a favorable outcome. At complete resection transverse section survival rate is 75%.

If there are metastases, then the percentage drops to 50. At grade 4, the outcome is not favorable. Doctors give a life span of 3-5 years, subject to all recommendations.

Symptoms of cancer of the descending colon

The disease is characterized by:

• Heaviness in the left abdomen and lower back.
• Intestinal obstruction. Profuse diarrhea.
• An admixture of mucus, pus, blood in the feces.
• Weight loss of a person for a month by 10-15 kg.
• Dryness and pallor of the skin.
• Absence of vomiting.
• Rapid progression of the disease.

Surgical treatment of cancer

For the treatment of colon cancer, a combination of methods is used: chemotherapy, radiation therapy and surgical operations. Operational tactics play a leading role.

What do they do with online access. It all depends on the prevalence of localization, the volume of the lesion. If the focus is located in the right sections, then they resort to a hemicolonectomy operation, remove the entire cecum, the ascending colon, and a section of the transverse colon.

The lymphatic regional apparatus is completely excised. The remaining sections of the intestine are connected by making an anastomosis between the loops. If necessary, a stoma is applied - the loop section is brought out onto the abdominal wall.

If the left sections are affected, a left-sided ectomy is performed. The left sections of the intestine are excised with the imposition of anastomoses and stoma, if necessary.

If the tumor is small at an early stage, the intestine is not completely removed. Produce its resection - excision of a site or several loops. Be sure to remove the mesenteric lymph nodes.

In the later stages, palliative operations are performed aimed at preserving and prolonging the life of the patient, alleviating his suffering and providing comfort.

Cancer Survival

It depends directly on the duration of the course, the volume of the lesion, the stage of the pathology. If the tumor is small, without metastases and complications, then the prognosis is favorable. People are cured completely without relapses, the survival rate is close to 90%.

If there are metastases, then the percentage is significantly reduced, they look at the shape and volume of the operation.

Survival rates range from 50 to 70%. In the later stages, survival is low. With palliative tactics, people live 5 or more years - 15%, 2-3 years up to 30%.

Differential Diagnosis

Colon cancer should be distinguished from other pathologies with similar symptoms.

• inflammatory processes.

They are characterized by an acute course, the pain is more pronounced. Feature - liquid stools and profuse vomiting. High fever, pronounced intoxication syndrome. Amenable to antibacterial and anti-inflammatory treatment, does not have a long-term character.

• Acute appendicitis.

Severe pain in the right iliac region, high fever. At the same time, appendicular symptoms are positive. On palpation of the area, the pain increases.

In the general blood test, inflammatory changes are noted, there is no intestinal obstruction, jaundice. An inflamed appendicular process is determined by ultrasound.

• Nonspecific ulcerative colitis.

The pain is localized in the lower abdomen, there is no obstruction. Mucus impurities in the feces, diarrheal syndrome is characteristic, confirmed endoscopically. Actively treated with antibiotic therapy.

• Worm infestations.

They proceed without intoxication and temperature, without pain. Often there is itching in the anal region. In the general analysis of blood, eosinophilia is detected. Amenable to therapy with antihelminthic drugs.

The modern world, along with the growth of scientific achievements and methods of treatment, receives more and more "diseases of civilization".

People move less, sit for a long time, and refined food is more and more like a miracle of a chemical laboratory. The number of oncological diseases is growing, their transmission to offspring is gradually fixed at the genetic level.

Colon cancer is a malignant tumor that affects different parts of the colon. The incidence is high in both sexes after 50 years of age. It is very rare in young people. The danger lies in the long asymptomatic course and late detection of the tumor.

About the organ

The colon is part of the large intestine. It includes several departments:

• blind;
• ascending department;
• transverse colon;
• descending;
• sigmoid.

Functionally, digestion of food no longer occurs here. It absorbs water and electrolytes, forming feces. intestinal flora, living in the folds, synthesizes vitamins of group B, K, participates in maintaining immunity and prevents the reproduction of pathogenic microorganisms.

Causes of the disease

1. Nutrition Features. The predominance of refined foods with a small amount of vegetable fibers, rich in animal fats and simple carbohydrates. Such food slowly passes through the intestines, does not provide a nutrient substrate for microflora.
2. Reduced lifestyle physical activity leads to a decrease in the tone of the body as a whole and the intestines in particular, the movement of feces slows down, and a tendency to constipation appears.
3. Chronic constipation. If the stool is in the intestines for a long time, all the water is absorbed from it, it becomes dry. In the natural corners of the intestine, mucosal injury occurs.
4. Age after 50 years as a factor in the development of intestinal atony and a tendency to constipation.
5. Precancerous diseases: Crohn's disease, polyps, ulcerative colitis, diverticulosis, Turk's disease.
6. Permanent exposure to harmful substances in production.
7. Heredity. If there were relatives younger than 50 with colon cancer, then it is highly likely that it will develop again in future generations.

Kinds

Morphologically malignant tumors of the colon are represented by the following types:

1. Adenocarcinoma- the most common form, accounting for up to 80% of detected cancer. There are various degrees of differentiation. The higher it is, the better the prognosis for a cure. It can grow in the form of a node, infiltrative or mixed.
2. Mucosal adenocarcinoma(colloidal cancer) is in second place in terms of frequency, it accounts for up to 12%. Morphologically characterized by the synthesis of a significant amount of mucus. The diagnosis is made when the tumor is 50% extracellular mucus.
3. Signet cell carcinoma characteristic for the age of 40 years. Mucus collects in the cells, which pushes the nucleus to the edge. It grows infiltratively, early metastasizes to regional lymph nodes.
4. Squamous or glandular-squamous form are rare. Often develop on the border of the anal region. There are no signs of keratinization in the cells.
5. undifferentiated carcinoma does not have histological features of any of the forms. Aggressive type of tumor, grows infiltratively, metastasizes early. The survival prognosis is the least favorable.
6. solid cancer- carcinoma with a large accumulation of polymorphic cells and a small number of differentiated ones. Altered cells retain the ability to produce mucus.

By location

1. Ascending colon.
2. Transverse colon.
3. Hepatic flexure.
4. Hepatic angle.
5. Splenic flexure.

The nature of growth is divided into several types:

• endophytic- growth in the intestinal wall with the formation of ulcers;
• diffusely infiltrative– intraparietal spread without a clear boundary of healthy tissues;
• anular form with a circular lesion of the wall and narrowing of the lumen of the intestinal tube;
• exophytic- cancer in the form of a polyp grows into the lumen.

stages

According to the prevalence of the tumor, 4 stages are distinguished:

• I- is determined in the mucous and submucosal layers;
• IIa- cancer occupies up to half of the circumference of the intestine, there are no metastases;
• IIb- cancer up to half the radius of the intestine, grows beyond the wall, but there are no metastases;
• IIIa- the tumor is spread over more than half of the bowel circumference, there are no metastases;
• IIIb- metastases are diagnosed in regional lymph nodes;
• IV– infiltrates adjacent organs, multiple lymph node metastases, or any cancer volume with distant seeding of other organs.

TNM classification developed, where T is the state of the primary tumor, N is the lymph nodes, M is the presence of metastases. Depending on the severity of a trait, a specific number is assigned to it.

Symptoms

1. Bleeding can appear at any stage of cancer. When localized in the ascending section, the hepatic angle is characterized by hidden bleeding, which is not visible to the naked eye. Left side carcinoma is accompanied by the appearance of dark blood in the stool, often mixed with stool and mucus.
2. Abdominal pain characteristic of the later stages, in some patients it is absent.
3. Constipation is the cause and effect of the tumor, is associated with impaired patency, narrowing of the lumen.
4. Tenesmus- false urge to defecate, more typical for tumors of the final sections.
5. Intestinal obstruction develops gradually, the diameter of the intestine narrows. Sometimes it can occur acutely and be the first symptom of carcinoma.
6. Weakness, loss of appetite and weight- signs of exhaustion under the influence of the tumor process.
7. Anemia appears with hidden long-term bleeding from the right sections of the intestine.
8. Ascites and liver enlargement appears in the later stages of cancer.

Diagnostics

1. General inspection does not give reliable information about a tumor of the colon. characteristic symptoms for her no. Complaints during the collection of anamnesis for any problems with the intestines after 50 years give the right to assume the development of carcinoma.
2. General blood analysis reflects inflammatory reactions, which may accompany cancer, anemia with overt or latent bleeding.
3. Kal on occult blood necessary to verify the completed or slight bleeding from upper divisions. But the method is not informative enough, because blood in the stool is detected when bleeding from the gums, hemorrhoids, depends on the food consumed.
4. Finger examination of the rectum necessary for differentiating colon cancer from rectum.
5. Colonoscopy allows you to visually assess the spread of the tumor, conduct a biopsy and remove polyps.
6. Irrigoscopy carried out after an enema with a barium suspension, inflating the loops of the intestines with air allows you to notice adenomas of small sizes.
7. Ultrasound of the abdominal cavity and pelvic organs diagnose the prevalence of the tumor process, metastases in the lymph nodes and other organs. The method is less sensitive, it is used when it is impossible to perform computed tomography.
8. CT- This is a series of layered images that display the topographic location of a cancerous tumor relative to other organs, the degree of germination, and prevalence.
9. Definition tumor markers . There are no specific ones for colorectal cancer, but the appearance in the blood of a cancer-embryonic antigen (CEA), markers CA-19-9, CA-50 in the presence of additional symptoms allows the diagnosis of carcinoma. Monitoring of CEA after therapy reflects its effectiveness and the development of relapse.

Treatment

Surgical removal of carcinoma and the area of ​​its metastasis. The choice of operation depends on the location pathological process. The right-sided lesion ends with the removal of the caecum, ascending section, hepatic flexure and part of the transverse, as well as adjacent lymph nodes. An anastomosis is formed between small intestine and the rest is thick.

With adenocarcinoma of the left sections, the transverse colon, splenic angle, descending section, omentum and mesentery are resected. Reduced to the anastomosis with the small intestine. If it is impossible radical removal organ, palliative treatment is carried out: colostomy, bypass anastomosis.

1. Radiation therapy is prescribed after surgery at 4 stages of cancer, not earlier than 15-20 days from the intervention. Irradiate the area of ​​pathology to destroy the remaining cells. Assign a single dose of 2 Gy, in total - up to 50 Gy.

Chemotherapy performed after surgery and when surgery is not possible. Use courses such drugs as Tegafur, Capacitabine, Oxaliplatin, Irinotecan.

A more advanced treatment with a targeted effect on receptors is the use of monoclonal antibodies to vascular factor(Avastin), epidermal growth receptor inhibitors (Panitumumab).

Video about the modern method of surgical intervention using stapler technology:

Rehabilitation

The food is fractional, in small portions 4-5 times a day. Preference for slimy cereals and soups, processed vegetables, fermented milk products, chicken meat, lean fish.

For the next 3 months, avoid heavy lifting and heavy physical labor. Patients with an inoperable stage imposed by a colostomy may need the help of a psychotherapist.

Regular monitoring is required to detect recurrence in a timely manner. Every 3 months - digital examination, barium enema, every 6 months - ultrasound of the liver and abdominal organs, chest x-ray. Determination of CEA is mandatory, which indicates a recurrence of the tumor.

Prevention

1. Proper nutrition, the use of fresh vegetables and fruits, bread with bran.
2. Physical activity, exercise, walking.
3. Timely treatment of constipation and its causes.
4. Dispensary observation if available precancerous diseases or hereditary predisposition.
5. After 50 years, a digital examination of the rectal area is recommended for all patients.

Forecast

Late diagnosis of colon cancer worsens the prognosis. The impossibility of carrying out the operation at the last stage leads to lethal outcome during a year. Rejection surgical treatment in earlier stages will allow you to live up to 2 years.

After the operated carcinoma of the first stage, the five-year survival rate reaches 90%, with the involvement of lymph nodes in the process - up to 50%. Localization of adenocarcinoma in the right parts has an unfavorable prognosis, up to 20% of survivors within 5 years after radical removal.

Relapses occur in 85% of cases in the next 2 years after treatment.

Learn more about the problem of recurrence in this video:

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The urgency of the problem and the prevalence of the disease

The leading role in the causes of death from oncological diseases still belongs to tumors of the digestive organs, including colorectal cancer. The individual risk of developing this disease reaches 5-6%. This means that during the life of 1 out of 20 people develop cancer of this localization. About 1 million new cases of colon cancer are diagnosed each year worldwide. In Russia, as in many European countries and North American countries, the incidence of colon cancer has been steadily increasing in recent years, having long exceeded similar indicators of rectal cancer, amounting to 16.2 per 100 thousand of the population.

Only 20% of patients are diagnosed with cancer in stages I-II. Most of colon neoplasms (about 40%) are detected in Stage III. Every third patient diagnosed with colon cancer for the first time in his life had distant metastases. And only about 2% of tumors are detected during preventive examinations.

Etiology

The causes of colon cancer have not been sufficiently studied, although the main risk factors for the development of this disease are known.

Table 2.Histological classification of colon cancer

1. Age of patients older than 50 years. After 40 years, the number of adenomas and other neoplasms of the colon increases. After the age of 50, the risk of developing colorectal cancer doubles in each subsequent decade of life. 2. Features of nutrition. Dietary factors that increase the risk of developing colon cancer include: excessive fat intake, overnutrition, excessive alcohol consumption (especially beer), eating foods with a limited fiber content.

3. Genetic syndromes(see Benign tumors).

4. Previous diseases: adenomas of the colon, ulcerative colitis, Crohn's disease of the colon, previous colon cancer, previous cancer of the female genitals or breast.

5. History of colorectal cancer with blood relatives.

Colon cancer classification

By growth patterns distinguish between exophytic and endophytic tumors. Exophytic tumors grow into the intestinal lumen as a polyp, nodule, or villous formation resembling a cauliflower. With the disintegration of an exophytic tumor, saucer-shaped cancer occurs, which looks like an ulcer with a dense bottom and roller-shaped edges protruding above the surface of the unaffected mucosa.

Endophytic (infiltrative) cancer grows mainly in the thickness of the intestinal wall. The tumor spreads along the perimeter of the intestine and covers it circularly, causing a narrowing of the lumen. With the decay of endophytic cancer, an extensive flat ulcer is visible, located along the perimeter of the intestine with slightly raised dense edges and an uneven bottom (ulcerative or ulcerative-infiltrative form). Endophytic tumors are more common in the left half of the colon.

Most often, cancer develops in the sigmoid (in 50%) and caecum (in 15%) intestine, less often in other sections (the ascending colon is affected in 12%, the hepatic flexure in 8%, transverse colon- in 5%, splenic flexure - in 5%, descending colon- in 5%).

Colon cancer occurs in the mucous membrane, then goes to all layers of the intestinal wall and goes beyond it, growing into the surrounding organs and tissues. The spread of the tumor along the intestinal wall is insignificant, even with endophytic growth it does not exceed 4–5 cm, most often 1–2 cm.

Histological classification of colon cancer is presented in table 2:

A specific feature of colon cancer is a rather long local spread of the tumor (including germination into surrounding organs and tissues) in the absence of metastases to regional lymph nodes, they can appear quite late. Tumor metastasis occurs lymphogenous(for 30%), hematogenous(in 50%) and implantation(in 20%) by way.

lymphatic pathway. There are 3 stages of metastasis to regional lymph nodes:

Stage I - epicolic and paracolic lymph nodes;

Stage II - intermediate or proper mesenteric lymph nodes;

Stage III - para-aortic, in the region of the root of the mesentery of the colon.

Each group is usually affected by metastases sequentially, but there are often exceptions and metastases can be found in the intermediate or basal group, and the epiparacolic lymph nodes remain intact.

Further, the lymph is collected in the lymphatic cistern, located transversely in the region of the 1st-2nd lumbar vertebrae. From the cistern, the lymph flows through the thoracic lymphatic duct into the venous system in the region of the left venous angle (the confluence of the subclavian vein with the internal jugular). In the same place, supraclavicular metastases are usually determined.

Hematogenous way Metastasis is associated with the germination of the tumor in the venous network with subsequent spread through the bloodstream - primarily to the liver, lungs, bones and other organs.

Implantation way metastasis, or contact, is associated with the germination of the tumor of all layers of the intestinal wall, the separation of cancer cells from the main mass of the tumor and their implantation along the peritoneum. These cancer cells give rise to a small bumpy rash called peritoneal carcinomatosis. The latter is usually accompanied by cancerous ascites. Manifestation of carcinomatosis are metastases to the navel and the peritoneum of the small pelvis. These metastases can be identified by digital rectal and vaginal examinations. Their detection indicates a running process.

TNM classification of the International Union against Cancer (2010, seventh edition)T is the primary tumor.

TX - Primary tumor cannot be assessed.

T0 - no data on the primary tumor.

Tis - carcinoma in situ: intramucosal or invasion into the lamina propria of the mucosa.

T1 - the tumor grows into the submucosa.

T2 - the tumor grows into the muscle membrane.

TK - the tumor grows into the subserous base or into tissues not covered by the peritoneum around the colon or rectum.

T4 - the tumor grows into other organs or structures and / or into the visceral peritoneum.

T4a - the tumor grows into the visceral peritoneum.

T4b - the tumor grows into other organs or structures.

N - regional lymph nodes.

Regional lymph nodes are pericolic, as well as lymph nodes located along the ileocolic, right colonic, middle colonic, left colonic, sigmoid and inferior mesenteric arteries.

NX - insufficient data to assess the status of regional lymph nodes.

N0 - no signs of metastatic lesion of regional lymph nodes.

N1 - metastases in 1-3 regional lymph nodes.

N2 - metastases in 4 or more regional lymph nodes.

M - distant metastases.

MX - insufficient data to determine distant metastases.

M0 - distant metastases are not determined.

M1 - there are distant metastases.

Grouping cancer of the esophagus by stage.

Clinical picture and objective examination data

Clinical manifestations of colon cancer depend on the location of the malignant neoplasm, the degree of spread of the tumor process and the presence of complications.

A. M. Ganichkin (1970) identified 6 clinical forms of colon cancer:

toxic-anemic form- characterized by anemia of varying severity, general symptoms (weakness, weakness, loss of appetite, weight loss), intoxication;

obstructive form- characterized by the appearance of signs of impaired intestinal patency and is accompanied by cramping abdominal pain, rumbling and increased peristalsis, stool retention and poor gas passage;

enterocolitic form- accompanied by bloating, alternating diarrhea and constipation, the presence of pathological impurities in the feces, dull, aching pain in the abdomen;

pseudo-inflammatory form- characterized by a low severity of intestinal disorders against the background of signs of an inflammatory process in the abdominal cavity (pain in the area of ​​the tumor process, local pain on palpation with possible tension in the muscles of the anterior abdominal wall of the abdomen);

tumor (atypical) form- it is not characterized by general symptoms, impaired intestinal patency. With this form of colon cancer, a tumor is palpated in the abdominal cavity;

dyspeptic form- its characteristic features are symptoms of "gastric" discomfort (nausea, belching, feeling of heaviness in the epigastric region), accompanied by pain, localized mainly in the upper abdomen.

It should be noted that the allocation of clinical forms is to a certain extent conditional and mainly characterizes the leading symptom complex. Nevertheless, knowledge of the manifestations of colon cancer makes it possible to suspect the presence of a tumor even in cases where the disease proceeds with mild intestinal disorders.

Main symptoms colon cancer are: abdominal pain, impaired motor-evacuation function of the intestine, the presence of pathological discharge with feces, a change in the general condition of the patient, the presence of a palpable tumor in the abdominal cavity.

Stomach ache observed in 80-90% of patients. Tumors of the colon can proceed without pain for a long time, and only when the neoplasm spreads beyond the intestinal wall and when it passes to the parietal peritoneum and surrounding organs, pain appears, the intensity and frequency of which may be different. Especially often, pain occurs when the tumor is localized in the right half of the colon and, as one of the first symptoms, occurs 2–3 times more often than with cancer of the left half. They are associated with inflammation in the zone of tumor decay and the transition of the inflammatory process to the peritoneum. Pain can be of low intensity, dull or pulling, but with the development of intestinal obstruction, they intensify and take on a cramping character.

intestinal discomfort, manifested by loss of appetite, belching, nausea, a feeling of heaviness in the epigastric region due to violations of the motor-evacuation function of the colon. Important role reflex functional disorders of other organs of the digestive system play in the development of intestinal discomfort.

Intestinal disorders due to inflammatory changes in the intestinal wall, violations of its motility and narrowing of the lumen. They are manifested by rumbling in the stomach, constipation, diarrhea. The accumulation of fecal masses proximal to the tumor is accompanied by an increase in the processes of putrefaction and fermentation, leading to bloating with retention of stool and gas. With a sharp narrowing of the intestinal lumen, partial or complete obstructive obstruction develops.

One of the most important clinical manifestations of colon cancer is the presence of pathological discharge from the rectum. Such secretions include mucus, blood, pus, tumor masses. More often, pathological impurities in the feces are observed with distal left-sided localization of the tumor. The appearance of pus and tumor masses indicates the addition of an inflammatory process, leading to the disintegration of the tumor, infection and the formation of perifocal and intratumoral abscesses.

To development syndrome of endogenous intoxication lead to the absorption of decay products by the inflamed mucosa, a change in the normal composition of the intestinal microflora, accompanied by the appearance of pathogenic strains that secrete exo- and endotoxins.

Palpable through the abdominal wall tumor is one of the symptoms that most often indicate a far advanced tumor process. Although in some patients, more often when the tumor is localized in the right half of the colon, the presence of a palpable tumor may be the only, but not an early clinical manifestation of the disease.

Examination of the patient with suspected colon cancer, it is necessary to begin with a thorough clarification of the anamnestic data, general examination, palpation and percussion.

At inspection the patient is often noted pallor of the skin, weight loss.

During questioning the patient needs to pay attention to complaints of dull pain in the abdomen, dyspepsia, intestinal disorders and find out their cause. It is very important to ask the patient leading questions, in particular, to find out the presence of alternating constipation and diarrhea, rumbling in the abdomen, periodic bloating. It is necessary to focus the patient's attention on the presence of pathological impurities in the stool.

Palpation the abdomen is performed in various positions of the patient's body (standing, lying on his back, on the right and left sides). Exophytic tumors are more easily palpated. With endophytic growth, it is more difficult to determine the neoplasm. The palpated tumor has a dense or densely elastic consistency, its surface is often bumpy. In the absence of inflammatory complications, the tumor is painless or slightly painful on palpation, has fairly clear contours. The displacement of the neoplasm depends on the mobility of the affected part of the intestine and on the germination of the tumor in the surrounding tissues. The most mobile tumors of the transverse colon, less mobility is observed in tumors of the caecum. Neoplasms of the right flexure and ascending colon are inactive.

Percussion the sound above the tumor is usually dull, but with neoplasms affecting the posterior wall, especially the caecum, dullness may not be determined.

Finger examination rectum is mandatory for any violations of bowel function. In this case, it is possible to identify distally located tumors of the rectum, determine the tone of the sphincter, and establish the presence of pathological impurities in the feces.

Complications

Complications of colon cancer include:

Obstructive intestinal obstruction;

Perforation of the colon tumor with the development of peritonitis;

Perifocal inflammatory-purulent processes (purulent paracolitis, paranephritis, phlegmon of the abdominal wall, retroperitoneal space);

Bleeding from the tumor (rarely profuse);

Germination of the tumor in neighboring organs and the development of interorgan fistulas.

Laboratory and instrumental diagnostics

A general blood test can detect an increase in ESR, detect hypochromic anemia, and in some patients - leukocytosis, indicating a concomitant inflammatory process.

A fecal occult blood test is performed to diagnose occult bleeding. Tumors are injured by feces and bleed into the intestinal lumen. The reaction is based on the property of some substances to easily oxidize and change color in the presence of hemoglobin and hydrogen peroxide. Benzidine is used as a reagent (Gregersen's test). In the presence of blood in the feces, the benzidine test gives a blue-green color. However, in 50–70% of cases, the results of this test are false positive. Their causes are bleeding from the gums in periodontal diseases, as well as swallowing blood during nosebleeds. Despite the low specificity of this test, its mass use, according to experts, can reduce mortality from colorectal cancer by 30%.

Another direction in the early detection of colon cancer is based on the definition the level of tumor markers, in particular, cancer embryonic antigen (CEA), a peptide isolated from embryonic cells of the human gastrointestinal tract. An increase in the level of CEA in the blood was noted in 38% of patients with polyps, and the level of CEA increased as the size of the tumor increased. So, at stages I–II, an increase in the level of CEA was already detected in 52% of patients, and at stage IV, in all. It should be emphasized that, unfortunately, there are no tumor markers strictly specific for colorectal cancer. An increase in the level of CEA (more than 6 μg/l) can be observed not only in colon cancer, but also in tumors of the breast, lungs, pancreas, ovaries, and adenocarcinomas of other localizations. And besides, with some somatic diseases: cirrhosis of the liver and chronic hepatitis, ulcerative colitis, pancreatitis, tuberculosis, pneumonia, cystic fibrosis, kidney failure, Crohn's disease, autoimmune diseases.

At the same time, the degree of CEA increase can correlate not only with the mass of the tumor, but also with its degree of differentiation: patients with poorly differentiated tumors may have a normal level of this marker. A high initial level of CEA serves as an indirect sign of a poor prognosis.

Other markers of colon cancer include CA-19-9 and CA-50. They are highly informative in the diagnosis of the primary tumor, and their significance in the early detection of relapses has not been fully determined.

It should be emphasized again that the content of serum markers does not have independent significance in the diagnosis and assessment of the extent of the spread of the disease. More often, based on their increase, one can judge the prognosis of the disease. This method can be useful for dynamic monitoring of patients, as well as for evaluating the effectiveness of treatment.

Diagnosis of colon cancer instrumental diagnostics, as a rule, put on the basis of x-ray and endoscopic studies.

The main method of X-ray examination of the colon is irrigoscopy(Fig. 182). The method consists in the retrograde injection of a contrast agent through the rectum using the Bobrov apparatus, which makes it possible to achieve tight filling of the organ and to study in detail the position, shape, size and features of the colon contour.

Rice. 182. X-ray picture of colon cancer (irrigograms). A - the filling defect is indicated by arrows;

B - the arrows indicate the area of ​​the circular narrowing of the intestinal lumen

In this case, the method of double contrasting is also used, that is, the second stage of barium enema. The second stage is performed after emptying the intestine from the radiopaque suspension. The study is carried out with dosed filling of the intestine with air using the Bobrov apparatus. Against the background of double contrasting, a detailed study of the relief of the mucous membrane becomes possible. The interpretation of the x-ray picture is based on the same principles as the analysis of the results of x-ray examination of the esophagus, stomach and duodenum using oral contrast. In colon cancer, areas of narrowing of the colon are identified, “niches”, filling defects, changes in the relief of the mucous membrane are determined, and the motor activity of the intestine is assessed.

It should be remembered that with tight filling of the organ during irrigoscopy, the lumen of the colon looks much wider than with oral contrast.

The most characteristic radiological signs of colon cancer are the presence of:

1) filling defect (marginal, circular or central);

2) limited narrowing of the intestine, accompanied by its expansion above and below the segment affected by the tumor;

Rice. 183. Colon cancer.

Endoscopic picture 3) irregularities of the bowel contour, atypical mucosal relief, breakage of folds and absence of gaustra in the affected area;