Ascending colon cancer prognosis. Causes of colon cancer. Division by stage

Crayfish colon occupies one of the first places in the structure of oncological diseases. The disease affects equally often men and women, usually aged 50-75 years. The frequency of the disease is highest in the developed countries of North America, Australia, New Zealand, occupies an intermediate position in European countries and is low in the regions of Asia, South America and tropical Africa. In Russia, the symptoms of the disease occur with a frequency of 17 observations per 100,000 population. About 25,000 new cases of the disease are detected annually (in the US - more than 130,000).

Symptoms of different forms of the colon

Cancer arises in the mucous membrane, then germinates all layers of the intestinal wall and goes beyond it, infiltrates the surrounding organs and tissues. The tumor spreads along the intestinal wall slightly. Beyond the visible edges, even with endophytic cancer, it is detected at a distance of no more than 4-5 cm, more often 1-2 cm.

There are six forms clinical course cancer:

toxic-anemic,

enterocolitic,

dyspeptic,

obstructive,

pseudo-inflammatory,

neoplastic (atypical) form of cancer.

Exophytic forms of the disease are more common in the right half of the colon, are nodular, polypoid and villous-papillary; the tumor grows into the lumen of the colon.

Endophytic tumors of colon cancer are more common in the left half of the colon. They are saucer-shaped and diffuse-infiltrative, in the latter case, they often cover the intestine circularly and narrow its lumen.

Most malignant tumors of the colon have the structure of adenocarcinoma (in about 90% of patients), less often - mucosal adenocarcinoma ( mucous cancer), signet cell carcinoma (mucocellular carcinoma), squamous cell carcinoma (keratinizing and non-keratinizing) and undifferentiated cancer.

Specific signs of colon cancer

The specific symptoms of the disease are a rather long local spread of the tumor (including germination into surrounding organs and tissues) in the absence of metastasis to regional The lymph nodes which may appear quite late.

Metastasis in cancer occurs by lymphogenous (30%), hematogenous (50%) and implantation (20%) routes. Metastases of colon cancer most often occur in the liver, less often - in the lungs, bones, pancreas.

Diagnosis of colon cancer

The clinical symptoms of the disease depend on the location of the tumor, its type, growth, size, stage of development, and the presence of complications. Early forms diseases occur without symptoms of colon cancer and are detected during colonoscopy for other diseases or during a dispensary examination. Most patients see a doctor for symptoms of blood in the stool, mucus discharge, sudden onset constipation, decreased caliber of stool, gastrointestinal discomfort, pain, deterioration of the general condition.

With tumors of the right half of the cancer, orano arise general symptoms colon cancer - malaise, weakness, moderate anemia, dull pain in the right side of the abdomen. Often in relatively early stage the tumor is palpable.

For tumors of colon cancer of the left half, the following symptoms are characteristic:

frequent constipation,

stool in the form sheep feces with traces of blood on its surface,

signs of partial intestinal obstruction(flatulence, bloating, rumbling, cramping pains against the backdrop of constant dull pains).

Symptoms of a violation of the general condition (weight loss, fever, fatigue, weakness, anemia) are associated with intoxication and are especially pronounced in cancer of the right half of the colon.

In some patients, the only symptom of colon cancer is a palpable tumor (more often with tumors of the right half of the colon).

Pain as a symptom of colon cancer

Abdominal pain is a symptom of colon cancer in 80-90% of patients, especially often when the tumor is located in the right half of the colon. They are associated with inflammatory process in the zone of a decaying tumor and its transition to the peritoneum, they can be insignificant (dull, pulling), but with the development of intestinal obstruction, they become very intense, cramping.

Intestinal dyspepsia as a manifestation of a tumor of the colon

Intestinal dyspepsia is manifested by loss of appetite, belching, nausea, a feeling of heaviness in epigastric region. Intestinal disorders are caused by inflammatory changes in the intestinal wall, impaired motility and narrowing of the lumen. They are manifested by constipation, diarrhea, their alternation, rumbling in the stomach and its swelling. At sharp narrowing intestinal lumen develops obstructive intestinal obstruction (partial or complete).

Pathological secretions (an admixture of blood, pus, mucus in the feces) are observed in 40-50% of patients. Blood in the feces in colon cancer is a symptom of the decay of the tumor and the development of concomitant colitis.

Prognosis of life in colon cancer and features of its treatment

Mortality in radical surgical treatment is 6 - 8%. The five-year prognosis of life in colon cancer depends on the stage of the disease and the degree of differentiation of tumor cells; among radically operated patients, it averages 50%. If the tumor does not extend beyond the submucosa, then the five-year prognosis approaches 100%. With exophytic tumor growth, the prognosis of life is somewhat better than with endophytic.

The prognosis of life in cancer largely depends on the presence or absence of metastases in regional lymph nodes. In the presence of such metastases, the five-year survival rate is 40%, and in their absence - 80%. The prognosis worsens with a decrease in the degree of tumor differentiation.

Surgical removal of colon cancer

The main treatment for this disease is surgery.

Before surgery on the colon, patients need preoperative preparation for bowel cleansing. AT last years when preparing the intestines, Fortran, dissolved in 3 liters of water, is used orally. Orthograde bowel lavage is also used by introducing 6-8 liters isotonic solution through a probe placed in duodenum. Less often, a slag-free diet and cleansing enemas are used. In our article, we will discuss the treatment of colon cancer.

The choice of the method of surgical treatment depends on the localization of the tumor, the presence or absence of complications and metastases, and the general condition of the patient. In the absence of complications (perforation, obstruction) and metastases, radical operations are performed - removal of the affected sections of the intestine along with the mesentery and regional lymph nodes.

For cancer of the right half of the colon, a right-sided hemicolectomy is performed (remove terminal department ileum 15-20 cm long, caecum, ascending and right half of the transverse colon), completing the operation by applying an end-to-side or side-to-side ileo-transverse anastomosis. In oncology of the middle third of the intestine, colon cancer is treated in the form of resection of the transverse colon, completing it with end-to-end colonanastomosis. With a tumor of the left half of the intestine, a left-sided hemicolectomy is performed (a part of the transverse colon, the descending colon and part of the sigmoid colon are removed) with the imposition of a transverse sigmoid anastomosis.

In the presence of an unremovable tumor or distant metastases, palliative surgical treatment of colon cancer is performed, aimed at preventing intestinal obstruction: palliative resections, imposition of a bypass ileo-transverse anastomosis, transversosigmoanastomosis, etc., or a colostomy is applied. Chemotherapy in postoperative period does not increase life expectancy. The optimal drug regimen, as well as the value of pre- and postoperative radiotherapy, has not been established.

Chemotherapy for Colon Tumors

Most often metastases of colon cancer are detected in the liver, with 70-80% of metastases appearing within the first 2 years after surgical treatment of colon cancer. Treatment - combined: they are removed surgically (possibly in 4-11% of cases), selective administration of chemotherapy drugs is carried out in arterial system liver, embolization of hepatic artery branches in combination with intrahepatic chemotherapy, etc.

Causes of a malignant tumor of the colon

Risk factors for developing colon cancer include:

high fat diet and low content vegetable fibers (cellulose),

age over 40 years old,

adenomas and colon cancer in history,

the presence of direct relatives with colorectal cancer,

polyps and polyposis syndromes (Gardner, Peitz-Jeghers-Touren,

familial juvenile polyposis)

Crohn's disease,

nonspecific ulcerative colitis, etc.

Most often, cancer develops in the sigmoid colon (50% ) and the blind (15%) intestine, less often in other parts of the intestine (ascending colon - 12%, right bend - 8%, transverse intestine - 5%, left bend - 5%, descending colon - 5%).

International classification of colon cancer

T- primary cancer tumor

TX - insufficient data to assess the primary tumor

TO - no data for the presence of a primary tumor

T-s - cancer in situ: intraepithelial tumor or tumor with lamina propria invasion

T1 - colon cancer tumor invades the submucosa

T2 - the tumor grows into the muscle layer

TK - a colon cancer tumor grows into the muscle layer and subserous base or surrounding tissues of non-peritonealized areas of the intestine

T4 - colon cancer tumor invades the visceral peritoneum and / or spreads to neighboring organs and anatomical structures

N - regional lymph nodes

NX - insufficient data to evaluate regional lymph nodes

N0 - no metastases to regional lymph nodes

N1 - metastases in 1-3 regional lymph nodes

N2 - metastases in 4 or more regional lymph nodes

Regional include paracolic and pararectal lymph nodes, as well as lymph nodes located along a. ileocolica, a. colica dextra, a. colica media, a. colica sinistra, a. mesenterica inferior, a. rec-talis superior, a. iliaca interna.

M- Distant metastases of colon cancer

MX - not enough data to determine distant metastases

MO - no distant metastases of colon cancer

Ml - there are distant metastases

The histopathological structure of the tumor is also taken into account. There are well-differentiated, moderately or poorly differentiated, undifferentiated and tumors, the degree of differentiation of which cannot be determined.

Domestic classification of cancer by stages

Stage 0 colon cancer - intraepithelial tumor, only the mucous membrane is affected without signs of infiltrative growth (Tis carcinoma in situ), without metastases.

Stage I - a small tumor (Tl, T2), localized in the thickness of the mucosa and submucosa without regional and distant metastases (N0, MO).

Stage II - a tumor that occupies no more than a semicircle of the intestinal wall (TK, T4), does not go beyond it and does not pass to neighboring organs (N0, M O) (single metastases to the lymph nodes are possible).

Stage III - the tumor occupies more than a semicircle of the intestinal wall, grows through the entire thickness of the wall, spreads to the peritoneum of neighboring organs (any T (without metastases) N0) or any T with multiple metastases to the lymph nodes (N1, N2), without distant metastases (MO) .

Stage IV - a large tumor (any T), growing into neighboring organs with multiple regional metastases (any N), with distant metastases (Ml).

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. The intestinal flora that lives in the folds synthesizes B and K vitamins, 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. Lifestyle with reduced 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 impact 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. It happens varying degrees 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 amount differentiated. 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- determined in the mucosa and under mucous layer;
• 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.

Developed TNM classification , 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 urges to defecation, are more characteristic of end-section tumors.
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 when hidden prolonged bleeding from the right 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 is a series of layered images that display the topographic location cancerous tumor relative to other organs, the degree of germination, prevalence.
9. Definition tumor markers . specific for colorectal cancer no, but the appearance in the blood of a cancer-embryonic antigen (CEA), markers CA-19-9, CA-50 in the presence 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 of the 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 the small intestine and the remaining large intestine.

With adenocarcinoma of the left sections, the transverse colon is resected, splenic angle, descending section, omentum and mesentery. 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. Appoint single dose 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 modern method 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, dairy 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 essential for timely detection relapse. Every 3 months - digital examination, irrigoscopy, every 6 months - ultrasound of the liver and abdominal organs, X-ray examination chest. Determination of CEA is mandatory, which indicates a recurrence of the tumor.

Prevention

1. Proper nutrition, consumption fresh vegetables and fruit, 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 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.

Located under the liver, on the right, in the upper right quadrant 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. It is characterized by a 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.

Expressed 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 violation digestive functions intestines.

• Rapid weight loss.

Caused by tumor blockage of the lumen of the colon:

• Pallor skin followed by progressive 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, unrelated to hormonal disruptions or pregnancy, in some of the fair sex menstruation becomes profuse, reminiscent of 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, strong fallout hair.

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 to the 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, since 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 - big risk lethal outcome.

Symptoms of cancer of the ascending colon

For cancer of this department of the organ, all the general symptoms are characteristic. 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 acute attack are admitted to the hospital in an emergency.
• 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%.

On the late 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 passing food bolus along 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. With complete resection of the transverse section, the 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 right iliac region, high fever. At the same time, appendicular symptoms are positive. On palpation of the area, the pain increases.

AT general analysis blood are noted inflammatory changes, no intestinal obstruction, jaundice. An inflamed appendicular process is determined by ultrasound.

• Nonspecific ulcerative colitis.

Pain is localized in lower sections abdomen without 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 area. In the general analysis of blood, eosinophilia is detected. Amenable to therapy with antihelminthic drugs.

The urgency of the problem and the prevalence of the disease

Leading role in the causes of death from oncological diseases still belongs to tumors of the digestive system, 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 neoplasms of the colon (about 40%) is 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%) colon, less often in other sections (the ascending colon is affected in 12%, the hepatic flexure in 8%, the transverse colon in 5%, the 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 bulk 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 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. An important role in the development of intestinal discomfort is played by reflex functional disorders of other organs of the digestive system.

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 examination 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 palpable. 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 complete blood count 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, renal 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;

Colon cancer is a malignant neoplasm that forms on the lining of the cells of the large intestine.

Among all known types of tumors of the digestive system, colon cancer (RCC) ranks third in prevalence, behind cancer of the stomach and esophagus. According to statistics, about 15% of patients with gastrointestinal oncology suffer from colon cancer. More often the tumor occurs in patients aged 50-75 years, affects men and women.

The disease is common in developed countries. Most cases were noted in Canada and America, after them in the list of leaders in the disease - Russia and European countries. Very rarely, ROK affects the inhabitants of Africa and Asia.

Characteristic features malignant formations in the intestine are: distant metastasis, prolonged tumor growth. Pathology is treated by proctologists, oncologists, specialists from the field of abdominal surgery.

Causes of Colon Cancer

According to experts, malignant neoplasms in this area should be considered a polyetiological disease. An important factor influencing the development of cancer is unbalanced diet, in which animal fats predominate, and vitamins and coarse fiber are in short supply.

because of a large number consumed animal fat stimulates liver production. As a result, the microflora in the large intestine changes. The breakdown of animal fats produces carcinogens that can cause colon cancer. Animal fat directly affects the formation of peroxidases, which negatively affect the intestinal mucosa. With a deficiency of coarse fiber in the diet, intestinal motility becomes lethargic.

As a result, carcinogens for a long time are in the intestine, affect the mucosa in an unfavorable way, causing malignant degeneration of cells. The situation can be aggravated by vitamin deficiency, stagnation of feces in the intestines, permanent damage to the mucosa by fecal masses in the areas of natural bowel bends.

Studies have shown that another factor cancer causing colon, is an excess of sex hormones, in particular progesterone. It reduces selection bile acids in the intestinal lumen.

Another reason that increases the risk of malignant neoplasms in the colon is the presence of diseases: Crohn's disease, polyposis of various origins, non-specific ulcerative colitis, diverticulosis, adenomatous polyps. These diseases are not equally likely to cause cancer.

If familial hereditary polyposis is diagnosed, the probability of oncology is high in all patients, with adenomatous polyps - in half of the patients. Intestinal diverticula are rarely malignant.

Types of colon cancer

There are three forms of cancer based on the type of tumor growth. It:

• exophytic colon cancer (nodular, polypoid, villous-papillary) is more often isolated in the right intestine;
• endophytic (infiltrating, circularly stricturing, ulcerative infiltrative) cancer is more often isolated in the left intestine;
• mixed.

If we take into account histological structure cancerous growth, isolated adenocarcinoma, solid, cricoid-cell, scirrhous cancer. According to the level of differentiation, a neoplasm can be highly differentiated, medium-differentiated, or low-differentiated. Colon cancer progresses through 4 stages:

• 1A - characterized by a node with a diameter of up to 1.5 cm, not extending beyond the mucous layer. There are no secondary foci;
• 2A - a tumor with a diameter of more than 1.5 cm, not extending beyond the boundaries of the outer wall of the intestine. There are no secondary foci;
• 2B - a tumor of the diameter indicated above, single lymphogenous metastases;
• 3A - neoplasia occupies more than half of the organ, protrudes beyond the boundaries of the outer wall of the intestine. There are no secondary foci;
• 3B - the tumor can have any diameter, there are many lymphogenous metastases;
• 4 - the neoplasm spreads to nearby tissues, there is big number lymphogenous metastases.

Symptoms of Colon Cancer

At the beginning of its development, colon cancer does not show symptoms. In the future, patients begin to feel pain and discomfort in the intestines, irregular stools, note the presence of mucus and blood in the feces. Pain usually manifests itself when the right sections in the intestine are affected. At first, the pains are aching in nature, as the disease progresses pain attack becomes cramping, sharp. This speaks of intestinal obstruction. This complication often occurs when the tumor affects the left intestine. This interferes with the circulation of intestinal contents.

Other signs of colon cancer are belching, abdominal discomfort, and loss of appetite. Such symptoms are characteristic of cancer that has affected the descending and sigmoid colon. With left-sided malignant neoplasm in the colon, patients complain of diarrhea and constipation, flatulence.

With neoplasia in sigmoid colon mucus and blood are found in the feces. In the case of a different localization of cancer, such symptoms are observed less frequently, since the discharge has time to be processed and mixed with feces during movement through the intestines. If the tumor is localized in the right parts of the intestine, the doctor can detect it by palpation.

In addition to intestinal obstruction, cancer may be accompanied by perforation of the intestine due to the germination of the machine tools of the colon, neoplasia necrosis. Foci of decay increase the risk of infection, development purulent inflammation, sepsis. In case of germination, purulent fusion of the intestinal wall, bleeding may begin. Distant metastases cause malfunction of other organs.

Diagnosis of colon cancer

A complex of laboratory, endoscopic, clinical, radiological data is used to diagnose the disease. First, the doctor listens to complaints, examines the patient. To clarify the anamnesis, palpation, percussion of the abdomen and rectal examination are performed.

If oncology is suspected, irrigoscopy is prescribed. This will reveal filling defects. If the doctor has a suspicion of perforation of the large intestine or obstruction, he refers the patient to an x-ray of the abdominal organs.

One of the diagnostic methods is colonoscopy - a relatively new procedure that allows you to determine the localization of the tumor, the stage, type and growth rate of the neoplasm. During the procedure, an endoscopic biopsy is indicated, then the material taken is sent to morphological study. The fecal analysis is evaluated for the presence of occult blood.

In a blood test important indicator there will be a hemoglobin level (anemia occurs with oncology), the patient is also being tested for a cancer-embryonic antigen. To establish whether there are metastases in the lymph nodes and distant organs, ultrasound of the abdominal organs and computed tomography are performed.

Colon cancer treatment

The method of treatment is selected comprehensively, individually for each patient. The main method of treatment is surgical method. The volume of surgical intervention is determined by the site of the lesion, the stage of development of the disease, the presence of complications and metastases, general condition patient's health.

If there are no complications and this moment the disease did not metastasize, then a radical operation is prescribed - the part of the intestine affected by the tumor is removed. Regional lymph nodes are also subject to removal.

As the operation proceeds, the surgeon will have to decide what to do next - remove the colostomy or choose a one-stage restoration of the passage through the intestines. Removal of a colostomy is more often chosen for intestinal obstruction, perforation of the tumor, bleeding. If the tumor is found to be inoperable, distant metastases are found in different bodies, then palliative surgery is performed to prevent intestinal obstruction.

Radiation therapy is used by physicians as adjuvant therapy. It may be appointed prior to surgical operation to reduce the activity of malignant cells, reduce their metastatic ability, and with it, minimize the risk of recurrence. When the doctor has doubts about the effectiveness of the performed surgical intervention, he prescribes a course of postoperative radiotherapy of a local nature.

Chemotherapy for colon cancer is rarely prescribed, as independent methodology treatment. As a rule, medication is prescribed after surgery. For the purpose of prevention, chemotherapy is prescribed for the treatment of poorly differentiated neoplasms. Cytostatics in the correct ratio (levamisole, fluorouracil, leucovorin) are taken for about a year.

What to do before and after the operation?

Before surgery, all stages of treatment, preparation measures and postoperative procedures are explained to the patient. Psychological attitude plays an important role in the treatment of any cancer. The patient must understand what is required of him, strictly follow the recommended procedures and believe in the best.

Before surgery, the patient's intestines must be cleaned. To do this, the doctor prescribes a laxative or cleansing (the orderlies wash the intestines with a solution that enters through a special probe). An enema is given immediately before the operation.

A prerequisite is the observance of the diet - vegetables and bread must be excluded from the diet before the operation. Two days before the appointed time, you need to take castor oil. A few days before the scheduled operation, the doctor prescribes sulfa drugs and antibiotics to the patient.

When the operation is over, it is necessary to provide the patient complete care, rehabilitation, aimed at a speedy recovery. The main tasks are: to prevent intoxication, dehydration and shock state of the patient's body. On the first day after the operation, it is forbidden to eat any food. On the second day, you can drink water, gradually try soft food with a semi-liquid consistency. Over time, the doctor will allow you to include broth, pureed cereals, scrambled eggs, compote and vegetable puree, tea and juice.

To avoid constipation, which is very undesirable after intestinal surgery, the patient is given twice a day Vaseline oil. laxative effect oil prevents the accumulation of feces, the development of constipation. Due to this, exposure to postoperative sutures can be avoided.

Diet for bowel cancer

It is important to adjust the patient's diet in such a way as to prevent the growth of the tumor, to alleviate the symptoms. Doctors recommend eating 6 small meals a day. The diet should include:

• various cereals;
• fat free dairy products(yogurt, curdled milk, kefir, fermented baked milk);
• fresh and cooked fruits, vegetables, berries;
• dishes from poultry, fish, meat, mashed (you need to cook for a couple);
• jelly, puree and juice from vegetables, fruits.

It is necessary to exclude from the patient's diet all foods that contribute to excessive gas formation. These are bran and legumes, cabbage, raw beam and garlic, mushrooms and rough meat, freshly baked and whole wheat bread, nuts and tomatoes, citrus fruits and soda.

Prognosis for a tumor of the colon

If you consult a doctor in time and catch the disease at its very beginning, the prognosis will be favorable. More precisely, patients with a tumor detected at stage 1 can live for about 5 more years after treatment.

The survival rate is 90-100%. If a we are talking about the treatment of stage 2 cancer, after treatment for 5 years, about 70% of patients will live. With stage 3 cancer with metastases to the lymph nodes, 30% of patients have a chance to live 5 years after treatment.

Cancer can and should be treated, regardless of the prognosis, medicine does not stand still, and in a year a new medicine may well be invented that can save 100% of patients. This is a reason to believe and take care of your health.

If colon cancer is not treated, the following complications are possible:

• Intestinal obstruction occurs due to an overgrown tumor that has blocked the intestinal lumen. Approximately 15% of patients experience such a complication, but more often it is found with a tumor in the left half of the colon (in the descending section);
• inflammatory-purulent process occurs in about 10% of cases. More often purulent infiltrate, phlegmon and abscesses appear in cancer of the ascending colon;
• perforation of the intestinal wall is diagnosed in 2% of patients. So rare complication, however, the most dangerous - it ends lethally. Intestinal rupture is the result of ulceration and subsequent disintegration of tumor tissues, after which the contents of the intestine enter into abdominal cavity causing peritonitis. When the contents of the intestine enter the tissues located behind the intestine, a phlegmon or abscess of the retroperitoneal space is formed;
• the germination of the tumor in the hollow organs leads to the formation of fistulas (intestinal-vaginal and intestinal-vesical).

How to avoid bowel cancer?

To prevent the occurrence of oncological diseases of any localization, you need to take a responsible approach to your health. Patients who fall into the risk group should be observed by a doctor so as not to miss the early symptoms of the disease. Precancerous conditions need to be diagnosed and treated in time.

Nutrition needs to be adjusted in such a way as to reduce the amount in the diet fatty foods and carbohydrates, increase foods high in fiber. It is important to avoid obesity, fight constipation. An active lifestyle is a good friend of health.

Bad habits must be thrown categorically, without regret. It is important to assess the factors that provoke oncological diseases try to eliminate them from your life. This will minimize the risk of any disease, not just cancer, since the canons of a healthy lifestyle are equally effective for all ailments.