Cancer of the rectum and colon symptoms. Symptoms of cancer of the ascending colon. M - distant metastases

is a malignant tumor of epithelial origin, localized in the colon. Initially, it is asymptomatic, later it manifests itself with pain, constipation, intestinal discomfort, impurities of mucus and blood in the fecal masses, deterioration and signs of cancer intoxication. Often a node is palpated in the projection of the organ. With progression, intestinal obstruction, bleeding, perforation, infection of the neoplasia and the formation of metastases are possible. Diagnosis is based on symptoms, radiography, CT, MRI, colonoscopy and other studies. Treatment - surgical resection the affected part of the intestine.

ICD-10

C18 C19

General information

Crayfish colon- a malignant neoplasm originating from the cells of the mucous membrane of the large intestine. Ranks third in prevalence among oncological lesions digestive tract after tumors of the stomach and esophagus. According to various sources, it ranges from 4-6 to 13-15% of total malignant tumors GIT. It is usually diagnosed at the age of 50-75 years, it is equally often detected in male and female patients.

Colon cancer is widespread in developed countries. The leading positions in the number of cases are occupied by the United States and Canada. Enough high performance morbidity is observed in Russia and European countries. The disease is rarely detected in residents of Asian and African states. Colon cancer is characterized by prolonged local growth, relatively late lymphogenous and distant metastasis. Treatment is carried out by specialists in the field of clinical oncology, proctology and abdominal surgery.

The reasons

Experts believe that colon cancer is a polyetiological disease. Important role in the development of malignant neoplasia of this localization, the features of the diet play, in particular, an excess of animal fats, a lack of coarse fiber and vitamins. Presence in food a large number animal fat stimulates the production of bile, under the influence of which the microflora of the large intestine changes. In the process of splitting animal fats, carcinogens are formed that provoke colon cancer.

An insufficient amount of coarse fiber leads to a slowdown in intestinal motility. As a result, the resulting carcinogens are in contact with the intestinal wall for a long time, stimulating the malignant degeneration of mucosal cells. In addition, animal fat causes the formation of peroxidases, which also Negative influence on the intestinal mucosa. The lack of vitamins, which are natural inhibitors of carcinogenesis, as well as stagnation of feces and constant traumatization of the mucosa by fecal masses in the areas of natural bowel bends exacerbate the listed adverse effects.

Recent studies indicate that sex hormones, in particular progesterone, play a role in the occurrence of colon cancer, under the influence of which the intensity of excretion decreases. bile acids into the intestinal lumen. It has been established that the risk of developing malignant neoplasia of this localization in women with three or more children is two times lower than in nulliparous patients.

There are a number of diseases that can transform into colon cancer. These diseases include Crohn's disease, ulcerative colitis, polyposis of various origins, solitary adenomatous polyps and diverticulosis. The likelihood of these pathologies degenerating into colon cancer varies greatly. With familial hereditary polyposis without treatment, malignancy occurs in all patients, with adenomatous polyps - in half of the patients. Intestinal diverticula are extremely rare.

Classification

Depending on the type of growth, exophytic, endophytic and mixed forms of colon cancer are distinguished. Exophytic cancer is nodular, villous-papillary and polypoid, endophytic - circular-strictoring, ulcerative-infiltrative and infiltrating. The ratio of endophytic and exophytic neoplasia is 1:1. Exophytic forms of colon cancer are more often detected in the right sections of the intestine, endophytic - in the left. Taking into account histological structure distinguish between adenocarcinoma, cricoid, solid and scirrhous colon cancer, taking into account the level of differentiation - highly differentiated, moderately differentiated and low-differentiated neoplasms.

According to the traditional four-stage classification, the following stages of colon cancer are distinguished.

• I stage- a node with a diameter of less than 1.5 cm is detected, not extending beyond the submucosal layer. There are no secondary foci.
• IIa stage- a tumor with a diameter of more than 1.5 cm is detected, spreading to no more than half the circumference of the organ and not extending beyond the outer wall of the intestine. No secondary foci
• IIb stage- Colon cancer of the same or smaller diameter is detected in combination with single lymphogenous metastases.
• IIIa stage- neoplasia extends to more than half the circumference of the organ, and extends beyond the outer wall of the intestine. There are no secondary foci.
• IIIb stage- Colon cancer of any diameter and multiple lymphogenous metastases are detected.
• IV stage- a neoplasm with invasion into nearby tissues and lymphogenous metastases or neoplasia of any diameter with distant metastases is determined.

Cancer Symptoms

Initially, colon cancer is asymptomatic. Subsequently, pain, intestinal discomfort, stool disorders, mucus and blood in the fecal masses are observed. Pain syndrome often occurs with damage to the right intestine. At first, the pain is usually mild, aching or dull. With progression, there may be sharp cramping pains indicating the occurrence of intestinal obstruction. This complication is more often diagnosed in patients with damage to the left parts of the intestine, which is due to the peculiarities of the growth of neoplasia with the formation of a circular constriction that prevents the promotion of intestinal contents.

Many patients with colon cancer complain of belching, anorexia, and abdominal discomfort. The listed signs are more often found in cancer of the transverse, less often in lesions of the descending and sigmoid colon. Constipation, diarrhea, rumbling, and flatulence are typical of left-sided colon cancer, which is associated with an increase in the density of fecal masses in the left intestine, as well as with frequent circular growth of neoplasms in this area.

For neoplasia sigmoid colon characterized by impurities of mucus and blood in the feces. With other localizations of colon cancer, this symptom is less common, because when moving through the intestines, the secretions have time to be partially processed and evenly distributed over the fecal masses. Palpation of colon cancer is more often detected when located in the right intestine. It is possible to feel the node in a third of patients. The listed signs of colon cancer are combined with common features oncological disease. Weakness, malaise, weight loss, pale skin, hyperthermia, and anemia are noted.

Complications

Along with the intestinal obstruction already mentioned above, colon cancer can be complicated by organ perforation due to germination of the intestinal wall and neoplasia necrosis. When foci of decay are formed, there is a danger of infection, development purulent complications and sepsis. With germination or purulent fusion of the vessel wall, bleeding is possible. In the event of distant metastases, there is a violation of the activity of the relevant organs.

Diagnostics

Colon cancer is diagnosed using clinical, laboratory, endoscopic, and x-ray findings. First, complaints are clarified, the anamnesis of the disease is clarified, a physical examination is performed, including palpation and percussion of the abdomen, rectal examination. Then patients with suspected colon cancer are prescribed barium enema to detect filling defects. If intestinal obstruction or perforation of the colon is suspected, an abdominal radiography is used.

Patients undergo colonoscopy, which allows to assess the location, type, stage and type of growth of colon cancer. During the procedure, an endoscopic biopsy is performed, the resulting material is sent to morphological study. Schedule a stool test for occult blood, a blood test to determine the level of anemia and a cancer embryonic antigen test. To detect lesions in the lymph nodes and distant organs, CT and ultrasound are performed abdominal cavity.

Colon cancer treatment

Treatment is operative. Depending on the extent of the process, radical or palliative treatment is performed. surgical intervention. Radical operations for colon cancer are one-stage, two- or three-stage. When carrying out a one-stage intervention, a hemicolectomy is performed - resection of a section of the colon with the creation of an anastomosis between the remaining sections of the intestine. In multi-stage operations for colon cancer, a colostomy is first performed, then the affected intestine is removed (sometimes these two stages are performed at the same time), and after a while intestinal continuity is restored by creating a direct anastomosis.

With advanced colon cancer, extended interventions are carried out, the volume of which is determined taking into account the damage to the lymph nodes and nearby organs. If it is impossible radical removal neoplasia perform palliative operations (imposition of a colostomy, the formation of a bypass anastomosis). Colon cancer with perforation, bleeding, or intestinal obstruction a stoma or bypass anastomosis is also applied, and after the patient's condition improves, a radical operation is performed. For colon cancer with distant metastases, chemotherapy is prescribed.

Forecast and prevention

The prognosis for colon cancer is determined by the stage oncological process. Medium five-year survival at the first stage it is from 90 to 100%, at the second - 70%, at the third - 30%. All patients who have undergone surgery for neoplasms of this localization should be under the supervision of a specialist oncologist, regularly undergo radiological and endoscopic studies to detect local recurrences and distant metastases.

Colon cancer is a disease that most often affects people in the developed countries of the West, in the east people get sick with this type of cancer less often.

This is probably due to lifestyle, nutrition or ecology, but no one can say for sure.

Classification and types of colon cancer

Colon cancer is classified according to several criteria, which we will now consider in the table along with examples.

Stages of cancer development

After the operation, the patient is forbidden to eat and drink during the day, the next day it is allowed to take grated food in small portions, preferably at least five times a day. A further diet will be prescribed by the doctor individually, but it should be understood that most products will have to be abandoned in favor of cereals and mashed potatoes.

A month after the operation, the patient is prescribed a course of radiation therapy, and possibly chemotherapy to prevent the recurrence of the disease.

Video: The prognosis for patients is quite optimistic. The survival rate of such patients after surgery is almost one hundred percent if cancer is detected at the first stage. After the operation, a person lives for about five more years, or even more. And there, perhaps, new drugs will be invented that will allow such patients to live even longer. That's why mental attitude essential for treatment.

The patient must remember that recovery is entirely dependent on him, if he strictly follows the doctor's advice, then the chances will increase significantly.

If the disease is started, left untreated, treated untimely or intermittently, forgetting about taking medications, then colon cancer can give complications that even lead to death.

These include:

• peritonitis;
• perforation of part of the intestine;
• inflammatory and suppurative lesion intestines;
• spread of the tumor to the genitals and organs urinary system, fistula formation.

Therefore, patients diagnosed with colon cancer need to treat the disease without delay, and in the future it is important to comply healthy lifestyle life, as it helps in recovery after any illness and is one of the keys to longevity.

Among all cancer, this type of tumor occurs in one in five out of a hundred cases of cancer, and if we consider tumors that affect gastrointestinal system then - here, colon cancer confidently holds the second place. The symptoms of this disease are mainly inherent in the elderly, regardless of gender.

What causes this disease?

The causes of malignant neoplasms have not yet been unequivocally determined, however, there are a number of factors that significantly increase the risk of the disease:

• genetic predisposition. This factor is relevant for people whose close relatives had this disease before the age of 50;
• Unhealthy diet with a predominance of proteins, animal origin, especially fatty;
• Lack of sufficient physical activity — sedentary image life;
• Violation in the digestive system, namely chronic constipation. In this state of affairs, solid faecal matter, passing the corners of the bends of the intestine, constantly injure him;
• Work related to hazardous production;
• Old age - above 50 years.

In addition, colon cancer can be the result of chronic pathological processes:

• Gardner's syndrome;
• adenomatous polyposis;
• Ulcerative nonspecific colitis;
• diverticulosis;
• Crohn's and Turk's diseases;
• Amoebiasis;
• Polyps.

This is just a small list of factors that can cause colon cancer.

Stages of the course of the disease

Today, eight stages of the development of the disease are distinguished with the corresponding symptoms:

• Stage - 0 "TIS— N0 M0. At this stage, the tumor does not grow into the lymph nodes of a nearby location and distant metastases are not detected. The focus of the disease is preinvasive carcinoma of the epithelium or intestines, more precisely, its mucosa;
• Stage - 1 "T1-2 N0 M0". Metastases, both regional and remote, are not detected. At this stage, the neoplasm affects the submucosal tissues, and sometimes grows into muscle tissues;
• Stage - 2A "T3 N0 M0». There are still no metastases, and the tumor penetrates into neighboring tissues or their base;
• Stage 2B "T4 N0 M0». At this stage, the tumor grows on the cells of the visceral pleura, neighboring structures, and organs. Noticeable metastases are not yet detected;
• Stage 3A "T1-2 N1 M0». Lymph nodes affected by metastases appear adjacent to the tumor focus, there are no remote metastases, and the cancerous tumor affects the tissues of the muscular membrane;
• Stage 3B "T3-4 N1 M0». The tumor actively infiltrates into the tissues surrounding the intestine and the subserous base, often affects neighboring organs, and sometimes even grows into visceral pleura. Up to three metastases appear in nearby lymph nodes in the absence of remote ones;
• Stage 3C "T1-4 N2 M0». At this stage, a clear growth of the tumor is observed in all structures of the intestine and partial lesion tissues of neighboring organs, and the number of regional metastases increases to four. Distant metastases are not observed;
• Stage 4 "T1-4 N-3 M0-1». At this stage, the tumor damage to the tissues of the intestine and third-party organs is as large as possible. Metastases are found, both regional and distant. Forecasts in this case are disappointing.

Types of colon tumors

Most often, this type of cancer begins with the defeat of epithelial cells by carcinoma. This state of affairs is due to the fact that the main part of the cells of the mucous membrane of the colon consists of epithelium, therefore, cancer of the colon and rectum is almost always represented by epithelial carcinoma of the ascending and descending section. The probability of such a course of events is approximately 95%.

Sometimes there are tumors of other types:

• Squamous. With this type of tumor, squamous epithelial cells are reborn;
• Glandular-squamous. AT this case there is a degeneration of cells of both squamous and glandular epithelium;
• Ring cell carcinoma;
• Mucosal adenocarcinoma.

In addition to these (main) types of tumors, sometimes (rather rarely) carcinomas of unclassified symptoms occur.

Symptoms of the disease

Colon cancer does not always present in the same way. Its symptoms may be different, depending on the location of the lesion and the form of macroscopic tumor growth. Left and right side colon differ in their physiological functions and therefore respond differently to tumors.

Right-sided lesion of the intestine disrupts the physiology of absorption nutrients, which is accompanied by a deterioration in digestion, and a tumor localized on the left side leads to a significant decrease in patency, which is expressed by more frequent constipation, turning into chronic.

Most typical symptoms tumor growth in the colon, noticeable without medical examination:

• Violation normal process digestion. The symptoms are as follows - loss of habitual appetite, pulling sensations inside the abdomen, belching, nausea and vomiting, rumbling sounds, diarrhea, constipation, and in severe cases obstruction;
• The occurrence of discomfort in the lower abdomen, pain;
• Changes in the composition of feces - they are excreted with an admixture of mucus and bloody clots.

For right-sided localization of a tumor of the colon, the following symptoms are characteristic:

• A sharp decrease in overall tone;
• Chronic fatigue;
• Malaise;
• Frequent feverish conditions;
• development of anemia.

This behavior of the body is a consequence of hepatic poisoning with waste products or decay (on late stages) tumor cells.

The procedure for diagnosing a disease

At the forefront of diagnosis cancerous tumors, modern medicine puts 4 main types of research. Let's describe them in order.

Physical examination

At this stage, a visual assessment of the condition is carried out. skin, the degree of bloating and palpation is performed. The latter allows a preliminary assessment of the presence of a tumor, its size, density and mobility, as well as the degree of pain experienced by the patient during the examination. Next, the problem area is tapped in order to identify fluid in the peritoneum.

Radiography

X-rays are taken using contrast medium- irigoscopy method. This method allows you to identify such defects of the intestine as its expansion around the tumor, narrowing, shortening and the degree of excretion of the contrast agent.

Colonoscopy (endoscopic examination)

The essence of the study lies in cutting off a thin layer of tumor tissue for visual examination at the angle of view of a microscope in order to determine the type. The procedure is carried out surgically under general or local anesthesia.

Ultrasound and CTM

Examination using ultrasound and tomography allows, with a high degree of accuracy, to determine the size of the tumor, its affected area and to identify metastases, even remote from the location of the main focus, for example, in the liver.

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Methods of treatment of colon cancer

Comprehensive treatment consists of three types of therapy.

Surgery

The essence of the method is to remove the tumor surgically. At the same time, it is extremely important to carry out the procedure so that the edges of the cut-off tumor do not contain altered (tumor) cells. During surgical intervention, along with the main tumor, lymph nodes located near the focus, in the hepatic region, and all other identified metastases are also removed at the same time.

The degree of such interference can be local or volumetric:

• Right-sided location of the tumor. This arrangement suggests hemicolonectomy of the affected organ. Also, 10 cm of the site is subject to removal terminal department ileum and third part of the transverse colon, together with a segment adjacent to the greater omentum. In addition, cut off the blind and ascending colon. Removal of lymph nodes of a regional location is mandatory. At the end of the removal procedure, to form a small-colonic anastomosis, the small and large intestines are stitched together.
• Left-sided location of the tumor. The distal segment is removed transverse colon- its third of the descending section, the sigmoid is partially removed, and the descending is completely. The splenic flexure, mesentery and regional lymphs are completely removed, and at the end, the large intestine is fused with the small intestine. With extensive lesions of the spleen, it is removed completely.
• The tumor is small. If it is located in the middle of the affected intestine or the ascending section, they resort to its removal, simultaneously with the removal greater omentum and nearby lymph nodes.
• The tumor is inferior and in the sigmoid colon. This arrangement allows for bowel resection. Part of the sigmoid colon, adjacent lymph nodes and the mesentery are removed. In patients with intestinal obstruction, an obstructive resection of the colon is performed, after which, its continuity is restored. When a tumor affects large areas of tissue and even individual bodies, resort to operations of a combined type. Most often, the formation of liver metastasis is observed, and in women, metastases affect the ovaries. Such metastases are removed.

If the process of tumor development has gone far and the metastasis lesion is voluminous, a palliative method is used - the anastomosis is formed by the method of applying a colostomy.

The method of radiation (radiation) therapy

This method is used both before and after the operation. Preoperative radiation therapy designed to weaken cancer cells and facilitate surgical intervention, and postoperative - adjuvant therapy serves to consolidate the results surgical intervention and reduce the risk of relapse.

Adjuvant therapy consists in targeted irradiation of the affected tissue to inhibit cancer cells.

This treatment has a number of side effects with symptoms such as nausea and vomiting with loss of appetite, diarrhea and blood in the stool.

Chemotherapy

Its essence is the use of inhibitory cancer cells chemicals. On the this moment, there are quite a lot of drugs of this kind, however, the most in demand are irinotecan, capecitabine and oxyplatin.

Like radiation, chemotherapy side effects. Most often, nausea and vomiting, leukopenia are observed varying degrees(decrease in the level of leukocytes in the blood) and allergic reactions, mainly skin rashes, redness and itching.

Forecasts

Forecasts of survival in colon cancer can only be made after a clear definition of the type of tumor and the stage of its development, and only after the therapy, based on its results.

The initial stages give an almost 100% chance that after the treatment the patient will live for at least 5 years. At the second stage and at the beginning of the third, this percentage is reduced to 60 - 70%, and the third stage leaves a chance for no more than half of the patients. With regards to the last, fourth stage, treatment is not always offered with it, since even with all measures taken, the prognosis is extremely negative - such a patient lives on average from six months to a year.

Prevention of colon cancer

Self-identify disease early stages impossible, because the symptoms accompanying it are not quite obvious, and therefore the following is recommended for the risk group:

• Annual examination of feces for occult blood;
• Once every 5 years, conduct a sigmoidoscopy;
• Do a colonoscopy at least once every 10 years.

In addition, it should be understood that the best treatment- this is prevention, so be sure to balance the diet in the direction of reducing the consumption of animal fats, proteins and compensating for them herbal products. In addition, one should respond in time to inflammatory processes in the large intestine - treat them in a timely manner, and if polyps are detected, they must be removed.

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The incidence of colon cancer is the third most common among all oncological diagnoses. And according to experts, it will only grow. The reasons for this are in the deteriorating environmental situation, changes in the diet modern man, immobility and many other factors.

The concept of " colorectal cancer"implies a malignant neoplasm emanating from the mucous membrane of the colon (colon) and rectum (rectum). Approximately 40% of carcinomas occur in the rectum and 60% in the colon.

Diagnosed on initial stages, bowel cancer is curable in 90% of cases. It is its early detection that is the main task facing the medicine of all developed countries.

But today the picture is as follows: of the newly diagnosed cases of colon cancer, 45% are stage 3 and 35% are stage 4. Half of patients die within a year after diagnosis.

Anatomy: basic concepts

The very name "colon" comes from the localization of this intestine. It is located along the perimeter of the abdominal cavity, as if bordering it. Rising from the right iliac region up to the liver, it makes a bend to the left, goes transversely, then again after a bend at the level of the spleen it goes down and goes into the small pelvis, where it continues into the rectum.

Anatomically, it distinguishes the following departments:

• Rising colon.
• Hepatic flexure.
• Transverse colon.
• Splenic flexure.
• Descending colon.
• Sigmoid colon.

As the chyme advances ( food bolus) sequentially in all these departments, liquid is absorbed from it and dense stool masses are formed.

The incidence of cancer various departments not the same: sigmoid colon - 35%, blind - 25%, ascending, transverse colon, hepatic and splenic flexures - 8-9% each, descending - 5%.

Causes of the disease

Approximately 5% of cases of malignant neoplasms of the intestine develop against the background of hereditary syndromes – familial polyposis and hereditary non-polyposis cancer. All other cases are sporadic. The risk factors are reliably:

• The presence of this diagnosis in the next of kin.
• Dietary preferences in favor of red meat and fats, but with a small amount of fiber (vegetables and fruits).
• Sedentary lifestyle, overweight.
• Age over 50 years.
• Chronic bowel disease.
• The presence of adenomatous benign polyps.
• Available cases of cancer of other localizations.

Classification

Almost 90% of colorectal cancer is represented by adenocarcinoma, that is, a tumor originating from the glandular cells of the mucous membrane. It can be highly, medium and low-differentiated. The lower the cell differentiation, the more malignant the tumor.

Other histological variants include mucoid, cricoid, and squamous cell carcinomas.

According to the macroscopic structure, the tumor can be exophytic (grows into the intestinal lumen), endophytic (grows into the wall and compresses it circularly) and mixed. The most common form is an exophytically growing polyposis mass with ulceration.

International TNM classification suggests various stages local spread of the tumor (T-tumor), the presence of atypical cells in the lymph nodes (N-nodus), as well as the presence of distant metastases (M).

In relation to the intestines, there are:

1. Tis - the tumor is limited to the epithelium.
2. T 1,2,3 - germination, respectively, of the submucosal layer, muscle membrane, all layers without going beyond the organ.
3. T4 - the tumor extends beyond the boundaries of the intestinal wall and grows into neighboring organs and tissues.

1. N0 - lymph nodes are intact.
2. N1 - no more than 3 lymph nodes are affected.
3. N2 - metastases in more than 3 lymph nodes.

1. M0 - no metastases in other organs.
2. M1 - there are distant metastases in any quantity.

Based on the determination of the prevalence of the tumor according to these three criteria, the clinical stage of the disease is formed:

I - T1-2, N0, M0.

II - T 3-4, N0, M0.

III - T any, N1-2, M0.

IV - T any, N any, M1.

Symptoms

Located in the right sections (caecum, ascending section, hepatic flexure of the colon), the neoplasm can for a long time don't show yourself. The most common first syndrome of this localization of cancer is toxic-anemic. The patient is concerned about weakness, nausea, weight loss, shortness of breath. Such patients can be examined for anemia (low hemoglobin) for a long time.

Pain also quite often accompanies the right-sided localization of the tumor. When attached to perifocal inflammation, the neoplasm can mimic symptoms acute appendicitis or cholecystitis.

Violation of defecation and obstruction of the right sections of the intestine occurs much less frequently, only in extremely advanced stage, or when located in the region of the ileocecal valve (then symptoms of small bowel obstruction develop).

Left-sided localization (sigmoid colon, splenic flexure, descending colon) appears first intestinal symptoms:

• constipation alternating with diarrhea;
• flatulence;
• frequent urge to defecate;
• the appearance of mucus and blood in the stool.

Pain in the left side of the abdomen is often cramping in nature, but can be permanent. The disease quite often debuts with obstructive intestinal obstruction, for which patients in urgent order get on the operating table in the duty surgical hospital.

Cancer of the transverse colon, as well as the hepatic and splenic flexures, is manifested by both general and intestinal symptoms. Pain in the upper abdomen and in the hypochondrium provokes the search for gastritis, peptic ulcer, cholecystitis, pancreatitis.

Diagnostics

• Complaints, anamnesis, examination. The first doctor a patient comes to is a general practitioner or surgeon. Any of the above symptoms should alert you to a cancer diagnosis. Pay attention to age, the presence of the disease in relatives, other risk factors. On examination, it is sometimes possible to palpate (feel through the anterior abdominal wall) the tumor.
• Laboratory diagnostics. A blood test may reveal a decrease in hemoglobin and red blood cells, and a stool test often reveals the presence of blood (evidence of microbleeding).
• Colonoscopy is the gold standard for diagnosing colon tumors. After the bowel cleansing procedure, it is examined sequentially from the sigmoid to the caecum. If a tumor or polyp is detected, a biopsy of suspicious areas can be taken immediately.
• Irrigoscopy. This is an x-ray of the bowel after it has been contrasted. Contrasting can be conventional - barium suspension, or double - with air injection. This study is performed less often, mainly when it is impossible to perform a colonoscopy. It is quite informative in relation to the anatomy of the neoplasm.
• CT colonoscopy. This method can be an alternative endoscopic examination, but if a tumor is detected, the patient will be recommended to perform a biopsy.

If carcinoma is diagnosed, further examination is aimed at clarifying clinical stage diseases, which is very important for the choice of treatment tactics. For this purpose:

• Ultrasound or CT of the abdominal organs and retroperitoneal lymph nodes.
• CT of the lungs.
• General clinical tests, ECG.
• Possible direction to additional examinations– PET CT, skeletal bone scintigraphy, brain MRI, laparoscopy.
• If necessary - echocardiography, spirometry, USDG of vessels, consultations related specialists(cardiologist, neurologist, endocrinologist) to solve possible surgical treatment.
• Studies of the level of oncomarkers CEA, C19.9.
• Examination of a tumor biopsy RAS mutation if distant metastases are detected.

Treatment

Surgical intervention

Surgery is the main treatment for colon cancer.

In stages I and II, surgical intervention is in a radical way. At Stage III- is also the main one, but is supplemented by chemotherapy. In stage IV, the operation is used as a palliative method to eliminate obstruction.

Principles of oncological operations:

• The volume of resection should be sufficient for complete confidence in radicalism (at least 10 cm above and below the edge of the tumor).
• Vessels feeding the neoplasm are tied up as early as possible.
• Simultaneous removal of regional (nearby) lymph nodes.
• A thorough revision of the abdominal cavity for the presence of distant metastases is carried out.

The main types of operations for colon cancer:

• Endoscopic resection is applicable for intraepithelial spread of the formation. During a colonoscopy, a suspicious polyp is removed and sent to histological examination. If a highly differentiated adenocarcinoma is detected that does not grow into the submucosal layer, there is no damage to the polyp stem, the treatment is considered radical; further follow-up is carried out.

Endoscopic tumor resection

• Right-sided hemicolectomy - removal of the right half of the colon. Performed with tumors of the blind, ascending departments, hepatic flexure. After removal, an anastomosis (fistula) is formed between the ileum and the transverse colon.
• Left hemicolectomy. When the cancer is localized in the left section of the transverse colon, descending and in the upper part of the sigmoid colon, the left half of the colon is removed with the formation of a transverse sigmoid anastomosis.
• segmental resection. Shown at small tumors in the transverse colon or sigmoid colon. The area with the tumor is removed, the regiogaric lymph nodes are excised, the ends of the intestine are sutured.
• Obstructive resection (Hartmann-type operation). This surgical intervention is performed when it is impossible to form an anastomosis at the same time as removing the tumor (for example, with intestinal obstruction). The section of the intestine with the neoplasm is resected, its leading end is brought to the skin abdominal wall(colostomy), and the outlet is sutured.
• In the future, after proper preparation, intestinal continuity can be restored and the colostomy removed.
• Palliative operations. They are performed to eliminate the symptoms of intestinal obstruction. In this case, the tumor itself may not be removed. This is basically the removal of a colostomy (unnatural anus) or the formation of a bypass anastomosis.
• Laparoscopic resections. Today, almost any resection can be performed laparoscopically for small and uncomplicated tumors. Such operations are less traumatic for the patient and are characterized by a shorter rehabilitation period.

Chemotherapy

Drug treatment that uses drugs that block the division or destroy malignant cells, as a result of which the tumor decreases in size or disappears altogether.

Chemotherapy for colon cancer is used:

In stage II, if there is doubt about the radicalness of the operation:

• damage to the edges of the resection (part of the intestinal wall, along the edge of the removed area);
• low tumor differentiation;
• carcinoma grows through all layers of the intestinal wall (T4);
• increase in tumor markers 4 weeks after surgery.

In stage III cancer, postoperative period- adjuvant chemotherapy. The goal is to destroy those left in the body. malignant cells and prevention of relapse.

In stage IV, as palliative chemotherapy, as well as neoadjuvant (perioperative) chemotherapy for single liver or lung metastases.

The most commonly used drugs are fluorouracil, capecitabine, oxaliplatin, irinotecan, and other drugs. Schemes and combinations of destination may be different. The course usually lasts six months.

Complications of chemotherapy (nausea, weakness, baldness, diarrhea, damage to the skin and mucous membranes) always accompany this type of treatment to one degree or another. But they can be corrected both medicinally and non-drug methods and are not grounds for refusing treatment.

Colon cancer with metastases

Carcinomas of this localization most often form metastases in the liver, lungs, brain, bones, spread through the peritoneum.

Modern medicine gives a chance to patients even with the 4th stage, if not completely cured, then at least control its progression, as in any chronic disease.

Single liver and lung metastases can be resected either simultaneously with the primary tumor or after several courses of neoadjuvant chemotherapy.

With an inoperable tumor with multiple metastases, polychemotherapy is performed. Its duration is continuous until the end of life, or until the progression or development of intolerance. CT inhibits the growth of tumors and metastases, thereby prolonging the life of the patient.

At the 4th stage of adenocarcinoma, chemotherapy is in some cases supplemented with targeted drugs. These are monoclonal antibodies that bind to specific receptors of tumor cells and block their stimulation to divide.

Of the targeted drugs, Bevacizumab is the most commonly used, as well as Cetuximab and Panitumumab in the absence of mutations in the KRAS gene.

Dynamic Surveillance

After completion of treatment, the patient undergoes periodic examinations and examinations by an oncologist for the first 1-2 years - every 3 months, then - once every 6 months, after 5 years - once a year. Target - timely detection relapses. For this, FCS, a study of blood tumor markers, ultrasound of the abdominal organs, radiography or CT of the lungs are performed.

Forecast and prevention

There is no specific prevention of bowel cancer, but early detection is the key to successful treatment.

Stage 1 colon cancer after radical treatment is characterized by a survival rate of 90%.

5-year survival after treatment 2 tbsp. is 76%, 3 tbsp. - about 45%, at 4 tbsp. - no more than 5%.

• Examination of feces for occult blood annually in persons over 50 years of age, with positive test- colonoscopy.
• Flexible sigmoidoscopy 1 time in 5 years, colonoscopy - 1 time in 10 years. CT colonoscopy is acceptable as a screening.
• With a burdened heredity for bowel cancer, these studies are recommended from the age of 40.

Colon cancer is cancerous growth, developing in one of the colon sections of the intestine. This pathology ranks second in the number of diagnosed cases of gastrointestinal cancer. The most susceptible group of the population to this disease are the elderly.

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Risk Factors for Colon Cancer

In oncological practice, it is customary to separate the following risk factors for the development of a mutation in the colon:

1. genetic predisposition. A symptom of the hereditary transmission of this pathology is the formation of a tumor at a young age.
2. A disproportionate diet in which a person consumes an excessive amount of food of animal origin.
3. Sedentary and sedentary way of life. In medicine, this factor is also called hypodynamia.
4. Frequent constipation. Mechanical damage intestinal walls can provoke a mutation of mucosal cells, which is a key mechanism for tumor formation.
5. (chronic ulcerative inflammation intestines and polyps).
6. age factor. predominantly diagnosed in patients over 50 years of age.
7. Carcinogenic effect toxic substances in production.

Colon cancer stages

• 0 Stage . Pathology is localized in the thickness of the intestinal mucosa. There are no foci secondary lesion regional lymph nodes and distant organs.
• 1 stage. The tumor grows into the submucosal and muscular layers of the gastrointestinal tract. intestinal tract. At this stage, they are also not noted.
• 2A Stage. grow into tissues adjacent to the intestine. AT lymph nodes and distant organs are not diagnosed with metastatic lesions.
• 2B Stage . Oncology is in neighboring organs and the inner sheet of the pleura. Metastases are absent.
• 3A Stage. within the submucosal and muscular layers. Metastatic lesions are determined in 1-3 regional lymph nodes.
• 3B Stage . Oncological lesions of the subserous layer are combined with secondary foci of malignant growth in several lymph nodes.
• 3C Stage. The neoplasm occupies the entire volume of the intestine and, at the same time, metastatic spread of mutated cells to 4 or more lymph nodes occurs.
• 4 stage. malignant process reaches a considerable size. Metastases are detected in the lymphatic system and distant organs.

Oncological lesions of the colon are also classified according to location:

1. Cancer of the ascending colon. (12%).
2. Cancer of the sigmoid colon. (50%).
3. .(15%).
4. Cancer of the transverse colon. (8%).
5. Cancer of the intestinal fold (15%).

Symptoms and initial signs

Signs of a malignant lesion of the colon depend on the stage and location of the tumor. So, a neoplasm of the right part of the intestinal tract causes disturbances in the processes of digestion, and oncology of the left part of the intestine is manifested by difficulty in the passage of feces. In some cases, patients independently identify pathological compaction, which is often the first reason to seek medical help.

Common symptoms of colon cancer include the following:

• pain syndrome, which tends to gradually increase in pain intensity;
• digestive dysfunction in the form of bloating, intestinal obstruction, frequent burping, nausea and feeling of heaviness in the lower abdomen;
• the presence of blood and mucous inclusions in the feces;
• violation of the general somatic condition of the patient (chronic subfebrile temperature body, weight loss, malaise). In addition, malignant provokes the development of cancer intoxication.

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Modern diagnostics of neoplasms of the colon

Establishing an oncological diagnosis consists of the following activities:

1. The initial physical examination of the patient, during which the doctor determines the condition of the skin, the presence of compaction in the abdomen and enlarged lymph nodes.
2. Radiography. Holding x-ray examination with the use of a contrast agent makes it possible to detect a malignant neoplasm and find out its size.
3. Colonoscopy. This technique includes visual inspection inner wall intestines with a special optical instrument. During endoscopic examination held . Histological and cytological analyzes the affected area determine the final diagnosis.
4. Ultrasound procedure. The method is used to clarify the size and spread of a cancerous tumor.

Colon cancer treatment

Cancer Therapy gastrointestinal tract includes the following methods:

1. Surgical excision pathological tissue followed by intestinal closure. During resection of the neoplasm, the doctor also removes nearby lymph nodes. The volume and complexity of the surgical intervention is determined by the degree of spread of the tumor.
2. Radiation therapy and chemotherapy are considered palliative treatments. An indication for such therapy is considered.
3. . In modern oncological practice, specialists are increasingly using drugs that have a targeted effect on the cancer focus.

Forecast

The prognosis of an oncological lesion of the colon, detected at the initial stages, is favorable. Diagnosis malignant neoplasm at the stage of spread beyond the intestines, it suggests a negative outcome of treatment and a threat to the life of the patient. In such cases, patients undergo symptomatic therapy.

Colon cancer - how long do they live?

If the patient has colon cancer at stage 1, the five-year survival after surgical treatment is 90-100%. In the later stages, this figure is in the range of 20-50%.