Tumor of the transverse colon. Symptoms of cancer of the descending colon. Symptoms of cancer of the ascending colon

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 ones;
Lack of sufficient physical activity- sedentary lifestyle;
Violation in the digestive system, namely chronic constipation. In this state of affairs, solid fecal masses, passing the corners of the bowels, 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, tumor growth is not observed in The lymph nodes 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, there is a clear growth of the tumor in all structures of the intestine and partial damage to the 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. The left and right sides of the colon differ in their physiological functions, and therefore react to the tumor in different ways.

Right-sided lesion of the intestine violates the physiology of absorption of 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 of the normal process of 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

Radiography is carried out with the use of a contrast agent - the method of irigoscopy. 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 performed 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.

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 section of the transverse colon is removed - its third of the descending section, the sigmoid colon is partially removed, and the descending section is completely removed. 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 of the greater omentum and nearby lymph nodes.
The tumor is inferior and in the sigmoid colon. This arrangement allows for bowel resection. Part is removed sigmoid colon, neighboring lymph nodes and mesentery. 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 is designed to weaken cancer cells and facilitate surgery, and postoperative adjuvant therapy serves to consolidate the results of surgery and reduce the risk of recurrence.

Adjuvant therapy consists in directed irradiation of the affected tissue section to suppress 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 has 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, because even with all the 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, timely response to inflammatory processes in the large intestine - treat them in a timely manner, and in case of detection of polyps, they must be removed.

Causes of Colon Cancer

The main causal factors in the development of colon cancer are due to a number of pathogenetic and etiological provocateurs, oncologists identify the following important reasons:

Hereditary-familial factor in the development of colon cancer. The risk of occurrence increases significantly if there is a burdened family history. This is especially true of the most genealogically close relatives - parents, brothers, sisters.

Irrational nutrition, overeating, unbalanced diets, eating a huge amount of animal fats, a lack of coarse vegetable fiber and vitamins (the prevalence of refined foods) is especially detrimental. Animal fats stimulate the production of bile, which changes the microflora of the large intestine (there is a process of splitting animal fat and the formation of carcinogenic peroxidase substances that provoke colon cancer).

Insufficient fiber intake leads to a slowdown in intestinal motility and already formed carcinogens long time have contact with the intestinal wall, stimulating the malignant degeneration of the cellular structures of the mucosa, and cannot be eliminated from the intestine.

lack of vitamins and mineral complexes in the food consumed, and these are natural inhibitors of carcinogenesis, deepen the adverse effect.

An inactive lifestyle is hypodynamia, and as a result.

Systematic chronic constipation, in which the risk of injuring the natural physiological curves of the intestine with solid feces increases significantly.

Atony or hypotension of the intestine, characteristic of a more advanced age.

Precancerous diseases, which include: non-specifically developing ulcerative colitis, Peutz-Jeghers syndrome, colonic diverticulosis, solitary adenomatous polyps, familial hereditary polyposis, Türk's syndrome.

age factor. After age 50, the risk factor increases in direct proportion to age.

Work with harmful working conditions: contact with chemicals, specialties related to the processing of asbestos, mountain dust, work in sawmills.

In the formation of colon cancer, a certain role is assigned to sex hormones, in particular, progesterone, under its influence, the release of bile acids into the intestines.

The risk of development increases in nulliparous women, they have it twice as high as those who have already given birth to three or more children.

Colon Cancer Symptoms

The symptomatology of this pathology directly depends on the location and type of malignant tumor, its size and staging of development.

At the very beginning of the onset, colon cancer is completely asymptomatic and can be accidentally diagnosed during a planned dispensary examination. If certain symptoms are already beginning to appear, then most likely the patient will complain of: sudden constipation, progressive pain and intestinal discomfort, decreased ability to work, defecation disorders, mucus and bloody impurities in the feces.

Pain syndrome and malaise indicates damage to the right parts of the intestine (pain of low intensity, aching). With the defeat of the left departments - flatulence, rumbling of the abdomen, frequent urges to defecate without result, feces look like " sheep feces”, with traces of bloody and mucous masses, the appearance of sharp contractions-attacks, indicating the occurrence of intestinal obstruction, which is due to the peculiarities of the spread of neoplasia with the further formation of a formed narrowing that prevents the advancement of fecal masses.

Many patients complain of dysphagia, lack of urge to eat and discomfort in the abdominal area, general weakness and systematic malaise, weight loss, excessive pallor of the skin, hyperthermic manifestations and - this is more common in cancer of the transverse colon, less often in lesions of the descending colon and sigmoid.

Also, the symptomatology depends on the subspecies of colon cancer, their oncologists distinguish six main forms:

one). Obstructive with the main symptom - intestinal blockage. With partially manifested obstruction, the rumbling of gases and bloating, attacks of a cramping nature, and difficult discharge of feces are characteristic. With a complete variant of obstruction, immediate surgical intervention is required.

2). Toxico-anemic. Inherent in this form is anemia, malaise, painful pallor.

3). Dyspeptic. Symptoms of nausea and further vomiting, belching, pain in the upper abdominal area, bloating.

four). Enterocolitic. Characteristic disorder of the stool, rumbling, blood impurities and mucus in feces.

5). Pseudo-inflammatory. There is hyperthermia, minor pain and intestinal disorders, an increase in the erythrocyte sedimentation rate and.

6). Tumor-like. This is an atypical subspecies - asymptomatic.

Colon cancer stages

Classify the main four stages of colon cancer development:

0 stage. When only the mucous layer is affected, signs of malignant infiltrative growth are not determined, there are no metastases and the lymph nodes are not affected.

1 stage. A small primary tumor is determined, not exceeding one and a half centimeters in size, which is formed in the submucosal and mucous layers. Metastases are not typical.

Stage 2. The lesion is over 1.5 cm, but extends to less than half of the semicircle of the outer wall of the intestine, does not penetrate nearby organs. Single recorded metastases are possible.

3 stage. The size of the tumor exceeds the semicircle of the intestine, it is already growing into the intestinal wall, growing into adjacent organ cavities. Numerous foci in regional lymph nodes, but there are no distant metastases yet.

Stage 4. A large tumor, with penetration into nearby tissue structures and multiple metastases.

Colon cancer treatment

The leading prevailing method for the treatment tactics of colon cancer is surgical intervention. The treatment and choice of tactics for the surgical intervention is determined by the attending surgeon, based on a whole list of factors - this is the type of malignancy, the presence of distant foci and concomitant diseases in humans, the presence of complications, the localization of the pathologically occurring process, the stage of the process, the general condition at the time of the operation , age of the patient.

Depending on the scope pathological process perform a radical approach (almost all subtypes of colon cancer) or a palliatively oriented intervention (for severely neglected forms that cannot be operated on), combined operations(when spreading to nearby organs and tissue structures).

Radical operations are performed in the absence of distant foci and any associated complications. Their essence is that the sections of the intestine affected by a malignant neoplasm are excised along with the lymph nodes adjacent to them and part of the mesentery. The operation can be performed in one approach with the restoration of the passage of the intestinal chyme or in several stages with the removal of the colostomy (used for intestinal obstruction, the presence of bleeding and perforation of the intestine itself malignant neoplasm).

The goal of palliative surgery is to prevent the development of obstruction in the intestine with the imposition of a bypass joint or removal of the colostomy. To completely exclude the participation of loops in the process, they are sutured, adducting and abducting, between the connection itself and the fistula, and then the fistula, together with the part of the intestine isolated during the suturing, is resected. Such an operation is most relevant for carrying out in the presence of a large number of fistulas and with a fleeting deterioration in the patient's body condition.

Surgical interventions according to localization:

one). If colon cancer is localized zonal on the right side, then an operation called right-sided hemicolectomy is performed: the cecum, one third of the transverse colon, the ascending part and about ten centimeters of the ileum in the terminal section are to be removed. Excision is carried out in one approach and regionally determined lymphatic growths and articulation formation small intestine with thick.

2). In left-sided lesions, a left-sided hemicolectomy is performed, respectively. Create a joint and delete following departments: part of the sigmoid colon, mesenteric part, one third of the transverse section, descending colon, regional lymph nodes.

3). A small neoplasia in the center of the transverse intestine is removed, as is the omentum itself with overgrowths of lymphatic tissues.

four). The tumor in the underlying part of the sigmoid colon or its central part is resected by the lymph nodes and the mesenteric part, and then a part of the large intestine is connected to the end of the small intestine.

5). When neoplasia spreads to nearby tissue and organ structures, malignantly altered areas are removed using a combined operation.

Radical operations for colon cancer can be both one-stage and carried out in several stages:

one). When performing a one-stage surgical intervention, a hemicolectomy is performed, the essence of which is to remove a part of the colon with the creation of an articulation between the remaining sections of the resected intestine.

2). When carrying out multi-stage interventions for colon cancer, a colostomy is first performed, and after that the malignantly altered intestine is excised (sometimes at the same time), and after a period of time, after recovery, an operation is performed to restore intestinal continuity by forming a direct articulation.

3). With widespread colon cancer in the body, volumetric surgical interventions are performed, its volume is calculated taking into account the damage to both the lymph nodes and nearby organs. If extensive radical excision of the neoplasm is not possible, palliative measures are performed.

If there is the slightest chance that the patient will survive reoperation and he has a high percentage of predicted survival, it is more desirable to perform staged operations. If a person's condition does not allow for advanced cases to do this and the body is so weakened that the risk of mortality from surgical interventions is quite high, then one-stage resection of the affected areas of the body is chosen.

Surgical treatment of colon cancer is always additionally combined with subsequent radiation exposure and chemotherapy.

Radiation therapy in the treatment of colon cancer is rather complementary in nature. Procedures begin at least a couple of weeks after the last surgical intervention. The zone of direct growth and progression of neoplasia is often exposed to radiation ( local exposure). Radiation therapy has adverse effects in the form of side effects that tend to occur as a result of damage to the mucous layer of the intestine by the rays - this is vomiting and constant nausea, refusal to eat. The purpose of its use in the preoperative period is to inhibit the biological activity of malignant cancer cells, reduce their malignant potential and the possibility of postoperative recurrences.

Chemotherapy for colon cancer is used only in complex form, very rarely as an independent course of therapy (usually after symptomatic surgery). For the treatment of poorly differentiated malignant tumors, it is carried out in the adjuvant mode. Reception of a number of cytostatic modern safe drugs(Levamisole, Fluorouracil, Leucovorin) does not stop for at least one calendar year. The drugs are as safe as possible and devoid of side effects, so they are much easier to carry. But, nevertheless, in some recorded cases, one can observe the following undesirable consequences: allergic rashes- and erythematous rash, vomiting, nausea, leukopenic manifestations in the analyzes (decrease in the concentration value of the leukocyte mass).

Colon cancer prognosis

The prognosis for colon cancer can be characterized as moderately favorable, it is determined by the staging at which the patient was identified and taken into account and when the appropriate treatment of the oncological process began.

When colon cancer is diagnosed, the predicted further development worsens with all the ensuing consequences and complications and possibly developing side effects. Lethal outcomes registered after operations varies within 8%.

The average five-year survival rate for the first stage of cancer is about 90 to a maximum of 100%, for the second stage - 70%, and already in the third - 30%, after radical excision - 50%. In the presence of a tumor that does not grow through the submucosa, survival reaches a maximum - all 100%. In the absence of distant lesions in lymphatic growths - 80%, but in the presence of metastasis, and especially in the liver, this figure decreases to 40%.

With early detection of cancer of the ascending colon and cancer of the transverse colon, the prognosis is still favorable: the treatment finishes with a complete recovery in 95% of treated patients. Cancer of the descending colon in the total number of morbidity does not reach 5% of all registered cases, and timely treatment also brings successful results in curing patients.

All patients who underwent surgery to excise neoplasia should be under the active supervision of an oncologist, regularly undergo examinations, both radiological and endoscopic for early detection and prevention of local recurrences or possible distant metastases.

The earlier a malignant lesion is initially diagnosed and resection is performed, the greater the chances of a favorable outcome. In advanced situations and incorrect therapeutic cancer treatment mortality reaches 100%.

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 not balanced diet, in which animal fats predominate, and vitamins and coarse fiber are in short supply.

Due to the large amount of animal fats consumed, liver production is stimulated. 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 the secretion of 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, 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, a large number of lymphogenous metastases are observed.

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 a left-sided malignant neoplasm in the colon, patients complain of diarrhea and constipation, flatulence.

With neoplasia in the 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, the development of purulent inflammation, and 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 organs abdominal cavity.

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, an important indicator will be the level of hemoglobin (anemia occurs in oncology), and the patient is also 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 the 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, and the general state of health of the patient.

If there are no complications, and at the moment the disease has not metastasized, 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 recognized as inoperable, distant metastases in different organs are detected, 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 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, the patient is explained all the stages of treatment, preparation measures and postoperative procedures. 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 must be taken Castor oil. A few days before the scheduled operation, the doctor prescribes sulfa drugs and antibiotics to the patient.

When the operation is already over, it is necessary to provide the patient with full 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 an operation on the intestines, vaseline oil is given to the patient twice a day. 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;
low-fat 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 the tumor tissue, after which the contents of the intestine enter the 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;
tumor growth in hollow organs leads to the formation of fistulas (enterovaginal and gastrointestinal).

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 should be adjusted in such a way as to reduce the amount of fatty foods and carbohydrates in the diet, increase foods with high content fiber. It is important to avoid obesity, fight constipation. active image life - good friend 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 only oncological, since the canons healthy lifestyle of life are equally effective for all ailments.

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 (food bolus) moves sequentially through all these departments, liquid is absorbed from it and dense fecal 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:

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

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

M0 - no metastases in other organs.
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 may not manifest itself for a long time. 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 hypochondria 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 to 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 the clinical stage of the disease, which is very important for choosing 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, vascular ultrasound, consultations related specialists(cardiologist, neurologist, endocrinologist) to decide on possible surgical treatment.
Studies of the level of oncomarkers CEA, C19.9.
Study of tumor biopsy for 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. Indicated for 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 mainly 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 the remaining malignant cells in the body and prevent relapses.

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 a malignant tumor localized in one of the sections of the colon. In the structure of the incidence of malignant neoplasms of the gastrointestinal tract, colon cancer ranks second, and in the overall structure of oncological diseases it is 5-6%. The disease occurs equally in both men and women aged 50-70 years. The most commonly diagnosed cancer is the sigmoid colon.

The reasons

hereditary factor. The hallmark of hereditary colon cancer is the presence of the disease in young age(up to 50 years) with close relatives.
Unbalanced diet (the predominance of a large number of animal products).
Physical inactivity is a sedentary lifestyle.
Chronic constipation. Injury to the places of physiological bends of the intestine with feces.
Precancerous diseases: ulcerative colitis, familial adenomatous polyposis, Gardner's disease, Crohn's disease, diverticulosis, Turk's disease, single and multiple polyps, amoebiasis, etc.
Age over 50 years.
Harmful working conditions.

Colon cancer stages

Classification

Since the colonic mucosa is represented by glandular epithelium, adenocarcinoma (a tumor of epithelial cells) is more common than other oncological diseases, it accounts for 90-95% of all malignant neoplasms of the colon. Significantly less common: ring cell carcinoma (cells in the form of vesicles and not united with each other), mucous adenocarcinoma (in the tumor tissue a large number of mucus), squamous (the basis is cells squamous epithelium) and glandular-squamous (the tumor consists of glandular and squamous epithelium). In addition, undifferentiated and unclassified carcinomas may occur.
.

Symptoms

Symptoms of colon cancer depend on the location of the tumor and on its macroscopic form of growth, since the right and left halves of the colon have different physiological functions. If the tumor is located in the right half of the intestine, the absorption process is disrupted and, as a result, malnutrition. When the left colon is affected, the symptoms are associated with violation of the patency of fecal masses in the intestine.

Sometimes patients themselves find a tumor in their abdomen, this is one of the signs of colon cancer. In addition, the development of the disease is characterized by the following signs:

The development of pain syndrome.
A disorder of the digestive function, which manifests itself in the form of a decrease in appetite, belching, a feeling of heaviness in the abdomen and rumbling, nausea, vomiting, bloating, constipation, diarrhea and intestinal obstruction.
Admixture of blood and mucus in the stool.
Change in the general condition of the patient: general weakness and malaise, fatigue, fever, development of anemia. These symptoms are characteristic of cancer of the right half of the colon and develop as a result of absorption of tumor decay products, which leads to intoxication.

Diagnosis of colon cancer

The basis of the diagnosis of a malignant neoplasm is the use of the following methods:

Colon cancer treatment

Used in the treatment of colon cancer surgical method, radiation and chemotherapy.

Surgical method

There are certain principles for performing a radical operation for the treatment of colon cancer. They consist in the fact that the edges of the cut-off of the intestine during microscopic examination should not contain tumor cells. In addition, all regional lymph nodes are removed. The localization of the neoplasm and the degree of its prevalence affect the volume and nature of the surgical intervention.

If the tumor is located on the right side colon, then right-sided hemicolonectomy is performed (removal of part of the intestine). As a result of this operation, the caecum, ascending colon, hepatic flexure and the proximal third of the transverse colon with part of the greater omentum, as well as about ten centimeters of the terminal section are removed. ileum. To comply with the principle of radicalism, it is necessary to remove regional lymph nodes. At the end of the operation, a small-colonic anastomosis is formed (connection of the small intestine and large intestine).

With damage to the left side of the colon, a left-sided hemicolectomy is performed (removal of the distal third of the transverse colon). During the operation, a part of the transverse colon, the splenic flexure, the descending colon, a third of the sigmoid colon, regional lymph nodes, part of the greater omentum and the mesentery are removed. At the end of the operation, a colonic anastomosis is formed (connection of the large intestine and small intestine).

If the tumor is small and is located in the middle part of the transverse colon, it is resected together with the regional lymph nodes and the greater omentum. The formation of the colonic anastomosis is final stage surgical intervention.

Bowel resection shown in the localization of the tumor in the middle and lower part of the sigmoid colon. During the operation, a portion of the sigmoid colon, mesentery, and regional lymph nodes are removed. The final stage of the operation is the formation of a colonic anastomosis (connection of the large intestine and small intestine).

If the tumor process is complicated by intestinal obstruction or damage to the intestine, an obstructive resection of the colon is performed. Restoration of its continuity is performed after a short period of time. If the tumor spreads to other organs and tissues, combined operations are performed, and if metastases are detected in the liver, ovaries and other organs, they are removed.

Palliative operations carried out in the case of a high prevalence of the tumor process and in the presence of multiple metastases. These operations include: the imposition of a colostomy, the formation of a bypass anastomosis.

Radiation therapy

Adjuvant (postoperative) radiation therapy is performed for stage T4 colon cancer. Treatment begins 15-20 days after combined surgery. The total focal dose is 50-60 Gy, and the single focal dose is 2 Gy. The area of tumor growth is subject to irradiation.

In some cases, as a result of radiation therapy, there may be various complications resulting from damage to the intestinal mucosa after its irradiation. Their main manifestations are: loss of appetite, nausea, vomiting, diarrhea, the appearance of intestinal discharge containing mucus and blood.

Chemotherapy

For a long time, only fluorouracil (5-FU) was the drug that had the necessary efficacy in the treatment of colon cancer. Currently, there are many modern chemotherapy drugs: oxyplatin (a platinum drug), irinotecan (a topoisomerase 1 inhibitor), capecitabine.

Currently, for the treatment of colon cancer, the following is used: targeted therapy (point effect on certain molecular targets - receptors), which are of no small importance in the life of the cell. Therapy with monoclonal antibodies to the vascular growth factor VEGF (avastin), an inhibitor of the epidermal growth factor receptor EGFR (erbitux, panitumumab).

As a result of chemotherapy treatment of colon cancer, in some cases, there are side effects its application. The main symptoms are: nausea, vomiting, allergic skin rashes, the development of leukopenia (decrease in the level of leukocytes in the blood).

Prevention and screening

Screening programs are used for early detection and prevention of colon cancer. To date, clear rules for their implementation have not yet been developed, but the following methods can be used:

Analysis of feces for occult blood. It is recommended that the survey be carried out once a year.
Flexible sigmoidoscopy. Experts recommend conducting a survey once every five years.
Colonoscopy. The study is recommended to be carried out general anesthesia once every 10 years.

The basis for the prevention of colon cancer is a balanced diet with a predominance of plant products and a reduction in the intake of animal fats. When inflammatory diseases the large intestine needs them timely treatment, and if polyps are found, their removal is recommended.

Disease prognosis

If the disease is detected in the early stages, the prognosis is favorable, for example five-year survival with colon cancer stage I is 90-100%, stage II - 60-70%, III - 30-50%. At stage IV of the disease, treatment is not always offered to patients. By vital indications sometimes palliative surgery is performed, after which the average life expectancy is from 6 to 12 months.