Adenocarcinoma of the hepatic angle of the colon. Clinical and anatomical forms of ROC

The colon is a section of the gastrointestinal tract belonging to the large intestine, which is a continuation of the cecum and then continues into the sigmoid colon. The direct process of digestion does not occur in it, because... it ends earlier, but there is active absorption useful substances, electrolytes, fluids and feces are formed. Cancer colon(denoted by the abbreviation ROK) is the appearance of a malignant tumor in any part of the intestine, which is accompanied by a corresponding clinical picture and course of the disease.

Statistical data

More often this disease is diagnosed in residents North America and in Australia, these rates are lower in European countries, and are most rare in Asia, South American and African countries. Colon cancer accounts for 5-6% of the total number of detected oncological diseases, and among all malignant tumors of the gastrointestinal tract it ranks 2nd.

More than 70% of patients with colon cancer seek help having already reached the last stages (3-4), which makes treatment difficult. At the same time, it was found that if we produce surgery and chemotherapy, when the process is still localized, survival for five years is observed in 92% of patients. If treatment is carried out for existing regional metastatic foci, the five-year survival rate is 63%, with distant metastases - only 7%.

Causes of pathology

Conditions for anyone cancer Often these are processes that lead to prolonged inflammation in tissues, frequent injury, and toxic damage. In this case, it is believed that colon cancer can be provoked by the following factors:

Hereditary predisposition leads to early appearance tumors in the intestine. If you have relatives who experienced ROC before the age of 50, this fact most likely indicates high risk development of the disease and hereditary burden.
Irrational unbalanced diet with a dominant role of animal fats and refined foods, as well as reduced content fiber leads to disruption of peristalsis in the intestine, the contents remain in it for too long and lose water, dense stones with sharp edges are formed.
Long-term constipation, because in this case, the stool becomes hard and can seriously damage the intestinal wall. Damage leads to inflammatory reactions and increased division of epithelial cells, which increases the likelihood of developing cancerous tumor.
The presence of intestinal diseases, called precancerous, that is, also often transforming over time into cancerous tumors: Crohn's disease, UC, glandular polyps, diverticulosis, familial polyposis, etc.
Old age, when blood circulation in the intestines deteriorates, atony (decreased contractility muscles of the intestinal walls, leading to constipation), accumulate pathological changes in tissues.

The detection rate of colon cancer increases after 40 years of age and reaches a maximum at 60-75 years of age. The disease can also be caused by factors such as:

obesity, especially in the male part of humanity;
work in harmful conditions associated with industrial intoxications;
smoking and love of alcohol.

Classification

ICD 10 - malignant tumor of the colon is designated by code C18 (C18.1, C18.2, C18.3, C18.4, C18.5, C18.6, C18.7).

Under the term “Transverse colon cancer”, several types of tumors are distinguished depending on their origin (from what type of cells they developed) and morphology (the above classification is important when histological examination neoplasm tissue):

Adenocarcinoma is the most common type of colon cancer, originating from atypically changed epithelial cells its inner surface.
Mucous adenocarcinoma - originates from glandular epithelium The walls of the intestine, which secretes mucus, are accordingly always heavily covered with it.
Signet ring cell carcinoma - represented by signet ring cells containing mucus in the cytoplasm, visible as a cluster of vesicles that are not connected to each other.
Squamous cell carcinoma - formed from squamous epithelium; bridges and keratin granules are visible under microscopy; it is detected quite rarely.
Glandular squamous cell tumor – combines the qualities squamous cell carcinoma and adenocarcinoma.
Undifferentiated cancer - the cells that make up the tumor do not secrete mucus and are not components of the glands; they form cords that are separated by the connective tissue stroma.
Unclassified cancer - diagnosed when the tumor does not correspond to any of the listed options.

Depending on how the tumor grows relative to the intestinal walls, there are three forms:

Exophytic growth - if the tumor protrudes into the intestinal lumen;
Endophytic growth - cancer begins to grow into the intestinal wall and can spread to surrounding organs and tissues;
Transitional form - there are signs of both forms.

Stages of Colon Cancer

The stages determine the severity of the process, how much the cancer has spread within the intestine and surrounding tissues:

Stage 0 – tumor cells are located within the intestinal mucosa and have not yet spread to its deeper layers and lymph nodes;
Stage 1 – the submucosa of the intestinal wall is also affected;
Stage 2A – colon cancer has spread to muscle layer its walls, on adjacent tissues, close the intestinal lumen by half or more, there is no metastatic spread.
Stage 2B – cancer grows into the pleura, there are no metastases;
Stage 3A – the above and metastases in regional lymph nodes;
Stage 3B - cancer affects the subserosal layer of the intestine and nearby tissues, may affect other organs and the pleura, there are metastases in no more than 3 regional lymph nodes;
Stage 3C – metastases spread to more than 4 regional lymph nodes, the intestinal lumen closes;
4 – distant metastases appear in other organs.

The stage of the disease determines the prognosis.

Symptoms and clinical manifestations

What symptoms will accompany developing cancer colon, often correlates with the localization of the process. Let's look at this in more detail.

Cancer of the ascending colon. Most often, patients with tumors of this localization suffer from pain, which is explained by the fact that the passage of contents from the small intestine to the cecum is disrupted due to the closure of the lumen by the tumor. Digested food is constantly pushed forward by contractile movements of the intestines and meets resistance, against this background cramping pain occurs, intoxication appears, and intoxication increases. Often the tumor can be felt through the abdominal wall, like a hard pathological node in the intestine.

Cancer of the hepatic flexure of the colon. In this place, the lumen of the intestine quickly closes with the growth of the tumor; difficulties often arise with the introduction special device– an endoscope used to examine a pathological focus and take biopsy material from tumor tissue. These difficulties are caused by severe swelling mucous membrane and decreased intestinal motility.

Transverse colon cancer. Transverse colon cancer generally manifests itself in the same way - due to impaired movement of feces through the intestine, sharp pains as the main symptom, intestinal obstruction develops and toxins begin to be absorbed. If the growth of cancer is endophytic, then there may be no pain until the tumor spreads to surrounding tissues.

Tumor of the hepatic angle of the colon. In this case, the main role in the development of symptoms is played by the anatomical proximity to the loop of the duodenum, that is, the tumor can spread to it, cause stenosis, and disrupt the separation of bile into its lumen. As the tumor grows, disintegrates, metastasizes, a reaction occurs to the process in other parts of the intestine and organs abdominal cavity. This manifests itself in exacerbation chronic diseases and the occurrence of acute: adnexitis, cholecystitis, ulcers of the duodenum and stomach, etc. Also, one should not forget about the development of obstruction, and sometimes the formation of fistulas in the rectum or duodenum.

Cancerous tumors of the descending colon. In general, they threaten the same as tumors of the hepatic angle of the colon. The difference is in the location of detection during palpation, localization of pain and treatment features.

In general, we can describe the course of colon cancer by highlighting the main forms and syndromes that appear with the disease in question. Symptoms of colon cancer in various clinical cases can be combined, but usually the predominant ones can be identified:

tumor-like form of cancer - when the patient does not feel anything, but the tumor is felt during palpation;
obstructive – when the intestinal passage closes and symptoms develop mainly due to impaired passage of food. Cramping pain appears, the abdomen swells, symptoms pathognomonic for intestinal obstruction appear (splashing noise, falling drop symptom, Obukhov Hospital symptom, etc.), vomiting occurs, intoxication occurs;
toxic-anemic - hemoglobin decreases, against which the patient becomes pale, sleepy, lethargic, weakens, loses tolerance to physical activity, experiences dizziness, shortness of breath, spots appear before the eyes, dark spots etc;
pseudo-inflammatory – imitates an inflammatory process in the abdomen, the patient experiences slight abdominal pain dyspeptic disorders, temperature, ESR, blood leukocytes increase;
enterocolitic - as the name suggests, the picture of the disease includes diarrhea or constipation, bloating, rumbling, pain, feces with mucous, bloody, purulent discharge;
dyspeptic – an aversion to certain foods may develop, patients experience nausea, vomiting, frequent belching, heaviness, epigastric pain, and gases accumulate in the intestines.

This is what happens big picture. If you notice symptoms of colon cancer, go to the hospital immediately. As you can see, colon tumors can give symptoms that disappear for other diseases, so you should always be on guard.

Diagnostic methods

First of all, always general examination doctor Evaluated appearance patient: condition of the skin, mucous membranes, constitution. The presence of cancer can be suspected by palpation (palpation), if there are quite large tumors, and enlargement of the superficial lymph nodes is also detected. At the same time, using percussion (tapping), it is possible to determine the presence of fluid in the abdominal cavity, which may indirectly indicate a tumor process.

Secondly, laboratory tests. General analysis blood will reveal increased ESR and leukocytosis, which indicate existing inflammation in the body. Tests for specific oncological markers are already practically exact result. Fecal occult blood test positive result also indirectly supports the presence of cancer, but only in conjunction with other reliable signs.

Thirdly, instrumental methods. First, this is a survey radiography, then radiography with contrast, colonoscopy, sigmoidoscopy, ultrasound, computed tomography, magnetic resonance imaging. All studies are prescribed by the doctor after assessing the clinical picture.

Fourth, study of biopsy specimens. The diagnosis of cancer is accurate only after a biopsy (sampling of tumor tissue) and examination of the resulting materials under a microscope. If clear signs of a malignant tumor are detected, a diagnosis of colon cancer is made; if the result is questionable, an immunohistochemical study of the biopsy specimen is also performed.

Features of treatment: video surgery, relapses

Before choosing a tactic, the doctor carefully evaluates the stage of the tumor process, its spread, and the condition of the patient’s body - accompanying pathologies, age. The most effective is radical (complete) removal of all tumor cells, metastases, affected lymph nodes with adjuvant (that is, carried out after surgery against cancer) chemotherapy and/or radiation therapy. However, the extent to which this is feasible is limited in each specific case by the neglect of the process and the general condition of the body.

If the tumor appears on the right, then a right-sided hemicolonectomy is performed, when the cecum, ascending colon, 1/3 of the transverse colon and end part ileal Regional lymph nodes are also removed, because Tumor cells may remain there, which will cause new cancer in the future.

Finally, an end-to-end anastomosis (stitching) of the small and large intestines is formed.
For a tumor present in the left parts of the colon, a left-sided hemicolectomy is performed, where the distal 1/3 of the transverse colon, the descending colon, partially the sigmoid colon, plus the adjacent mesentery and lymph nodes are removed. Upon completion, the intestine is sutured end to end, or (depending on the conditions) a colostomy is formed, and only then, months later, at the next operation, both ends are sutured.

Often patients appear at the oncologist with a process that has spread to other organs. In this case, if possible, not only part of the intestine is removed, but also all affected parts of the organs.

When metastases are multiple and distant, radical surgery is not possible; palliative interventions. For example, a colostomy is done in case of intestinal obstruction due to obstruction by a tumor, in order to remove the contents of the intestine and alleviate the suffering of the patient, or the formation of fistulas.

Radiation therapy begins approximately three weeks after surgery; it can cause nausea, vomiting, which is explained by a damaging effect on the intestinal mucosa, and numerous other complications, but is necessary to prevent recurrence.

After radiation therapy Temporary and long-term complications may occur:

feeling of increased weakness;
violation of the integrity of the skin at the sites of exposure;
decreased function of the reproductive system;
inflammation Bladder, dysuric disorders, diarrhea;
symptoms of radiation sickness (leukemia, the appearance of areas of necrosis, tissue atrophy).

The fight against cancer is long, persistent and difficult, but very often not hopeless.
Chemotherapy is usually easier for the patient with the advent of modern drugs.

The modern world, along with the growth of scientific achievements and treatment methods, is receiving more and more “diseases of civilization.”

People move less, sit a lot, and refined food increasingly resembles a miracle from a chemical laboratory. The number of cancer diseases is growing, and their transmission to offspring is gradually being fixed at the genetic level.

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

About the organ

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

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

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

Causes of the disease

Nutritional Features. The predominance of refined foods with a small amount of plant fiber, rich in animal fats and simple carbohydrates. Such food passes slowly through the intestines and does not provide a nutrient substrate for microflora.
Lifestyle with reduced physical activity leads to a decrease in the tone of the body in general and the intestines in particular, the movement of feces slows down, and a tendency to constipation appears.
Chronic constipation. If feces stay in the intestines for a long time, all the water is absorbed from it and it becomes dry. In the natural corners of the intestine, injury to the mucous membrane occurs.
Age after 50 years as a factor in the development of intestinal atony and a tendency to constipation.
Precancerous diseases: Crohn's disease, polyps, nonspecific ulcerative colitis, diverticulosis, Turk's disease.
Permanent impact harmful substances in production.
Heredity. If you have had relatives under 50 years of age with colon cancer, there is a high chance that it will develop again in future generations.

Kinds

Morphologically malignant formations colon are represented by the following types:

Adenocarcinoma– the most common form, accounting for up to 80% of detected cancers. Happens varying degrees differentiation. The higher it is, the better the prognosis for cure. It can grow in the form of a node, infiltratively or mixed.
Mucous adenocarcinoma(colloid cancer) is in second place in frequency, accounting for up to 12%. Morphologically characterized by the synthesis of a significant amount of mucus. The diagnosis is made when the tumor consists of 50% extracellular mucus.
Signet ring cell carcinoma typical for people under 40 years of age. Mucus collects in the cells, which pushes the nucleus to the edge. It grows infiltratively and early metastasizes to regional lymph nodes.
Squamous or glandular-squamous form are rare. Often develop at the border of the anal region. There are no signs of keratinization in the cells.
Undifferentiated carcinoma does not have histological features none of the forms. An aggressive type of tumor, it grows infiltratively and metastasizes early. The survival prognosis is the least favorable.
Solid cancer– carcinoma with a large accumulation of polymorphic cells and a small number of differentiated ones. The modified cells retain the ability to produce mucus.

By location

Ascending colon.
Transverse colon.
Hepatic flexure.
Hepatic angle.
Splenic flexure.

The growth pattern is divided into several types:

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

Stages

Based on the prevalence of the tumor, there are 4 stages:

I– determined in the mucous and submucosal layer;
IIA– cancer occupies up to half the circumference of the intestine, there are no metastases;
IIb– cancer up to half the radius of the intestine, grows beyond the wall, but there are no metastases;
IIIA– the tumor spreads over half the circumference of the intestine, there are no metastases;
IIIb– metastases are diagnosed in regional lymph nodes;
IV– infiltrates adjacent organs, multiple lymph node metastases, or any volume of cancer with distant seeding of other organs.

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

Symptoms

Bleeding can appear at any stage of cancer. When localized in the ascending section, the hepatic angle, hidden bleeding is characteristic, which is not noticeable to the naked eye. Carcinoma of the left sections is accompanied by the appearance dark blood in stool, often mixed with feces and mucus.
Abdominal pain typical for late stages, is absent in some patients.
Constipation is the cause and consequence of a tumor, associated with obstruction of patency, narrowing of the lumen.
Tenesmus – false urges to defecation, are more typical for tumors of the terminal sections.
Intestinal obstruction develops gradually, the diameter of the intestine narrows. Sometimes it can occur acutely and be the first symptom of carcinoma.
Weakness, loss of appetite and weight– signs of exhaustion under the influence of the tumor process.
Anemia appears when hidden prolonged bleeding from the right parts of the intestine.
Ascites and liver enlargement appears in the later stages of cancer.

Diagnostics

General inspection does not provide reliable information about a tumor of the colon. Characteristic symptoms for her no. Complaints during anamnesis about any problems with the intestines after 50 years give the right to assume the development of carcinoma.
General blood analysis reflects inflammatory reactions, which can accompany cancer, anemia with obvious or hidden bleeding.
Feces for occult blood necessary to verify existing or minor bleeding from the upper sections. But the method is not informative enough, because blood in the stool is detected when there is bleeding from the gums, hemorrhoids, depends on the food consumed.
Digital rectal examination necessary to differentiate colonic from rectal cancer.
Colonoscopy allows you to visually assess the spread of the tumor, perform a biopsy and remove polyps.
Irrigoscopy carried out after a barium enema, inflating the intestinal loops with air makes it possible to notice small adenomas.
Ultrasound of the abdominal cavity and pelvic organs diagnose the extent of the tumor process, metastases in the lymph nodes and other organs. The method is less sensitive and is used when computed tomography is not possible.
CT is a series of layer-by-layer images that display the topographic location of the cancer tumor relative to other organs, the degree of germination, and prevalence.
Determination of tumor markers. There are no specific ones for colorectal cancer, but the appearance in the blood of carcinoembryonic antigen (CEA), markers CA-19-9, CA-50, if present additional symptoms allows you to diagnose carcinoma. Monitoring of CEA after therapy reflects its effectiveness and the development of relapse.

Treatment

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

For adenocarcinoma of the left sections, the transverse colon, splenic angle, descending section, omentum and mesentery are resected. They are anastomosed with the small intestine. If radical removal of the organ is not possible, palliative treatment is performed: colostomy, bypass anastomosis.

Radiation therapy prescribed after surgery at stage 4 cancer, no earlier than 15-20 days from the intervention. The pathological area is irradiated to destroy the remaining cells. Assign single dose 2 Gy, in total - up to 50 Gy.

Chemotherapy carried out after surgical treatment and if surgery is not possible. The following drugs are used in courses: Tegafur, Capacitabine, Oxaliplatin, Irinotecan.

More advanced treatment with point impact on receptors is the use of monoclonal antibodies to vascular factor(Avastin), epidermal growth receptor inhibitors (Panitumumab).

Video about modern method surgical intervention using stapler technology:

Rehabilitation

Meals are fractional, in small portions 4-5 times a day. Preference for slimy porridges and soups, processed vegetables, fermented milk products, chicken meat, lean fish.

Avoid heavy lifting and heavy physical labor for the next 3 months. Patients with an inoperable stage of colostomy may need the help of a psychotherapist.

Regular monitoring is required for timely detection relapse. Every 3 months - digital examination, irrigoscopy, every 6 months - ultrasound of the liver and abdominal organs, x-ray examination chest. It is necessary to determine CEA, which indicates tumor recurrence.

Prevention

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

Forecast

Late diagnosis of colon cancer worsens the prognosis. Inability to perform surgery on last stage leads to fatal outcome during a year. Refusal surgical treatment for more early stages will allow you to live up to 2 years.

After operated stage 1 carcinoma, the five-year survival rate reaches 90%, when lymph nodes are involved in the process - up to 50%. Localization of adenocarcinoma in the right parts has an unfavorable prognosis, with up to 20% surviving within 5 years after radical removal.

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

Learn more about the problem of relapse in this video:

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is a malignant tumor of epithelial origin localized in the colon. Initially, it is asymptomatic, but later manifests itself in pain, constipation, intestinal discomfort, mucus and blood in the feces, deterioration of the condition and signs of cancer intoxication. Often a node is palpated in the projection of the organ. With progression, intestinal obstruction, bleeding, perforation, infection of neoplasia and the formation of metastases are possible. The diagnosis is made taking into account symptoms, radiography, CT, MRI, colonoscopy and other studies. Treatment is surgical resection of the affected part of the intestine.

ICD-10

C18 C19

General information

Colon cancer is a malignant neoplasm that originates 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 the total number of malignant tumors of the gastrointestinal tract. 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 of the disease are occupied by the United States and Canada. Enough high performance incidences are observed in Russia and European countries. The disease is rarely detected in residents of Asian and African countries. Colon cancer is characterized by a long local growth, relatively late lymphogenous and distant metastasis. Treatment is carried out by specialists in the field of clinical oncology, proctology and abdominal surgery.

Causes

Experts believe that colon cancer is a polyetiological disease. Important role in the development of malignant neoplasia of this localization, dietary features play a role, in particular, excess animal fats, lack coarse fiber and vitamins. Presence in food large quantity animal fat stimulates the production of bile, under the influence of which the microflora of the large intestine changes. During the breakdown of animal fats, carcinogens, causing colon cancer.

An insufficient amount of coarse fiber leads to slower intestinal motility. As a result, the resulting carcinogens remain 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 have Negative influence on the intestinal mucosa. The lack of vitamins, which are natural inhibitors of carcinogenesis, as well as fecal stagnation and constant traumatization of the mucous membrane in the areas of natural bends of the intestine by feces aggravate these adverse effects.

Recent studies indicate that sex hormones play a certain role in the occurrence of colon cancer, in particular progesterone, under the influence of which the intensity of secretion 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 half as low as in nulliparous patients.

There are a number of diseases that can transform into colon cancer. Such diseases include Crohn's disease, ulcerative colitis, polyposis of various origins, solitary adenomatous polyps and diverticulosis. The likelihood of these pathologies developing 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 become malignant extremely rarely.

Classification

Depending on the type of growth, exophytic, endophytic and mixed form colon cancer. Exophytic cancer is nodular, villous-papillary and polyp-shaped, endophytic - circular-stricturing, 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 parts of the intestine, endophytic forms - in the left. Taking into account histological structure distinguish between adenocarcinoma, signet ring cell, solid and scirrhous colon cancer, taking into account the level of differentiation - highly differentiated, moderately differentiated and poorly differentiated neoplasms.

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

Stage I– a node with a diameter of less than 1.5 cm is detected, not extending beyond the submucosal layer. There are no secondary lesions.
IIa stage– a tumor with a diameter of over 1.5 cm is detected, extending no more than half the circumference of the organ and not extending beyond outer wall intestines. There are no secondary lesions
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 lesions.
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.

Symptoms of cancer

Initially, colon cancer is asymptomatic. Subsequently, pain, intestinal discomfort, stool disorders, mucus and blood in the feces are observed. Pain syndrome most often occurs when the right parts of the intestine are affected. At first, the pain is usually mild, aching or dull. With progression, sharp cramping pain may appear, 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 growth characteristics of neoplasia with the formation of a circular narrowing that prevents the movement of intestinal contents.

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

For neoplasia sigmoid colon characteristic impurities of mucus and blood in the stool. In other localizations of colon cancer, this symptom is less common, since as it moves through the intestines, the secretions have time to be partially processed and evenly distributed throughout the fecal matter. By palpation, colon cancer is more often detected when located in the right parts of the intestine. The node can be palpated 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 perforation of the organ due to invasion of the intestinal wall and necrosis of neoplasia. When foci of decay form, there is a danger of infection, development purulent complications and sepsis. With germination or purulent melting of the vessel wall, bleeding is possible. When distant metastases occur, disruption of the activity of the relevant organs is noted.

Diagnostics

Colon cancer is diagnosed using clinical, laboratory, endoscopic and radiological findings. First, complaints are clarified, the medical history is clarified, a physical examination is carried out, including palpation and percussion of the abdomen, rectal examination. Then, patients with suspected colon cancer are prescribed irrigoscopy to identify filling defects. If intestinal obstruction or perforation of the colon is suspected, plain radiography of the abdominal cavity is used.

Patients undergo a colonoscopy to evaluate the location, type, stage, and growth pattern of colon cancer. During the procedure, an endoscopic biopsy is performed, and the resulting material is sent for morphological examination. A stool occult blood test, a blood test to determine the level of anemia, and a carcinoembryonic antigen test are ordered. To detect foci in lymph nodes and distant organs, CT and ultrasound of the abdominal cavity are performed.

Treatment of colon cancer

Treatment is surgical. Depending on the extent of the process, radical or palliative surgery is performed. Radical operations for colon cancer can be 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 part of the intestine is removed (sometimes these two stages are performed simultaneously), and after some time the continuity of the intestine is restored by creating a direct anastomosis.

In case of advanced colon cancer, extensive interventions are carried out, the volume of which is determined taking into account the damage to the lymph nodes and nearby organs. If radical removal of neoplasia is not possible, palliative operations are performed (colostomy, formation of bypass anastomosis). For colon cancer with the development of perforation, bleeding or intestinal obstruction a stoma or bypass anastomosis is also performed, and after the patient’s condition improves, radical surgery is performed. For colon cancer with distant metastases, chemotherapy is prescribed.

Prognosis and prevention

The prognosis for colon cancer is determined by the stage of the oncological process. The average five-year survival rate for the first stage ranges from 90 to 100%, for the second - 70%, and for the third - 30%. All patients who have undergone surgery for neoplasms of this location should be under the supervision of an oncologist and regularly undergo radiological and endoscopic examinations to detect local relapses and distant metastases.

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

Symptoms of different forms of colon

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

There are six forms clinical course cancer:

toxic-anemic,

enterocolitic,

dyspeptic,

obstructive,

pseudoinflammatory,

tumor (atypical) form of cancer.

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

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

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

Specific signs of colon cancer

Specific symptoms of the disease are a fairly prolonged local spread of the tumor (including germination into surrounding organs and tissues) in the absence of metastasis to regional lymph nodes, which can appear quite late.

Metastasis in cancer occurs by lymphogenous (30%), hematogenous (50%) and implantation (20%) pathways. Colon cancer metastases most often occur in the liver, less often in the lungs, bones, and pancreas.

Diagnosis of colon cancer

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

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

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

frequent constipation,

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

signs of partial intestinal obstruction (flatulence, bloating, rumbling, cramping pain against a background of constant dull pain).

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

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

Pain as a sign of colon cancer

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

Intestinal dyspepsia as a manifestation of colon tumor

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

Pathological discharge(admixture of blood, pus, mucus in the stool) are observed in 40-50% of patients. Blood in the stool with colon cancer is a symptom of tumor disintegration and the development of concomitant colitis.

Life prognosis for colon cancer and features of its treatment

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

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

Surgical removal of colon cancer

The main treatment for this disease is surgery.

Before colon surgery, patients need preoperative preparation aimed at cleansing the intestines. IN last years When preparing the intestines, Fortran is used orally, dissolved in 3 liters of water. Orthograde intestinal lavage is also used by introducing 6 - 8 liters of isotonic solution through a probe installed in the duodenum. Less commonly used is a slag-free diet and cleansing enemas. In our article we will discuss the treatment of colon cancer.

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

For cancer of the right half of the colon, a right-sided hemicolectomy is performed (remove the terminal section of the ileum with a length of 15-20 cm, the cecum, the ascending and right half transverse intestine), completing the operation by applying an ileo-transverse anastomosis of the end-to-side or side-to-side type. For oncology middle third intestines treat colon cancer in the form of resection of the transverse colon, completing it with end-to-end coloanastomosis. In case of a tumor of the left half of the intestine, a left-sided hemicolectomy is performed (part of the transverse colon, descending colon and part of the sigmoid colon is removed) with transversosigmoid anastomosis.

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

Chemotherapy for colon tumors

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

Causes of colon cancer

To factors increased risk development of colon cancer include:

diet with high content fat and low content plant fibers (cellulose),

age over 40 years,

history of adenomas and colon cancer,

presence of direct relatives with colorectal cancer,

polyps and polyposis syndromes (Gardner, Peutz-Jeghers-Touraine,

familial juvenile polyposis),

Crohn's disease,

nonspecific ulcerative colitis, etc.

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

International classification of colon cancer

T- primary tumor of cancer

TX - insufficient data to assess the primary tumor

TO - no evidence for the presence of a primary tumor

T-s - carcinoma in situ: intraepithelial tumor or tumor with invasion of the lamina propria

T1 - colon cancer tumor invades the submucosa

T2 - tumor grows into the muscle layer

T3 - a colon cancer tumor grows into the muscular layer and subserosal base or surrounding tissues of non-peritoneal areas of the intestine

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

N - regional lymph nodes

NX - insufficient data to evaluate regional lymph nodes

N0 - no metastases to regional lymph nodes

N1 - metastases in 1-3 regional lymph nodes

N2 - metastases in 4 or more regional lymph nodes

Regional include paracolic and pararectal lymph nodes, as well as lymph nodes located along a. ileocolica, a. Colica dextra, a. Colica media, a. Colica sinistra, a. mesenterica inferior, a. rectalis superior, a. iliaca interna.

M- distant metastases of colon cancer

MX - insufficient data to determine distant metastases

MO - no distant metastases of colon cancer

Ml - there are distant metastases

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

Domestic classification of cancer by stages

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

Stage I - small tumor(Tl, T2), localized in the thickness of the mucous and submucosal membranes without regional and distant metastases (N0, MO).

Stage II - a tumor that occupies no more than the semicircle of the intestinal wall (T3, T4), does not extend beyond its limits and does not spread to neighboring organs (N0, M O) (single metastases to the lymph nodes are possible).

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

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

Colon cancer is quite common; the pathology ranks second among cancer diseases of the digestive canal. Mostly this disease is diagnosed in people over 60 years of age.

Colon cancer is a malignant neoplasm that can be localized in any part of this department. This tendency to develop a pathological process is explained by anatomical features. The colon includes:

ascending, descending, sigmoid sections;
cecum;
hepatic and splenic flexures.

Colonic, jejunal and ileum: 1 - large oil seal; 2 - transverse colon; 3 - free colon band; 4 - mesentery of the transverse colon; 5 - jejunum; 6 - ascending colon; 7 - cecum; 8 - sigmoid colon; 9 - ileum

The final formation of feces occurs in the colon. When consumed certain products, the development of certain pathologies, this process is disrupted, which leads to the occurrence stagnation, as a result of which the risk of neoplasm formation increases significantly.

Classification

Kinds

Depending on the structural features of the neoplasm, as well as on its qualitative composition, the following types of this pathology are distinguished:

Adenocarcinoma. Is the most common. Pathological process develops in the epithelial layer of the intestine.
Mucous adenocarcinoma. Such a neoplasm produces significant amount mucus.
Signet ring cell carcinoma. Outwardly it looks like a cluster of bubbles that are not connected to each other.
Squamous cell tumor. Formed from squamous epithelium, between the cells of which there are bridges and keratin. Diagnosed extremely rarely.
Glandular-squamous. Has signs of squamous cell carcinoma and adenocarcinoma.
Undifferentiated cancer. Characterized by the presence of cells that do not constitute glands and do not produce mucus. They form small cords separated by a connective tissue stroma.
Unclassified cancer. Diagnosed in cases where the symptoms do not correspond to any of the above types.

Macroscopic forms

Depending on the nature of tumor growth, it can be:

exophytic. This tumor grows into the intestinal lumen;
endophytic. Pathological tissues grow deep into the wall of the colon;
transitional. It has signs of endo- and exophytic forms.

Left-sided cancer is often represented by endophytic tumor growth. If the neoplasm is localized on the right, then in most cases it has signs of an exophytic form.

Stages

Based on the extent of the process and its prevalence, the neoplasm is divided into several stages of growth.

Stage	Characteristic
0	Only the intestinal mucosa is affected. There is no pathological process in the lymph nodes.
1	The neoplasm is small in size and grows into the mucous and submucosal layers of the wall.
2A	The tumor grows into the muscle layer and nearby tissues, its size covers the lumen of the organ by less than half the diameter. There are no metastases.
2B	Pathological cells penetrate the pleura, no metastatic growths are observed.
3A	In addition to the above signs, it is possible to detect metastases in several regional lymph nodes.
3B	Malignant formations are noted in the lymph nodes. The intestine is blocked by the tumor by more than half.
3C	Characterized by damage to more than 4 lymph nodes, the tumor completely covers the intestinal lumen. Metastasizes to neighboring structures.
4	Metastases spread to distant organs.

In addition, there is a TNM classification, according to which you can find out the extent of the pathological process:

T – means primary tumor;
N – indicates the spread of the tumor to the lymph nodes;
M – shows metastases.

To determine severity cancer pathology 1, 2 or 3 are placed next to each other. If any of the signs is not detected, it is indicated by the number 0.

Causes

The development of colon cancer is often associated with the following factors:

Symptoms

Clinical manifestations completely depend on the location of the tumor, its size and the advanced stage of the process.

In the early stages, the disease is asymptomatic. It can be detected completely by chance during a routine examination.
A little later, patients begin to complain of:
- pain varying intensity and character (aching, stabbing, etc.);
- symptoms of general intoxication of the body: great loss weight, loss of appetite, discomfort in the stomach, weakness, rapid fatigue.
When the tumor is localized on the right, the following are noted:
- bleeding;
- anemia;
- a tumor that can be palpated.
Left-sided cancer occurs with signs of intestinal blockage, alternating constipation and diarrhea, and flatulence. It cannot be detected during an objective examination of the patient. IN stool there is blood and mucus.

In addition, with colon cancer, there are discharges that are unusual physiological processes- blood, pus, mucus. Typically bright clinical picture occurs with significant progression of the pathological process.

Diagnostics

To diagnose colon cancer, the patient is prescribed a series of tests. First of all you need to pass lab tests: blood for tumor markers, feces to detect hidden blood.

Colonoscopy makes it possible to examine the condition of the walls of the colon from the inside, as well as take a biopsy to further determine the nature of the tumor.

Instrumental diagnostic methods are also prescribed.

Method	Grade
Physical examination	Allows you to conduct objective examination The patient's skin color is determined by palpation of the abdomen. The doctor can tap to determine the presence of fluid in the abdominal cavity, and also palpate the tumor if it has reached a large size.
Sigmoidoscopy	It consists of examining the lower intestine using a special apparatus.
Colonoscopy	Endoscopic examination with a special optical device. It makes it possible to examine the condition of the walls of the colon from the inside, as well as take a biopsy to further determine the nature of the tumor.
Radiography	Before the examination, the patient is injected with a contrast agent. The photographs allow us to see the tumor, its size, and its exact location.
	They allow us to accurately examine the structure of the neoplasm and its prevalence. These methods do not cause discomfort to patients during the procedure.

Palpation of the colon (video)

Treatment

To combat a malignant process in the colon, surgery is used in combination with radiation and chemotherapy. Treatment is selected based on the location, prevalence and severity of the disease.

Surgical intervention

It is the most effective way to fight tumors. It depends on the location of the formation and its nature.

Radiation therapy

Radiation is indicated after surgery for 14-21 days. It affects the area where the tumor is located. During this procedure, it is possible side effects in the form of nausea, vomiting, loss of appetite.

Chemotherapy

This treatment method is also used after surgical excision of a colon tumor and helps to destroy residual metastases. The patient is prescribed drugs such as ftorafur, 5-fluorouracil. In most cases they are well tolerated, but sometimes such adverse reactions like nausea skin rash, vomiting, abnormal blood counts.

Chemotherapy is carried out taking into account the patient's condition. If the body is too weak and cannot tolerate such heavy treatment, all activities are aimed at improving the quality of life.

In addition, chemotherapy is often combined with biotherapy. The patient is prescribed modifier drugs biological action. However, today there is no clear opinion about the use of this therapy.

Possible complications

In the absence of treatment, possible the following complications colon cancer:

Bedsores on the intestinal walls as a result of congestion.
Perforation of walls.
Tumor metastasis to the pancreas, stomach, liver.
Obstruction, intussusception.
Inflammatory phenomena in the tissues surrounding the formation.

Forecast

Patient's life expectancy after therapeutic measures determined by the type of tumor growth and stage of development. Patients who have completed a therapeutic course at stages 1-2 of the disease can live more than 5 years.

If there are no metastases in regional lymph nodes, the prognosis is favorable: the survival rate after treatment is about 80%. When a malignant tumor spreads to nearby tissues, this figure decreases to 40%.

In cases of late detection of the cancer process and lack of treatment, all patients die within the next 5 years.

Prevention

To prevent the development of intestinal tumors, you need to eat right. It is worth giving up eating refined foods and enriching your diet with vegetables, fruits, cereals, and dairy products.

Has a positive effect on health; moderate physical exercise, daily gymnastics, swimming.

Also, patients suffering from benign neoplasms should undergo routine examinations in a timely manner. This approach makes it possible to timely diagnose possible degeneration into cancer and prescribe the necessary treatment.

Foods that prevent colon cancer (photo gallery)

Cereals Fruits Vegetables Dairy products

Screening

For the purpose of early diagnosis malignant neoplasms The following research methods are used in the colon:

Fecal occult blood test, or hemoccult test.
Colonoscopy.
Sigmoidoscopy.

Neoplasms in the large intestine (video)

Colon cancer is terrible pathology which could lead to the death of the patient. Therefore, you need to carefully monitor your health, promptly contact specialists and follow recommendations regarding the prevention of this disease.