Tumor of the colon. Prognosis of Survival in Ascending Colon Cancer

In most cases, colon cancer is detected quite late. The disease is detected after the patient has tumor metastases and damage to other organs and tissues. Colon cancer detected at an early stage increases the chances of a cure.

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

Colon cancer symptoms

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

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

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

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

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

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

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

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

With the right-sided form of cancer, patients often find the tumor themselves during palpation of the abdomen. Bloody discharge in colon cancer is more often observed in exophytic types of tumors, begins with the decay of the tumor, and is a late manifestation of malignant formation.

Colon cancer: survival

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

Cancer of the ascending colon: symptoms

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

Cancer of the splenic flexure of the colon

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

Cancer of the transverse colon: symptoms

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

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

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

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

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

Chemotherapy for colon cancer

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

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

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

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

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

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

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

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

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

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

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

Where to go for colon cancer?

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

Bibliography

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

Colon cancer treatment prices

Name of service	Price
Consultation with a chemotherapist	Price: 5 150 rubles
Administration of intrathecal chemotherapy	Price: 15 450 rubles
brain MRI	Price from 8 900 rubles
Chemotherapy	Price from 50 000 rubles
Comprehensive cancer care and HOSPICE program	Price from 9 690 rubles per day
Gastrointestinal oncology program	Price from 30 900 rubles
Lung Cancer Program	Price from 10 250 rubles
The program of oncodiagnostics of the urinary system	Price from 15 500 rubles
Cancer Diagnostic Program "Women's Health"	Price from 15 100 rubles
Cancer Diagnostic Program "Men's Health"	Price from 10 150 rubles

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

This is another contribution of a person for the opportunity to live in civilized conditions. According to statistics, ROK is literally the scourge of developed countries, where people are used to eating refined food.

The colon is conceived by nature as an actively working part of the intestine, where fecal masses are formed, where there should be no congestion, and therefore the structure of the mucosa is quite specific. Refined food, poisons, and some other damaging factors lead to the development of polyps, adenomatous growths that are prone to malignancy.

The causes of this type of colorectal cancer are congestion and trauma to the colon mucosa with feces.

The clinical manifestations will depend on in which part of the colon the tumor is localized. If the tumor is located on the right side of the abdomen (ascending colon), then the earliest signs will be abdominal pain, poor appetite, rumbling in the abdomen, a feeling of heaviness.

Cancer of the descending colon later gives a pain syndrome, but almost immediately manifests itself with intestinal problems: constipation, alternating them with diarrhea, bloating, a feeling of a dense heavy lump on the left, with bleeding when the process is started.

The closer to the sigmoid colon, the more often the cancer is manifested by mucous feces with an admixture of blood, with the decay of the tumor with pus, the pain is localized in the lower abdomen and is given to the lower back, legs, and kidneys.

And, of course, with all localizations, a toxicoanemic syndrome is inevitable: weight loss, pallor, yellow or gray skin, weakness, anemia, and thermoregulation disorders.

Diagnosis and treatment

It is impossible to detect colon cancer only according to the examination and anamnesis, especially in the early stages. A complex of laboratory and instrumental examinations is required. This is a biochemical blood test with the determination of specific antigens, X-ray examination using a barium suspension, sigmoidoscopy, colonoscopy with biopsy for histological examination, ultrasound, and in some cases diagnostic laparoscopy.

Surgical treatment, tactics of management and the type of intervention performed are determined by the oncologist operating on the basis of data on the localization of the tumor, its type, stage, the presence of metastases, concomitant diseases, the age of the patient and his general condition.

The operation is combined with chemotherapy or drug treatment is used as a palliative method if surgery is not justified (with extensive colon cancer or in the presence of a large number of metastases).

The prognosis is moderately unfavorable. The average survival rate after successful surgery is 50% within five years after the intervention. The earlier colon cancer is detected and the affected part is resected, the higher these figures are up to 100%. Without treatment and with advanced stages within five years, the mortality rate is 100%.

Colon cancer occupies one of the first places in the structure of oncological diseases. The disease affects equally often men and women, usually aged. The frequency of the disease is highest in the developed countries of North America, Australia, New Zealand takes an intermediate place in European countries and is low in the regions of Asia, South America and tropical Africa. In Russia, the disease occurs with a frequency of 17 observations per population. Near-new cases of the disease are detected annually (more than in the USA).

Increased risk factors for colon cancer include a diet high in fat and low in plant fibers (cellulose), age over 40 years, history of adenomas and colon cancer, direct relatives with colorectal cancer, polyps and polyposis syndromes ( Gardner, Peutz-Jeghers-Touren, familial juvenile polyposis), Crohn's disease, ulcerative colitis, etc.

Pathological picture. Most often, cancer develops in the sigmoid colon (50%) and caecum (15%), less often in other sections (ascending colon - 12%, right bend - 8%, transverse colon - 5%, left bend - 5% , descending colon - 5%).

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

Exophytic forms of cancer are more common in the right half of the colon, are nodular, polypoid and villous-papillary; the tumor grows into the intestinal lumen. Endophytic tumors are more common in the left half of the colon. They are saucer-shaped and diffuse-infiltrative, in the latter case, they often cover the intestine circularly and narrow its lumen.

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

A specific feature of colon cancer is a rather long local spread of the tumor (including germination to surrounding organs and tissues) in the absence of metastasis to regional lymph nodes, which may appear quite late.

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

International classification of colon cancer

T - primary tumor

Tx - insufficient data to evaluate the primary tumor

TO - no data for the presence of a primary tumor

Colon cancer: symptoms

The symptoms of colon cancer depend on the location of the tumor. Since the contents of the right side of the colon are still semifluid, even large tumors of the caecum and ascending colon may not cause constipation and symptoms of intestinal obstruction. On the other hand, these tumors ulcerate, which causes chronic blood loss; blood in the stool is not visible. Microcytic hypochromic anemia develops; patients often complain of fatigue. heartbeat. chest pain. Due to the fact that bleeding from the tumor is usually periodic, a single study of feces for occult blood is not always informative.

The detection of iron deficiency anemia of unknown etiology in any adult patient (with the exception of premenopausal multiparous women) should entail an endoscopic or x-ray examination of the entire colon (Fig. 92.1).

Cancer of the caecum and cancer of the ascending colon is more common in blacks than in whites.

In the transverse and descending colon, the feces are denser. Therefore, tumors localized here usually impede the passage of intestinal contents, which is manifested by intestinal colic. symptoms of intestinal obstruction and sometimes intestinal perforation. X-ray often reveals a characteristic narrowing of the intestinal lumen in the form of an apple core (Fig. 92.2).

Tumors localized in the rectum and sigmoid colon are often accompanied by the appearance of fresh (scarlet) blood in the feces. tenesmus and narrowing of the fecal column. however, anemia is rare. Similar symptoms are also characteristic of hemorrhoids. however, the appearance of constipation or rectal bleeding requires urgent digital rectal examination and sigmoidoscopy.

Cancer of the ascending colon

Recently, in many countries of the world there has been an increase in the incidence of colon cancer.

In many Western European countries, colorectal cancer has even moved to second place in terms of the number of gastrointestinal cancers.

The large intestine is the distal part of the gastrointestinal tract; There are usually three main sections of the large intestine:

In turn, the colon also consists of several departments:

ascending colon;
right bend;
transverse colon;
left bend;
descending colon;
sigmoid colon.

The smooth muscles of the colon consist of an inner layer (circular, continuous) and an outer layer (longitudinal, unevenly expressed).

A cancerous tumor in the colon grows into the retroperitoneal tissue, duodenum, pancreas, etc. In this case, the statistics of the development of tumors is approximately as follows:

in the ascending colon - 18% of cases;
in the transverse colon - 9% of cases;
in the descending colon - 5% of cases;
in the sigmoid colon - 25% of cases;
in the rectum - 43% of cases.

The leading private Israeli clinic #8220; Elite Medical successfully treats cancer of the ascending colon. We offer our patients the latest treatment methods and highly professional medical care; due to this, a fairly high percentage of recoveries is achieved. Elite Medical guarantees that patients will be treated by the most highly qualified doctors from around the world.

Cancer of the ascending colon has similar symptoms to many other diseases, so gastritis, cholecystitis, peptic ulcer, and other diseases can be diagnosed instead. In order to establish an accurate diagnosis, it is necessary to undergo a series of examinations.

Our doctors

Tumors of the caecum and ascending colon

Percussion with a swollen abdomen, tympanitis is determined in all departments, but sometimes it is possible to establish one, sharply stretched bowel loop with higher tympanitis and visible peristalsis (Val's symptom).

Laboratory methods for analyzing blood and urine are not of great importance in the diagnosis of intestinal obstruction in colon cancer. However, a complete blood count may show anemia, depending on the malignant process, as well as leukocytosis with the development of inflammatory changes in the adductor loop of the colon or in the tumor itself. More specific are such changes as hypochloremia, a decrease in the level of potassium, sodium, hypoproteinemia, but they develop in the later stages, when pronounced clinical symptoms of intestinal obstruction come to the fore.

A very important sign that helps to establish the correct diagnosis is the palpation of a tumor in the abdomen. True, this is possible only with deep palpation, when there is no sharp bloating. Much depends on the skill of the doctor, on the use of various positions of the patient for probing the abdomen. Not only in the position of the patient lying on his back, but also in the position on his side, on all fours, it is necessary to examine the patient's stomach.

Tumors of the blind and ascending colon are most often palpated. It is known that it is precisely with such localization that cancerous tumors grow rapidly, often become infected, and inflammation passes to adjacent organs and tissues, in particular to the anterior and lateral walls of the abdomen, while the tumor is fixed and well palpable. Tumors of the transverse and sigmoid colon are identified when they reach a large size. It is more difficult to feel the tumors of the right and left bends of the colon.

A tumor in the abdomen is determined in approximately 1/3 of patients admitted to the clinic with intestinal obstruction for colon cancer. However, it should be remembered that other formations of the abdominal cavity, accompanied by signs of intestinal obstruction, can be taken for a tumor. These include intussusception, thrombosis of the mesenteric vessels with necrosis of the colon.

In our many years of practice, we observed and operated on 2 patients who had a tumor in the right upper quadrant of the abdomen that was palpable and had clinical signs of colonic obstruction. One patient was taken for surgery with a diagnosis of acute cholecystitis, and he turned out to have a tumor of the right half of the transverse colon, and the second patient was urgently taken for surgery with a diagnosis of cancer of the transverse colon with obstructive obstruction, and she was diagnosed with acute cholecystitis with an infiltrate around the gallbladder. bubble. However, such errors do not reduce the value of palpable tumor formations in the abdomen for correct diagnosis. It is only necessary to evaluate all the symptoms in the aggregate.

Symptoms and treatment of colon cancer

Colon cancer is common, and morbidity and mortality rates are constantly increasing, especially in economically developed countries. The causes of the pathology are as follows: a diet with a predominance of trans fats, a sedentary lifestyle, chronic obstipation, harmful production factors, severe concomitant diseases of the digestive system (ulcerative colitis, Crohn's disease, numerous polyps of the mucous membrane).

The hereditary predisposition to the oncological lesion of this organ matters. There are different types of cancer. They differ in cellular composition and source of pathology. In most cases, adenocarcinoma of the colon, which is formed from the epithelial lining, is diagnosed.

Anatomy of the colon

The organ consists of the following sections: ascending, transverse, descending and sigmoid colon. In the first, fluid is absorbed, and feces are formed from the remaining components in the remaining parts.

The ascending colon is a continuation of the blind colon, has a length of cm, passes into the transverse section. The latter is usually 50 cm long and continues at an angle into the descending colon.

It is characterized by the fact that the lumen of the organ in it gradually decreases. The duration of this section is 20 cm, it passes into the sigmoid intestine. Its length is about half a meter, ends at the junction with the rectum.

Colon Cancer Symptoms

The clinic of the cancerous process of the organ depends on the location of the pathological focus. Symptoms disturb the patient when the tumor has grown or metastasized to neighboring organs. The distribution process is quite slow, it takes a lot of time.

Symptoms of a colon tumor depend on which part is affected by the disease. If there is a lesion of the ascending section, the patient is worried about discomfort in the digestive tract, more often in the epigastric region and the left hypochondrium. The contents of this section of the colon are liquid, so obturation rarely occurs, only in the case of an advanced stage of pathology. In such situations, it is even possible to palpate the tumor during the examination.

There are hidden bleedings. The patient is diagnosed with anemia with all the accompanying complaints in this pathology - weakness, lethargy, increased fatigue. The skin is pale.

Symptoms of a cancerous lesion of the left side of the large intestine are characterized by similar signs. In these departments, the formation of feces occurs. The intestinal lumen is wider than in the area of the ascending part.

Cancer of the descending colon and other parts of this area grows in such a way that it helps to reduce the volume of the organ. This provokes the occurrence of intestinal obstruction.

The formation and evacuation of feces is impaired. Fermentation and putrefaction occurs in the intestine. Patients will complain of flatulence due to increased gas formation.

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Constipation in such situations alternates with diarrhea. The stool has an unpleasant putrid odor. The consistency and shape of the feces change. With an oncological lesion of the left side of the colon, the stool becomes thin. Blood impurities are observed. This is due to the collapse of the tumor. A cancerous lesion of the left side may ulcerate and be complicated by peritonitis.

It is important for patients to consult a doctor in situations where the shape and composition of the stool changes, discomfort and pain in the digestive tract are constantly worried. Also in cases of severe weight loss, increased fatigue, anemia.

Cancer stages and metastasis

The following degrees of oncological lesions of the colon are distinguished:

At stage 1, the tumor is no more than 1.5 cm, localized in the mucous or submucosal layer of the intestinal wall. Clinical symptoms are not observed, there is no metastasis. This stage is successfully cured.
2 degree of damage is characterized by large sizes, but does not leave the limits of the semicircle of the intestinal lumen. The tumor does not grow into other parts of the organ wall. There is either no metastasis, or there are single lesions by cancer cells of regional lymph nodes.
At stage 3, the tumor already sprouts all layers of the intestinal wall, the dimensions are larger than the semicircle of the organ. Metastases are not diagnosed. Stage 3 includes cases where the tumor is larger than the size indicated above, but with metastases to nearby lymph nodes.
At grade 4, the process spreads beyond the affected organ, the tumor grows into neighboring organs. A large number of metastases are diagnosed. This stage of cancer includes all cases of colon tumors with lesions of distant localizations - lungs, brain, bones, liver. The volume of the primary focus in such situations does not matter.

Metastasis occurs in 3 ways: through the lymphatic system, blood vessels and through germination in neighboring organs. This method is called implantation. Often there is a seeding of the peritoneum with cancer cells.

The nature of the localization of metastases depends on the location of the tumor. If it is located in the upper half of the abdominal cavity, cancer cells are more likely to enter the organs of the corresponding part of the body.

In situations where the lesion is anatomically closer to the rectum, the spread is diagnosed in the small pelvis.

Colon cancer most often metastasizes to the liver. The lungs, brain, testicles or ovaries, and the skeletal system are also affected.

If stage 2 and above are diagnosed, there are almost always lesions of regional lymph nodes.

Methods of treatment

The main thing that the attending physician needs to do is to remove the tumor surgically. The choice of the type of surgical intervention depends on the location of the pathological process, the degree of germination and metastasis.

During the operation, in addition to the tumor, resection of nearby lymph nodes is required, to which fluid is drained from the cancer-affected segment. The nature and extent of the intervention is determined by the attending physician.

If cancer of the ascending colon needs to be resected, an operation called a right-sided hemicolectomy is performed. In addition to the affected part of the organ, all the lymph nodes of this area are removed, an anastomosis is formed by connecting the small and large intestines.

Left-sided hemicolectomy is performed with the defeat of the oncological process of the left part of the colon. In addition to the pathological zone and lymph nodes, the mesentery of this zone is resected. An anastomosis is required.

Transverse colon cancer is removed along with nearby lymph nodes and the surrounding omentum.

If the tumor spreads to neighboring organs, surgeons perform combined interventions with the removal of cancerous areas.

In cases where surgical treatment is contraindicated, since it will lead to death, we are talking about palliative interventions. Usually form bypass connections for the passage of feces. This helps to avoid intestinal obstruction.

The removed material is immediately sent for examination in order to establish the stage of the process, the nature of the cancer cells. The conclusion of the doctor helps to determine further tactics.

The next stage of treatment - radiation and chemotherapy, is determined depending on the nature of the cancer cells. Irradiation is prescribed after surgery, usually after a couple of weeks. Often patients have side effects, but many tolerate the procedure well.

The next step is chemotherapy. It is an intravenous administration of anticancer drugs that inhibit the growth and spread of cancer cells. Usually tolerated by patients easier than radiation.

The duration of treatment depends on a large number of factors: the type of the tumor itself, the presence of metastases, the general condition of the patient, age, and severe comorbidities.

How long do people live with a diagnosis of rectal cancer? Read the link.

Find out in this article how to eat with a tumor in the rectum.

Conclusion

The disease is common, so it is important for patients to know what colon cancer is, its symptoms and treatment. Pathology is dangerous because it does not manifest itself in the early stages. In stages 1 and 2, the five-year survival rate is quite high.

The prognosis for stage 3 and 4 colon cancer is more pessimistic - about 40% of patients overcome the five-year milestone. The earlier the pathology is found, the higher the chances of a long-term remission.

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Colon cancer: symptoms, diagnosis and treatment

The colon continues the caecum and belongs to the main one and a half meter section of the large intestine. Behind it begins the rectum. The colon does not digest food, but absorbs electrolytes and water, so the liquid food substance (chyme) that enters it from the small intestine through the cecum becomes more solid stool.

Colon cancer: symptoms and forms of the disease

colon cancer

Colon cancer accounts for 5-6% of all bowel cancers and can occur in any of its departments:

ascending colon (24 cm);
transverse colon (56 cm);
descending colon (22 cm);
sigmoid colon (47 cm).

Tumors of the colon are formed on the walls and, with growth, can partially or completely close the lumen of the intestine, the inner diameter of which is 5-8 cm. Premalignant diseases that increase the risk of developing cancer are:

nonspecific ulcerative colitis;
diffuse polyposis;
adenomas.

Colon cancer symptoms are more likely to occur in people who eat a diet that is more meaty, including animal fat, fatty pork, and beef. To a lesser extent, they consume fiber. Vegetarians, on the other hand, suffer from cancer much less often.

The frequency of intestinal cancers has increased among workers in sawmills and those associated with asbestos processing. Constipation is a predisposing factor in the appearance of oncological tumors, since they form in the folds of the colon, where stool masses stagnate. With polyposis and chronic colitis, the symptoms should also be taken seriously, since tumors of double or triple localization can “hide” behind them. Most often, multiple foci can appear in the blind (40%) and sigmoid (25%) colon.

infiltrating endophytic;
exophytic (grow inside the intestine);
delimited;
mixed.

Early symptoms of colon cancer (ROC) are not bright, although the state of health decreases, as well as the ability to work, appetite is lost. But at the same time, patients gain weight, and do not lose weight.

In the future, colon cancer, the symptoms can be mistaken for signs of an intestinal disorder, which are manifested by:

constant dull pain in the abdomen, not associated with eating;
periodic and cramping pains due to diarrhea or constipation;
rumbling and transfusion in the intestines;
uneven bloating on one side, where the intestinal lumen narrowed;
anemia on the right side due to slow chronic blood loss.

With an increase in symptoms, patients may find:

intestinal obstruction;
bleeding;
inflammation: peritonitis, phlegmon and abscess.

Important! You need to worry about flatulence, feces in the form of sheep droppings, with blood and mucus, with pulling or sharp cramping pains, which indicates intestinal obstruction and tumor decay. And also in violation of intestinal motility, intoxication, which will be indicated by fever, anemia, weakness, fatigue and sudden weight loss.

Causes of Colon Cancer

Obesity is the main cause of bowel cancer.

The main causes of bowel cancer in the colon are associated with the presence of:

heredity - when such a form of cancer is detected in close relatives, the risk of oncological disease increases;
refined food and animal fats on the menu and malnutrition;
inactive lifestyle, physical inactivity and obesity;
persistent chronic constipation and at the same time injuries of the intestine with feces in its physiological bends;
atony and hypotension of the intestine in older people;
precancerous diseases: familial polyposis, solitary adenomatous polyps, diverticulosis, ulcerative colitis, Crohn's disease;
age factor;
hazardous work in production: contact with chemicals and mountain dust.

Classification and stages of the colon

Colon cancers include:

often - adenocarcinoma (from epithelial cells);
mucous adenocarcinoma (develops from the glandular epithelium of the mucous membrane);
colloid and solid cancer;
less often - cricoid cell carcinoma (the form of cells in the form of vesicles that are not united with each other);
squamous or glandular-squamous (the basis of the tumor is only epithelial cells: squamous or glandular and squamous)
undifferentiated carcinoma.

Departments, types and forms of colon cancer. Localization of tumors

Clinically, colon cancer manifests itself depending on the location of the tumor in its departments, the degree of spread and complications, which aggravate the course of primary cancer.

If cancer of the ascending colon is diagnosed, symptoms are manifested by pain in 80% of patients more often than with a tumor of the descending colon on the left. The cause is a violation of the motor function: the pendulum movement of the contents from the small intestine to the caecum and vice versa. The tumor can be palpated through the abdominal wall, which indicates cancer of the ascending colon, the prognosis will depend on the stage, the presence of metastases, successful treatment, restoration of motor (motor-evacuation) function, and the absence of intoxication of the body.

Cancer of the transverse colon with spastic contractions of the intestine, which pushes the stool through a narrow lumen near the tumor, causes sharp pain. They are exacerbated by perifocal and intratumoral inflammation of the intestinal wall, accompanied by infection from decaying tumors.

Cancer of the transverse colon is not initially manifested by pain syndromes until the tumor spreads beyond the intestinal wall, passes to the peritoneum and surrounding organs. Then the tumor can be palpated through the anterior wall of the peritoneum, and the pain will occur with different frequency and intensity.

Cancer of the hepatic flexure of the colon leads to narrowing and obstruction of the intestinal lumen. Sometimes the surgeon fails to insert the endoscope there due to deep mucosal infiltration and stiffness.

Cancer of the hepatic angle of the colon may appear as a disintegrating tumor in the hepatic flexure of the colon that grows into the duodenal loop. With such dislocation of the tumor, chronic diseases are stimulated: gastric and duodenal ulcers, adnexitis, cholecystitis and appendicitis.

There is a threat of intestinal obstruction, a colonic fistula or in the duodenum is possible. Cancer of the ascending colon, as well as that of the hepatic angle, can also be complicated by subcompensated stenosis of the duodenum and impaired colonic patency, atherosclerotic cardiosclerosis, and secondary hypochromic anemia.

With such a diagnosis, right-sided hemicolectomy and gastropancreatoduodenal and resection of perirenal tissue on the right side, excision of liver metastasis in the presence of it in the 7th segment of the organ is required.

Cancer of the splenic flexure of the colon, descending colon and sigmoid colon occurs in 5-10% of patients with bowel cancer. The pain syndrome can be combined with a hyperthermic reaction (fever), leukocytosis and rigidity (tension) of the abdominal wall muscles in front and on the left. Fecal masses can accumulate above the tumor, which leads to increased processes of decay and fermentation, bloating and retention of stools and gases, nausea, and vomiting. In this case, the normal composition of the intestinal flora changes, pathological discharge from the rectum appears.

The main forms of colon cancer and their symptoms:

Obstructive with a leading symptom: intestinal obstruction. With partial obstruction, the symptoms are manifested: a feeling of fullness, rumbling, bloating, bouts of cramping pain, difficulty passing gases and feces. With a decrease in the lumen of the intestine - acute intestinal obstruction, which requires emergency surgery.
It is toxic-anemic and leads to the development of anemia, weakness, high fatigue and a pale appearance of the skin.
Dyspeptic with characteristic nausea and vomiting, belching, aversion to food, with pain in the upper abdomen, accompanied by heaviness and swelling.
Enterocolitic with intestinal disorders: constipation or diarrhea, distension, rumbling and bloating, accompanied by pain, blood and mucus in the stool.
Pseudo-inflammatory with fever and abdominal pain, minor disorders, elevated ESR and leukocytosis.
Tumor-like without any special symptoms, but during the examination, you can feel the tumor through the wall of the abdomen.

Diagnosis, treatment and prognosis in colon cancer. How to prepare for the operation?

Diagnosis of colon cancer (as well as of the entire intestine) is carried out using:

Physical examination, while assessing the patient's condition: the color of the skin, the presence of fluid in the peritoneal cavity (determined by tapping). It is possible to determine the approximate size of the tumor through the abdominal wall only with large nodes.
Laboratory blood tests, including the determination of specific antigens, feces for the presence of blood.
Instrumental research methods: sigmoidoscopy to assess the condition of the lower intestine, colonoscopy to examine and obtain tissue for biopsy, x-ray with a barium suspension to detect the location of the tumor, ultrasound and CT to clarify the prevalence of the oncological process and a clear image of the anatomical structures.

Colon cancer treatment

Treatment of cancer (intestine) of the colon is carried out by radical surgery and subsequent radiation and chemotherapy. The doctor takes into account the type and location of the tumor, the stage of the process, metastases and concomitant diseases, the general condition of the patient and age.

Treatment of colon cancer without complications (obstruction or perforation) and metastases is carried out by radical operations with the removal of the affected areas of the intestine with the mesentery and regional lymph nodes.

In the presence of a tumor in the colon on the right, a right-sided hemicolonectomy is performed: the caecum, ascending colon, a third of the transverse colon and 10 cm of the ileum in the terminal section are removed. Regional lymph nodes are removed simultaneously, and anastomosis is formed (connection of the small and large intestine).

Surgical treatment of colon cancer

If the colon is affected on the left, a left-sided hemicolonectomy is performed. Perform an anastomosis and remove:

one third of the transverse colon;
descending colon;
part of the sigmoid colon;
mesentery;
regional LU.

A small tumor in the center of the transverse section is removed, as is the lymph node omentum. The tumor at the bottom of the sigmoid colon and in its center is removed with the LU and the mesentery, the large intestine is connected to the small intestine.

When the tumor spreads to other organs and tissues, the affected areas are removed by a combined operation. Palliative operations are started if the form of cancer has become inoperable or is running.

During the operation, bypass anastomoses are applied to the sections of the intestine, between which there is a fecal fistula, in order to exclude acute intestinal obstruction. For complete shutdown, the afferent and efferent loops of the intestine are sutured between the anastomosis and the fistula, and then the fistula, together with the switched off part of the intestine, is removed. Such an operation is relevant in the presence of multiple fistulas and high fistulas with a transient deterioration in the patient's condition.

Informative video: treatment of colon cancer with surgery

How to prepare for surgery

Before the operation, the patient is transferred to a slag-free diet and cleansing enemas and castor oil are prescribed for 2 days. Dishes from potatoes, any vegetables, bread are excluded from the diet. For prophylactic purposes, the patient is prescribed antibiotics and sulfa drugs.

Immediately before the operation, the intestines are cleansed with a laxative Fortrans or an orthograde bowel lavage is performed using an isotonic solution administered through a tube.

Radiation and chemotherapy

Radiation therapy in the area of tumor growth begins 2-3 weeks after surgery. In this case, side symptoms are often observed due to damage to the mucous membrane in the intestines, which are manifested by lack of appetite, nausea and vomiting.

The next stage is chemotherapy with modern drugs to eliminate side effects. Not everyone can easily endure chemistry, therefore, in addition to nausea and vomiting, allergic skin rashes, leukopenia (a decrease in the concentration of leukocytes in the blood) may appear.

Postoperative measures

During the first day, the patient does not take food, receives medical procedures to eliminate shock, intoxication and dehydration. On the second day, the patient can drink and consume semi-liquid and soft food. The ration is gradually expanding:

Important. To eliminate constipation and the formation of a fecal lump, the patient should take vaseline oil twice a day as a laxative. This measure prevents injury to fresh sutures after surgery.

Complications during treatment. Consequences of colon cancer

If left untreated in the early stages, the malignant process leads to severe complications:

intestinal obstruction;
bleeding;
inflammatory-purulent processes: abscesses, phlegmons;
perforation of the intestinal walls;
the development of peritonitis;
germination of the tumor in the hollow organs;
fistula formation.

Informative video: postoperative complications in patients with colorectal cancer: diagnosis and treatment

With irradiation, early temporary complications may appear, which disappear after the completion of the course. Symptoms of complications are manifested:

weakness, fatigue;
skin erosions in the epicenter of exposure;
oppression of the functional work of the genital organs;
diarrhea, cystitis with frequent urge to urinate.

With the accumulation of a certain critical dose of radiation, late complications are manifested by symptoms similar to radiation sickness. They do not go away, but tend to grow and manifest themselves:

Prognosis for Colon Cancer

When diagnosed with colon cancer, the prognosis worsens with all complications and side effects. Lethal outcomes after operations of a tumor of the colon are in the range of 6-8%. If there is no treatment and oncology is running, the mortality rate is 100%.

Survival within 5 years after radical surgery - 50%. In the presence of a tumor that has not spread beyond the submucosa - 100%. In the absence of metastases in regional lymph nodes - 80%, in the presence of metastases in the lymph nodes and in the liver - 40%.

Informative Video: Colon Cancer Recurrence

Prevention measures

Colon cancer prevention is aimed at conducting medical examinations to detect early symptoms of cancerous tumors. The use of modern automated screenings makes it possible to identify high-risk groups and send them for examination using endoscopes.

Important! When precancerous conditions or benign tumors are detected, it is important to put patients on dispensary records and treat them.

Conclusion! Doctors should conduct, and the population should support, the promotion of a healthy lifestyle and rational nutrition among all segments of the population, active sports, long walks in green areas in order to exclude oncological diseases.

How to recognize and treat bowel cancer in more detail, see also other articles on bowel oncology:

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Colon cancer is common, and morbidity and mortality rates are constantly increasing, especially in economically developed countries. The causes of the pathology are as follows: a diet with a predominance of trans fats, a sedentary lifestyle, chronic obstipation, harmful production factors, severe concomitant diseases of the digestive system (, Crohn's disease, numerous polyps of the mucous membrane).

The organ consists of the following sections: ascending, transverse, descending and sigmoid colon. In the first, fluid is absorbed, and feces are formed from the remaining components in the remaining parts.

The ascending colon is a continuation of the cecum, has a length of 15-20 cm, passes into the transverse section. The latter is usually 50 cm long and continues at an angle into the descending colon.

Colon Cancer Symptoms

The clinic of the cancerous process of the organ depends on the location of the pathological focus. Symptoms disturb the patient when the tumor has grown or metastasized to neighboring organs. The distribution process is quite slow, it takes a lot of time.

Symptoms of a colon tumor depend on which part is affected by the disease. If exists ascending lesion, the patient is concerned about discomfort in the digestive tract, more often in the epigastric region and the left hypochondrium. The contents of this section of the colon are liquid, so obturation rarely occurs, only in the case of an advanced stage of pathology. In such situations, it is even possible to palpate the tumor during the examination.

There are hidden bleedings. The patient is diagnosed with anemia with all the accompanying complaints in this pathology - weakness, lethargy, increased fatigue. The skin is pale.

Symptoms of cancer left side of the large intestine characterized by similar features. In these departments, the formation of feces occurs. The intestinal lumen is wider than in the area of the ascending part.

Cancer of the descending colon and other parts of this area grows in such a way that it helps to reduce the volume of the organ. This provokes the occurrence of intestinal obstruction.

The formation and evacuation of feces is impaired. Fermentation and putrefaction occurs in the intestine. Patients will complain of flatulence due to increased gas formation.

in such situations alternate with diarrhea. The stool has an unpleasant putrid odor. The consistency and shape of the feces change. With an oncological lesion of the left side of the colon, the stool becomes thin. Blood impurities are observed. This is due to the collapse of the tumor. A cancerous lesion of the left side may ulcerate and be complicated by peritonitis.

It is important for patients to consult a doctor in situations where the shape and composition of the stool changes, discomfort and pain in the digestive tract are constantly worried. Also in cases of severe weight loss, increased fatigue, anemia.

Cancer stages and metastasis

The following degrees of oncological lesions of the colon are distinguished:

Metastasis occurs in 3 ways: through the lymphatic system, blood vessels and through sprouting into neighboring organs. This method is called implantation. Often there is a seeding of the peritoneum with cancer cells.

In situations where the lesion is anatomically closer to the rectum, the spread is diagnosed in the small pelvis.

Colon cancer most often metastasizes to the liver. The lungs, brain, testicles or ovaries, and the skeletal system are also affected.

If stage 2 and above are diagnosed, there are almost always lesions of regional lymph nodes.

Methods of treatment

During the operation, in addition to the tumor, resection of nearby lymph nodes is required, to which fluid is drained from the cancer-affected segment. The nature and extent of the intervention is determined by the attending physician.

If resection of cancer of the ascending colon is necessary, an operation called right hemicolectomy. In addition to the affected part of the organ, all the lymph nodes of this area are removed, an anastomosis is formed by connecting the small and large intestines.

Left hemicolectomy carried out with the defeat of the oncological process of the left part of the colon. In addition to the pathological zone and lymph nodes, the mesentery of this zone is resected. An anastomosis is required.

Transverse colon cancer is removed along with nearby lymph nodes and the surrounding omentum.

If the tumor spreads to neighboring organs, surgeons perform combined interventions with the removal of cancerous areas.

The removed material is immediately sent for examination in order to establish the stage of the process, the nature of the cancer cells. The conclusion of the doctor helps to determine further tactics.

The next stage of treatment is radiation and chemotherapy, is determined depending on the nature of the cancer cells. Irradiation is prescribed after surgery, usually after a couple of weeks. Often patients have side effects, but many tolerate the procedure well.

Next stage - chemotherapy. It is an intravenous administration of anticancer drugs that inhibit the growth and spread of cancer cells. Usually tolerated by patients easier than radiation.

The duration of treatment depends on a large number of factors: the type of the tumor itself, the presence of metastases, the general condition of the patient, age, severe comorbidities.

is a malignant tumor of epithelial origin, localized in the colon. Initially, it is asymptomatic, later it manifests itself with pain, constipation, intestinal discomfort, impurities of mucus and blood in the fecal masses, deterioration and signs of cancer intoxication. Often a node is palpated in the projection of the organ. With progression, intestinal obstruction, bleeding, perforation, infection of the neoplasia and the formation of metastases are possible. Diagnosis is based on symptoms, radiography, CT, MRI, colonoscopy and other studies. Treatment - surgical resection 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 lining of the large intestine. It ranks third in prevalence among oncological lesions of the 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. It is usually diagnosed at the age of 50-75 years, it is equally often detected in male and female patients.

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

The reasons

Experts believe that colon cancer is a polyetiological disease. An important role in the development of malignant neoplasia of this localization is played by the peculiarities of the diet, in particular, an excess of animal fats, a lack of coarse fiber and vitamins. The presence of a large amount of animal fats in food stimulates the production of bile, under the influence of which the microflora of the large intestine changes. In the process of splitting animal fats, carcinogens are formed that provoke colon cancer.

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

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

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

Classification

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

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

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

Cancer Symptoms

Initially, colon cancer is asymptomatic. Subsequently, pain, intestinal discomfort, stool disorders, mucus and blood in the fecal masses are observed. Pain syndrome often occurs when the right intestine is affected. At first, the pain is usually mild, aching or dull. With progression, sharp cramping pains 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 peculiarities of the growth of neoplasia with the formation of a circular constriction that prevents the promotion of intestinal contents.

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

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

Complications

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

Diagnostics

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

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

Colon cancer treatment

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

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

Forecast and prevention

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

Diagnosis of the disease

To diagnose tumors of the colon, X-ray examination (irrigoscopy), endoscopic examination (colonoscopy), digital and endoscopic examination of the rectum (sigmoidoscopy) are used.

Clinical manifestations of colon cancer

Clinical manifestations of colon cancer largely depend on the location malignant neoplasm, degree of distribution tumor process and availability complications aggravating the course of the underlying disease.

The most common symptoms: pain in the abdomen, a violation of the motor-evacuation function of the intestine, clinically manifested by alternating constipation and diarrhea, pathological discharge with feces, a change in the general condition of the patient, and, finally, a tumor palpable through the anterior abdominal wall.

Stomach ache- the most common symptom of colon cancer and are observed in almost 80% of patients. In clinical observations with right-sided localization of the tumor, pain, as one of the first symptoms of cancer, occurred 2-3 times more often than with cancer of the left half. This fact is explained by a violation of motor function: pendulum-like movement of intestinal contents from the small intestine to the blind and vice versa.

Spasmodic contractions of the intestine, pushing the feces through the lumen of the intestine partially blocked by the tumor, cause pain. Intratumoral and perifocal inflammation of the intestinal wall, often associated with decaying infected tumors, exacerbates pain.

Tumors of the colon can proceed without pain for a long time, and only when the neoplasm spreads beyond the intestinal wall, when moving to the peritoneum and surrounding organs, pain appears, the intensity and frequency of which may be different. Depending on the localization of the tumor, the pain syndrome can simulate chronic appendicitis, cholecystitis, peptic ulcer of the stomach and duodenum, chronic adnexitis.

For malignant neoplasms of the right half of the colon, a combination of pain syndrome, hyperthermic reaction (fever), leukocytosis and rigidity (tension) of the muscles of the anterior abdominal wall is characteristic. The clinical manifestations of the disease resemble destructive appendicitis, and the correct diagnosis can only be established during the revision of the abdominal organs during surgery. Analysis of the clinical course of cancer of the right half of the colon showed that in almost 60% of cases the presence of a tumor is accompanied by pain in the right abdomen, intestinal disorders, hyperthermia, symptoms of intoxication and anemia.

This combination of clinical symptoms is characteristic of the toxic-anemic form of colon cancer.

Violations of the motor-evacuation function of the colon lead to stagnation of intestinal contents and cause such symptoms of discomfort as a feeling of heaviness in the abdomen, loss of appetite, and nausea. An important role in the development of intestinal discomfort is played by reflex functional disorders of other organs of the digestive system. Absorption of decay products by the inflamed mucosa, a change in the normal composition of the intestinal microflora, accompanied by the appearance of pathogenic strains that secrete exo- and endotoxins, leads to the development of endogenous intoxication syndrome. Functional disorders of the gastrointestinal tract in patients with colon cancer are manifested by a violation of the passage of contents, constipation, bloating, paroxysmal pain.

The accumulation of feces above the tumor is accompanied by an increase in the processes of putrefaction and fermentation, leading to bloating with retention of stool and gases.

In cases where the course of the tumor process is complicated by the development of intestinal obstruction, the clinical picture of patients with colon cancer is dominated by symptoms such as bloating with difficulty in passing feces and gases, nausea, belching, and vomiting. The pains are paroxysmal in nature. According to some authors, when a malignant tumor is localized in the left half of the colon, the stenosing nature of the tumor growth leads to a narrowing of the intestinal lumen, as a result of which the feces, accumulating above the tumor, can be palpated through the abdominal wall and are sometimes mistaken for a tumor.

One of the fairly frequent and relatively early clinical manifestations of colon cancer are pathological discharge from the rectum. These include mucus, blood, pus, tumor masses, etc. Most often, pathological impurities in the feces were noted with the left-sided localization of the colon tumor than with the location of the tumor in the right half (62.4% and 18.5%, respectively). Much less marked discharge of pus, fragments of tumor masses, indicating the addition of the inflammatory process, leading to the disintegration of the tumor, infection and the formation of perifocal and intratumoral abscesses. In any case, the presence of such secretions quite often indicates a widespread tumor process.

One of the symptoms indicating a far advanced tumor process is a tumor palpated through the abdominal wall. The frequency of this symptom ranges from 40 to 60%.

Any of the symptoms listed above (pain, intestinal disorders, the presence of pathological impurities in the stool) can be present in any bowel disease, not just tumors. An analysis of the clinical course of colon cancer indicates a significant percentage of diagnostic errors (up to 35%), leading to hospitalization in general therapeutic and infectious diseases clinics for the treatment of anemia of unknown etiology, dysentery, etc. The percentage of patients hospitalized in general surgical hospitals for emergency indications at altitude remains high. obstructive intestinal obstruction.

The following clinical forms of colon cancer are distinguished:

toxic-anemic, characterized by varying degrees of severity of anemia, general symptoms, intoxication;
obstructive- characterized by the appearance of signs of impaired intestinal patency and accompanied by paroxysmal abdominal pain, rumbling and increased peristalsis, stool retention and poor gas passage;
enterocolitic form accompanied by bloating, alternating diarrhea with constipation, the presence of pathological impurities in the feces, dull, aching pain in the abdomen;
pseudo-inflammatory form, characterized by low severity of intestinal disorders against the background of signs of an inflammatory process in the abdominal cavity;
tumor (atypical) form, for which general symptoms are uncharacteristic, impaired intestinal patency, with a palpable tumor in the abdominal cavity;
dyspeptic form, the characteristic features of which are symptoms of gastric discomfort (nausea, belching, feeling of heaviness in the epigastric region), accompanied by pain, localized mainly in the upper floor of the abdominal cavity.

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

Complicated forms of colon cancer

Complications that often accompany colon cancer and have a direct impact on the course of the disease and the prognosis of the tumor process include intestinal obstruction of varying severity, perifocal inflammation, tumor perforation, intestinal bleeding, and tumor spread to surrounding organs and tissues.

According to the literature, the incidence of intestinal obstruction in patients with colon cancer ranges from 10 to 60%. Such pronounced differences in the frequency of this complication are largely due to the fact that the vast majority of patients with a complicated course of the tumor process end up in emergency surgical hospitals, and not in specialized medical institutions.

The clinical course of the disease largely depends on the severity of intestinal obstruction. In case of decompensated form of intestinal obstruction (sharp bloating with retention of stool and gases, vomiting, cramping pains throughout the abdomen against the background of severe metabolic disorders), emergency surgical intervention is indicated, the volume and nature of which depends not only on the location of the tumor, but also on the severity of the developed complications. In cases of a compensated form of obstructive intestinal obstruction, conservative measures are often effective, allowing the patient to be prepared for a planned operation.

The passage of liquid intestinal contents is preserved when the intestinal lumen is narrowed to 0.8-1 cm; in cancer of the right half of the colon, ileus phenomena (intestinal obstruction) usually occur with large tumor sizes. As the stenosis progresses, an expansion of the intestine above the tumor is formed, leading to the accumulation of feces and the appearance of aching pains in the abdomen, sometimes cramping and spastic in nature.

When the tumor is localized in the left colon, the development of intestinal obstruction is often preceded by constipation, alternating with profuse, fetid loose stools. In cases of decompensated intestinal obstruction, the disorder of the function of the organs of the gastrointestinal tract is quickly joined by metabolic disorders, leading to a violation of the vital functions of organs and systems.

Intratumoral and perifocal inflammatory processes are of great danger in colon cancer. The frequency of such complications is quite high: from 12 to 35%.

Inflammatory changes in the tumor, caused by the presence in the intestinal contents of a large number of virulent microorganisms, the qualitative and quantitative composition of which changes with the decay of the tumor tissue, lead to infection and the formation of inflammatory infiltrates and abscesses.

In most clinical cases, histological examination of removed preparations in patients with a perifocal inflammatory process showed ulceration of the tumor and signs of acute purulent inflammation with the formation of abscesses, necrosis and fistulas in the thickness of adipose tissue, tumor stroma or in the lymph nodes.

Perforation of the intestinal wall and bleeding from a decaying tumor are the most formidable complications of this disease. Prolonged stasis of intestinal contents against the background of chronic intestinal obstruction in combination with trophic disorders of the intestinal wall lead to the formation of bedsores and perforation.

The most unfavorable for the prognosis is perforation of the tumor into the free abdominal cavity, leading to diffuse fecal peritonitis. With perforation of a segment of the intestine, devoid of peritoneal cover, an acute purulent focus is formed in the retroperitoneal space. In a number of patients, a pinpoint perforation is covered by an omentum or a nearby organ, leading to the formation of a perifocal inflammatory process that spreads to nearby organs and tissues. Perifocal and intratumoral inflammation, which complicates the course of the underlying disease, on the one hand, and perforation of the colon tumor, on the other hand, are links in the same pathological process, which is based on the infection of the affected section of the colon with conditionally pathogenic strains of microorganisms penetrating through the pathologically altered intestinal wall. .

Diagnostics

Improving the methods of clinical examination of the patient with the use of modern X-ray and endoscopic techniques, the use of a wide arsenal of screening diagnostic methods, until recently, did not significantly improve the early detection of colon cancer. More than 70% of patients with colon cancer at the time of hospitalization had III and IV stages of the disease. Only 15% of them turned to a specialist within 2 months from the moment the first symptoms of the disease appeared. In less than half of the examined patients, the diagnosis was established within 2 months from the onset of the disease, and in every fourth it took more than six months to determine the nature of the disease. Quite often occurring diagnostic errors led to the performance of unreasonable surgical interventions, physiotherapy procedures, leading to the dissemination of the tumor process.

The diagnosis of colon cancer is established on the basis of X-ray and endoscopic studies. An equally important method of physical examination of the patient is palpation of the abdomen, which allows not only to identify a tumor in the abdominal cavity, but also to assess its consistency, size, and mobility.

Research types

X-ray examination, along with colonoscopy, is leading in the diagnosis of colon cancer.
Irrigoscopy allows you to get information about the localization of the neoplasm, determine the extent of the lesion, determine the form of tumor growth, assess its mobility, and sometimes judge the relationship with other organs. When performing barium enema, it is also possible to detect synchronous tumors of the colon. The latter circumstance is also important because with the stenosing nature of the growth of the neoplasm, endoscopic examination does not allow assessing the state of the overlying sections of the colon before surgery.
Endoscopy, along with the visualization of a malignant tumor, allows obtaining material for histological examination, which is a necessary attribute of the preoperative diagnosis of a malignant neoplasm.
The simplest and most widely used method of endoscopic examination of the colon is sigmoidoscopy, at which it is possible to assess the condition of the lower part of the intestinal tube. When performing sigmoidoscopy, the researcher assesses the condition of the colon mucosa, vascular pattern, the presence of pathological impurities in the intestinal lumen, elasticity and mobility of the intestinal wall. When a colon tumor is detected, its size, appearance, consistency, mobility during instrumental palpation are studied, and a biopsy is performed.

Determination of the degree of spread of the tumor process

The program for examining a patient before surgery, in addition to the already listed traditional methods, includes special X-ray and radioisotope studies.

Hematogenous metastasis is based on the process of embolization by cancer cells of the venous outflow tracts from the organ affected by the tumor process. Penetration of tumor cells into venous vessels occurs as a result of invasion and destruction of the vessel wall by the tumor. The bulk of venous blood in patients with colorectal cancer through the system of the inferior and superior mesenteric veins enters the portal vein, which explains the main localization of distant metastases in the liver.

Ultrasound procedure has found wide distribution for assessing the degree of spread of the tumor process. It is based on the principle of registering the reflected ultrasonic wave from the interface between tissues that differ in density and structure. With its high resolution and information content, ultrasound is a practically harmless diagnostic method that allows visualizing tumor nodes with sizes
0.5-2.0 cm.

The anatomical and topographic structure of the liver, the good distribution of ultrasound in it determines the high information content of the study. It is important that ultrasound helps to determine not only the nature of pathological changes in the liver, but also to establish the localization and depth of focal changes. When performing ultrasound tomography, a layered image of the internal structure of the liver is obtained and pathological volumetric formations or diffuse changes are detected. Ultrasound of the liver can be repeated quite often without harm to the patient's body, which allows you to evaluate the results of the treatment.

Application of X-ray computed tomography(CT) in medicine has contributed to a significant improvement in the diagnosis of various pathological conditions.

Computed tomography has the following important advantages over other examination methods:

represents the image of anatomical structures in the form of a cross section, excluding the combination of their images;
causes a clear image of structures that slightly differ in density from each other, which is extremely important for diagnosis;
provides an opportunity for quantitative determination of tissue density in each area of the image of the studied organ for differential diagnosis of pathological changes;
has a non-invasive nature of the diagnostic method, safety and low radiation exposure to the patient's body.

According to researchers, in the analysis of CT images of metastatic tumors of colorectal cancer, in 48% of cases, tumor nodes contained calcifications, and sometimes total calcification of metastatic tumors was detected.

Radionuclide (isotope) methods diagnosis and assessment of the spread of colorectal cancer in the daily practical work of medical institutions are used quite rarely. One of these methods is positive scintigraphy, based on the use of such specific preparations as gallium in the form of a citrate complex, as well as bleomycin labeled with an indium isotope.

COLON CANCER TREATMENT

The choice of the type of surgical intervention and the rationale for its scope

The history of surgical treatment of colon cancer has more than 150 years. Reybard in 1833 performed the first resection of the colon for a malignant tumor with the formation of an interintestinal anastomosis. In Russia in 1886 E.V. Pavlov performed the first resection of the caecum for its malignant tumor with an anastomosis between the ascending colon and the ileum. Unlike manipulations on the small intestine, resection of the large intestine, according to V. Schmiden (1910), is one of the most important surgical interventions associated with the existence of such features as the presence of pathogenic microflora in the contents of a hollow organ, the absence of mesentery in fixed areas of the colon intestines, a thinner layer of muscle membrane. These features of the colon predetermine the increased demands on the reliability of the formation of interintestinal anastomoses, taking into account the anatomical features of the various parts of the colon and the adequacy of the blood supply to the anastomosed segments.

The main disadvantage of these surgical interventions is the presence of albeit a temporary colostomy - the output of the intestine to the anterior abdominal wall. Therefore, in specialized oncoproctological clinics, there is a rethinking of the indications for performing two-stage surgical interventions, considering them justified only in debilitated patients with symptoms of decompensated intestinal obstruction.

The volume and nature of surgical intervention for colon cancer depends on a number of factors, among which the most important are the localization, the degree of spread of the tumor, the presence of complications of the underlying disease, as well as the general condition of the patient.

The choice of the type of surgical intervention in the complicated course of colon cancer

Most patients with colorectal cancer are admitted to specialized medical institutions in stages III and IV of the tumor process. Many of them have various complications (obstructive form of intestinal obstruction, perforation of the tumor, bleeding and perifocal inflammation), often requiring emergency surgical intervention.

The results of surgical interventions in patients with complicated colorectal cancer to a certain extent depend on the qualifications of the operating surgeon, his ability to assess the degree and severity of the pathological process complicating the course of the underlying disease, and taking into account the general condition of the patient.

When choosing the type of surgical intervention, they seek not only to save the patient from acute surgical complications, but also, if possible, to perform a radical operation.

One of the most dangerous complications of colon cancer is perifocal and intratumoral inflammation, often spreading to surrounding tissues. The frequency of such complications is quite high and ranges from 6% to 18%. This complication is manifested by a clinic of acute inflammation and intoxication, and the spread of the process to neighboring organs and surrounding tissues contributes to the formation of infiltrates, abscesses, and phlegmon. Often, a pronounced inflammatory process in the tumor and its surrounding organs is interpreted as tumor infiltration, which is the reason for the inadequate volume of surgical intervention.

The presence of perifocal and intratumoral inflammation in colon cancer has a significant impact on the choice of the volume and nature of surgical intervention only in cases where the inflammatory process spreads to the surrounding organs and tissues, and forces one to resort to combined surgical interventions.

Combined operations for colon cancer

Expansion of the volume of surgical intervention due to the spread of a malignant tumor to nearby organs and tissues increases the duration of the operation, trauma and blood loss. The exit of the tumor beyond the intestinal wall indicates a far advanced neoplastic process, but the absence of distant metastases allows performing a combined operation, which, improving the quality of life of patients, eliminates severe complications of the tumor process and creates real prerequisites for the use of specific methods of antitumor treatment.

Palliative surgery in patients with colon cancer

Almost 70% of patients with colon cancer at the time of surgical intervention are diagnosed with stages III and IV of the disease, and in every third patient, among those operated, distant metastases are diagnosed, mainly in the liver and lungs. The development of intestinal obstruction forces resorting to symptomatic surgical interventions - colostomy, the formation of a bypass anastomosis in patients with stage IV of the disease. However, an increasing number of surgeons for advanced colorectal cancer are opting for palliative resection or hemicolectomy.

Palliative resection of the colon or hemicolectomy significantly improves the quality of life, saving the patient from such complications of the tumor process as purulent-septic complications, bleeding, tumor decay with the formation of a fecal fistula.

A comparative analysis of the immediate and long-term results of treatment of patients with colon cancer who underwent resection or hemicolectomy, regardless of whether the operation was radical or palliative, showed that the frequency and nature of postoperative complications were approximately the same.

Palliative surgical interventions in the scope of resection or hemicolectomy find more and more supporters and are increasingly the operation of choice for metastatic colon cancer. This was facilitated by a decrease in the frequency of postoperative complications and mortality, the expansion of indications for resection of organs affected by metastases (liver, lungs). When determining the indications for palliative surgical interventions in the scope of colon resection or hemicolectomy, both the general condition of the patient and the degree of tumor dissemination are taken into account.

One of the important factors affecting the prognosis for the course of the disease in patients undergoing liver resection for metastases is the time interval between treatment for the primary tumor and the detection of liver metastases. It has been established that the longer the duration of the relapse-free course of the tumor process, the more favorable the prognosis of surgical treatment of liver metastases.

When determining the scope of surgical intervention for metastatic colorectal cancer, an important role is played by the study of the functional state of the liver. Liver failure itself is one of the main causes of postoperative mortality in major liver resections. The liver is an organ with great compensatory capabilities. Enough 10-15% of its healthy parenchyma for the full functioning of the body.

An important issue for determining surgical tactics is the number of metastatic nodes in the liver. Multiple nodes significantly worsen the prognosis and are one of the main reasons for the refusal of active surgical tactics. However, the presence of multiple nodes localized in one anatomical half of the liver is not a contraindication to surgical treatment, although, of course, the prognosis in such patients is much worse than with a single and single (2-3 nodes) metastases.

Combined treatment of colon cancer

The reasons for the failure of surgical treatment of patients with colon adenocarcinoma are local recurrences and distant metastases. Unlike rectal cancer, in this disease, local recurrences are relatively rare, and liver metastases predominate. In patients with stage III colon cancer, local recurrences occur in 7% of cases, and distant metastases - in 20%. The occurrence of these unfavorable secondary tumor formations is due to the dissemination of tumor cells during surgery. To increase the ablasticity of surgical interventions, preoperative radiation therapy, which has recently begun to be introduced into the practice of oncoproctological clinics, allows.

Depending on the sequence of application of ionizing radiation and surgical intervention, pre-, post- and intraoperative radiation therapy is distinguished.

Preoperative radiotherapy

Depending on the goals for which preoperative radiation therapy is prescribed, two main forms can be distinguished:

irradiation of operable forms of colon cancer;
irradiation of inoperable (locally advanced) or doubtfully operable forms of tumors.

The death of tumor cells as a result of radiation exposure leads to a decrease in the size of the tumor, delimitation from the surrounding normal tissues due to the growth of connective tissue elements (in cases of prolonged preoperative irradiation and delayed operations). Realization of the positive effect of preoperative radiation therapy is determined by the magnitude of the radiation dose.

In clinical studies, it has been shown that a dose of 40-45 Gy leads to the death of 90-95% of subclinical growth foci. A focal dose of not more than 40 Gy, administered at 2 Gy daily for 4 weeks, does not cause difficulties in performing the subsequent operation and does not have a noticeable effect on the healing of the postoperative wound.

Postoperative radiotherapy

Certain advantages of postoperative radiotherapy are:

planning of the volume and method of irradiation is carried out on the basis of data obtained during the operation and after a thorough morphological study of the removed tissues;
there are no factors that have a negative impact on the healing of postoperative wounds;
surgery is performed as quickly as possible from the moment of clarifying the diagnosis of the disease.

To achieve a therapeutic effect in postoperative radiation therapy, it is necessary to apply high doses - at least 50-60 Gy.

The presence of inflammation in the area of surgical intervention, impaired blood and lymph supply leads to a delay in the supply of oxygen to tumor cells and their complexes, which makes them radioresistant. At the same time, normal tissues in the state of regeneration become more radiosensitive, namely, they must be included in a larger volume in the target for postoperative irradiation, because. it is necessary to act on the tumor bed, the entire postoperative scar and areas of regional metastasis.