Colon cancer symptoms and life prognosis. Colon cancer: symptoms, diagnosis and treatment

Diagnosis of the disease

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

Clinical manifestations of colon cancer

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

Most common symptoms: abdominal pain, impaired motor-evacuation function of the intestine, clinically manifested by alternating constipation and diarrhea, pathological discharge with feces, changes general condition the patient and, finally, a tumor palpable through the anterior abdominal wall.

Stomach ache– most common symptom colon cancer and are observed in almost 80% of patients. In clinical observations with right-sided tumor localization, 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 cecum and back.

Spasmodic contractions of the intestine, pushing feces through the intestinal lumen partially blocked by the tumor, cause pain. Intratumoral and perifocal inflammation of the intestinal wall, often accompanying disintegrating infected tumors, aggravates pain.

Colon tumors can occur for a long time without pain, and only when the tumor spreads beyond the intestinal wall, when moving to the peritoneum and surrounding organs, pain appears, the intensity and frequency of which may vary. Depending on the location of the tumor, the pain syndrome can simulate chronic appendicitis, cholecystitis, peptic ulcer stomach and duodenum, chronic adnexitis.

Malignant neoplasms of the right half of the colon are characterized by a combination of pain, hyperthermic reaction (increase in temperature), leukocytosis and rigidity (tension) of the muscles of the anterior abdominal wall. Clinical manifestations of the disease resemble destructive appendicitis, and correct diagnosis can only be determined during an inspection of the abdominal organs during surgery. An 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 symptoms of discomfort such as a feeling of heaviness in the abdomen, loss of appetite, and nausea. Important role Reflex functional disorders of other organs of the digestive system play a role in the development of intestinal discomfort. Absorption of decay products by the inflamed mucous membrane, change normal composition 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 impaired passage of contents, constipation, bloating, and paroxysmal pain.

The accumulation of feces above the tumor is accompanied by increased 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 passing feces and gases, nausea, belching, and vomiting. The pain is paroxysmal in nature. According to a number of authors, when localizing malignant tumor in the left half of the colon, the stenotic nature of tumor growth leads to a narrowing of the intestinal lumen, as a result of which feces, accumulating above the tumor, can be palpated through the abdominal wall and are sometimes mistaken for a tumor.

One of the fairly common and relatively early clinical manifestations of colon cancer is pathological discharge from the rectum. These include mucus, blood, pus, tumor masses, etc. Most often, pathological impurities in stool are noted when the colon tumor is located on the left side, rather than when the tumor is located in the right half (62.4% and 18.5%, respectively). Discharges of pus and fragments of tumor masses, indicating the addition of an inflammatory process leading to tumor disintegration, infection and the formation of perifocal and intratumoral abscesses, are noted much less frequently. In any case, the presence of such discharge quite often indicates a widespread tumor process.

One of the symptoms indicating an advanced tumor process is a tumor palpable 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 with any intestinal disease, not just tumors. 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 unknown etiology, dysentery, etc. The percentage of patients hospitalized in general remains high surgical hospitals for emergency indications at the height of obstructive intestinal obstruction.

The following clinical forms of colon cancer are distinguished:

• toxic-anemic characterized by varying degrees of anemia, general symptoms, and intoxication;
• obstructive– characterized by the appearance of signs of intestinal obstruction and accompanied by paroxysmal abdominal pain, rumbling and increased peristalsis, stool retention and poor passage of gases;
• enterocolitic form, accompanied by bloating, alternating diarrhea with constipation, the presence of pathological impurities in the feces, dull, aching pain in a stomach;
• pseudoinflammatory form, characterized by low severity of intestinal disorders against the background of signs of an inflammatory process in the abdominal cavity;
• tumor (atypical) form, which is not characterized by general symptoms, intestinal obstruction, with a palpable tumor in the abdominal cavity;
• dyspeptic form, characteristic features 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 selection clinical forms, to a certain extent, conditionally and mainly characterizes the leading symptom complex. However, knowledge of the manifestations of colon cancer allows us to suspect the presence of a tumor even in cases where the disease occurs with mild intestinal disorders.

Complicated forms of colon cancer

Complications that quite 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 varying degrees severity, perifocal inflammatory process, tumor perforation, intestinal bleeding, as well as 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. With a decompensated form of intestinal obstruction (severe bloating with retention of stool and gases, vomiting, cramping pain 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 complication that has developed. In cases of compensated form of obstructive intestinal obstruction, conservative measures are often effective in preparing the patient for planned surgery.

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

When the tumor is localized in the left parts of the colon, the development of intestinal obstruction is often preceded by constipation, alternating with copious foul-smelling loose stools. In cases of decompensated intestinal obstruction, the dysfunction of the gastrointestinal tract organs is quickly joined by metabolic disorders, leading to disruption of the vital functions of organs and systems.

Intratumoral and perifocal inflammatory processes pose a 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 of a large number of virulent microorganisms in the intestinal contents, the qualitative and quantitative composition of which changes with the disintegration of tumor tissue, lead to infection and the formation of inflammatory infiltrates and ulcers.

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

Perforation of the intestinal wall and bleeding from a disintegrating tumor are the most dangerous complications of this disease. Long-term 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 prognosis is tumor perforation into the free abdominal cavity, leading to diffuse fecal peritonitis. When a segment of intestine devoid of peritoneal cover is perforated, an acute purulent focus forms in the retroperitoneal space. In a number of patients, the pinpoint perforation is covered by the 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, complicating the course of the underlying disease on the one hand, and perforation of a colon tumor on the other, are parts of the same pathological process, which is based on infection of the affected part of the colon with conditionally pathogenic strains of microorganisms penetrating through the pathologically altered intestinal wall .

Diagnostics

Improving the methods of clinical examination of a patient using modern X-ray and endoscopic techniques, and the use of a wide arsenal of screening diagnostic methods, until recently, have not significantly improved the early detection of colon cancer. More than 70% of patients with colon cancer at the time of hospitalization had stages III and IV of the disease. Only 15% of them consulted a specialist within 2 months from the onset of the first symptoms of the disease. 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 case it took more than six months to determine the nature of the disease. Quite frequently occurring diagnostic errors led to unnecessary surgical interventions and physiotherapeutic procedures leading to dissemination of the tumor process.

The diagnosis of colon cancer is made on the basis of x-ray and endoscopic examinations. 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 evaluate its consistency, size, and mobility.

Types of studies

• X-ray examination, along with colonoscopy, is leading in the diagnosis of colon cancer.
• Irrigoscopy allows you to obtain information about the localization of the tumor, establish the extent of the lesion, determine the form of tumor growth, assess its mobility, and sometimes judge the relationship with other organs. When performing irrigoscopy, it is also possible to identify synchronous tumors of the colon. The last circumstance is also important because with the stenosing nature of the growth of the neoplasm, endoscopic examination does not allow assessing the condition of the overlying parts of the colon before surgery.
• Endoscopic examination, along with visualization of a malignant tumor, allows one to obtain material for histological examination, which is a necessary attribute of the preoperative diagnosis of a malignant neoplasm.
• The simplest and most widespread method of endoscopic examination of the colon is sigmoidoscopy, in which it is possible to assess the condition of the lower 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.

Determining the degree of spread of the tumor process

Program for examining the patient before surgery, in addition to those already listed traditional methods, includes special x-ray and radioisotope studies.

Hematogenous metastasis is based on the process of embolization of pathways by cancer cells venous outflow from an organ affected by a 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 venous blood in patients with colorectal cancer, the system of the inferior and superior mesenteric veins enters the portal vein, which explains the fact that the main localization of distant metastases is in the liver.

Ultrasonography found wide use to assess the degree of spread of the tumor process. It is based on the principle of recording a reflected ultrasonic wave from the interfaces of tissues that differ in density and structure. Possessing high resolution and information content, ultrasound is a practically harmless diagnostic method that allows you to visualize tumor nodes measuring
0.5-2.0 cm.

The anatomical and topographic structure of the liver and the good propagation of ultrasound in it determine 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 layer-by-layer image of the internal structure of the liver is obtained and pathological space-occupying formations or diffuse changes. Ultrasound of the liver can be repeated quite often without harm to the patient’s body, which makes it possible to evaluate the results of the treatment.

Applications 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:

• presents an image of anatomical structures in the form of a cross section, excluding the combination of their images;
• provides a clear image of structures that differ slightly in density from each other, which is extremely important for diagnosis;
• provides an opportunity to quantitatively determine tissue density in each image area of ​​the organ under study for differential diagnosis of pathological changes;
• It has a non-invasive diagnostic method, safety and low radiation exposure to the patient’s body.

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

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

TREATMENT OF COLON CANCER

Choosing the type of surgical intervention and justifying its scope

Story surgical treatment Colon cancer dates back 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 cecum for a malignant tumor with an anastomosis between the ascending colon and ileum. In contrast to manipulations on the small intestine, resection of the colon, according to V. Schmiden (1910), is one of the most important surgical interventions associated with the existence of such features as the presence pathogenic microflora in the contents of a hollow organ, absence of mesentery in fixed areas of the colon, thinner layer of muscularis propria. These features of the colon predetermine increased demands on the reliability of the formation of interintestinal anastomoses, taking into account anatomical features various departments colon and the adequacy of blood supply to the anastomosed segments.

The main disadvantage of these surgical interventions is the presence of a temporary colostomy - the removal of the intestine to the anterior abdominal wall. Therefore, in specialized oncoproctology clinics, the indications for performing two-stage surgical interventions are being rethought, considering them justified only in weakened patients with symptoms of decompensated intestinal obstruction.

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

Choosing the type of surgical intervention for complicated 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 experience various complications (obstructive form of intestinal obstruction, tumor perforation, bleeding and perifocal inflammatory process), often requiring emergency surgical intervention.

The results of surgical interventions in patients with complicated colorectal cancer depend to a certain extent 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 strive not only to save the patient from acute surgical complication, but also, if possible, perform radical surgery.

One of the most dangerous complications Colon cancer is perifocal and intratumoral inflammation, often spreading to surrounding tissues. The frequency of this complication is quite high and ranges from 6% to 18%. This complication is manifested by the clinic of acute inflammation and intoxication, and the spread of the process to neighboring organs and surrounding tissues contribute to the formation of infiltrates, abscesses, and phlegmons. Often, a pronounced inflammatory process in the tumor and surrounding organs is interpreted as tumor infiltration, which is the reason for the inadequate scope 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 surrounding organs and tissues, and forces the use of combined surgical interventions.

Combined operations for colon cancer

Expanding the scope 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. Extension of the tumor beyond the intestinal wall indicates an advanced neoplastic process, but the absence of distant metastases makes it possible to perform a combined operation, which, while improving the quality of life of patients, eliminates severe complications tumor process and creates real prerequisites for the use specific methods antitumor treatment.

Palliative surgical interventions 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 on, distant metastases are diagnosed, mainly in the liver and lungs. The development of intestinal obstruction forces one to resort to symptomatic surgical interventions - colostomy, formation of bypass anastomosis in patients with stage IV of the disease. However, more and more surgeons for advanced colorectal cancer prefer palliative resection or hemicolectomy.

Palliative resection of the colon or hemicolectomy significantly improves the quality of life, relieving the patient of such complications of the tumor process as purulent-septic complications, bleeding, tumor disintegration 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 form of resection or hemicolectomy are finding more and more supporters and are increasingly the operation of choice for metastatic colon cancer. This was facilitated by a decrease in the incidence of postoperative complications and mortality, and an expansion of indications for resection of organs affected by metastases (liver, lungs). When determining indications for palliative surgical interventions such as colon resection or hemicolectomy, both the general condition of the patient and the degree of tumor dissemination are taken into account.

One of important factors, which has a 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 for surgical treatment of liver metastases.

When determining the extent of surgical intervention for metastatic colorectal cancer, studying the functional state of the liver plays an important role. Liver failure itself is one of the main causes postoperative mortality with extensive liver resections. The liver is an organ with great compensatory capabilities. 10-15% of its healthy parenchyma is enough for the full functioning of the organ.

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 refusing 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.

Combination treatment of colon cancer

The reasons for failure of surgical treatment of patients with colon adenocarcinoma are local relapses and distant metastases. Unlike rectal cancer, with this disease local relapses are relatively rare, and liver metastases predominate. In patients with stage III colon cancer, local relapses 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. Preoperative radiation therapy, which has recently begun to be introduced into the practical activities of oncoproctology clinics, can increase the ablasticity of surgical interventions.

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 purposes for which preoperative radiation therapy is prescribed, two main forms can be distinguished:

1. irradiation of operable forms of colon cancer;
2. 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 tumor size and separation from surrounding normal tissues due to the proliferation of connective tissue elements (in cases of prolonged preoperative irradiation and delayed operations). Implementation positive effect preoperative radiation therapy determined by the radiation dose.

Clinical studies have shown that a dose of 40-45 Gy leads to the death of 90-95% of subclinical growth lesions. A focal dose of no more than 40 Gray, administered at 2 Gray daily for 4 weeks, does not cause difficulties in performing subsequent surgery and does not have a noticeable effect on the healing of the postoperative wound.

Postoperative radiotherapy

Certain advantages of postoperative radiotherapy are:

• planning the volume and technique of irradiation is carried out on the basis of data obtained during surgery and after a thorough morphological study of the removed tissues;
• there are no factors influencing bad influence on the healing of postoperative wounds;
• surgical intervention is performed as quickly as possible from the moment of clarifying diagnosis of the disease.

To achieve a therapeutic effect during postoperative radiation therapy, it is necessary to high doses– at least 50-60 Gray.

The presence of inflammatory phenomena in the surgical area, disruption of 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 a state of regeneration become more radiosensitive, namely in larger volume must be included in the target for postoperative irradiation, because it is necessary to influence the tumor bed, the entire postoperative scar and areas of regional metastasis.

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

ICD-10

C18 C19

General information

Colon cancer – malignancy, originating from the cells of the mucous membrane 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. Usually diagnosed at the age of 50-75 years, it is equally often detected in male and female patients.

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

Causes

Experts believe that colon cancer is a polyetiological disease. An important role in the development of malignant neoplasia of this localization is played by dietary features, 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. During the breakdown of animal fats, carcinogenic substances are formed that provoke colon cancer.

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

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

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

Classification

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

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

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

Symptoms of cancer

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

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

For neoplasia sigmoid colon characteristic impurities of mucus and blood in the stool. In other localizations of colon cancer, this symptom is less common, since as it moves through the intestines, the secretions have time to be partially processed and evenly distributed throughout the fecal matter. By palpation, colon cancer is more often detected when located in the right parts of the intestine. The node can be palpated in a third of patients. The listed signs of colon cancer are combined with common features oncological disease. Weakness, malaise, weight loss, pale skin, hyperthermia and anemia are noted.

Complications

Along with the intestinal obstruction already mentioned above, colon cancer can be complicated by perforation of the organ due to invasion of the intestinal wall and necrosis of neoplasia. When foci of decay form, there is a risk of infection, development of purulent complications and sepsis. With germination or purulent melting of the vessel wall, bleeding is possible. When distant metastases occur, disruption of the activity of the relevant organs is noted.

Diagnostics

Colon cancer is diagnosed using clinical, laboratory, endoscopic and radiological data. First, complaints are clarified, the medical history 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 irrigoscopy to identify filling defects. If intestinal obstruction or perforation of the colon is suspected, plain radiography of the abdominal cavity is used.

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

Treatment of colon cancer

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

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

Prognosis and prevention

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

EPIDEMIOLOGY

Colon cancer (COC) ranks 2-3 in the structure of malignant neoplasms of the gastrointestinal tract and accounts for 4-6% of all cancer incidence. The predominant age of patients is over 50 years. In 2007, the number of patients diagnosed with cancer for the first time in their lives was 30,814 people: 12,709 men and 18,105 women. The incidence rate in 2007 in Russia as a whole was 21.7 per 100 thousand population. Its highest indicators in 2005 for men were registered in the Magadan region (35.9), for women - in the Chukotka Autonomous Okrug (32.1), the lowest - in the Republic of Tyva (for men - 4.7, for women - 4.8). The mortality rate among men from ROC in Russia in 2005 was 10.1 per 100 thousand population, among women - 7.7.

ETIOLOGICAL AND PATHOGENETIC FACTORS

According to most researchers, the increase in the incidence of cancer is influenced by the following etiological and pathogenetic factors:

1) the nature of the population’s diet: low-slag food with a predominance of animal fats, proteins and refined carbohydrates (sugar);

2) sedentary lifestyle - hypokinesia, obesity, age over 50 years;

3) hypotension and intestinal atony in old age - chronic constipation;

4) the presence of endogenous carcinogens in the intestinal contents (indole, skatole, guanidine, steroid hormone metabolites)

and their effect on the intestinal mucosa under conditions of prolonged stagnation of feces; 5) chronic traumatization by feces of the mucous membrane of the colon in places of physiological bends.

PRE-CANCER DISEASES

Precancerous diseases include:

Chronic colitis, in particular chronic nonspecific ulcerative colitis and granulomatous colitis (Crohn's disease), which constitute the main group of optional precancerous diseases;

Diverticula (diverticulosis) of the colon (diverticulitis). They rarely become malignant;

Polypous lesions of the colon (obligate precancer):

a) single polyps (adenomatous, villous), which become malignant in 45-50% of cases, especially polyps >2 cm in size; villous polyps become malignant more often;

b) multiple polyposis of the colon, which, in turn, can have the following forms:

genetically determined:

Familial hereditary diffuse polyposis;

Peutz-Jeghers syndrome;

Turk's syndrome; non-hereditary:

Sporadic polyposis;

Combined polyposis;

Cronkhite-Canada syndrome;

Familial hereditary polyposis (is an obligate precancer and leads to cancer in almost 100% of cases).

Crohn's disease is a chronic nonspecific inflammation of the submucosal layer with ulceration of the mucous membrane, granulomatous changes (hence another name - granulomatous colitis), fistulas, infiltrates, accompanied by narrowing of the lumen, inflammation, thickening of the intestinal wall. The pathology can also be localized in the rectum, but most often in the terminal section ileum. Disease

may resemble sarcoidosis, fissures, rectal ulcers. The intestinal topography resembles a “cobblestone street” with linear ulcers.

Polyps are hyperplastic (inflammatory) and adenomatous (glandular).

Morphologically, polyps are papillary and tubular growths of glandular tissue with a stroma that differs from the normal mucous membrane in the polymorphism of cellular elements, high mitotic activity, and complete or partial loss of the ability to differentiate.

Polyps are smooth and velvety (villous). It is advisable to distinguish two groups of colon polyposis - hereditary and non-hereditary, since in genetically determined forms it is necessary to examine relatives and all family members of the patient, even if there are no complaints of gastrointestinal dysfunction. At the same time, extraintestinal concomitant manifestations of Peutz-Jeghers, Gardner, and Turk syndromes may be early diagnostic paraneoplastic signs of colon polyposis.

Thus, Peutz-Jeghers syndrome is characterized by polypous lesions of the gastrointestinal tract with finely spotted melanin hyperpigmentation of the mucous membrane of the cheeks and lips, as well as other natural anatomical openings of the human body. Gardner's syndrome is characterized by a combination of polypous lesions of the colon with multiple benign tumors (bone exostoses, osteomas of the skull and lower jaw, epidermoid cysts and skin tumors) and postoperative cicatricial desmoids. For Turk's syndrome, a combination of colon polyposis with tumors of various parts of the nervous system (gliomas and glioblastomas) is typical.

With combined polyposis, polyps are found not only in the colon, but also in the stomach, duodenum and small intestine. A relatively rare variety of it is Cronkhite-Canada syndrome - a non-hereditary, generalized gastrointestinal polyposis in combination with total alopecia and nail atrophy. Therefore, taking into account the possibility of simultaneous localization of neoplasms in other parts of the gastrointestinal tract, a comprehensive X-ray endoscopic examination is indicated even if a single polyp is detected in the colon.

PREVENTION

1. Preventive examinations are necessary to identify population groups increased risk and early forms of colorectal cancer. Modern automated screenings involve the use of developed questionnaire cards with their subsequent processing on a computer. Of great importance in this case is the use of a hemocult test to select high-risk groups for the purpose of subsequent endoscopic examination (sigmoidoscopy, fibrocolonoscopy with morphological examination of tumor biopsies).

2. Clinical examination, observation and treatment of patients with precancerous diseases and benign tumors.

3. Formation and propaganda healthy image life, rational nutrition.

4. Improvement of the environmental situation.

5. In cured patients, taking into account the possibility of relapse or the appearance of a second tumor, in case of primary multiple lesions, clinical examination is indicated, including periodic active examinations using radiological, endoscopic, morphological and laboratory methods.

Pathological and anatomical characteristics

ROC can be localized in any anatomical region, but the frequency of their involvement is not the same. The predominant localization of ROC is the sigmoid colon - 50%, in 2nd place is the cecum - 21-23%. The remaining departments are affected much less frequently. In 1-3% of cases, multiple primary localization of the tumor is observed.

According to the clinical material of the Russian Cancer Research Center (Knysh V.I. et al., 1996), tumors were localized in the right half of the colon in 34.3% of patients, in the left - in 59.3%, i.e. much more often.

Clinical and anatomical forms of ROC:

1) exophytic (polypoid, villous-papillary, nodular);

2) endophytic (infiltrating, ulcerative-infiltrative, circular-stricturing);

3) transitional or mixed.

Cancer with a predominantly exophytic growth pattern is more often observed in the right half of the colon, and with a predominantly infiltrating growth pattern - in the left.

According to the domestic histological classification, the following forms of colon tumors are distinguished: adenocarcinoma, solid cancer, mucous (ring cell) and scirrhosous cancer. There are also 3 degrees of differentiation of cancer: highly differentiated, moderately differentiated and poorly differentiated.

We present the International Morphological Classification

1. Adenocarcinoma:

a) highly differentiated;

b) moderately differentiated;

c) poorly differentiated.

2. Mucous adenocarcinoma:

a) mucoid cancer;

b) mucous cancer;

c) colloid cancer.

3. Signet ring cell carcinoma - mucocellular.

4. Undifferentiated cancer (carcinoma simplex, medullary, trabecular).

5. Unclassified cancer.

Patterns of metastasis

Metastasis of ROC has its own characteristics.

Lymphogenic pathway. There are 3 stages of metastasis to regional The lymph nodes:

Stage I - epicolic or paracolic lymph nodes;

Stage II - intermediate or actual mesenteric lymph nodes;

Stage III - para-aortic, to the region of the root of the mesentery of the colon.

Next, the lymph is collected in the lymphatic tank, located transversely in the region of the I-II lumbar vertebrae. From the cistern, lymph flows through the thoracic duct into the venous system in the area of ​​the left venous angle - the confluence of the subclavian vein with the internal jugular vein. Supraclavicular metastases are usually identified there.

Hematogenous route metastasis is associated with the growth of a tumor into the venous network with subsequent spread through the bloodstream - primarily to the liver, lungs, bones and other organs.

Implantation path metastasis, or contact, is associated with tumor germination of all layers of the intestinal wall, separation of cancer cells from the bulk of the tumor and their implantation in the peritoneum. These cancer cells give rise to a small, lumpy lesion called peritoneal carcinomatosis. The latter is usually accompanied by cancerous ascites. Manifestations of carcinomatosis are metastases to the navel and along the pelvic peritoneum. These metastases can be identified during the initial examination of the patient using digital rectal and vaginal examination methods. Their detection indicates a running process.

Stage division

The stage of colon cancer or the extent of the tumor process is determined by the following 3 components:

Size and depth of invasion of the primary tumor;

Metastasis to regional lymph nodes;

Metastasis to distant organs.

I stage- a tumor up to 1.5 cm in greatest dimension, localized within the mucous membrane and submucosal layer of the intestinal wall. There are no regional metastases at this stage.

II stage:

a) tumor large sizes, but occupying no more than the semicircle of the intestine and does not grow into the serous layer; there are no regional metastases;

b) a tumor of the same or smaller size, but there are single metastases in the nearest regional lymph nodes.

III stage:

a) a tumor that occupies more than half the circumference of the intestine, growing through all layers of its wall and serous cover; no metastases;

b) a tumor of any size, but in the presence of multiple metastases in regional lymph nodes.

IV stage- an extensive tumor growing into neighboring organs, the presence of multiple lymph node metastases, or a tumor of any size with the presence of distant metastases.

It should be noted that the stage of the disease must be reliably established after a comprehensive examination of the patient - clarification of the local status, possible metastases, morphological research operating material. Lack of appropriate

information often leads to an unreasonable overestimation of the stage of the process, which, naturally, is reflected in the indicators of neglect.

To unify the staging of ROC, the International clinical classification according to the TNM system (2002).

INTERNATIONAL CLASSIFICATION ACCORDING TO THE TNM SYSTEM (2002)

Classification rules

The classification below is only applicable to cancer. In each case, histological confirmation of the diagnosis is necessary.

Anatomical regions

Colon

1. Vermiform appendix.

2. Cecum.

3. Ascending colon.

4. Hepatic flexure of the colon.

5. Transverse colon.

6. Splenic flexure of the colon.

7. Descending colon.

8. Sigmoid colon. Rectosigmoid junction

Regional lymph nodes

Below are the main groups of lymph nodes for each anatomical region.

Vermiform appendix: ileocolic lymphatics

ical nodes.

Cecum: ileocolic and right

colon lymph nodes.

Ascending colon: ileocolic, right

colon, middle colic lymph nodes.

Hepatic flexure: right colic and middle rims

thoracic lymph nodes.

Metastases to other lymph nodes are regarded as distant. The exception is a primary tumor that has spread to other segments of the colon and rectum or to the small intestine.

Clinical classification of TNM

T - primary tumor

Tx - assessment of the primary tumor is impossible. T0 - no primary tumor detected.

Tis - cancer in situ: Cancer cells are found within the basement membrane of the glands or in the lamina propria*.

T1 - the tumor affects the submucosal layer.

T2 - the tumor penetrates the muscle layer.

Note!

* To cancer in situ does not include tumors that penetrate the submucosal layer or muscular plate of the mucous membrane.

T3 - the tumor penetrates into the subserous layer or peritoneal and pararectal tissue not covered by peritoneum.

T4 - the tumor affects neighboring organs and tissues*, ** and (or) penetrates the visceral peritoneum.

Note!

* Damage to adjacent organs and tissues includes spread of the tumor to other parts of the colon through the serosa (for example, spread of a tumor of the cecum to the sigmoid colon).

** Macroscopic spread of the tumor to neighboring organs is considered stage T4. Organ damage, according to microscopic examination, is regarded as stage pT3.

N - regional lymph nodes

The condition of regional lymph nodes cannot be assessed.

N0 - no metastases in regional lymph nodes. N1 - 1 to 3 regional lymph nodes are affected. N2 - 4 or more regional lymph nodes are affected.

Note!

The detection of affected lymph nodes of a normal shape in the pericolitic or pararectal fatty tissue in the absence of residual lymph nodes without histological confirmation is described by pN and is regarded as metastases to regional lymph nodes. In turn, the detection of metastatic nodes of irregular shape is defined as pT and indicates vascular damage. In the case of microscopic invasion of the vein wall, the tumor is described as V1, in case of macroscopic invasion - as V2.

M - distant metastases

Mx - there is not enough data to determine distant metastases.

M0 - no distant metastases. M1 - there are distant metastases.

Pathomorphological classification of pTNМ

For the purpose of pathomorphological assessment of the N index, 12 regional lymph nodes or more are removed. It is now accepted that the absence of characteristic tissue changes

pathomorphological examination of biopsy samples of a smaller number of lymph nodes allows us to confirm the pN0 stage.

Grouping by stages

Complications

Complications of ROC include:

Obstructive intestinal obstruction;

Perforation of a colon tumor with the development of peritonitis;

Perifocal inflammatory and purulent processes (purulent paracolitis, paranephritis, phlegmon of the abdominal wall, retroperitoneal space);

Bleeding from the tumor (rarely profuse);

Tumor growth into neighboring organs and development of interorgan fistulas.

CLINICAL PICTURE

Symptoms of cancer of the right and left half of the colon

The clinical manifestations of cancer are very diverse and are determined by the location of the tumor, the anatomical type of tumor growth, the histological structure of the cancer, the stage and extent of the tumor process, complications and individual reactivity of the body.

The clinical picture of ROC is characterized by the following groups of symptoms.

1. Abdominal pain. As an initial sign, they are 2-3 times more likely to occur when the tumor is located in the right half of the colon. The nature of the pain can be very diverse - from dull, aching minor pain to severe, paroxysmal pain, forcing patients to be hospitalized in surgical hospitals as an emergency. The appearance of such pain indicates a violation of the passage of intestinal contents, the development of intestinal obstruction, which is observed most often with the left-sided localization of the tumor.

2. Intestinal discomfort (loss of appetite, belching, sometimes vomiting, feeling of heaviness in the upper abdomen). These symptoms are more often observed when the transverse colon, its right half, is affected, and less often when the tumor is located on the left side.

3. Intestinal disorders (constipation, diarrhea, alternating constipation with diarrhea, rumbling and bloating). These symptoms of intestinal passage disorder are most often observed when the tumor is located on the left side, which is explained, firstly, by the predominantly circular growth of the tumor in the left half of the colon, and secondly, by the dense consistency of already formed feces. The final stage of disruption of intestinal passage is the development of partial and then complete obstructive colonic obstruction.

4. Pathological discharge in the form of blood, mucus, pus during defecation is a common manifestation of cancer of the distal sigmoid colon.

5. Violation of the general condition of patients is expressed by malaise, increased fatigue, weakness, weight loss, fever, pallor of the skin and increasing hypochromic anemia. All these general symptoms of the disease are associated with intoxication of the body caused by a disintegrating cancerous tumor and infected intestinal discharge, characteristic of cancer of the right half of the colon. It is associated with the functional feature (absorption capacity) of the mucous membrane of this part of the colon.

The presence of a palpable tumor is rarely the first symptom of the disease; it is usually preceded by other symptoms. Them

No less palpable determination of the tumor often serves as the basis for making the correct diagnosis.

Main clinical forms

Currently, according to most researchers, it is advisable to distinguish 6 forms of the clinical course of ROC.

1. Toxic-anemic form - most often observed in cancer of the right half of the colon, in which signs of a violation of the general condition of patients against the background of progressive hypochromic anemia and fever come to the fore. Such patients are examined for a considerable time in various medical institutions for anemia of unknown origin until intestinal disorders appear. This contingent of patients requires careful special examination of the entire colon.

2. Enterocolitic form - the clinical picture of the disease begins with intestinal disorders. Such patients are often given various diagnoses: colitis, enteritis, enterocolitis, and in the presence of blood in the stool or liquid stool - a diagnosis of dysentery. Therefore, in the presence of these symptoms, a thorough examination of the entire colon is always required.

3. Dyspeptic form - characterized by the presence of signs of gastrointestinal discomfort. With this form of ROC, a diagnosis is often made: gastritis, peptic ulcer, cholecystitis, etc., therefore, only the upper gastrointestinal tract is examined. At further progression diseases are accompanied by intestinal disorders, and the correct diagnosis is established only after a complete X-ray endoscopic examination of the colon.

4. Obstructive form - most often serves as a manifestation of cancer of the left half of the colon with symptoms of progressive intestinal obstruction (partial and complete obstructive colonic obstruction).

5. Pseudo-inflammatory form - in the clinical picture of the disease, the first place is taken by signs of an inflammatory process in the abdominal cavity (abdominal pain, fever, the appearance of signs of peritoneal irritation, in a blood test - leukocytosis). This symptom complex is often a manifestation of the course of ROC, complicated by a purulent-inflammatory process of the type of paracolitis. This form of cancer is difficult to diagnose, since depending on the location of the tumor the clinical picture

can simulate acute appendicitis, cholecystitis, adnexitis, pyelonephritis and other inflammatory diseases of the abdominal cavity and pelvis.

6. Tumor (atypical) form - in this form of colon cancer, the disease begins with the fact that the patient himself or the doctor, during a routine examination against the background of complete well-being, palpably finds a tumor in the abdominal cavity. Palpation of a tumor in the abdomen is a common occurrence in patients with ROC. However, only those cases when palpation of the tumor clinically dominates, and other signs are not expressed or are so insignificant that they do not attract the patient’s attention should be classified as a tumor form of cancer.

DIFFERENTIAL DIAGNOSTICS

Taking into account the close relationship of the colon with the organs of the abdominal cavity, retroperitoneal space, and anterior abdominal wall, ROC must be differentiated from many diseases of both the colon itself and adjacent organs and tissues. Most often this is:

1) inflammatory diseases of the colon - chronic colitis, chronic ulcerative colitis, Crohn's disease, appendiceal infiltrate, etc.;

2) specific inflammatory processes - tuberculosis, actinomycosis;

3) extraintestinal diseases of the abdominal and pelvic organs;

4) nonepithelial benign (leiomyoma, fibromyoma) and malignant (sarcoma) tumors of the colon;

5) other types of intestinal obstruction - adhesive, strangulation, volvulus, intussusception, coprostasis, dynamic intestinal obstruction;

6) colon polyposis;

7) diverticulosis (diverticulitis) of the colon;

8) kidney tumors and cysts, nephroptosis;

9) extraorgan retroperitoneal tumors;

10) ovarian tumors and cysts.

The scheme of differential diagnosis of diseases of the colon is presented in table. 21.1.

Table 21.1. Differential diagnosis of certain diseases of the colon

Chronic colitis is more often a consequence of previous dysenteric or amoebic colitis. Frequent exacerbations and bacterial carriage are possible.

Chronic nonspecific ulcerative colitis is characterized by autoallergy to the own mucous membrane of the colon, which is rejected, exposing the wound surface; red blood cells, plasma, plasma proteins, etc. are released through it. Patients can lose up to 500 ml of blood per day. Frequent, loose stools are observed - several dozen times a day. Due to the chronic inflammatory process, the intestine becomes short (up to 60-80 cm), the lumen narrows; Endoscopic examination reveals ulcers that are subject to biopsy and morphological examination.

Crohn's disease is a terminal ileitis, but the pathological process can also be localized in the colon and rectum. This nonspecific inflammatory infiltrate can occur as cecal cancer. X-ray shows an alternation of narrowed and expanded areas. The intestine is deformed. The endoscopic picture resembles a “cobblestone street”.

Periappendicular infiltrate is a consequence of acute appendicitis. It includes the cecum, appendix, greater omentum, loop of small intestine, and anterior abdominal wall. As a rule, in its center there is a melted vermiform appendix, an abscess, which can, under certain conditions, break into the free abdominal cavity. Typically, the infiltrate appears on the 3rd and subsequent days after an attack of acute appendicitis, which was not diagnosed in a timely manner. The infiltrate is usually palpated in the right iliac region and is initially painful. Such patients are subject to conservative treatment - they are prescribed local cold, antibacterial, anti-inflammatory, and detoxification therapy. In case of abscess formation and breakthrough of the abscess into the free abdominal cavity, emergency surgical intervention is indicated - laparotomy, appendectomy and drainage of the abdominal cavity.

After conservative treatment and resorption of the infiltrate, appendectomy is indicated after 4-6 months.

Tuberculosis of the colon is more often localized in the cecum and develops in young people and those suffering from pulmonary tuberculosis. These patients have a smooth tumor in the projection of the cecum, which is characterized by dense elastic

consistency, soreness, inactivity. Patients experience low-grade fever, leukopenia, and lymphocytosis. It is possible to detect tubercle bacilli in the stool. Diagnosis is aided by colonoscopy with biopsy.

Actinomycosis is rare. With this disease, an infiltrate of woody density is formed, often with fistulas in the area of ​​the cecum. The differential diagnosis is facilitated by the detection of a radiant fungus - actinomycete - in drusen released from the fistula.

Nonepithelial tumors of the colon are rare. Their malignant variants are characterized by infiltrating growth and decay. Sarcoma can reach large sizes.

Tumors of the sigmoid colon, due to the high mobility of its mesentery, often have to be differentiated from tumors and ovarian cysts. Therefore, in case of ovarian pathology, examination of the colon is necessary.

A large group of tumors of the retroperitoneal space and nearby organs also requires differential diagnosis between them and ROC - ranging from nephroptosis, kidney cysts, primary or secondary liver cancer, liver echinococcus, stomach cancer, pancreas, etc.

DIAGNOSTICS

Diagnosis of ROC should be comprehensive, including clinical examination, radiological, endoscopic laboratory methods, as well as special additional methods, incl. explorative laparotomy.

1. Clinical methods:

Patient's complaints. Symptoms associated with insufficient digestion, absorption, exudative enteropathy, intestinal discomfort, pathological discharge;

Taking an anamnesis, in which indications of the presence of familial polyposis, colitis and other previous diseases can be found;

Objective research data - all methods of objective research are used: examination, palpation, percussion of the abdominal cavity with a mandatory change in the patient’s position;

Digital examination of the rectum must also be carried out in various positions of the patient.

2. X-ray diagnostics- irrigoscopy, irrigography, survey radiography of the abdominal cavity. These methods have their own resolution capabilities and are constantly being improved.

Colon examination is performed using contrast agent- a solution of barium sulfate, which is injected into the colon using an enema. Tight filling of the intestine with barium solution is not always carried out, but according to indications.

The following technique is most often used: 300-400 ml of barium sulfate solution is injected into the intestines with the patient positioned on the back or left side and the first x-ray is taken. In this case, the rectum and sigmoid colon are contrasted. Then they lift the foot end of the couch on which the patient lies; in this position, the splenic (left) flexure and the distal segment of the transverse colon are filled. A 2nd x-ray is taken. Then the patient turns on his right side; at the same time the right bend is filled. The patient stands in an upright position - the cecum and ascending colon are filled. For double contrast, air is introduced into the intestinal lumen using a gas outlet tube.

Most often, tumors reveal a defect in the filling of the colon, barium depot, absence of haustration, narrowing of the intestinal lumen, rigidity of the intestine, non-distension of the intestine, impaired displacement and peristalsis, as well as flow of the contrast agent beyond the intestinal contour when a fistulous tract appears.

Plain radiography of the abdominal cavity allows you to determine the symptom of Kloiber's cup. They indicate a violation of passage through the intestine, but can occur both with obstructive obstruction and with paralytic obstruction.

The state of passage through the gastrointestinal tract can be judged by taking 2-3 sips of thick barium, which normally should leave the lumen of the stomach after 2 hours, the small intestine after 6-8 hours, and reach the rectum after 15-20 hours. Deviations from the specified time indicators indicate a violation of the passage, which may serve as a basis for making a decision on emergency surgery.

3. Endoscopic diagnostics- sigmoidoscopy, fibrocolonoscopy, laparoscopy (with biopsy, taking smears for cytological and histological examination).

Fibercolonoscopy allows you to examine the lumen of the colon up to the dome of the cecum. The study includes mandatory

taking material for cytological and histological examination (Fig. 21.1).

4. Laboratory diagnostics:

Complete blood count (for colon tumors, typical hypochromic anemia, increased ESR, leukocytosis);

Fecal occult blood test (positive Gregersen test, cryptohemtest);

Coagulogram (signs of hypercoagulation are observed);

A blood test for carcinoembryonic antigen (CEA), a glycoprotein found in the plasma, intestines, pancreas and liver of embryos and newborns. In small concentrations, CEA is found both in healthy people and in some forms of malignant neoplasms, in particular in ROC and rectal cancer.

5. Special additional methods studies to clarify the extent of the tumor process:

Liver scan - to diagnose hematogenous metastases;

Ultrasound and CT - for the diagnosis of metastases in the liver and retroperitoneal lymph nodes and collectors (Fig. 21.2).

6. Exploratory (diagnostic) laparotomy.

TREATMENT

The main method of treatment for ROC is surgical, which includes 2 types of surgical interventions.

1. Radical operations:

a) one-stage: right-sided hemicolectomy (Fig. 21.3), resection of the transverse colon, left-sided hemicolectomy, intra-abdominal resection of the sigmoid colon, anterior resection of the rectosigmoid colon with restoration of intestinal continuity or resection of the rectosigmoid colon according to Hartmann;

b) 2- and 3-stage operations: Zeidler-Schloffer operation (colostomy + intestinal resection + closure of intestinal stoma), operation of obstructive colon resection according to Mikulich or according to Grekov, etc.;

c) combined operations with resection of adjacent organs and surrounding tissues for locally advanced forms of ROC.

2. Palliative operations:

a) application of bypass anastomosis;

b) the imposition of an intestinal stoma - ileostomy, cecostoma, transversostomy, sigmostoma.

It is advisable to end surgical interventions on the colon with digital stretching (devulsion, redressing) of the anus. According to indications, intubation is performed with a probe or a double-lumen tube of the afferent intestine.

Tactics for cancer complicated by acute intestinal obstruction

Obstructive intestinal obstruction is one of the common complications during ROC. Its development is influenced by a number of factors; the dominant ones are: localization, anatomical shape and stage of the tumor process. Intestinal obstruction with cancer of the sigmoid or descending colon develops 2-3 times more often than with damage to the right half of the colon, for the following reasons:

1) the diameter of the sigmoid and descending colon is almost half the diameter of the cecum and ascending colon;

2) endophytic stenotic tumors more often develop in the left half;

3) the formed dense feces more often obstruct the stenotic area than the liquid or pasty contents of the oral sections of the colon.

In the treatment of patients with acute intestinal obstruction caused by a tumor, a very important point is the choice of tactics and nature of surgical intervention. As a rule, such operations are performed in unfavorable conditions in seriously ill patients, weakened by the underlying and concomitant diseases, which undoubtedly affects the outcome of treatment.

The main goal of surgical intervention for obstructive colonic obstruction at the 1st stage is to empty the intestines of contents and eliminate its obstruction. This problem can be solved in 2 ways: by creating a fistula (colostomy) to divert intestinal contents outside or by creating a bypass anastomosis to divert it into the intestine. Each of these interventions can be definitive (usually for stage IV cancer) or temporary, performed to prepare the patient for subsequent stages. These surgical interventions are palliative in nature and are aimed primarily at eliminating the immediate threat to the patient’s life resulting from obstruction of the colon.

In some cases, with complicated forms of colon cancer, radical surgical interventions such as primary obstructive resection, including the imposition of a proximal colostomy, can be performed. Subsequent stages are performed several months later, after additional preparation of the patient. However, primary radical operations in patients with obstructive intestinal obstruction of tumor origin are indicated only if their general condition is satisfactory and there are no symptoms of peritonitis and ascites. Under the same conditions, but with an unremovable tumor, a bypass interintestinal anastomosis can be performed.

In case of acute intestinal obstruction caused by a tumor of the right half of the colon, as well as the right and middle thirds of the transverse colon, the following surgical interventions can be performed:

1) right hemicolectomy with removal of the ends of the ileum and transverse colon to the anterior abdominal wall;

2) application of a bypass ileotransverse anastomosis, application of a bypass or ileotransverso anastomosis with unilateral exclusion of the right half of the colon and removal of the aboral end of the ileum to the anterior abdominal wall, application of a double-barreled ileostomy and cecostomy.

Right-sided hemicolectomy for acute obstructive colonic obstruction, which is a radical operation, is performed only if the patient’s general condition is satisfactory and there are no signs of peritonitis or ascites.

During the period of acute intestinal obstruction caused by cancer of the left half of the colon, 2 types of surgical interventions are mainly used: obstructive resection of the tumor-affected area of ​​the colon with a proximal colostomy or colostomy alone. Primary resection is carried out only if the patient’s general condition is satisfactory and there are no signs of peritonitis or ascites. However, the main type of surgical intervention for acute obstructive obstruction of the left half of the colon is the imposition of a fistula proximal to the tumor on the colon (transversostomy, sigmostoma).

For acute intestinal obstruction caused by a cancerous tumor of the left half of the colon, it is widely used

3-stage Zeidler-Schloffer type operation. This operation is performed in cases where there are symptoms of peritonitis. At its 1st stage, a discharge colostomy is applied proximal to the tumor (like a cecostoma, transversostomy or sigmostoma); Stage 2 consists of resection of the tumor-affected area of ​​the left half of the colon and the application of an interintestinal anastomosis to restore intestinal continuity; this stage is performed after complete elimination of signs of intestinal obstruction and improvement of the patient’s general condition. At the 3rd stage, usually 2-3 weeks after the healing of the anastomosis performed at the 2nd stage, the colostomy is closed.

One of the surgical interventions used for acute colonic obstruction caused by cancer is the Hartmann operation, proposed for the treatment of cancer of the sigmoid and rectosigmoid colon, as well as tumor lesions of the upper ampullary rectum. The essence of the operation is the resection of the tumor-affected area of ​​the colon and the application of a proximal single-barreled colostomy. The advantage of the operation is the possibility of subsequent delayed restoration of the continuity of the intestinal tract.

Advanced cancer remains a significant cause of cancer-related mortality worldwide. Chemotherapy can improve survival in most patients. For many decades, 5-fluorouracil has been used for this purpose. As monochemotherapy, the drug is used at a total dose of 2600 mg/m2 in the form of a 24-hour infusion weekly until toxicity occurs. The standard combination chemotherapy for ROC is a combination of 5-fluorouracil with folic acid - fluorouracil at a dose of 500 mg/m2 intravenously on days 1, 8, 15, 22, 29, 36 and leucovorin (calcium folinate) at a dose of 500 mg/m2. m 2 intravenously as a 2-hour infusion 1 hour before the administration of 5-fluorouracil on the same days.

In the last 10 years, there has been an evolution in the treatment of cancer with the transition from treatment with 5FU/LV to PCT: fluoropyrimidines with oxaliplatin (FOLFOX, XELOX) or irinotecan (FOLFIRI, R-IFL) with their integration into therapeutic strategies, when surgical treatment is increasingly important place in the treatment of patients with metastases. Oxaliplatin with 5FU/LV (FOLFOX) is the first combination to demonstrate superiority over 5FU/LV in the adjuvant treatment of colorectal cancer. In correlation with this, the median

The survival rate of patients with metastatic colon cancer is between 17 and 22 months. The combination of 5-fluorouracil/folic acid + capecitabine or oxaliplatin is considered as the regimen of choice in the 1st line of therapy for metastatic colorectal cancer. When high-dose oxaliplatin chemotherapy was added to a simple regimen (5-FU/LV once every 2 months) as 2nd line chemotherapy for metastatic colorectal cancer, it resulted in an extension of median survival from 6.8 to 8.8 months and an increase in survival to 4.5 months

Current trends in the treatment of cancer are associated with the use of treatment methods specific to each patient, which is facilitated by the identification of the genetic and molecular profile of tumors and an increase in the number of targeted agents. Molecular prognostic factors are best studied in colorectal cancer due to its greater prevalence and accessibility for research and diagnosis among all solid tumors - these are tumor suppressors of oncogenesis p53, k-ras, DCC, biochemical determinants of 5-fluorouracil metabolism and DNA repair defects. Improvements in treatment outcomes for common forms of cancer can continue with the development of multimodal approaches and the introduction of new targeted agents with innovative combinations of chemotherapy drugs.

Two of the most promising targets for the treatment of colorectal cancer are epithelial growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF). Angiogenesis is a prerequisite for tumor growth of more than 2 mm, since in this case simple diffusion of oxygen can no longer support the rapid proliferation of malignant cells. The process of angiogenesis is a precise balance between inhibitory and stimulatory factors, knowledge of which helps to identify targets for the treatment of colorectal cancer. Angiogenesis in primary tumors sequentially triggers a cascade of molecular events leading to rapid exponential tumor growth. In primary tumors, liver metastases can develop without traditional angiogenesis pathways, co-opting into the existing hepatic vasculature. The study of angiogenesis has identified many different targets that can be attacked by agents such as tyrosine kinase inhibitors. There are currently many antiangiogenic agents undergoing preclinical evaluation, of which

several are in phase I and II clinical trials. However, preliminary results already suggest that antiangiogenic therapy may be an important addition to conventional chemotherapy for cancer.

Components that inactivate EGFR or bind VEGF have demonstrated clinical activity both alone and in combination with chemotherapy in phase II and III clinical trials. The most promising of these components are cetuximab, which blocks the binding of EGF and FCF-α to EGFR, and bevacizumab, which binds free VEGF. Cetuximab and irinotecan were evaluated in two clinical trials in the United States. The results of the use of cetuximab in patients refractory to irinotecan with EGFR-positive colorectal metastases were studied. In 10.5% of cases, partial regression was noted; in 22.5% of patients, objective regression was achieved using cetuximab and irinotecan. Another promising agent is bevacizumab, an anti-VEGF monoclonal antibody variant. VEGF is produced by healthy and tumor cells. Its activity towards two tyrosine kinase receptors has been established. VEGF signaling is a manifestation of physiological and pathological angiogenesis. Bevacizumab has been studied as an antiangiogenic therapeutic factor as a single agent and in combination with chemotherapy in patients with stages III and IV ROC. In addition to its direct antiangiogenic effect, bevacizumab may promote more efficient delivery of chemotherapy drugs by damaging tumor vasculature and reducing increased tissue pressure in the tumor. The addition of bevacizumab 5 mg/kg to chemotherapy (5FU/LV) resulted in a higher response rate (40 vs. 17%), increased time to tumor progression (9 vs. 5.2 months), and prolonged median survival (21.5 versus 13.8 months). Studies aimed at identifying marker genes help predict tumor response to chemotherapy. The goal of these studies is to identify patients who need chemotherapy and provide treatment according to the molecular profile of the tumor and the patient.

Radiation treatment of ROC is currently used to a limited extent (Vazhenin A.V. et al., 2003), which is due to factors such as colon mobility, small wall thickness, risk of perforation, as well as radioresistance of colon adenocarcinoma.

LONG-TERM RESULTS

Long-term results of treatment of patients with early stages of colon cancer are satisfactory. For tumors limited to the mucous membrane, the 5-year survival rate reaches 90-100%. At stage II, this figure decreases to 70%. In stage III with metastases to the lymph nodes, the 5-year survival rate is about 30%.

Questions for self-control

1. What are the morbidity rates for ROC.

2. List precancerous diseases of the colon.

3. Give the pathological and anatomical characteristics of ROC.

4. Describe the features of cancer metastasis.

5. How is division carried out into stages?

6. List the main clinical manifestations ROCK.

7. What are the features of the course of ROC depending on the location?

8. List the main clinical variants of ROC.

9. What diseases is it performed with? differential diagnosis ROCK?

10. Describe the principles and methods for diagnosing ROC.

11. Which diagnostic value Do they have X-ray and endoscopic examination methods?

12. Cover the principles of treatment of ROC.

13. What volumes of operations are performed depending on the location of the cancer?

14. What is the essence of palliative operations?

15. List the indications for drug and combination treatment.

Thus, malignancy in diffuse polyposis occurs in almost 100% of cases.

Some authors associate the increase in cases of colorectal carcinomas in developed countries with an increase in the content of meat and animal fat in the diet, especially beef and pork, and a decrease in fiber. There has been a sharp decline in cases of the disease among vegetarians. The frequency of colonorectal carcinomas is high among workers in asbestos production and sawmills.

Most often, cancerous tumors develop in places where the colon bends, i.e., in places where feces stagnate, which makes it possible to consider chronic constipation as one of the predisposing factors. Chronic colitis and, most importantly, colon polyposis also play a role.

The favorite localization of cancer is the cecum, hepatic flexure, splenic angle and sigmoid colon. Approximately 40% are affected by the cecum and 25% by the sigmoid colon. In cancer that occurs against the background of polyposis, multiple foci of tumor development (double and triple localization) are common.

In colon cancer, there are exophytic (growing inside the intestine) limited forms, endophytic infiltrating and mixed.

Based on the histological structure, cancers arising from the glandular epithelium of the intestinal mucosa are defined as adenocarcinomas, solid and colloid cancers; rarely the tumor has the structure of signet ring cell, undifferentiated or squamous cell carcinoma.

Clinical symptoms vary depending on the location of the tumor. The clinical picture of colon cancer in the early stages does not manifest itself with any striking symptoms, although a careful questioning of the patient can reveal changes general well-being, decreased ability to work, decreased appetite. Weight loss with colon cancer is rare; on the contrary, patients may even gain weight.

Subsequently, a number of signs of intestinal disorders appear: rumbling and transfusion in the intestines, diarrhea and constipation, periodic cramping or constant dull pain in the abdomen not associated with food intake. When a narrowing of the intestinal lumen by a cancerous tumor develops, unilateral uneven bloating occurs. Right colon cancer causes anemia due to slow, chronic blood loss.

Subsequently, the signs of the disease increase; in severe cases, intestinal obstruction, bleeding, and inflammatory complications (abscess, phlegmon, peritonitis) are observed.

When examining the patient, no external signs are detected, and only if the tumor is large or in thin patients can it be felt through the abdominal wall.

X-ray examination plays an important role in diagnosis. With the current level of knowledge and examination techniques, a radiologist is able to detect colon cancer even in the absence of clear clinical signs. The study is carried out using a barium contrast suspension, given either orally or administered through an enema. In some cases, the relief of the intestinal mucosa is additionally studied against the background of air introduced into its lumen. In this case, a filling defect is detected in exophytic (tumors protruding into the intestinal lumen) or areas of narrowing with irregular mucosal relief and uneven, corroded contours.

For cancer of the distal parts, i.e. damage to the sigmoid colon, the number necessary methods The examination also includes sigmoidoscopy and colonoscopy, in which the intestinal mucosa is examined with the eye and, if a tumor is detected, a biopsy is performed.

The selection of patients for examination is carried out after analyzing clinical symptoms, obtaining the results of a stool test for the presence of blood, and determining carcinoembryonic antigen in the blood.

To exclude liver metastases, ultrasound tomography (US) is performed. Laparoscopy (endoscopic examination of the abdominal cavity) is indicated to exclude generalization of the malignant process.

Radical treatment of colon cancer is only possible through surgery. Options for operations vary depending on the level of tumor location: for cancer of the cecum, ascending tract, and hepatic flexure of the intestine, the entire right half of the intestine is removed, creating an anastomosis between the ileum and transverse colon (right hemicolectomy). In case of cancer of the transverse colon, its resection is performed to restore the patency of the anastomosis between the remaining segments; for cancer of the splenic angle and descending section, the entire left half large intestine with an anastomosis between the transverse colon and sigmoid colon (left-sided hemicolectomy); finally, in case of sigmoid colon cancer, it is resected. There are a number of modifications of these operations, which we will not dwell on.

Preparing patients for surgery And consists of thoroughly cleansing the intestines. 3-4 days before surgery, patients are transferred to a light, slag-free diet, excluding bread, potatoes and other vegetables from the diet. For two days, the patient receives castor oil and repeated enemas, including the evening before the operation. As a preventative measure, a course of antibiotics and sulfonamides is administered for 2-3 days.

After the operation, in addition to general events To combat postoperative shock, dehydration and intoxication, the patient is prescribed Vaseline oil 30 g twice a day. This mild laxative will prevent the formation of dense feces, which could injure the suture line of the anastomosis. From the 2nd day, drinking is allowed, and then light liquid food, gradually expanding the diet, and after the first normal stool patients are transferred to a general diet.

In inoperable, advanced forms of colon cancer, it is necessary to perform palliative operations - the application of bypass anastomoses or fecal fistula to prevent the possible development of acute intestinal obstruction when the intestine is blocked by a tumor. In addition to palliative operations undergo a course of chemotherapy.

Recurrences of colon cancer are rarely observed, only as a result of non-radical surgery and in the absence of distant metastases, repeated operations are resorted to.

Colon cancer metastasizes through the lymphatic tract, affecting the lymph nodes of the mesentery, and then a group of nodes along the abdominal aorta. Hematogenous metastases most often occur in the liver. When a tumor grows into the serous covering of the intestine, dissemination of the process through the peritoneum may occur, accompanied by ascites.

For colon cancer, the prognosis depends on the stage of the process, but in the absence of metastases to the lymph nodes it is relatively favorable, since almost half of the patients receive a permanent cure.

Patients in risk groups are subject to dispensary observation. Prevention of colon cancer mainly comes down to timely radical treatment intestinal polyposis, as well as proper treatment colitis in order to prevent it from becoming chronic.

Important preventative measure is to normalize nutrition, reduce the content of meat products in the diet, and fight constipation.

Since a decrease in the risk of colon cancer in smokers has been observed, some authors recommend starting to smoke as a preventative measure after 60 years of age. But smoking (especially cigarettes!) can cause other health problems, so the ideal solution to the problem at present is the NICOTER program of the ONCONET System.

Symptoms of transverse colon cancer: treatment and prognosis

The colon is the longest part of the large intestine. If you visualize it, it resembles a slightly distorted letter “P”. The rectum completes the U-shaped colon.

IN digestive tract this organ does not take part, but absorbs liquid and electrolytes that enter the body during meals. Chyme or liquid contents of the small intestine, which enters the colon, turns into feces, and exits into the rectum. The length of the colon is one and a half meters and is divided into four sectors:

• Ascending colon – 24 cm;
• Transverse – 56 cm;
• Descending colon – 22 cm;
• Sigmoid - 47 cm.

Colon cancer is one of the most common diseases in developed countries and is in second place among oncological pathologies of the gastrointestinal tract. The USA and Canada are recognized as the leaders in the number of patients with colon tumors. There is a high percentage of cases in European countries, Japan, and Australia, but residents of other Asian countries and African countries rarely suffer from this pathology. The disease most often affects people aged 65 and above.

Causes

A malignant tumor is located on the walls of the colon and, when growing, can completely block the intestinal lumen, which is 5-8 cm in diameter.

The causes of colon cancer have many factors, both pathogenetic and etiological. Pathology can occur as a result of:

• Precancerous diseases left to chance - ulcerative colitis, diffuse polyposis, diverticulosis, Crohn's disease, hereditary polyposis, adenoma.
• Poor nutrition – refined carbohydrates, animal fats, proteins.
• Obesity.
• Age category over 50 years.
• Chronic constipation against the background of senile atony.
• Increased content of endogenous carcinogen in the intestinal contents.
• Permanent damage to the bends of the intestine with feces.
• Sedentary lifestyle.

Important! Vegetarians are susceptible to cancer much less often than those who eat meat, and in particular fatty beef and pork.

Classification

Colon cancer is divided into three forms:

• Endophytic tumor. In this type of pathology, the neoplasm does not have clear boundaries and is localized in the intestinal walls on the left side. The tumor can be ulcerative-infiltrative, circular-structuring and infiltrating.
• Exophytic formation has the form of polyps, nodules or villous-papillary. This type of tumor appears in the intestinal lumen on the right side.
• Combined or mixed.

According to the international classification, colon cancer is divided into types, which are determined by analysis of the cellular structure.

• Adenocarcinoma can be poorly differentiated, moderately differentiated and highly differentiated. Develops from epithelial cells.
• Mucous adenocarcinoma represents colloid, mucoid and mucinous cancer. Formed in the glandular epithelium of the intestinal mucosa.
• Signet ring - cellular or mucocellular cancer. Tumor cells are separately located blisters.
• Colloid cancer.
• Glandular-squamous and squamous. The tumor was formed from epithelial cells - glandular-squamous and flat.
• Undifferentiated carcinoma consists of a medullary-trabecular constitution.

Colon cancer varies according to the location of the tumor, the degree of damage to tissues and organs, and the severity of the course. The clinical picture of the disease has six forms:

1. enterocolitic;
2. dyspeptic;
3. obstructive;
4. toxic-anemic;
5. atypical or tumor;
6. pseudo-inflammatory.

A malignant tumor can be located anywhere in the intestinal tract. More than 50% of patients suffer from oncology of the rectum and sigmoid colon; all other tumors appear in the area of ​​the right flexure or hepatic angle of the colon, in the cells of the ascending and transverse and descending sections, as well as in the area of ​​the splenic flexure.

Cancer of the ascending colon Cancer of the ascending colon, in 18% of cases, its symptoms resemble other diseases. Signs characteristic of this pathology:

• pain syndrome localized in different areas - in the groin area, right hypochondrium, upper abdomen and entire abdomen, iliac region on the right side.
• disturbances in the functioning of the intestines - diarrhea, constipation or their alternations.
• increased intestinal peristalsis, manifested in the form of strong rumbling, distension, and bloating.
• the color of the stool turns to dark color due to the admixture of blood, the presence of pus and mucus in it.
• the presence of a dense infiltrate with an uneven surface.

Important! Cancer of the ascending segment is characterized by late appearance of metastases. Due to this, large tumors are considered operable.

If metastasis occurs in the lymph nodes and atypical cells remain in them for a long time, then removal of the lymph nodes along with the mesentery will help stop the growth of the tumor throughout the patient’s body.

Descending oncology

A tumor of the descending colon accounts for 5% of these other anomalies. Due to the fact that the lumen of the descending colon has a small diameter, and stool has a semi-solid consistency, one of the main signs of oncology is the constant alternation of frequent stools and constipation.

For cancer of the descending section it is also typical:

• complete or partial intestinal obstruction, accompanied by paroxysmal pain in the peritoneum;
• presence of blood in feces.

Malignant formation of the hepatic angle and flexure

Cancer of the hepatic flexure of the colon narrows the intestinal lumen, which causes obstruction. In terms of its symptoms, the pathology is similar to a cancerous tumor of the ascending colon. Bleeding caused by organ damage leads to anemia.

The neoplasm in the place where the hepatic angle is located has the appearance of a disintegrating tumor that has grown into the duodenum. With this location of cancer, stimulation of the appendix, cholecystitis, adnexitis and ulcers of the stomach and duodenum occurs. This malignant formation leads to the appearance of a colonic fistula and intestinal obstruction.

Neoplasm of the transverse colon

Transverse colon cancer is characterized by severe pain. This is due to spastic contraction of the intestine, when feces are pushed through the narrow lumen of the intestine in the area of ​​the tumor. The process of cleansing the body is aggravated by inflammation caused by the breakdown of the formation. On initial stage, until the tumor penetrates beyond the walls of the intestine, pain rarely appears, and the tumor is palpable.

Tumors of this type account for 9% of the total number of colon cancers.

Signs of transverse colon cancer appear as follows:

• rapidly developing intestinal obstruction;
• frequent belching;
• heaviness in the upper abdomen;
• a sharp decrease in body weight due to constant nausea and vomiting;
• bloating and rumbling in the abdomen are chronic;
• flatulence;
• constipation and diarrhea;
• secretion of mucus, blood, pus at the time of defecation;
• The patient's condition deteriorated sharply, the skin was pale, weakness and fatigue developed from minor exertion.

Cancer of the splenic flexure of the colon

This pathology occurs in 10% of patients with colon cancer. Painful sensations, if this is a splenic type of pathology, are combined with an unreasonable increase in body temperature, muscle tension in the anterior and left peritoneal wall and leukocytosis.

Feces accumulate above the location of the tumor, which causes rotting, fermentation, stool retention, gas, bloating, nausea and vomiting. The composition of the intestinal flora changes.

Forms

The main forms and symptoms of colon cancer:

• Toxic-anemic causes anemia, increased fatigue, pallor skin, weakness.
• Dyspeptic disease is caused by nausea, belching, vomiting, aversion to food, a feeling of heaviness and bloating, which is accompanied by pain.
• Obstructive disease has leading signs – intestinal obstruction. Due to partial obstruction of feces, bloating and rumbling of the abdomen, a feeling of fullness, cramping pain, difficulty in passing gases and feces occur. Reducing the intestinal lumen requires emergency surgical intervention.
• Enterocolitic form, causing problems with the intestines - distension, rumbling, bloating, diarrhea, constipation. All this is accompanied by pain and the presence of blood and mucus in the feces.
• Pseudo-inflammatory with increased body temperature, the presence of pain, increased ESR, leukocytes in the blood.
• The tumor-like form does not have any specific symptoms, but the tumor can be felt during examination.

Complication

Colon cancer has serious consequences if the patient does not receive proper and timely treatment.

1. Intestinal obstruction affects 15% of patients. This complication occurs due to the growth of a tumor in the left side of the colon.
2. Cellulitis, abscesses and other purulent-inflammatory processes occur in 10% of patients with this type of cancer. The formation of abscesses is inherent in the neoplasm of the ascending department.
3. Perforation of the intestinal walls is observed in only 2% of patients, but in small cases this complication ends in death. Rupture of the intestinal walls occurs due to tumor disintegration and ulceration. Such anomalies lead to intestinal contents entering the abdominal cavity and peritonitis occurring. Intestinal masses trapped in the fiber cause phlegmon and abscesses in the retroperitoneal zone.
4. Penetration of a cancerous tumor into hollow organs leads to the appearance of fistulas - intestinal-vesical and intestinal-vaginal.

Stages

All oncological diseases have four stages of disease development and the initial stage is zero.

• Stage 0 – the mucous membrane is damaged, but there are no infiltrations, metastases, lymph nodes are unchanged.
• Stage 1 – does not appear in the submucosa and intestinal mucosa large tumor, metastasis is not observed.
• Stage 2 – the neoplasm has blocked 1/3 of the intestinal lumen. There is no germination into neighboring organs. Single metastases appeared in the lymph nodes.
• Stage 3 – the circumference of the intestine is half covered by the tumor. It has grown beyond its location and affected nearby organs. There are metastases in the lymph nodes.
• Stage 4 – the tumor is more than five centimeters in size and has penetrated other organs. Metastasis is observed throughout the body.

Symptoms

The main symptoms of colon cancer are as follows:

• the presence of blood in the stool;
• intestinal disorder in the form of non-systematic diarrhea occurring in different time without the participation of food taken;
• wave-like, girdle pain in the abdomen.

Similar symptoms may be associated with other pathologies not related to oncology.

• stomach ulcer;
• ulcerative enterocolitis;
• haemorrhoids;
• severe food poisoning;
• exotic food;
• stress.

For example, hemorrhoids are most often the cause of blood in the stool. This is due to the fact that hemorrhoids burst when feces pass through.

Important! As people age, they need to pay attention to a number of signs that indicate they have colon cancer.

Undoubted symptoms include:

Free legal advice:

• visiting the toilet more than four times a day;
• after eating any food, abdominal pain develops;
• loss of appetite, aversion to food, lethargy, pallor, cold sweat;
• an unpleasant odor appears from the mouth, and belching is accompanied by a putrid odor;
• the feeling that there is something extra in the anus, which in the future begins to hang outside the anus;
• vomiting after and before meals.

Early stage colon tumors almost always go unnoticed, as symptoms are absent or mild.

Important! Modern people and older people are accustomed to the fact that they have a loss of strength, malaise, and digestive disorders. But to prevent cancer after 60 years of age, it is necessary to undergo annual examinations, and especially for intestinal and colon cancer. This disease is the second leading cause of death worldwide. Lung cancer comes first.

Diagnostics

Diagnosis of colon oncology, as well as intestinal cancer, is carried out using a comprehensive examination - clinical, endoscopic, radiological and laboratory.

• A clinical examination consists of collecting anamnesis, talking with the patient, palpating and percussing the abdominal cavity, examining the rectum using a finger through the anus.
• X-ray examination includes irrigography, irrigoscopy and plain radiography of the abdominal organs.
• Endoscopic diagnosis is carried out using sigmoidoscopy, laparoscopy, and at the time of the procedure, material is taken for biopsy and fibrocolonoscopy.
• Laboratory diagnostics consists of a coagulogram, a general blood test, the study of stool for the presence of occult blood, and an analysis for tumor markers.
• additional diagnostics include computed tomography, magnetic resonance tomography and ultrasound.

Differential diagnosis of cancer allows us to identify what the tumor is - a benign formation, polyps, tuberculosis of the intestine, or a sarcoma of the colon.

If palpation of the right iliac region revealed a tumor, then it may represent an appendiceal infiltrate or a disordered connection of tissues surrounding the inflamed appendix.

Treatment

In order for the prognosis for a patient with ROC to be good, treatment must be comprehensive.

Colon tumors are treated with surgery followed by chemotherapy and radiation. The doctor will draw up a treatment plan, which will take into account the type of tumor, stage of the process, location, presence of metastases, general condition and age of the patient, as well as concomitant diseases that the patient’s medical history told him about.

Before the operation, the patient must follow a slag-free diet. 2 days before the procedure, he is given cleansing enemas and prescribed to drink castor oil. Potatoes, all vegetables, and bread are excluded from the diet. For preventive purposes, antibiotics and sulfonamides are prescribed.

Immediately before surgery, the patient again cleanses the intestines using laxatives or undergoes orthograde lavage of the intestines using a probe with an isotonic solution.

Treatment of the disease without complications such as obstruction, intestinal rupture and metastases is carried out by radical operations with removal of the affected areas of the intestine with the mesentery and lymph nodes.

If there is a tumor in the colon on the right, a right hemicolonectomy is performed. During this operation, the cecum, ascending colon, one third of the transverse colon and 10 cm of the ileum in the terminal section are removed. At the same time, resection of nearby lymph nodes is performed. After everything necessary has been removed, a connection of the small and large intestine or anastomosis is performed.

If the tumor has affected the colon on the left side, then a left-sided hemicolonectomy is prescribed. An anastomosis is performed and the following is removed:

• 1/3 of the transverse colon;
• descending colon;
• part of the sigmoid;
• mesentery;
• lymph nodes.

If the tumor is small in the center of the transverse section, then it is removed, as well as the omentum and lymph nodes. The tumor located at the bottom of the sigmoid colon and in the center is excised with lymph nodes and mesentery. Next, connect the large intestine to the small intestine.

If the tumor affects other organs and tissues, all affected areas are removed through surgery. Palliative therapy is started when the form of cancer is advanced and if the tumor is inoperable.

At the time of the operation, bypass anastomoses are made to the areas of the intestine between which there is a fecal fistula. This is necessary to exclude acute intestinal obstruction. If you need to completely disconnect the intestine, the afferent and efferent loops of the intestine are sutured between the anastomosis and the fistula, and then the fistula with the disconnected part of the intestine is removed. This operation is necessary in the presence of multiple fistulas and a rapid deterioration of the patient’s condition.

Chemotherapy is prescribed to avoid adverse effects. Radiation irradiation is carried out three weeks after tumor removal. Both methods of therapy have many side effects - nausea, vomiting, hair loss, skin rash, damage to the intestinal mucosa, and lack of appetite.

For the first day after surgery, the patient is given therapeutic measures to eliminate dehydration, intoxication and shock. The next day, the patient can begin taking water, liquid and soft foods. Next, the patient’s diet is gradually expanded. He is prescribed the following foods:

Important! In order to prevent constipation, the patient is given Vaseline oil. It helps to gently cleanse the intestines, without damaging postoperative sutures.

Forecast

Patients diagnosed with colon cancer need to know that their prognosis will be worsened by complications and side effects. Fatalities after removal of a colon tumor is 6-8%. In the absence of treatment and if the disease is advanced, the mortality rate is 100%.

Survival rate at 5 years:

• after the operation – 50%.
• In the presence of a tumor that has not affected the submucosa - 100%.
• In the absence of metastasis to the lymph nodes - 80%.
• In the presence of metastases in the liver and lymph nodes - 40%.

Payr's syndrome: what is to blame for the splenic angle of the colon?

In the bend of the colon in the left hypochondrium, problems may arise, leading to a characteristic symptom complex - Payr's syndrome

Payr's syndrome, or splenic angle syndrome

A German surgeon, professor at the University Hospital in Greifswald, Erwin Payr, described the clinical picture of the disease, which is caused by a narrowing of the large intestine in the area of ​​its inflection at the junction of the transverse colon with the descending colon. This symptom complex was manifested by cramping pain in the left hypochondrium, associated with impaired patency of intestinal contents and gases in the area of ​​the splenic flexure of the colon. Subsequently, this disease (more precisely, the syndrome) was named after the scientist who discovered it - Payr's syndrome. One of the sphincters, located just below the splenic flexure, is named after this surgeon.

Research shows that about 46% of cases of chronic colostasis are associated with Payr's syndrome. That is, the problem is quite common. Lack of awareness of doctors about this disease leads to the fact that patients are treated for a long time for other diagnoses.

Patients with pain in the left hypochondrium are often treated for completely different diagnoses.

Symptoms that are observed with splenic angle syndrome

1. Abdominal pain. This is the most common symptom of Payr's syndrome. The pain is usually localized in the left hypochondrium. Sometimes abdominal pain in localization resembles a heart attack. The pain is described by patients as severe and lasts several minutes. These pains may recur several times over several weeks and months. It is quite common to experience increased pain when physical activity and after generous intake food. Many patients note an increase in pain intensity with age.

And although a number of authors classify Payr's syndrome as a clinical variant of irritable bowel syndrome (IBS, Irritable Bowel Syndrome), there are still studies confirming the presence of inflammatory changes in histological examination of the intestinal wall.

2. Constipation. Most patients report stool retention. The duration of constipation can reach 5 days. Obviously, the intensity of the pain syndrome depends on the duration of constipation.

3. Ileocecal reflux. Due to overstretching of the large intestine, reflux of the contents of the large intestine into the small intestine can occur - colonic reflux. Rejection can also be of a congenital nature: with a congenital anomaly of the ileocecal valve and its insufficiency. When colonic contents enter the small intestine (due to a significant difference in the composition and quantity of microflora), an inflammatory process occurs. The so-called reflux ileitis. Therefore, pain can also be observed in the right abdomen.

4. Nausea and vomiting. The reasons for the mechanism are reflex.

5. Fever, headache, irritability. And if a systemic reaction, an increase in temperature, is a rather rare symptom, then irritability and headache are constant companions of a patient with Payr's syndrome. If you have chronic pain and stress, try to stay calm... Plus, intoxication is added to nervous exhaustion.

Causes of Payr's syndrome

Pain and discomfort in gastrointestinal tract have many different causes, pain in the area of ​​the splenic angle is no different here. Here are a number of reasons:

1. Pronounced bending of the colon in the splenic angle. May be a consequence of coloptosis ( low position transverse colon). Coloptosis can be either a congenital anomaly (for example, a long transverse colon) or observed in overweight patients. In general, coloptosis is often observed in obese people. Why colon also called Intestinum Crassum in honor of the commander Marcus Licinius Crassus (who suppressed the uprising of Spartacus), a very plump man.

The long transverse colon results in the formation of a very strong bend at the splenic angle

2. Accumulation of gases. This is believed to be the most common cause of splenic flexure syndrome and is due to excess gases in the large intestine. In order for the patient to get rid of discomfort, it is necessary to reduce gas formation and improve the release of gases.

2. Bloating. Here there is more due to neighboring organs, for example, the stomach. Excessive gas production can be caused by poor digestion of food in the stomach and small intestine. Or due to the so-called aerophagia - swallowing air. It's pretty common reason colic in newborns (aerophagia when screaming and crying). This can occur when drinking quickly, chewing gum, or breathing through the mouth.

3. Inflammatory bowel diseases (nonspecific ulcerative colitis and Crohn's disease). With these diseases, the intestinal mucosa suffers quite severely.

4. Food poisoning. Most often caused by various bacterial agents (salmonella, staphylococcus, clostridia, pathogenic strains of E. coli).

5. Postoperative period. Against the background of postoperative paresis (functional weakening of peristalsis). This can lead to pain in the left hypochondrium.

6. Various obstacles. This is usually cancer of the descending colon.

7. Functional weakening of peristalsis during peritonitis.

8. Intestinal obstruction.

9. Changing the composition of the diet. The presence of a large amount of short-chain carbohydrates in the diet: they can retain water in the intestinal lumen and enhance fermentation processes. Examples: apples, prunes, Brussels sprouts, cherries. Products that increase flatulence: potatoes, soybeans, peas, broccoli, alcohol.

Diagnosis of Payr's syndrome

Currently there is no single diagnostic procedure that can accurately identify and confirm Payr's syndrome.

1. Taking an anamnesis. Like in a student's medical history. A characteristic “sketch” of a future diagnosis can be drawn up after a detailed questioning of the patient: how, where and what is bothering him. It is necessary to identify the connection between pain and body position, food intake, and movement. How and under what circumstances the symptoms appeared. Need information about concomitant diseases. Therefore, asking the patient has always been and will be in the first place.

2. Inspection. By palpation you can determine the location of abdominal pain, its nature and intensity. Sometimes, when percussing in the area of ​​the splenic angle, there may be a characteristic “drum” sound in the left hypochondrium.

3. Irrigography. No, not a colonoscopy. Nevertheless, for the recognition of Payra's disease, it is a decisive method. This is an x-ray diagnostic method that uses barium sulfate as a contrast agent. The barium suspension is diluted with saline in a ratio of 1 to 3 and injected into the rectum (the intestine is pre-cleansed with laxatives) under the control of an X-ray screen. In this case, they pay attention to the shape and position of the large intestine (and the method is quite visual). The pictures are taken in a supine position (with a full colon) and standing - after emptying. Attention is focused on the bend of the colon at the splenic angle.

4. Colonoscopy. With this method, it is possible to identify a number of diseases that lead to disruption of the passage of intestinal contents (including adenocarcinoma of the colon).

5. Computed tomography and magnetic resonance imaging of the abdominal cavity.

Treatment of Payr's syndrome

1. Diet correction. Actually, this is the first recommendation that is given to a patient with this problem. Foods that promote flatulence should be avoided. Foods high in fat, starch and sugar should be limited. It is recommended to increase the amount of fiber in your diet. Meals should be fractional, in small portions.

2. Normalization of stool. If diet does not provide adequate treatment, then mild laxatives are recommended.

3. Avoiding swallowing air. In addition to avoiding chewing gum and drinking soda, doctors advise taking prebiotic supplements before meals and chewing food thoroughly.

4. Medicines. For Payr's disease the following is used:

Antacids. Reduces bloating.

Antispasmodics. Given to relieve abdominal pain.

Antihistamines. Some are used to relieve pain and intestinal spasms

Metoclopramide. Improves peristalsis and relieves abdominal pain.

5. Physiotherapy. Pain syndrome is relieved by electrophoresis with novocaine on the anterior abdominal wall, diathermy on lumbar region. Therapeutic gymnastics gives a good effect.

Indications for surgery for Payr's syndrome

Persistent pain syndrome that cannot be relieved with medication, as well as a clinical picture of partial intestinal obstruction

Progression of disease symptoms despite adequate conservative therapy.

Surgical treatment of Payr's syndrome comes down to two operations: resection of the transverse colon or prolapse of the splenic angle by dissecting the colosplenic and colophrenic ligaments. In the latter case, laparoscopic techniques performed well.

Prognosis of splenic angle syndrome

The prognosis in the initial stages and with appropriate treatment is favorable. The effect of surgery is good, but there is a risk of complications from surgery. I remind you: do not self-medicate. Seek help from your doctor.

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

Symptoms of different forms of colon

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

There are six forms of clinical cancer:

toxic-anemic,

enterocolitic,

dyspeptic,

obstructive,

pseudoinflammatory,

tumor (atypical) form of cancer.

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

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

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

Specific signs of colon cancer

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

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

Diagnosis of colon cancer

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

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

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

frequent constipation,

bowel movements sheep feces with traces of blood on its surface,

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

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

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

Pain as a sign of colon cancer

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

Intestinal dyspepsia as a manifestation of colon tumor

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

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

Life prognosis for colon cancer and features of its treatment

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

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

Surgical removal of colon cancer

The main treatment for this disease is surgery.

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

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

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

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

Chemotherapy for colon tumors

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

Causes of colon cancer

Increased risk factors for developing colon cancer include:

a diet high in fat and low in plant fiber (cellulose),

age over 40 years,

history of adenomas and colon cancer,

having direct relatives with colorectal cancer,

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

familial juvenile polyposis),

Crohn's disease,

nonspecific ulcerative colitis, etc.

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

International classification of colon cancer

T- primary tumor of cancer

TX - insufficient data to assess the primary tumor

TO - no evidence for the presence of a primary tumor

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

T1 - colon cancer tumor invades the submucosa

T2 - tumor grows into the muscle layer

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

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

N - regional lymph nodes

NX - insufficient data to evaluate regional lymph nodes

N0 - no metastases to regional lymph nodes

N1 - metastases in 1-3 regional lymph nodes

N2 - metastases in 4 or more regional lymph nodes

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

M- distant metastases of colon cancer

MX - insufficient data to determine distant metastases

MO - no distant metastases of colon cancer

Ml - there are distant metastases

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

Domestic classification of cancer by stages

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

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

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

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

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