Colon cancer: symptoms, treatment, surgery
Colorectal cancer (PKK) is almost half of all cases of intestinal tumors, significantly outpacing the frequency of colon tumors. The disease is insidious in its localization, as the rectum is closed by the sphincter muscle, lose which entails the need for traumatic operations, resulting in violation of the natural act of defecation, which significantly complicates the habitual way of life of the patient.
Tumors of the rectum are everywhere, but most of them are diagnosed in the countries of Western and Central Europe, USA and the UK. The inhabitants of Asia and Africa are less prone to cancer in terms of specific power, including a large number of plant components.
The average age of patients is 50-60 years, that is approaching old age, the risk of tumor increases. It is believed that men and women equally sick with tumors of the rectum, but according to some, men among patients still more. Possible detection of cancer and in young individuals with tumors often associated with more aggressive and with worse prognosis.
The rectum, unlike other parts of the gastrointestinal tract, it is available for inspection, but the number of running forms of the disease remains high. Late diagnosis becomes the cause of voluminous and traumatic operations, but they far are not always effective. Prognosis continues to be serious, and every year the number of patients with this tumor is increasing, which makes the problem of colon cancer is very relevant.
Causes and types of cancer of the rectum
Already for anybody not a secret that the increasing incidence of cancer of the colon is due to the lifestyle and diet of modern man. Especially good is the continuity among residents of large cities in economically developed countries. The rectum, as the end parts of the digestive system, experiencing the whole range of negative effects of carcinogens and toxic substances, which not only come from outside with food or water, but are formed during digestion in the intestine.
Among the causes of the PKK, the most important are:
- The nature of power, when dominated by animal fats, meat products, convenience foods, while fiber in your diet;
- Changes in the intestine in the form of chronic inflammation (colitis, proctitis), polyps, chronic anal fissures and Crohn’s disease and ulcerative colitis, accompanied by recurrent mucosal injury with subsequent scarring;
- Constipation, causing mechanical damage to the inner layer of the intestine dense content and increasing the contact time of the mucosa to carcinogens;
- The use of alcohol, even in small quantities, Smoking and a sedentary lifestyle, often combined with obesity and metabolic disorders;
Among precancerous changes emphasizes the importance of polyps, which are considered obligate precancer when they are placed in the rectum. This means that any polyp this location without a timely removal threatens to develop into cancer.
As a rule, patients suffering from the PKK, may indicate the presence itself of several predisposing factors, among which the main place belongs to nutrition, physical inactivity, and chronic inflammatory changes.
The tumor may be located in the upper, middle or lower parts of the rectum, from its location will depend on the nature of the treatment and prognosis.
The higher the cancer from the anal canal and its sphincters, the better the outcome and less traumatic treatment of waiting patients at equal other conditions.
Depending on the growth of the PKK may be exophytic when the tumor facing the inside of the body and endophytic growing in thicker walls. Endophytic cancer causes significant narrowing of the lumen of the intestine and tend to ulcerate.
From the standpoint of histological features, the majority of malignant tumors of the rectum – adenocarcinoma (glandular cancers), but there are also slimy, undifferentiated, fibrous tumor of high malignancy, and therefore worse prognosis.
Originating in the mucous membrane, the PKK gradually captures more area, grow into the muscular and serosal layer of the organ, leaving a cellular tissue of the pelvis, affecting the uterus and appendages, the vagina, the bladder in women, seminal vesicles, prostate, urinary tract in men. Tumor cells, once in the lymphatic and blood vessels, are distributed by him and give rise to metastases: lymph nodes in lymphogenous, hematogenous in the internal organs. Hematogenous metastases are most often found in the liver that collects from all sections of the intestine the blood brought by the portal vein for removal. The penetration of cancer cells in the serous covering of the bowel entails the so-called implantation metastasis, when the tumor spreads along the surface of the peritoneum.
Stages of colon cancer take into account the peculiarities of the neoplasm, its dimensions, a penetration into the surrounding tissue, and the nature of metastasis. Thus, the domestic oncologists there are four clinical stage of the tumor:
- 1 stage, when the tumor is no more than two inches, grows no deeper than the submucosal layer and has not metastasized.
- 2 the stage of the tumor up to 5 cm beyond the boundaries of the body but can manifest metastases in local lymph nodes.
- Stage 3 is accompanied by the germination of all layers of the intestinal wall and the appearance of metastases in local lymph nodes.
- Stage 4 characterizes much of the neoplasia, which penetrate into the surrounding tissue, tissue of the pelvic organs with lymphogenous and hematogenous metastasis in the lymph nodes and internal organs.
Manifestations and diagnosis of colon cancer
Rectal cancer is a common disease which many in the Internet and relevant literature. The increase in the number of patients makes the conduct educational work among the population, calling for the doctor’s visit. Having read about the symptoms of the disease, persons with pathology of intestinal often tend to exaggerate their complaints and to independently put a diagnosis of the tumor. In other cases, particularly susceptible patients and even abandon the examinations of doctors, believing himself doomed to die from cancer. This approach is fundamentally wrong, because
confirm or deny the existence of neoplasia can only be a specialist, and the symptoms and malignancy, and other diseases are often similar, which is confusing people who do not have sufficient medical knowledge.
Suspect colorectal cancer is possible at an early stage by the characteristic symptoms. Of course, if the patient suffers hemorrhoids, anal fissure, or chronic abscess in the rectal area to distinguish cancer from these diseases alone is unlikely to succeed, because some of them are similar. At the same time, the commonality of symptoms should not lead to panic and finding yourself dangerous disease. Not always bleeding, pain or discharge of blood but that’s about cancer, because the blood could be hemorrhoids, pus and mucus with inflammatory processes. To distinguish these diseases need examination by a proctologist, to independently put a diagnosis of the tumor impossible.
Symptoms of rectal cancer depending on the stage and location of education. They include:
- Various dyspeptic disorders;
- Bleeding and other pathological impurities in the stool;
- Violation of the chair until the intestinal obstruction;
- Signs of intoxication;
The first symptoms depend on the location of neoplasia. Other than bleeding occurring in almost all patients, possible pain as the first symptom in the case of low location of the cancer with the transition to the anal sphincter. In some cases, the disease occurs with disorders of the chair, often in the form of constipation, which can be regarded as manifestations of other diseases (proctitis, anal fissure, hemorrhoids).
Early-stage tumors may not produce specific symptoms, but 9 out of 10 patients in this period, there are signs of bleeding of the tumor. Bleeding is one of the most characteristic symptoms of colorectal cancer. Massive bleeding usually does not happen, the blood is in small portions, mixed with the feces or appears before him.
Patients hemorrhoids also usually see bleeding from the rectum, however, the blood will stand out after defecation, covering the stool on the outside that can be the hallmark of these diseases. In order to exclude cancer, which can occur in the presence of hemorrhoids, required examination by a proctologist and additional studies, self-test in this case is impossible.
In addition to blood in the stool can be detected mucus and pus, which reflects the secondary inflammation in the tumor and intestine (proctitis, proktoshigmoidit). These signs in the absence of anal fissures and chronic abscesses with a high probability indicate a malignant process.
The second most common after bleeding is syndrome intestinal disorders, which indicates the vast majority of patients with any stage of cancer. Characteristic is the constipation and the inability to complete a bowel movement. The presence of the tumor gives the feeling of a foreign body, and false urge to defecate, sometimes pain and suffering. While trying to release the intestine, the patient observes the separation of small quantities of blood, mucus, pus, while feces may not be. Such desires can sometimes be up to 15 per day.
To the extent that it increases the size of the neoplasia, constipation becomes harder and longer, and the abdomen swells from accumulated gas, there is a rumbling, pain, which are initially periodic in nature, but with the progression of cancer become permanent. The complete closure of the lumen of the intestine by tumors, the promotion of the stool stops developing intestinal obstruction. Pain if bowel obstruction is intense, cramping, vomiting and a complete absence of the chair and the discharge gas.
The severity and time of onset of pain depends on the location of the tumor. When finding it in the upper or middle section, the pain is intermittent and caused by the introduction of tumors into the surrounding tissue, while in cancer of the anal canal with sphincter involvement, pain occurs at an early stage of the disease and may be the first sign of trouble. Characteristically, the patient is experiencing pain because of the PKK, is trying to sit on one half of the buttocks – the so-called «symptom of the stool.»
Late stage of the disease, when the tumor affects structures of the pelvis, actively metastasizes, breaks, and inflamed, accompanied by General intoxication, weight loss, weakness, fever. Chronic blood loss lead to anemia.
With the appearance of suspicious symptoms or any violations by the intestines, you need to go to the doctor for the diagnosis. Rectum available to immediate inspection and pallavolo study, these methods do not require sophisticated equipment and can be done everywhere, but the frequency of running forms of cancer continues to remain high. It is connected not only with aggressiveness of certain tumors or-specificity of symptoms in the early stages, but with the reluctance of many patients to consult a doctor and undergo appropriate examinations.
To diagnose cancer specialist to examine the rectum, in detail asked about the nature of the complaints and will appoint additional researches, including:
Among the laboratory methods it is possible to test for colon cancer, which consists in the definition of cancerous-embryonic antigen and tumours marker CA-19-9. Typically, when the PKK, these figures increase, however, raising them is possible and in certain other diseases (ulcerative colitis, for example). In addition, cancer-embryonic antigen is often elevated in active smokers that you should consider when conducting analysis.
The most accurate way to know the structure of the tumor is histological examination of the fragments. Histological type (adenocarcinoma, mucous, and undifferentiated carcinoma) and the degree of differentiation determine the rate of growth, behavior of tumors and the prognosis for the patient.
Features of treatment of rectal cancer
Unlike other digestive tract, the rectum has a peculiar structure in the form of the anal sphincter that regulates the process of defecation. Without adequate functioning of this muscle structure it is difficult to imagine normal functioning of social and labor adaptation. In operations on the rectum of particular importance is the possibility of preserving the sphincter, or reconstructive operations, which will determine the future life of the patient.
The choice of a particular method of treatment and types of intervention is determined by the location of the tumor relative to the anal sphincter, the depth of ingrowth in the bowel wall and surrounding structures, great condition of the patient and stage of the tumor. Tend to combine radiation, chemotherapy and surgery, but surgical removal remains the main method of treatment of colon cancer.
When without operation not to manage…
Removal neoplasia is the most effective way to get rid of education, but at the same time, and the most traumatic. Operations on the rectum are difficult to conduct and often require the participation of two teams of surgeons simultaneously. In some cases, there is the need for subsequent plastic, because life is with a fecal fistula in the abdominal wall can not be called easy, including in the psychological for the patient with respect.
Of course, early detection of tumors can help to avoid large-volume transactions, however, the low location of the tumor factor beyond the control of the patient, but determining the nature of surgical treatment. Today, surgeons proctologists tend to resort to less traumatic intervention if it does not happen at the expense of radicalism. There are methods of preservation or reconstruction of the anal sphincter, which significantly improves the quality of life of patients in the postoperative period.
The operations in the intestine, plays an important role proper training, which is possible only for planned interventions. It includes the appointment of laxatives (liquid paraffin, magnesium inside), compliance with sparing diet. The commonly used cleansing enema increasingly give way to the intestinal lavage with a special solution, which can be taken orally or introduced through the 12-duodenum. Lavage solution (Fortran) is assigned in the amount of 3 liters for 18-20 hours before the planned operation.
If the swelling is accompanied by inflammation, necessarily antibiotic treatment, possibly in a shock dose prior to surgery for prevention of infectious complications.
Intervention is determined primarily by the proximity of the tumor to the anal sphincter. Analysis of results of operations showed that the compliance of the foundations of radicalism, it is sufficient to retreat to 2-5 cm from the lower pole of neoplasia and 12 cm from the top. Depending on whether the area of removed tissues the sphincter, the specific surgical technique. It is clear that the greatest difficulties will arise in tumors of the lower rectum, but in each case, the surgeon will try to save the patient’s sphincter with the possibility of good social adaptation in the future.
Nijneangarsk surgical treatment of rectal cancer
Until recently, the main and the only possible way to treat cancer located in the lower part of the rectum, were considered abdominoperineal extirpation (BPE). The operation consists of excision of the entire rectum together with the muscular sphincter, cellular tissue of the pelvis and the lymphatic apparatus. The intervention is performed in two steps: first, derive the sigmoid colon to the anterior wall of the abdomen, forming a colostomy to divert the stool, and then from the crotch and remove the rectum and cellular tissue of the pelvis (crotch point). With the participation of two teams of surgeons these stages are carried out simultaneously.
Indications for BPE cancer are considered to be closer to 6-7 cm from the anus, neoplasia, sprouting nearby tissue and metastasizing to local lymph nodes, and also advanced cases of the disease complicated by intestinal obstruction.
Possibility of restoration of intestinal continuity after BPE is gone, and the patient is forced to live with unnatural anus in the abdomen or the perineum. Postoperative rehabilitation is difficult, and to adapt to the usual way of life and, especially, of employment is not obtained in all patients. In this regard, surgeons possible resort to more lenient treatment if they do not contradict the radical.
To improve the quality of life of patients after radical intervention allows the creation of a perineal colostomy and artificial rectal sphincter. After abdominoperineal extirpation in this case, the crotch area is fed saved the end of the colon and using smooth muscle tissue is formed artificial sphincter. In addition, you can create an additional reservoir of large intestine in the pelvic cavity. Such modifications radical treatment is preferred for younger patients wanting to maintain an active lifestyle and being able to work. Modalities consider the absence of metastasis, the germination of the pelvic tissue, and the tumor should not take more than 1/2 the circumference of the rectum.
Men with common variants of colorectal cancer, when the affected area includes the bladder, prostate and seminal vesicles, the only possible becomes conducting evisceration of the pelvis with removal of all diseased structures, adipose tissue and lymph nodes. Operation is extremely traumatic and requires not only the creation of an unnatural anus, but also the possibility of diversion of urine in the absence of the bladder.
- Sectoral resection of the rectum and the anal sphincter, when incising a portion of the pulp and of the body wall with restoration of intestinal continuity. The condition for its implementation is the prevalence of the tumor is not more than a third of the circumference of the colon with ingrowth in the interior muscle sphincter.
- Transanal resection consists of excision of the fragment of the colon and it is feasible in the case of tumor invasion no deeper than the submucosal layer. After excision of the affected tissue is restored, the connection between the rectum and the anal sphincter.
- Abdominal-anal resection is indicated for tumors located above 5-6 cm from the anus, and occupying not more than 1/2 of the circumference of the rectum. After excision of the affected intestine the upper end of the large intestine is brought to the sphincter and formed a compound that promotes the movement of feces towards the anus. In some cases it is the abdominal-anal resection with excision of internal sphincter, which is recreated from the muscle layer of the colon.
Surgery for tumors srednetemperaturnogo and upper divisions
The location of the neoplasia on the relative distance from the anal sphincter allows you to remove it without disruption of intestinal continuity and preservation of the natural act of defecation. It is possible to conduct abdominal-anal resection with the sigmoid colon to the anus. With high growing neoplasia are shown anterior resection when removed the diseased piece of the body, and the ends are sewn together with restoration of bowel continuity. Sutures on intestinal wall can be produced using a special suturing devices, which greatly facilitates and accelerates operation.
If the tumor was complicated by intestinal obstruction, resection of the hold will be impossible, and then the method of choice becomes surgery Hartmann, when after removing the tumor, the rectum is sutured, and the anterior wall of the abdomen displays a colostomy to divert the stool. Subsequently, to restore continuity of the intestine is possible, but keep in mind certain difficulties due to the decrease in size of the remaining rectum and the development of adhesions in the pelvic cavity.
Because the risk of infection, postoperative complications and progression of the tumor during surgery on the intestine is quite large, the basic principles of surgical technique in these patients:
Unfortunately, often colorectal cancer is detected at a stage when curative treatment is no longer possible, and can help the sick only palliative surgery aimed at reduction of pain syndrome and elimination of intestinal obstruction and other complications of the tumor.
To include palliative interventions for the creation of a fecal fistula (colostomy) on the front wall of the abdomen by removal of the sigmoid colon with closure of the direct or the formation of a double-barreled colostomy due to dissection and fixation of the bowel to the abdominal wall. The excretion of intestinal contents through this artificially created hole eliminates intestinal obstruction, reduces pain and helps some to improve the General condition of the patient.
Features lifestyle after surgery on the rectum depends on the nature of the intervention. If the surgeon will be able to preserve the anal sphincter without compromising radicalism from the patient will need to diet and regular visits to the oncologist. In cases where the doctor has to go to the creation of unnatural anus, the patient is doomed to difficulties in the further rehabilitation. Such patients should be carefully monitor colostomy, paying due attention to hygienic procedures and diet. Work activity is often difficult and even impossible. After operations on the rectum, in some cases, patients are assigned a disability.
Radiation and chemo
Radiation and chemotherapy are usually not used in its own as in cancer of the distal bowel, but are included in the combination therapy of the tumor.
The irradiation is possible both before surgery and after it. Before the surgery radiation therapy aims to reduce the weight of the tumor tissue and is administered as a total dose of 20 Grams for five days. A few days later surgery performed. Such a short period of time between irradiation and removal of neoplasia associated with the possible development of radiation damage at the location of the cancer growth, which can cause perforation of the colon.
If in the study of removed lymph nodes was confirmed by the defeat of their metastatic process, the patient will additionally do postoperative radiotherapy of 40 Gy to the area of remote lymph nodes and the tumor growth area. Radiation after surgery helps to prevent cancer recurrence and further spread through the lymphatic and blood vessels.
Chemotherapy is used after surgical stage, either as an option of palliative care. For patients with rectal cancer developed schemes of chemotherapy, including 5-fluorouracil, Ftorafur, adriamycin, Eloxatin as the most effective. Such adjuvant chemotherapy is aimed at destruction of the remaining malignant cells in place of surgery and the obstruction of metastasis. If chemotherapy is prescribed for inoperable forms of the disease, it becomes reducing the size of the tumor and, consequently, of pain, relief of the passage of intestinal contents, as well as the fight against metastasis.
At all stages of treatment, patients need supportive and symptomatic therapy, intravenous infusion of fluids, nutrients and salt solutions. Adequate analgesia is a critical component both during surgery and in the provision of palliative care. Bowel cancer need regular monitoring of elektrolitnogo exchange and timely correction of violations that often accompany this disease. As a means of normalizing electrolyte balance, can be used sodium bicarbonate (baking soda), but that doesn’t mean that you need to follow recipes from the Internet and consume soda inside, alone, or even to enter into the rectum. Such experiments are fraught with serious complications and even fatal, so handling delicate metabolic process has the doctor given tests.
The prognosis of rectal cancer is always very serious. In the absence of metastasis five or more years to live until 70% of patients, but the presence of secondary neoplastic lesions reduces this figure to 40%. It is clear that the more pronounced tumor process and neglect the stage of the disease, the worse the prognosis. Young patients, often suffering aggressive cancers of the rectum, especially in lesions of the anal sphincter, it is not always possible to obtain satisfactory results of therapy.
Prevention of colon cancer is regular visits to the proctologist all persons suffering from any lesions of the intestine (polyps, inflammation, anal fissure). Examination by a specialist should be conducted annually or more often if indicated. All, without exception, especially the elderly, need to pay due attention to the diet, increasing the proportion of plant components and fiber and abandoning a large quantity of animal fat and alcohol. If you suspect the presence of tumor in the bowel, do not delay, you need to immediately go to the doctor. Only with early recourse we can expect a good result of treatment.