In the early stages, symptoms of colon cancer are usually nonspecific and take the form of abdominal pain and flatulence, which may suggest gallbladder disease or peptic ulcer disease.

This also happens, since colon and rectal cancer in the early stages of development does not cause alarming symptoms.

Most colorectal cancer patients do not report any significant complaints, or they are mild or non-specific symptoms, consistent with many diseases and diseases of the digestive system.

Early detection of tumors of the colon and rectum is critical for the effectiveness of therapy.

Patients with tumors diagnosed at earlier stages have a much better prognosis and a chance for faster cancer treatment.

Colon Cancer Symptoms

The symptoms of the disease depend on the location and stage of the cancer.

The first symptoms of serious diseases such as colorectal cancer and anal cancer often escape the attention of the patient because they are very non-specific and in most cases resemble common gastrointestinal disorders.

It happens that they are often underestimated and not equated with such threats as rectal or colon cancer. Below is a detailed list of the most common symptoms of colorectal cancer.

Most cases of colorectal cancer are diagnosed in patients over 50 years of age.

The disease usually develops slowly.

The symptoms of colon cancer depend in part on the location of the tumor. Both rectal and colorectal cancer are very rare in people over 40 years of age.

Bleeding from the anus is often seen as a symptom of hemorrhoids.

There are situations when the patient does not have any alarming symptoms of cancer, and colon cancer or rectal cancer develops in his body.

In about 20% of cases of colon cancer, patients report urgent indications to the doctor, such as severe constipation, gastrointestinal obstruction, perforated peritonitis, or massive rectal bleeding.

Unfortunately, almost a fifth of colorectal carcinomas are diagnosed at the stage of neoplastic spread.

Both colorectal cancer and rectal cancer spread through the blood or lymphatics. The most common distant metastases occur in the liver, lungs, lymph nodes, bones, and brain.

Patients with a disseminated tumor additionally have symptoms characteristic of metastases:

• abdominal pain (in 44% of cases)
• change in the work and peristalsis of the intestine (43%)
• blood in stool (40%)
• general weakness (20%)
• anemia without other gastrointestinal symptoms (11%)
• weight loss and weakness (6%)

In addition, colorectal and anal cancer symptoms experienced by some patients include foreign body sensation in the rectum, urgency, bleeding, and painful stool pressure.

In the case of colon cancer, the presence of dark red blood in the stool and a noticeable swelling in the abdomen should be an alarming symptom.

The most common symptoms of cancer of the rectum and left colon include obvious bleeding from the lower gastrointestinal tract, abdominal pain, and changes in bowel habits.

Narrowing of the anus is also an important symptom of rectal cancer. Progressive infiltration of cancer cells causes gradual occlusion of the intestinal lumen and deterioration of its patency.

In patients with cancer of the right side of the colon, symptoms of colon and rectal cancer appear later.

In addition to the most common microcytic anemia, abdominal pain is common.

Occult bleeding into the gastrointestinal tract cannot be detected by viewing the stool. Patients with rectal cancer report gastrointestinal obstruction, constipation, peritonitis, and massive rectal bleeding.

Unfortunately, about 20% of colon and rectal cancers are diagnosed at the stage of neoplastic spread. Both cancers of the rectum and colon spread through the blood or lymphatic route, as well as through continuity in the abdomen.

The most common colorectal cancer metastases occur in the liver, lungs, non-regional lymph nodes, and intra-abdominal cavity, as well as in the bones and brain. Patients with advanced disease have colorectal cancer symptoms consistent with the site of metastatic cancer.

In the case of colorectal cancer, one should be aware of the possible occurrence of several atypical symptoms of colorectal cancer, such as: local invasion of the tumor with the formation of a fistula, the presence of fever with an unclear cause, the appearance of bacteremia and / or sepsis.

In the context of colon and rectal cancer treatment, patients who were diagnosed with tumors before (or were the first to have) clinical symptoms of colon cancer have a greater chance of being cured when they are diagnosed at an early stage of their development.

For this reason, all alarming symptoms should cause the patient to quickly visit a doctor and perform diagnostic tests of the colon.

Most physicians consider this to be the best and prefer colonoscopy for colon cancer studies.

This method, although the most expensive, has many advantages. It is a test with high sensitivity and specificity. It also allows you to detect precancerous conditions - adenomas, which occur in 25% of people over 50 years old.

The big advantage of colonoscopy is the fact that it allows you to remove polyps at the same time and is a way to prevent colorectal cancer, which leads to a decrease in the incidence.

In the early stages of colon and rectal cancer, there are no symptoms or non-specific abdominal pain or bloating, which may indicate complaints from the gallbladder or peptic ulcer.

In people with slowly developing anal cancer, there are changes in intestinal motility with possible rectal bleeding, but these symptoms are often underestimated by patients.

Colorectal cancer and rectal cancer, located on the left side, usually causes constipation, alternating with diarrhea, abdominal pain, there are symptoms of intestinal obstruction, nausea, and vomiting. Tumors located on the right side of the colon are manifested by nonspecific abdominal pain.

Symptoms characteristic of the development of rectal cancer are in this case also anemia, weakness, weight loss and a palpable swelling.

Symptoms of cancer of the right half of the colon:

• in the early stages of rectal cancer and bowel cancer, clinical symptoms may not appear;
• pain on the right side of the abdomen, near the navel, in the abdomen or epigastrium;
• dark color of the stool, an admixture of blood in the stool;
• Iron-deficiency anemia;
• hardness to the right side of the abdominal cavity, palpable.

Colon cancer symptoms (left side of colon)

• symptoms of limited intestinal obstruction (bloating, colic pain);
• blood in the stool;
• change in the rhythm of bowel movement.

Symptoms of rectal cancer:

• fresh blood in the stool;
• feeling of incomplete bowel movement;
• intestinal obstruction (colic pain), nausea, vomiting;
• painful pressure on the stool, pain in the perineum.

Symptoms of anal cancer:

• burning sensation in the anus
• discharge from the anus;
• pain, sensation of a foreign body in the anus;
• tumor;
• urinary and fecal incontinence

In the case of colon cancer and rectal cancer, be aware of the possibility of atypical symptoms, the most common symptoms of colorectal cancer are:

• local invasion of the tumor with the formation of fistulas, for example, in a loop of the gallbladder or small intestine;
• fever of unknown etiology;
• the appearance of bacteria and / or sepsis caused, for example, by streptococcal infection.

Unfortunately, it should be emphasized that the appearance of symptoms of colorectal cancer, on the basis of which one can suspect or diagnose rectal cancer, is most often associated with a worse prognosis due to the significant development of neoplastic disease.

Patients who have no symptoms of colorectal cancer and whose disease severity is lower are better treated. The sooner rectal cancer is detected, the more likely it is that the tumor will be treated effectively.

Provided with minor abbreviations

In most textbooks, cancers of the rectum and colon are treated separately. We combine them, because there is much in common between them both in origin and in diagnostic methods.

Cancer of the rectum and colon is a relatively common disease in men and women. However, men are more likely to get colon cancer than women. Although the rectum and colon are available for all kinds of diagnostic studies, cancer of these organs in many cases is detected in the last stage of development. Consequently, there are still major shortcomings in the organization of prevention and early detection of rectal cancer. Moreover, the rectum is available for examination by a local doctor, and precancerous bowel diseases, which usually develop over months and years, can be cured in a timely manner.

Unlike many types of malignant tumors, a clear relationship between the incidence of cancer of the rectum and colon and the place of residence, habits, customs and profession of the patient has not been established. Only information has been obtained on a higher incidence of rectal and colon cancer in the population of the United States and some European countries and on a low incidence of this cancer in the population of Japan, Chile and South Africa. It seems that in countries with a high incidence of gastric cancer in the population, the incidence of cancer of the rectum and colon is low, and vice versa.

Nothing is known about the causes of rectal cancer, just as the etiology of precancerous diseases of this organ is not known. Most clinicians argue that on the mucous membrane of the rectum, altered by a chronic inflammatory process, both malignant and benign tumors often appear. The latter (polyps) also have a tendency to malignancy. However, such statements, which are important for a practical physician, contribute little to the study of the etiology of cancer.

Only one precancerous disease of the large intestine of a clearly genetic origin is known - familial intestinal polyposis, which is inherited from generation to generation. In most cases, the disease ends with malignant degeneration of polyps. Probably, the appearance of single polyps also depends on the action of the genetic factor.

In almost all cases, malignant tumors found in the rectum and colon are adenocarcinomas (glandular cancers) with varying degrees of cell differentiation. Squamous cell carcinomas of the anus are relatively rare.

Many classifications of rectal cancer have been proposed. Some of them are based on etiopathogenetic signs, others are based on data from the clinical or pathomorphological development of the tumor. For a practitioner, the most convenient clinical and pathogenetic classification of rectal cancer, universally accepted in the USSR. According to this classification, four stages of tumor development are provided.

I stage. A small tumor is revealed, capturing the mucous and submucosal membranes of the intestine, without regional metastases.

II stage. At this stage, the tumor occupies more than the semicircle of the intestinal wall, but does not go beyond the intestine; in the nearest lymph nodes there may be a single metastasis.

III stage. The tumor affects more than the semicircle of the intestine, germinates the intestinal wall or the adjacent peritoneum, gives multiple metastases to the regional lymph nodes.

IV stage. An extensive tumor is found that has grown into neighboring organs, with multiple regional metastases, or a tumor of any size with distant metastases.

In recent years, in order to determine the prognosis of the disease, along with the above classification, a classification based on the results of studying the state of maturity (differentiation) of cancer cells has become increasingly common in practical medicine. Clinicians have long come to the conclusion that the more mature (differentiated) tumor cells, the better the prognosis of the disease, and vice versa.

Based on the assessment of the ratio of differentiated and undifferentiated cells in adenocarcinomas, four degrees of tumor differentiation are distinguished. I degree - when 75-100% of differentiated cells are detected, II - when there are 50-75% of them, III - 25 - 50% and IV degree - when there are 0-25% differentiated cells. By comparing the results of clinical and histological studies in accordance with these classifications, the doctor can more confidently determine the prognosis of rectal cancer.

Precancerous diseases of the colon and rectum

These include: polyposis (when single and multiple polyps are detected), including congenital (family), chronic colitis, and other diseases in which hyperplasia of the intestinal mucosa is detected. Precancerous diseases of the anus include chronic fissures, fistulas, and inflammatory processes.

The term "polyp" is incorrect, or rather, what is now called a polyp should be called an adenoma. However, the term has taken root everywhere. In the literature, there is another, as it were, a compromise name - an adenomatous polyp. There are also many other synonyms for the term "polyp". There are various classifications of polyps. Some of them are very complex, in which polyps are grouped depending on the etiology, pathogenesis, clinic and other pathological features, and more simple ones. For example, the following, in which all polyps are divided into five types: 1) ordinary (simple), 2) villous, or papillary, adenoma, 3) congenital (family), 4) youthful and 5) false.

A simple polyp is the most common type of polyp and is more common in men than in women. It is usually solitary. As a rule, it grows in a massive knot on a wide base or is on a stalk. Its dimensions are also very different - from a few millimeters to several centimeters in diameter. When examining the intestine through a rectoscope, a simple polyp stands out against a pale pink background of the intestinal mucosa with its intense pink or more often dark red color. It is found on the unchanged (normal) or hyperplastic intestinal mucosa.

Many oncologists noted that this polyp is prone to malignancy, even in a benign-looking polyp, pathologists often find foci of malignantly degenerated cells. Villous, or papillary, adenoma is one of the varieties of a simple polyp. In the structure of the incidence of intestinal polyps, it occupies no more than 15%. A papillary adenoma usually grows as a separate node without a stalk with characteristic numerous soft branched villi and protrusions on the surface, often an extensive network of vessels is found in it. Sometimes this neoplasm secretes a lot of mucus.

Papillary adenoma is mainly found on the mucous membrane of the rectum. Cases of a large node falling out through the anus and infringement of its base in it are described. Often, after surgical removal, papillary adenoma recurs. Malignant degeneration of this polyp, according to some researchers, occurs in 20-30% of cases. Even with microscopy of the material of the first biopsy, signs of malignancy of papillary adenoma are often noted.

Congenital (familial) polyposis may be the last form in the development of simple polyposis multiple, but its transmission from parents (both father and mother) to children is clearly traced. It is firmly established that the malignancy of one or more polyps occurs sooner or later in all those suffering from this disease.

Familial intestinal polyposis usually manifests itself and is diagnosed in the second - fourth decade of the patient's life, especially often at the age of 20. Once familial intestinal polyposis is established, in more than 50% of cases, foci of malignant cells are found in polyps. Therefore, in patients with familial polyposis, it is necessary to carefully examine the entire large intestine, from the anus to the caecum.

A juvenile polyp is often referred to as cystic or retentional. Such polyps are usually found in children in the first decade of life. Hence they got their name. Juvenile polyps are more often solitary, develop asymptomatically and are detected by chance before malignancy. Cells are visible in the polyp on section. Under a microscope, it is easy to determine that the cells are formed by retention cysts filled with mucin. After the removal of juvenile polyps, there are almost no relapses.

False polyps are not true adenomas at all, but are difficult to distinguish clinically from them. They are formed from the folds of the mucous membrane, thickened as a result of a long-term inflammatory process, in particular ulcerative colitis. False polyps are single and multiple, depending on the spread and course of the underlying disease. Although the likelihood of their degeneration into cancer is low, malignant neoplasms often occur on the intestinal mucosa with such polyps.

Polyps and colon cancers develop in approximately the same place: about 80% of all colon polyps and cancerous tumors are found in the rectum and sigmoid colon, the remaining 20% ​​more or less evenly throughout the rest of the colon. Therefore, if you use a proctoscope, you can examine the mucous membrane of the rectum and sigmoid colon over 25 cm and reveal more than 80% of malignant neoplasms of the large intestine (according to our data, 81.8%).

A proctoscope may not always be at hand, and cancerous nodes located near the anus, as well as tumors of the overlying sections of the intestine in the last stage of development, can be felt with the index finger inserted into the rectum. However, we know from our own experience that among people who consider themselves healthy, digital examination can detect only 18.2% of cancerous tumors that could be detected during rectosigmoscopic examination. In other words, 4 out of 5 cases of rectal and sigmoid colon cancer will be missed if you rely only on the results of a digital examination in your conclusions.

For many years in the medical literature, especially foreign, there has been a discussion about the possibility of degeneration of colon polyps into cancerous tumors. Two opposing points of view have been put forward. Proponents of one of them, and they are in the majority, argue that "benign" polyps are the precursors of cancer of the rectum and colon. They justify their opinion by the fact that the areas of distribution of polyps and cancer in the large intestine are almost the same, that is, in the sections of the intestine in which cancerous tumors are more often found, the probability of detecting polyps is also high. With multiple polyps, foci of malignant cells are often detected in several of them at once. The incidence of cancer in a polyp is directly proportional to its size: the larger the polyp, the more likely it is to be malignant.

Many doctors had the opportunity to follow the development of a cancerous tumor from a polyp in patients who refused to remove it for several years. In addition, often the macro- and microscopic pictures of a cancerous tumor are such that the structure of the polyp is clearly visible in them. In congenital polyposis of the large intestine, polyps are malignant in almost all cases.

A few supporters of a different point of view argue that cancer in the rectum occurs spontaneously and there is no direct connection with the polyposis of this intestine, because many people with intestinal polyps do not develop cancer throughout their lives, although polyps have not been subjected to any therapeutic effect; cancer also appears on the almost normal intestinal mucosa.

Thus, most clinical oncologists establish a direct link between the development of polyps and colon cancer. All clinical oncology and all measures for the prevention of rectal cancer are based on this provision.

The following is officially recognized. Many cancers of the rectum and colon arise from polyps. Hyperplasia of the colonic mucosa precedes the appearance of a polyp. This latent period of formation of a polyp on the hyperplastic mucosa, and from it a cancerous tumor, is often calculated for years. Not all and, apparently, not the majority of polyps degenerate into a cancerous tumor. However, it is not possible to determine the malignant potential of each polyp. Therefore, all polyps should be considered potentially malignant neoplasms and, based on such considerations, appropriate treatment should be prescribed for those suffering from colonic polyposis.

Detection and removal of polyps is still the main and most effective prevention of cancer of the rectum and colon. False polyps have no connection with other types of polyps. Cancer usually does not occur in a false polyp, but next to it in the mucous membrane, altered by a chronic inflammatory process.

Ulcerative colitis

The incidence of cancer against the background of chronic ulcerative colitis, according to various oncologists, ranges from 3 to 10%. The risk of cancer in patients with ulcerative colitis depends on the spread of this process through the intestines and on the duration of its existence. Especially high incidence of cancer suffering from ulcerative colitis for more than 10 years. Multiple false polyps indicate that profound changes have occurred in the intestinal mucosa and that the propensity of the rectum and colon to the incidence of cancer is very high, although the false polyps themselves do not always degenerate into cancer.

It is noticed that if the cancer seems to be superimposed on ulcerative colitis, the prognosis of the disease is relatively poor. This is due to the following circumstances. In such cases, cancerous tumors are often found simultaneously in many places in the intestine, and tumors are built from cells of varying degrees of maturity.

Timely diagnosis is often difficult due to abrupt changes in the intestinal mucosa by previous pathological processes. In addition, the general condition of the patient, exhausted by a long illness, often jeopardizes not only the definition of the disease, but also the subsequent pathogenetic treatment.

Manifestations of colorectal cancer

Depending on the localization of the tumor in the large intestine, certain clinical signs of the tumor will be noted. The functions of the various sections of the large intestine differ significantly. Their violation by a growing tumor is also reflected in the manifestations of cancer of each department of the colon and rectum. For the convenience of presenting the clinic of cancer of this organ, we will consider the manifestations of tumor development in three different sections of the large intestine: in its right half (which includes the blind and ascending intestines, the hepatic angle and the right half of the transverse colon), in the left half (the left side transversely colon, splenic angle, descending and sigmoid colon) and rectum (from the recto-sigmoid to the anus).

Before analyzing the signs of cancer of various parts of the large intestine, it should be noted that we will be able to tell the reader not the early symptoms of the disease, but the clinical manifestations of an already developed tumor. Therefore, it is more appropriate to talk about timely diagnosis here, since a tumor found in the initial stages of development is operable in most cases.

Colon cancer at an early stage of development does not show any signs. If it occurs against the background of precancerous diseases, the clinical picture is dominated by symptoms of damage to the large intestine, due to the development of a precancerous disease. The intestinal lumen of the right half of the large intestine is large, it still contains liquid feces. A cancerous tumor in this part of the intestine usually grows into the intestinal wall and then grows into its lumen. Therefore, the tumor can become large without disturbing the function of the intestine. There are practically no signs of intestinal obstruction if the tumor does not develop near the Bauhinian valve.

Symptoms of cancer of this section of the large intestine, as well as other sections, are divided into non-specific (general) and specific (local). Common signs include: loss of appetite, nausea, diarrhea, bloating due to the accumulation of gases in the intestines. Often, patients note pain in the right side of the abdomen, which, depending on their localization, is regarded as appendicular or as manifestations of gallbladder disease.

Almost always, the development of cancer of the right half of the colon is accompanied by anemia. With severe anemia, patients complain of general weakness, fatigue, shortness of breath, palpitations, dizziness and other disorders. The pathogenesis of these anemias is unknown. Apparently, some of them are due to heavy bleeding, if any. But in most cases, a small amount of blood enters the feces, which is detected only by the corresponding reactions. Often this is the only long-term sign of a growing tumor. Even easily noticeable anemia is not a sign of tumor inoperability.

It is also possible for the patient to lose weight, sometimes significant (the patient loses up to 10-19 kg of weight). However, this sign does not yet indicate a poor prognosis, since it occurs as a result of a violation of the process of absorption of food by the tumor. If the tumor becomes large, it begins to be palpated through the anterior abdominal wall: a large seal with varying degrees of mobility is determined. The most mobile tumors growing inside the intestine. The immobility of the tumor indicates its ingrowth into the surrounding tissues, often into the anterior abdominal wall.

If the tumor is not far from the Bauhinian damper and closes the "fistula" of the small intestine and large intestine with its mass, symptoms of partial or complete intestinal obstruction appear. Naturally, large tumors in the region of the hepatic angle of the colon or in the transverse colon also often cause obstruction, often incomplete.

Cases are described when a tumor growing in the caecum was first detected after perforation of the intestine and the development of local or general peritonitis. It was usually diagnosed first by the surgeon on the operating table. If castor oil was used to prepare the intestine for examination, sometimes mucus or blood is found in the intestinal lumen during rectoscopy.

The diagnosis of cancer of the right half of the large intestine is almost always substantiated by x-ray data. Neither the results of a digital examination of the rectum, nor the data of rectosigmoscopy in this case are of significant importance. The intestinal lumen of the left half of the large intestine is much narrower than the intestinal lumen of its right half, so blockage of the intestine by tumor masses occurs much more often here. In addition, cancerous tumors grow differently and in a different direction, they often spread around the circumference of the intestine, squeezing it and squeezing it. In this half of the intestine, the formation of feces ends, they become denser. Thus, conditions are created for the formation of various types of intestinal obstruction, even by relatively small tumors.

The most characteristic signs of a tumor are the disturbances of activity of intestines caused by it: at first there are the constipations which are quite often replaced by diarrheas. Constipation and diarrhea sometimes alternate. In some cases, such symptoms increase gradually, in others they appear suddenly and are accompanied by bloating, rumbling and other intestinal obstruction.

With the development of tumors in this half of the intestine, open bleeding is observed more often than with the development of tumors in its right half. Blood is often excreted with an admixture of mucus. Such bleeding, as a rule, causes anemia of varying degrees. Severe anemia is a more formidable symptom than the same anemia resulting from the development of a tumor in the right half of the large intestine.

The development of a tumor that surrounds the wall of the intestine with a ring is manifested first by a feeling of discomfort and stretching of the intestine in the left side of the abdomen. Occasionally, rumbling occurs with rolling gases through the intestines and convulsive pain attacks. At this time, the shape of the secreted feces changes, which can become ribbon-like or acquire some other configuration. Then comes a more severe partial or complete intestinal obstruction with its typical symptoms.

Tumors of the left half of the transverse colon, splenic angle and descending colon are usually diagnosed during x-ray studies. Sometimes blood or mucus detected during rectoscopy indicates the development of a tumor in the overlying intestine and is often its only symptom. Seals in the left side of the abdomen are usually not determined, even if the patient has a developed tumor.

Most often, tumors of the large intestine are found in the sigmoid colon and in its recto-sigmoid section. In the diagnosis of these tumors, the results of rectosigmoscopy are of primary importance if the tumor is located no higher than 25 cm from the anus, and the X-ray data are auxiliary. As a rule, it is not possible to probe the tumor with a finger inserted into the rectum. Fecal occult blood tests are usually positive, but they are often superfluous, since blood in the stool is determined visually.

The rectum has a large lumen, especially in the region of the ampulla. Its main function is to remove feces from the body. A cancerous tumor that develops in the intestinal wall spreads both along the length of the intestine and in the transverse direction, protruding into its lumen. Therefore, the main violations of the function of the rectum during the development of a tumor in it are in violation of the act of defecation.

A tumor in the rectum causes retention of feces in it after stool. The patient has a feeling of incomplete evacuation of feces after the act of defecation. The sensation of a foreign body in the rectum is also created by the tumor itself. The patient tries to get rid of constant tenesmus by frequent acts of defecation, but does not get relief, as the discomfort in the rectum remains.

Bleeding from the rectum occurs mainly when the tumor has already developed. Blood is found either in the form of streaks on the surface of the stool, or as an impurity in the stool. Sometimes pure blood is released either during the act of defecation, or outside of it. Such bleeding is completely impossible to distinguish from hemorrhoidal, moreover, cancer and hemorrhoids are often detected in the rectum at the same time. Without going into details of the distinguishing features of cancerous and hemorrhoidal bleeding, which are well described in the literature, we note that bleeding can be attributed to hemorrhoidal only after a thorough examination of the rectum.

Acute pain, if the anus is not involved in the cancerous process, usually does not happen. The tumor is usually detected before it closes the intestinal lumen. Therefore, the phenomena of obstruction are almost not observed. Cancer of the rectum is easily diagnosed by the results of rectoscopy and X-ray studies. The tumor is usually palpable with a finger.

In conclusion, the characteristics of the manifestations of colon cancer, it is necessary to pay attention to the features of the development of cancerous tumors in the transverse colon. Its lumen, compared with the lumen of the intestines of other parts of the large intestine, is medium.

In the clinic of tumor development in the transverse colon, signs of damage to that half of the intestine, closer to which the tumor is located, predominate. As you know, the transverse colon is almost adjacent to the anterior wall of the abdomen. As a result, even a small tumor in the intestinal wall can be detected by palpation of the abdomen. Since the stomach adjoins the transverse colon, when the tumor grows into the wall of one of these organs, the other is quickly included in the pathological process.

Cancer tumors of the large intestine in the last stage of development grow into the surrounding organs and tissues, and also metastasize to distant organs. However, due to the involvement of surrounding tissues in the process, even on the operating table, mistakes are often made in the interpretation of the changes that have occurred. Often, ordinary perifocal inflammation is regarded as an invasive tumor process. Therefore, the conclusion of the surgeon must necessarily be supported by the data of the pathomorphological study.

When an enlarged tuberous liver is palpated in a patient and jaundice and ascites are often easily determined, metastases in the lungs or bones are detected radiographically, enlarged, dense lymph nodes (Virchow's node, axillary and inguinal) are palpated, it should be considered that he has a tumor in the last stage development. If the established infiltration of surrounding organs and tissues is not confirmed by morphological data, one can only presumably speak of an advanced stage of the disease.

Cancer of the right half of the large intestine and transverse colon is sometimes complicated by perforation of the intestine at the site of the tumor, often grows into the liver, gallbladder, stomach, pancreas, small intestine and anterior abdominal wall. One of the severe complications of the disease is the formation of a fistula between the stomach and the transverse colon at the site of germination of these organs by the tumor.

Cancer of the descending colon and rectum in the last stage of development in women affects the genitals (metastases appear in the ovaries, a recto-vaginal fistula is formed, the uterus is “immured”), and in men it grows into the prostate gland, bladder, forming a fistula. The tumor also affects the sacrum, ureters, nearby nerve trunks and blood vessels. There are cases when tumor masses generally completely "bricked up" the small pelvis.

Diagnosis of colon cancer and methods of diagnostic studies

To detect cancer of the colon and rectum, a medical examination is carried out, which consists, first of all, in determining the general state of health of the patient, examining the areas of localization of the lymph nodes, palpation of the abdomen and digital examination of the rectum. In addition, the following data are used: anamnestic, hemoglobin content in the blood, the presence of blood in the stool, digital examination of the rectum and rectosigmoscopy. Of these, rectosigmoscopy data are of the greatest value.

X-ray, cytological and pathomorphological studies are carried out in patients who, during the initial study, have abnormalities in the functions of the colon and rectum. Not all people attach importance to the symptoms of bowel dysfunction if they are very mild. Only through a rigorous questioning can small changes in bowel function be detected, which are probably caused by a tumor process. Therefore, special attention should be paid to such minor violations. Collecting an anamnesis, it is possible to identify familial polyposis, which has not yet manifested itself in the patient.

If a patient is found to have had or is suffering from any type of colitis, they should be categorized as at increased risk for colorectal or colon cancer and investigated with particular care. When anemia is detected, it is always necessary to think about the possible development of a cancerous tumor in the caecum or ascending colon (development of tumors in the left half of the colon is usually accompanied by open massive bleeding). Data indicating the presence of blood in the stool also serve as a basis for the doctor to suspect the development of a tumor of the large intestine.

Rectosigmoscopy is performed after appropriate bowel preparation (bowel preparation is described above, in the section "Features of the study of patients for cancer detection"). First, the anus is examined and the rectum is examined with the index finger. After that, the patient is prepared for rectosigmoscopy. He needs to explain what you are going to do and what sensations he will experience (feeling of fullness in the rectum, as with the accumulation of gases, cramping pains in the lower abdomen are also possible). Reassure him and reassure him that if he relaxes completely, the discomfort will decrease and the examination will pass quickly.

The patient takes a knee-elbow position on the examination table, and he is covered with a sheet adapted for this purpose. The digital examination of the rectum is repeated to palpate it in a different position, as well as prepare and lubricate the anus and relax the sphincter muscles. Before the introduction of the rectoscope into the rectum, you must once again make sure that it is in good condition. First of all, you need to check whether the light at the end of the proctoscope lights up, whether the suction apparatus is working, whether the air injection system is working. After that, you need to lubricate the rectoscope with vaseline oil.

Never use force to insert a proctoscope. The rectoscope is inserted a few centimeters into the rectum along with the core and tip. Then the core with the tip is removed and the lighting is adjusted. When the lighting is adjusted, the walls and base of the rectum are examined. If a secret or water left after an enema is found in the rectum, they are sucked off. The axis of the overlying flexure of the normal rectum runs upward and to the left. Looking into the eyepiece of the proctoscope, slowly and carefully move the device along the axis of the intestine to its entire length. It is necessary to overcome the resistance with soft, smooth movements of the proctoscope. Usually, in patients who do not have intestinal anomalies and have not undergone surgery on the abdominal organs, the proctoscope is inserted over the entire length of the tube without additional manipulations.

To relieve the resulting intestinal spasm, which makes it difficult to advance the proctoscope, once again explain to the patient that the feeling of fullness in the rectum is completely natural and should not cause alarm. Ask him to breathe through an open mouth. Gently pump air into the intestines, but only if you cannot do without it. In a patient who does not complain and is undergoing a preventive study, it is better to stop the introduction of the proctoscope at around 16-18 cm than to hurt him.

Inspection of the mucous membrane of the sigmoid colon begins after determining whether there is blood and mucus in the lumen of the intestine above the rectoscope. If they are found during this examination, it is necessary to conduct an additional X-ray examination to identify the source of bleeding. The end of the rectoscope performs rotational movements along the walls of the intestine and at the same time examines its mucous membrane. In this case, the rectoscope is gradually removed. To more closely examine the intestinal mucosa, you can blow in air, which will stretch the intestine and straighten its folds.

If during rectosigmoscopy the doctor finds a tumor in the rectum or sigmoid colon, he needs to accurately describe the following: the size of the tumor in millimeters; its localization (indicate the distance from the anus); relationship with the intestinal wall (in which sector of the clock face or quadrant of the circle is located); the appearance of the tumor, its structure and color; features of the blood supply of the tumor node; its attachment to the mucous membrane (with or without a stalk).

The correct description of the tumor is of great importance not only for the effectiveness of the subsequent treatment of the patient, but also for preventing many misunderstandings that arise in most cases, when it is almost impossible to restore the previous appearance of the tumor. Having found a tumor during rectosigmoscopy, most doctors immediately refer the patient to oncological or proctological institutions. And some doctors, relying on their experience and skill, prefer to first take a biopsy of the detected tumor on their own and only then, after receiving the opinion of the pathologist, decide what to do with the patient.

A biopsy consists in the fact that part of the neoplasm is excised with special long forceps with small nippers at the end. If polyps or other neoplasms do not exceed 8-10 mm in diameter, they must be removed completely, i.e. strive to turn this diagnostic operation into a therapeutic one. As a rule, a biopsy or complete removal of all visible tumors is performed in order to give the pathologist more material for research.

Biopsy of vascular tumors, as well as tumors located high (in the recto-sigmoid region), is best performed in a hospital, where urgent measures can be taken in case of complications. If the tumor is large and it is impossible to completely remove it, a part of the tumor is plucked out with nippers: in a non-ulcerated tumor, the tip is taken so as not to damage the pedicle of the tumor, in which relatively large vessels often pass, and in an ulcerated tumor - a piece of tissue from the edge of the ulcer (it is better to take a few pieces) . Bleeding in most cases stops by pressing the wound with a swab.

Quite a lot of arguments “for” and “against” the biopsy by the local doctor are put forward. Naturally, the desire, experience and possession of the necessary technique for performing a biopsy by a local doctor cannot be discounted, but in all cases he must approach this operation very carefully. Supporters of biopsy in local and district hospitals justify their point of view by the fact that there it can be done faster and therefore start special treatment of the patient faster.

There is no need to re-prepare the bowel for rectosigmoscopy and biopsy. The patient may not know that he has been biopsied, and until he receives a response from the pathologist (possibly negative), he will not worry in vain. In addition, if a pathologist has identified a benign tumor (polyp) in a patient and its removal is not difficult, it is better to remove the tumor on the spot, without sending the patient a long distance to a specialized institution. And finally, a doctor who is able to provide the patient with the necessary assistance without outside participation receives deep moral satisfaction.

Opponents of a biopsy in situ, and they are in the majority, argue that a biopsy of a small tumor consists in its complete removal. In this case, it will be difficult for the oncologist to prescribe the appropriate treatment for the patient. If the tumor is diagnosed as cancerous, there is no need to confirm the diagnosis with on-site pathological data, because in all cases the patient must be referred to an oncologist. During the biopsy, severe bleeding or perforation of the intestine may begin. If this happened in an oncological institution, the patient will be provided with more qualified assistance than in a district or district hospital. In a specialized institution, a biopsy will be performed more correctly than in an institution of a general medical network, and therefore the diagnosis of a pathologist will be more accurate. Finally, after a biopsy, scarring is possible, which often complicates x-ray studies and surgery.

It seems to us more correct to recommend biopsy in specialized institutions, where doctors have not only experience and skills in performing such manipulations, but also no less specialized pathomorphological laboratories.

X-ray examinations of the colon and rectum

No other area of ​​medicine that uses X-ray examinations to diagnose diseases needs a qualified radiologist as much as proctology does to detect colon tumors. This need is due to the difficulties in interpreting radiological data of pathological changes in the intestine. In addition, there are some features in the very conduct of X-ray examination of the large intestine.

If an x-ray examination of the entire gastrointestinal tract is supposed, then it should be started with irrigoscopy, otherwise the barium suspension introduced into the stomach and lingering in the intestine for a long time will interfere with this study in a short time. Due to obstruction of the intestine, at least partial, of tumor origin, the barium suspension introduced through the mouth is sometimes so retained in the intestine that it is even necessary to resort to surgical intervention to remove it. In general, studies of the gastrointestinal tract using oral barium suspension provide very little information about the condition of the large intestine.

The only valuable X-ray method for examining the large intestine is irrigoscopy. However, the usual contrasting of the intestine in order to detect tumors in it is ineffective, especially if these neoplasms are small. Therefore, after the usual x-ray examination of the large intestine and the removal of the barium suspension from it, air is carefully injected through the rectum into the intestine. Due to this “double contrasting”, dark, air-containing intestinal lumens are clearly defined on radiographs, which stand out sharply against the background of a whitish, barium-covered mucosa. If the study is carried out correctly, the polyps appear in relief above the intestinal mucosa as whitish protrusions.

Data from a cytological study of swabs from the mucous membranes of the colon and rectum in difficult-to-diagnose cases, when, for example, it is necessary to differentiate cancer and intestinal diverticulum in a place inaccessible to the rectoscope, are very useful to the doctor. However, the negative conclusion of the cytologist in no way can indicate that there is no cancer. Therefore, only those conclusions are taken into account, which indicate that cancer cells were found in the smears.

Getting colon wash water is not as difficult as it might seem at first glance. The intestines are prepared for this procedure in the same way as for rectosigmoscopy. It is only necessary that the waters of the enema, delivered in the morning before the start of the study, depart clean. If they contain pieces of feces, the study cannot be carried out. It is necessary to prepare the intestines more carefully.

The patient should lie on the left side with the right leg bent at the knee. A rubber probe with many small holes at the end is inserted into the rectum. Then, 800-1000 ml of physiological saline is slowly poured into the intestine through a probe from a suspended Esmarch mug. After 10 minutes, the contents of the intestine are drained through a tee into a glass jar. If the wash water is mixed with feces, the study should be stopped and repeated after better preparation of the patient. The resulting washings are quickly delivered to the cytological laboratory, where they are treated in exactly the same way as with the washings of the stomach.

Naturally, not all doctors will conduct a complete examination of the patient themselves; most diagnostic studies are performed by narrow specialists. And yet, the attending physician bears full responsibility for the patient, who must know not only the results of individual studies, but also correctly determine their sequence. In short, he must do everything possible to quickly diagnose and carry out the necessary treatment of the patient.

If a tumor is discovered by chance during rectosigmoscopy in a patient who does not complain of bowel dysfunction, it is necessary first of all to accurately describe it and continue the search for other tumors, since neoplasms are often multiple. For this, not only rectosigmoscopy is used, but also x-ray studies, especially to detect highly located tumors. It has been proven that about 6% of polyps detected during rectoscopy have related formations in the ascending or descending colon, which can only be diagnosed by X-ray examination.

Then a biopsy is performed. After studying the removed neoplasms, the pathologist makes a conclusion and decides on the further treatment of the patient. When polyps are found without signs of malignancy, they are all removed: small ones (up to 10 mm in diameter) - with biopsy forceps, and their bed is electrocoagulated; larger ones - with a wire loop or with a scalpel. Patients whose polyps have been removed should be under dispensary observation. To monitor the condition of the intestine, they periodically undergo rectosigmoscopy and x-ray studies.

After a focus of malignant cells is detected in the biopsy material, patients undergo radical treatment in oncological dispensaries. A tumor that is located in the colon beyond the reach of the rectoscope is detected only by the results of an X-ray examination. Indirectly, it is evidenced by mucus and blood in the intestinal lumen, which are detected during rectosigmoscopy, as well as anamnesis and laboratory data.

Repeated thorough x-ray examination of the intestine is necessary, because if the diagnosis is confirmed, the patient will need to be recommended surgery. In addition, the first study does not always reveal small polyps (less than 1 cm in diameter), which are generally difficult to notice. Sometimes fecal masses or scars, constrictions and other pathological formations that linger in the intestines are taken for tumors of any size. Undoubtedly, before a second x-ray examination of the large intestine, even more thorough preparation of the patient (diet, laxatives, enemas) is needed than before the first.

After a second examination, the likelihood of a radiologist making an erroneous conclusion is significantly reduced. However, the radiologist cannot distinguish a benign tumor from a malignant one. Therefore, all colon tumors are assessed as potentially malignant. Even a single small tumor in the large intestine is sufficient reason to recommend laparotomy. Of course, the size and location of the tumor, the age and general condition of the patient should be taken into account.

It is necessary to remove polyps because about 25% of them turn out to be malignant tumors or significantly degenerate growths of the intestinal mucosa. During the operation, polyps are often found that were not detected by X-ray. They must also be removed. Based on the results of an urgent histological examination of excised polyps, the volume of surgical intervention is determined.

What to do if the patient makes complaints that make him suspect rectal or colon cancer? The study of such a patient should not be particularly different from that described above: anamnestic data are carefully collected; the abdomen and lymph nodes are palpated; blood, urine and feces tests are done (the latter for occult blood); the rectum is examined with a finger, and in women, in addition, the condition of the genital organs is determined; rectosigmoscopy and possibly a biopsy are performed; a survey x-ray of the intestine is taken in order to timely diagnose its obstruction; x-ray examinations of the large intestine are performed; as well as radiography of the organs of the chest cavity and bones (in order to detect metastases in the lungs and bones); and finally, intravenous (descending) urography to determine the status of the urinary tract.

During a biopsy, all suspicious areas of the tumor are excised. If there are discrepancies in the conclusion of the pathologist and in the clinical data, the biopsy must be repeated. It is necessary to repeat several times and x-ray studies, if the clinical and x-ray diagnoses are contradictory. Even a doctor with extensive experience and a well-established technique for X-ray examination of the large intestine, after careful preparation of the patient, may not determine the tumor. In addition, for the correct interpretation of radiological signs of changes in the most difficult areas of the large intestine (caecum, especially its posterior wall, hepatic and splenic angles, as well as the rectum), a very thorough study is necessary.

Having found hemorrhoids, fissures, fistulas, inflammatory or other diseases of the rectum, which can explain all the patient's complaints about rectal bleeding and pain in the lower abdomen, one should not refrain in some cases from painful, but necessary to exclude cancer diagnostic procedures. After all, hemorrhoids or colitis not only do not exclude cancer, but, on the contrary, are often combined with it in one patient.

And, finally, in cases that are difficult to diagnose, one should try to obtain some data from the cytologist by providing him with washings of the mucous membrane of the large intestine for examination. The last step is to resort to laparotomy. Such an intervention is much better than stretching out repeated studies for many months. Such clarification of the diagnosis of the disease can end tragically for a cancer patient.

Colon cancer (carcinoma) is a group of malignant neoplasms that form from the intestinal mucosa epithelium, differ in cell structure, growth form and can be localized in the blind, colon, sigmoid and rectum.

Most often, malignant tumors are localized in the colon and rectum, so colon cancer is commonly called colorectal.

In 70% of patients with colorectal cancer, provoking factors are detected during the examination, such as chronic, fistulas, anal tears, proctitis, polyposis, and others. In addition, the clinical manifestations of colon cancer are similar to the listed conditions, so patients may confuse its onset with the next relapse of their disease.

We propose to consider the causes, provoking factors and symptoms, as well as to analyze the main methods of diagnosis and treatment of this pathology. We would be happy if this information helps you protect yourself from colon cancer and allows you to identify the disease at an early stage.

Anatomical and physiological features of the large intestine

The reference point that defines the boundary of the small and large intestines is the ileocecal valve, below which the caecum begins. The large intestine ends with an anus, which is located in the perineum.

The large intestine has a length of 1.5 to 2 meters, and its lumen in some departments reaches 8 cm in diameter and gradually narrows towards the anus.

The wall of the large intestine consists of four layers: mucous, submucosal, muscular and serous.

The large intestine differs from the small intestine not only in color, length and diameter, but also in the presence of three longitudinal muscle bands that fold it.

The colon is supplied with blood by the superior and inferior mesenteric arteries.

Venous blood from the large intestine enters through the superior and inferior mesenteric veins into the splenic vein and then into the portal vein. Thus, colorectal cancer screenings are mainly localized in the liver.

The large intestine has several vital functions, namely:

• digestive (food that enters the digestive tract is still partially digested in the large intestine);
• excretory (through the large intestine, part of the harmful substances that are formed during the vital activity of the human body is excreted from the body with feces);
• protective (in the large intestine live beneficial bacteria that protect the body from pathogens);
• absorption (absorption of nutrients, water and vitamins continues in the large intestine).

Thus, the large intestine is one of the most important sections of the digestive tube and performs a number of functions necessary for the normal functioning of the human body.

Epidemiology of colon cancer

Colon cancer, in contrast to small intestine cancer, is more common.

The highest rates of colorectal cancer in the industrialized countries of America and Europe, but, for example, in Japan, this disease is rare. Low rates of colon cancer, including rectal cancer, in Africa and Asia.

In Russia, the incidence of colorectal cancer is at the level of 17.2 cases per 100,000 people.

In the structure of oncological diseases, colon carcinoma ranks 2nd in men and 3rd in women.

Most malignant tumors are localized in the colon.

Every third patient with colon cancer and every tenth patient with oncological diseases suffers from rectal cancer. The incidence rate of rectal cancer in the male population of our country is 12 per 100 thousand of us. and 8 per 100 thousand of us. for female.

People over 50 years of age suffer from colorectal cancer, but there are cases of the disease at a younger age. There is no significant difference between the incidence of colon cancer in men and women.

Causes and provoking factors of colon cancer

Medicine has not yet been able to determine the reliable cause of the degeneration of the epithelial cells of the intestinal tube. But on the basis of numerous clinical studies, a number of factors have been identified that provoke cancerous transformation of cells.

The following factors contribute to the development of colon cancer, including rectal cancer:

• nutritional features;
• alcohol abuse;
• chronic bowel disease;
• genetic propensity;
• chronic constipation;
• age over 50;
• professional hazards;
• papillomavirus infection;
• anal sex.

Let us consider in more detail the influence of provoking factors of colon and rectal cancer.

Features of nutrition. An increased risk of colon cancer is observed in people who eat mainly protein foods of animal origin and eat few vegetables, cereals, and fruits.

The intake of a large amount of meat and fats into the intestinal tract changes the intestinal biocenosis, as a result of which bacteria begin to produce carcinogens. Especially nutritional factor plays an important role in colon cancer.

Alcohol abuse. In persons who constantly drink alcohol, the colonic mucosa is irritated.

Intestinal diseases. There is a group of diseases called precancerous conditions that increase the risk of colon cancer. Such diseases are the following ailments:

• large intestine;
• Crohn's disease;
• intestinal adenomatosis;
• nonspecific ulcerative;
• inflammation of the colon of an infectious nature.

genetic predisposition. In persons whose close relatives have had bowel cancer before the age of 45, the risk of getting it increases several times. There are also two pathological conditions, such as familial polyposis-adenomatosis and hereditary non-polyposis colon cancer, which result from a genetic mutation and significantly increase the risk of colon cancer.

Chronic constipation leads to irritation of the mucosa of the large intestine, more precisely, the rectum, as a result of which the epithelium is constantly updated.

Accordingly, the more actively the cells divide, the higher the risk of their cancerous transformation.

Of the occupational hazards, the most significant is prolonged contact with asbestos, which can cause cancer of various locations, including the colon. Colon cancer can also be caused by other carcinogens, such as industrial poisons, nitrates, pesticides, exhaust gases, etc.

Papillomavirus infection. Papillomavirus is an oncogenic virus, therefore it can lead to the development of rectal cancer. Representatives of sexual minorities who practice anal sex are especially susceptible to this risk.

Anal sex. First, during non-traditional intimate contact, you can become infected with papillomavirus, which in itself increases the risk of rectal cancer. Secondly, classes lead to microcracks in the anus mucosa, anal tears, hemorrhoids, and all this can contribute to the development of rectal cancer.

Individuals at increased risk of developing colorectal cancer should have an annual examination by a coloproctologist in order to detect the disease in time.

Clinical course and classification of colorectal cancer

Depending on the form of growth, colon cancer, including rectal cancer, can be endophytic, exophytic and infiltrative.

In exophytic colon cancer, the tumor grows into the intestinal lumen.

Endophytic tumor growth is characterized by the spread of a malignant process in the thickness of the wall.

Infiltrative bowel cancer refers to the spread of a tumor to neighboring tissues that form a conglomerate with the rectum.

Also, tumors of the large intestine are distinguished by cellular composition, highlighting the following forms of cancer:

• adenocarcinoma;
• mucocellular cancer;
• undifferentiated cancer;
• unclassified cancer.

The most common form of colorectal cancer is adenocarcinoma, which occurs in 80% of patients.

There are four stages in the course of colorectal cancer.

Stage 1: the tumor does not extend beyond the mucosal and submucosal layers of the rectum. There are no regional or remote screenings. Cancer in the first stage is rarely diagnosed, since there are practically no symptoms of the disease.

2nd stage:

• the tumor occupies half the circumference of the intestinal wall, but does not extend beyond the submucosal layer. Tumor screenings are not determined;
• the tumor occupies half the circumference of the intestinal wall and does not go beyond the submucosal layer, but screenings are already determined in the regional (perintestinal) lymphatic collectors.

3rd stage:

• the tumor sprouts the entire thickness of the intestinal wall and can even affect pararectal tissue. The process covers almost the entire circumference of the intestinal wall, and in the regional lymphatic collectors there are single screenings;
• this stage is exhibited regardless of the size and depth of the tumor of the intestinal wall, if multiple screenings are determined in all groups of regional lymph nodes.

Stage 4: the tumor reaches a significant size, partially or completely overlaps the intestinal lumen. Tumor screenings appear not only in regional lymphatic collectors, but also in distant organs and tissues. In addition, the tumor can grow into neighboring organs (peritoneum, ovary, uterus, bladder, and others).

Metastasis of colorectal cancer

Colon cancer, like any other cancer, can spread in several ways, including:

• hematogenous;
• lymphogenous;
• transplantation.

Allocate regional and distant metastases (screenings) of colorectal cancer.

Regional screenings of colon carcinoma are localized in the mesenteric and pararectal lymphatic collectors, and in the later stages, the process can also affect para-aortic lymph nodes.

As mentioned earlier, due to the fact that venous blood from the colon enters the liver, hematogenous screenings of colorectal cancer are most often determined in this organ.

Also, the tumor can grow into neighboring organs and tissues, disrupting their structure and function.

Symptoms of colorectal cancer

Colorectal cancer may go unnoticed for a long time. Symptoms of the disease appear only when the tumor reaches a significant size, which disrupts the functioning of the intestine. Therefore, you need to carefully monitor your health and pay attention to any changes, even the smallest ones.

Clinical manifestations of colon cancer (colon and sigmoid colon):

• general weakness;
• decreased or complete lack of appetite;
• weight loss;
• causeless increase in body temperature;
• chair instability;
• abdominal pain;
• rectal bleeding;
• bloating;
• pallor of the skin.

Now let's take a closer look at the symptoms of colorectal cancer.

In the initial stages of the disease, patients do not have any specific symptoms. The first signs of colon cancer may be general weakness, decreased performance, malaise, excessive sweating, unreasonable fever, loss of appetite.

Weight loss in patients with colorectal cancer is rare. Clinical cases are known when patients, especially with malignant tumors of the colon, gained weight, but did not lose it.

Some patients may develop an aversion to meat food.

Fever in colon cancer is a sign of cancer intoxication. Body temperature can rise both to subfebrile (37-38 degrees) and to high numbers (above 38 degrees).

The instability of the stool can manifest itself in a form that is replaced by diarrhea or vice versa.

In the later stages of the disease, the symptoms of intestinal obstruction join the above manifestations: rumbling in the abdomen, bloating, pain in the abdominal cavity, anemia, etc.

In colon cancer, pain can be of a different nature and duration. Often observed cramping and dull constant pain in the abdomen.

Also, the appearance of blood in the feces, which is inside the feces or on their surface in the form of strips, can also indicate bowel cancer.

Symptoms of intestinal obstruction, such as rumbling, bloating, gas and fecal retention, appear in the later stages of colon cancer, when the tumor has reached a significant size that makes it difficult for stool to pass through the intestinal tube.

Although the rectum is part of the large intestine, the symptoms of rectal cancer are slightly different from those of other parts of the colon.

Symptoms of rectal cancer

In most patients, rectal cancer does not manifest itself in the initial stages, and some patients simply do not pay attention to its symptoms. Therefore, 70% of cases of rectal cancer are detected at late stages, when not only regional screenings are already present, but also secondary tumor lesions of distant organs.

People with rectal cancer may experience the following symptoms:

• frequent constipation;
• discharge of a different nature from the anus (mucous, purulent, bloody) during and after the act of defecation;
• aching pain in the rectum, which can radiate to the lower back, sacrum, lower abdomen, perineum;
• discomfort in the rectum and a feeling that the rectum has not completely emptied during the act of defecation;
• stomach ache;
• tenesmus (false painful urge to empty the bowels);
• change in the shape of feces, which become either ribbon-like or thin, like a pencil.

If you notice at least one of the above symptoms, we strongly recommend that you contact a specialist - a coloproctologist, who will prescribe the necessary studies to confirm or exclude colorectal cancer. Early diagnosis of this disease significantly increases the chances of recovery.

Consider the manifestations of rectal cancer in more detail.

Discharge from anus. Discharge from the rectum can be of a different nature. In the initial stages, the production of mucus increases, the excess of which is released from the anus.

The most common sign of rectal cancer is bleeding from the anus, which can be manifested by profuse bleeding, as well as in the form of stripes on the feces or drops inside the gross masses. The blood is fresh, undigested.

In the later stages of rectal cancer, the tumor begins to disintegrate, so its particles can come out of the anus. In addition, a malignant neoplasm can become infected, resulting in purulent discharge from the rectal canal.

Pain. Pain in the rectum can be both dull and paroxysmal in nature. Also, patients feel discomfort and the presence of a foreign body in the anus after a bowel movement.

Abdominal pain in rectal cancer is mostly present in the later stages of the disease. Mostly the pains are spastic in nature and spread throughout the abdomen.

Changes in the nature of the feces. In the later stages of rectal cancer, when the tumor partially blocks the lumen of the rectum, constipation becomes chronic. In addition, the shape of the feces changes, which become thin, like a tape or like a pencil.

Tenesmus. The presence of a tumor inside the rectum provokes the urge to empty the bowels, which causes pain to the patient.

Complications of colorectal cancer

The most common complication of colorectal cancer is intestinal obstruction, which can be both chronic and acute.

Also, in patients with colon cancer, including the rectum, complications such as intestinal bleeding, inflammation of the intestine (colitis, sigmoiditis, proctitis), perforation of the intestinal wall, toxic dilatation of the intestine, the formation of external and internal fistulas, abdominal abscesses, are common. anemia and others.

Any of the above complications significantly aggravates the patient's condition and worsens the prognosis of the disease, therefore, requires immediate treatment, and in some cases urgent surgical intervention.

Diagnostics

The algorithm for diagnosing colorectal cancer consists of several steps.

1. Subjective examination:

• collection of complaints;
• collection of anamnesis of life and disease.

2. Objective examination:

• examination of the patient;
• palpation of the abdomen;
• rectal digital examination of the rectum;
• auscultation of the abdomen.

3. Additional diagnostic methods:

• general blood analysis;
• analysis of feces for occult blood;
• blood test for tumor markers;
• anoscopy;
• sigmoidoscopy;
• colonoscopy;
• irrigoscopy;
• ultrasound examination of the abdominal organs;
• ultrasound examination of the rectum and pararectal tissue using an endorectal probe;
• sampling of material with subsequent histological examination;
• computed tomography (CT);
• magnetic resonance imaging (MRI);
• positron emission tomography combined with computed tomography (PET/CT);
• diagnostic laparoscopy.

When questioning a patient, the doctor may suspect colon cancer based on such signs as stool instability for the last 4 weeks, pain in the abdomen and anus, changes in the shape of feces, persistent constipation, and others, as well as an increase in symptoms of the underlying disease (colitis, hemorrhoids, paraproctitis, Crohn's disease, etc.).

When collecting an anamnesis, the doctor pays attention to the presence of precancerous conditions, chronic diseases of the large intestine and anorectal region, contact with carcinogens, genetic predisposition, etc., that is, the specialist tries to find or eliminate provoking factors.

When examining a patient, one can notice exhaustion, an increase in the abdomen due to bloating, pallor or earthiness of the skin, plaque on the tongue, and excessive sweating.

Tumors of the anorectal region can be seen with the naked eye.

With the help of palpation, it is possible to determine the presence of a neoplasm in the later stages, when it has reached a large size, especially in malnourished patients.

With the help of a rectal finger examination, the doctor can examine 10 cm of the length of the rectum.

Signs of a malignant neoplasm in this area are the following:

• painful and painless tumor-like protrusion of the intestinal wall into its lumen, which can be of various sizes. With exophytic growth of the tumor, its leg is determined, and with endophytic growth, a circular narrowing of the intestinal lumen;
• a change in the normal structure of the folds of the mucous membrane of the rectal canal;
• the appearance of blood on the glove during the study;
• change in the mobility of the rectum.

In the complete blood count, you can determine the acceleration of the erythrocyte sedimentation rate and signs of anemia (decrease in the level of erythrocytes and / or hemoglobin), which indicate chronic bleeding.

Since bleeding in bowel cancer can be minor and not detectable with the naked eye, all patients with diseases of the digestive tract are tested for fecal occult blood.

Also recently, almost all patients undergo a blood test to determine the levels of cancer-embryonic antigen and CA19.9, which are oncomarkers of colon cancer and allow one to suspect the presence of cancer in the body.

Abdominal auscultation is performed to listen to intestinal motility and determine the symptoms of intestinal obstruction (splash noise, falling drop noise, weakening of peristaltic noises, etc.).

Anoscopy and sigmoidoscopy are used mainly for rectal cancer.

These methods allow you to visually identify the tumor and evaluate changes in the mucous membrane of the rectal canal, as well as to collect material for histological examination.

Colonoscopy is an endoscopic method, which consists in the introduction of an endoscope with an optical device into the anus. The method allows you to study the mucosa of the rectum and sigmoid colon, to identify the tumor. In addition, the fibrocolonoscope, like the sigmoidoscope, is equipped with a biopsy tool.

Irrigoscopy is an x-ray examination of the intestine with double contrast, where barium and air are used as contrasts. On a fluoroscope, a radiologist examines intestinal peristalsis and patency, and the obtained images can reveal defects in the filling of the intestine and other signs of cancer.

Ultrasound examination of the abdominal cavity allows you to assess the spread of cancer to other organs and tissues, as well as to identify the tumor itself, intestinal obstruction, the presence of free fluid in the abdomen, etc.

In addition, endorectal ultrasound is performed, which is more informative in rectal cancer.

With the help of histological examination, it is possible to determine from which cells the tumor has developed in order to select the most effective method of treatment.

CT and MRI are mainly used not to search for a primary tumor of the intestine, but to assess the stage of cancer. Using these methods, it is possible to identify both regional and distant screenings in various organs and tissues.

PET/CT is today the most accurate method of diagnosing cancer, which is able to detect a malignant neoplasm at the metabolic level.

Since the cost of this study is very high, it is used only in difficult diagnostic cases, when it is necessary to determine the quality of the tumor, assess the prevalence of the process and diagnose recurrence.

Diagnostic laparoscopy for colorectal cancer allows you to examine the intestines and other abdominal organs in order to identify suspicious lesions and collect material for histological examination.

As you can see, the capabilities of modern medical diagnostic equipment make it possible to accurately determine the presence of a malignant tumor in the large intestine. The main thing at the first signs of the disease is to consult a specialist: a proctologist or a coloproctologist. If these specialists are not available in your clinic, you can consult a gastroenterologist or surgeon who will refer you to the right doctor.

Differential Diagnosis

Since the symptoms of colorectal cancer are similar to the manifestations of many other oncological and inflammatory diseases, it is necessary to carry out their differential diagnosis.

Most often it is necessary to differentiate colon cancer with the following diseases:

• prostate tumors;
• ovarian times;
• metastases to the large intestine;
• cervical cancer;
• gallbladder cancer;
• haemorrhoids;
• acute pancreatitis;
• inflammatory diseases of the pelvic organs (metritis, adnexitis and others);
• amoebiasis;
• abscesses of the abdominal cavity and retroperitoneal space and others.

Methods of treatment of colorectal cancer

Treatment for colorectal cancer can be either conservative with the use of chemotherapy, immunological agents, and X-rays, or surgical.

Surgical treatment of colorectal cancer

Surgery for colon cancer, including rectal cancer, is the only treatment that improves patient survival. Given this, surgical treatment for colorectal cancer is the main one.

The essence of the operation for colorectal cancer is to remove the part of the intestine affected by the tumor and restore its atomic integrity. The volume of surgical intervention directly depends on the location and size of the malignant neoplasm.

For small tumors, the tumor is removed and the integrity of the intestine is immediately restored, and for large neoplasms, the operation is performed in several stages.

In rectal cancer, a part of the intestine is completely removed, and its distal opening is brought out to the anterior abdominal cavity. After some time, if the patient's condition allows, rectal plasty is performed.

With regional metastases, not only the primary tumor is removed, but also all lymphatic collectors and fatty tissue in the area of ​​metastasis, and depending on the structure of the cells, the question of the need for chemotherapy or radiation therapy is decided.

If there are distant screenings of the primary tumor of the colon, radiation therapy can be performed first to reduce the number, and only then surgery. After the operation, a course of chemotherapy is prescribed. With this tactic, it is possible to increase the five-year survival rate of patients.

Radiation therapy

Radiation therapy is a targeted effect of ionizing radiation on the primary tumor or its screenings.

Radiation therapy for colorectal cancer is used to perform the following tasks:

• reduce the risk of tumor recurrence;
• increase the effectiveness of surgical treatment;
• reduce the number of screenings or the size of the primary tumor before surgery;
• to prolong the life of a patient with inoperable colon cancer.

Chemotherapy for colorectal cancer

This method is never used as a monotherapy, but with its help, in patients with colon cancer, it is possible to increase the effectiveness of other methods of treatment, such as surgery, and also to prevent tumor recurrence.

The most common cancer treatment regimens are Leucovorin, Irinotecan, Tegafur, Oxaliplatin, and Capecitabine.

The choice of the drug should be dealt with exclusively by the attending physician, who reliably knows the characteristics of the course of the disease, the presence of concomitant diseases and other aggravating factors.

The most severe form of colon cancer is metastatic cancer. The survival rate of such patients does not exceed 12 months. It is impossible to cure such cancer, it is possible only with the help of palliative treatment (surgery, chemotherapy, radiation therapy) to alleviate the patient's condition.

Traditional methods in the treatment of colon cancer

Before practicing alternative medicine methods, you should consult with your doctor. In addition, folk remedies can in no case be used as monotherapy, since their effectiveness is not enough to cope with a malignant tumor.

We propose to consider folk remedies and methods that have the greatest number of positive patient reviews.

• Cabbage juice: several leaves of white cabbage are washed under running water and smashed in a blender. The resulting mass is placed in gauze and the juice is squeezed out. It is recommended to consume daily 100 ml of cabbage juice 3 times a day 15 minutes before meals. The course of treatment is at least 5 weeks.
• Infusion of chaga: 10 grams of crushed chaga is poured into 500 ml of boiling water and allowed to infuse in a dark, cool place for 48 hours. Take 200 ml of infusion in the morning, afternoon and evening 15 minutes before meals. The course of treatment is from three to six months.
• Microclysters with chaga infusion: an infusion prepared according to the above recipe is injected into the anus with a douche twice a day: in the morning and at bedtime. For one procedure, you can enter from 40 to 60 ml of infusion.
• Complex tincture: you need to take 1 tablespoon of crushed aloe leaves, elecampane root and chaga. These ingredients are poured into a glass vessel with a lid and pour two glasses of dry red wine. Insist tincture for 7 days in a dark place. The medicine must be shaken in the morning and evening. Take 60 ml of tincture three times a day immediately after meals. The course of treatment is 4 weeks.
• Broth of buckthorn and chamomile: 10 grams of dry extract of buckthorn and 5 grams of dry extract of pharmaceutical chamomile pour 300 ml of boiling water, put on fire and boil for 5 minutes, after which the broth is removed from heat and filtered through a sieve. Use 100 ml of decoction three times a day until complete recovery.
• Celandine tincture: the plant is harvested in late spring, after which it is passed through a meat grinder. The resulting mixture is placed in gauze and the juice is squeezed out. 300 ml of fresh juice is poured into a dark glass bottle and 100 ml of ethyl alcohol is added to it. Store the medicine in the refrigerator. It is recommended to take 15 ml of tincture 4 times a day 15 minutes before meals.

The specialist recommends using folk remedies not to treat colon cancer directly, but to restore strength after surgical treatment with radiation or chemotherapy, as well as to improve the general condition in the process of palliative care.

Diet for colon cancer

The diet, both during the treatment of colon cancer and after surgical removal of the tumor, should be easily digestible and sparing, consist exclusively of healthy and high-quality food.

The main goal of dietary nutrition in this disease is to increase the body's resistance and restore strength.

Experts have compiled a list of products that have anti-cancer properties.

The following foods have anti-cancer properties:

• seafood;
• vegetables;
• berries (strawberries, raspberries);
• fruits (kiwi, watermelon, citrus);
• nuts;
• lactic acid products;
• wheat and rye bran;
• almost all types of cabbage;
• garlic;
• greens;
• olive oil.

Patients with colorectal cancer need to eat 5-6 times a day in small portions. Products must be processed with gentle heat treatment methods: baking, boiling, steaming.

Prevention of colon cancer

The main method of preventing colorectal cancer in people who are at risk and have provoking factors is a regular visit to a coloproctologist (once a year) and the passage of special studies (colonoscopy, sigmoidoscopy, etc.).

General preventive measures include the following:

• maintaining a healthy and active lifestyle;
• correct and balanced nutrition;
• timely fight against constipation;
• timely treatment of intestinal diseases, especially polyposis, Crohn's disease, hemorrhoids, paraproctitis and others);
• fecal occult blood test once a year (for people over 50 years old);
• sigmoidoscopy once every five years (for people over 50 years old);
• performing a colonoscopy once every ten years (for people over 50 years old).

Disease prognosis

Unfavorable and directly depends on the stage of the disease, the shape and affiliation of tumor cells, comorbidity and the age of the patient.

The five-year survival rate for stage 1 colon cancer is 80% and for stage 4 colon cancer is less than 5%.

As you can see, colon cancer survival rates, even when using the entire arsenal of treatment methods, are not very comforting. Therefore, we strongly recommend that you take care of your health, lead an active and healthy lifestyle, eat right and balanced, and seek medical help in a timely manner if you detect not only symptoms of colorectal cancer, but also any other bowel disease.

Colon cancer, the symptoms, causes and treatment of which will be discussed below, is a fairly common disease. It is especially common in people living in America, England, Africa and Greece. In our country, this disease ranks third among oncological diseases, second only to breast and prostate cancer.

This geographical distribution of intestinal cancer is due to the way of nutrition. Each of the regions adheres to a certain type of diet, using foods that change the intestinal flora in their diet.

Bacteria develop in this flora, which by the products of their vital activity not only poison the patient's body, but also produce carcinogenic substances that accelerate pathological cell division and form a tumor.

According to statistics, the male population from 50 to 70 years is more susceptible to this disease.

Classification and stages of the disease

Intestinal cancer is a fairly broad concept, since a tumor can develop in its different parts: in the caecum, in the colon and rectum, or in the anus. The neoplasm develops in the mucous membrane and grows along the intestinal wall. Further, the tumor grows into all intestinal tissues and begins to affect nearby organs.

In men, rectal cancer can spread to the seminal tubercles and prostate, and in women it can spread to the vagina and uterus.

There is a certain classification of colon cancer that develops in humans. Depending on the shape of the tumor, there are forms:

• endophytic;
• exophytic;
• saucer-shaped.

According to the type of cell structure, there are:

• adenocarcinoma;
• mucocellular cancer of the intestine;
• undifferentiated;
• unclassified form of cancer.

Adenocarcinoma appears most frequently, accounting for 80% of all known cases.

Speaking about the stages of cancer that affects the intestines, there are 4 of them:

1. At the first stage, the tumor is localized on the mucosa and submucosa, while its size is small.
2. At the second stage, the tumor has already increased in size, has pronounced symptoms, but does not yet give metastases.
3. At the third stage of development, the tumor has increased and, with its size, already completely fills the thickness of the intestinal walls. Metastases appear that affect nearby lymph nodes.
4. The fourth - the last stage, at which the tumor has already reached a huge size, metastases are not only in the lymph nodes, but also in neighboring organs. In this case, the treatment does not give a result, and the prognosis for the patient is not comforting.

The first and second stages of development are best treated. In the third stage, the probability of living another 5 years is 30%.

Causes of bowel cancer

The disease can develop against the background of erosive lesions of the intestinal walls, due to inflammatory processes in the intestine, which violate the integrity of the mucous membrane and provoke the formation of a tumor. The cause of the formation of cancer can also serve as an adenoma of the colon.

Among the predisposing factors that can cause bowel cancer in women and men, we can note:

• heredity;
• malnutrition;
• diseases of the large intestine.

The first symptoms of oncology may appear if a person eats a lot of animal fats and there are no vegetable fibers in the diet.

As a result of malnutrition, the intestines do not receive enough of a substance called hummus, which improves intestinal motility. Instead, with food, a person receives a large amount of bile acids and neutral fats, which tend to move very slowly through the intestines and at the same time irritate the mucous membrane.

As a result, the microflora in the organ changes, and, as described above, atypical cells are formed. People who play sports and often use synthetic mixtures, such as gainers and proteins, are also at risk. Bad habits, namely alcohol abuse, also play an important role in the development of pathology.

Cancer diagnosis can be genetic. If there were similar cases in your family, then the likelihood that you will get sick too increases by 20%. If close relatives were sick - brothers, sisters and parents, then the probability is even higher. In this case, it is recommended to consult a doctor who can calculate the likelihood of your illness.

The manifestation of cancer can become quite expected if a person has diseases such as polyps, Gardner syndrome, Peutz-Gigers, Turk, Cronkite-Canada, diverticulosis, Crohn's disease, pararectal fistulas and untreated rectal fissures.

Symptoms of oncology

Symptoms of colon cancer at an early stage are rarely recognizable; a tumor at the beginning of development can only be seen with a colcoscopic examination or palpation by a doctor. In the second stage, the tumor increases in size and begins to show visible signs. Symptoms in the early stages (1-2) may look like this:

• unmotivated weakness;
• loss of appetite and aversion to food;
• sleep disorders;
• sharp weight loss;
• heaviness after eating;
• bloating;
• ascites;
• mild pain in the abdomen;
• rumbling and flatulence;
• frequent constipation or fecal incontinence;
• impurities of blood in the feces;
• false urge to empty;
• pallor of the skin;
• sleep disturbance;
• ribbon-like stool.

Often the patient has belching, nausea, a feeling of bitterness in the mouth and vomiting. Less often, fever and anemia are observed, but they are formed against the background of infectious and inflammatory processes in the body, which further complicates the diagnosis.

If there are signs of colon cancer, be sure to consult a doctor and undergo a full diagnosis, as this disease can have unforeseen consequences.

Diagnosis of colon cancer and traditional treatment

Before treating oncology, it is required to undergo a series of procedures that will confirm the diagnosis and provide the doctor with more information about the neoplasm.

If colon cancer is suspected, diagnosis consists of several steps:

• examination and questioning of the patient;
• palpation of the rectum;
• sigmoidoscopy;
• analysis of blood and feces;
• colonoscopy;
• Ultrasound of the abdomen, small pelvis;
• endorectal ultrasound.

Based on the data obtained, the treatment of colon cancer begins. If there is a first or second stage of cancer, then chemotherapy is performed with drugs such as 5-fluorouracil and Ftorafur. Unfortunately, drugs help only 10% of the examined patients, in other cases, surgical treatment is prescribed.

Before removing the tumor, some patients undergo several sessions of radiation therapy, this allows you to stop cell division and slightly reduce the size of the tumor. Surgical treatment consists in the complete removal of the tumor along with metastases.

Before surgery, the patient must be prepared. In recent years, orthograde bowel lavage has been used. It is carried out by introducing 8 liters of isotonic solution through a probe, which is installed in the duodenum. Much less often used old methods - enemas and diets.

When diagnosed with colon cancer, treatment will depend on the location of the tumor and the presence of metastases. If there are no complications, then doctors remove the parts of the intestine and regional lymph nodes affected by the tumor.

The scheme of the operation is developed in advance by the surgeon, depending on how much the tumor has spread and whether the deep sections of the intestine have been affected.

After the operation, chemotherapy is required, but it is indicated for those people whose tumor has grown into all layers of the intestine. At the fourth stage, the operation is no longer performed, chemotherapy is possible, which is aimed solely at improving the quality of human life.

Sometimes chemotherapy acts as a prevention of recurrence of the disease. The period of rehabilitation of the patient after the operation is 3 months. In the future and throughout his life, he will be prescribed special drugs to maintain normal bowel function.

It is impossible to give a positive prognosis with confidence even with a correctly performed operation, since a number of complications may develop.

Prevention and alternative methods of treatment

As a prevention of bowel cancer, first of all, it is required to note a healthy diet. Modern medicine releases substances that reduce the risk of atypical cells. These include:

• ascorbic acid;
• selenium;
• vitamin A;
• beta carotene;
• vitamin E.

By consuming foods rich in these substances, a person will not only improve well-being and increase the body's defenses, but may also avoid intestinal oncology.

According to statistics, the risk of developing bowel cancer increases if a person works in sawmills and chemical industries. At the first symptoms of the disease, change your profession to a safer one. If polyps or inflammatory diseases are found in the intestines, treat them in a timely manner.

Among the folk ways that will help alleviate the condition of the patient, it can be noted:

Remember that you should not get carried away with folk recipes, they can go as an addition to traditional treatment, but not as the main therapy regimen.

Any disease is treated at the initial stage, so be attentive to your body and visit a doctor for preventive purposes.

Now we know what colon oncology is, the symptoms, causes and methods of its treatment. In ancient times, they said: aware - means armed. In this case, this proverb fits perfectly. Being theoretically savvy, a person can easily identify the body's alarm bells and seek help in a timely manner.

is a malignant tumor of various parts of the large intestine (cecum, colon, sigmoid, rectum), originating from the epithelium of the intestinal wall. Symptoms of colon cancer include abdominal pain, flatulence, intestinal disorders, impaired intestinal patency, pathological impurities in the feces, weakness, emaciation. Colon cancer can be determined by palpation of the abdomen; for confirmatory diagnosis, colonoscopy with biopsy, ultrasonography, irrigoscopy, CT, NMR, PET is performed. Radical methods of treatment are one-stage or staged resection interventions.

General information

Colorectal cancer is a malignant neoplasm that develops from the epithelial lining of the colon wall. Incidence statistics are disappointing: annually over 500 thousand new cases of colorectal cancer are detected in the world, and most of them occur in industrialized countries - the USA, Canada, Western Europe, Russia. In the structure of female oncopathology, colon cancer ranks second after breast cancer, and in men, it is second only to prostate cancer and lung cancer in frequency. Most cases of colorectal cancer occur in people over 50; men get sick 1.5 times more often than women. An alarming factor is late detection: in 60-70% of patients, colon cancer is detected at stage III-IV.

The reasons

Long-term study and analysis of the problem made it possible to name the most significant etiological factors that increase the risk of developing colon cancer - these are family-hereditary and alimentary factors, as well as precancerous diseases. Among genetically determined causes, familial polyposis is of the greatest importance, which in almost 100% of cases leads to the development of colon cancer. In addition, patients with Lynch syndrome have an increased risk of developing colorectal cancer - in this case, the tumor lesion usually develops in people younger than 45 years old and is localized in the right colon.

Investigating the dependence of the frequency of colon cancer on the nature of nutrition and lifestyle, it can be stated that the occurrence of oncopathology is facilitated by the predominance of animal proteins, fats and refined carbohydrates in the diet with a deficiency of vegetable fiber; obesity and metabolic disorders, hypokinesia. Various chemical compounds (aromatic hydrocarbons and amines, nitro compounds, tryptophan and tyrosine derivatives, steroid hormones and their metabolites, etc.) have a mutagenic and carcinogenic effect on intestinal epithelial cells.

The likelihood of colorectal cancer progressively increases in conditions of chronic constipation, long smoking history, chronic bowel disease. In particular, precancerous diseases in coloproctology include: chronic colitis (UC, Crohn's disease), diverticular disease of the large intestine, single colon polyps (adenomatous and villous polyps with a diameter of more than 2 cm become malignant in 45-50% of cases).

Classification

Colon cancer can occur in various anatomical regions of the large intestine, but the frequency of their involvement is not the same. According to the observations of specialists in the field of abdominal oncosurgery, the predominant localization is the descending colon and sigmoid colon (36%); followed by the caecum and ascending colon (27%), rectum and anal canal (19%), transverse colon (10%), etc.

According to the nature of growth, colon tumors are divided into exophytic (growing into the lumen of the intestine), endophytic (spreading into the thickness of the intestinal wall) and mixed (tumor-ulcers that combine exo- and endophytic forms of growth). Given the histological structure, colon cancer can be represented by adenocarcinoma of various levels of differentiation (more than 80%), mucosal adenocarcinoma (mucoid cancer), mucocellular (ring-shaped) cancer, undifferentiated and unclassified cancer; cancer of the rectum and anal canal additionally - squamous cell, basal cell and glandular squamous cell cancer.

In accordance with the international TNM system, based on the criteria for the depth of invasion of the primary tumor, regional and distant metastasis, the following stages are distinguished:

• Tx - there is not enough data to evaluate the primary tumor
• Tis - a tumor with intraepithelial growth or mucosal invasion is determined
• T1 - tumor infiltration of the mucosal and submucosal layers of the colon
• T2 - tumor infiltration of the muscular layer of the colon; the mobility of the intestinal wall is not limited
• T3 - germination of the tumor of all layers of the intestinal wall
• T4 - germination of the tumor of the serous membrane or spread to neighboring anatomical formations.

Taking into account the presence or absence of metastases in regional lymph nodes, the following degrees of colon cancer are distinguished: N0 (lymph nodes are not affected), N1 (from 1 to 3 lymph nodes are affected by metastases), N2 (4 or more lymph nodes are affected by metastases). The absence of distant metastases is indicated by the symbol M0; their presence - M1. Metastasis of colon cancer can be carried out by the lymphogenous route (to the regional lymph nodes), the hematogenous route (to the liver, bones, lungs, etc.) and by the implantation/contact route with the development of peritoneal carcinomatosis and cancerous ascites.

Cancer Symptoms

Clinical signs of colon cancer are represented by 5 leading syndromes: pain, intestinal disorders, impaired intestinal patency, pathological secretions, deterioration in the general condition of patients. Abdominal pain is the earliest and most consistent symptom of colon cancer. Depending on the localization of the tumor and the stage of the malignant process, they can be different in nature and intensity. Patients may characterize abdominal pain as pressing, aching, cramping. With severe pain in the right hypochondrium, it is necessary to exclude cholecystitis and duodenal ulcer in the patient; in the case of localization of pain in the right iliac region, the differential diagnosis is made with acute appendicitis.

Already in the initial stages of colon cancer, symptoms of intestinal discomfort are noted, including belching, nausea, vomiting, loss of appetite, a feeling of heaviness and fullness in the stomach. At the same time, intestinal disorders develop, indicating a violation of intestinal motility and the passage of intestinal contents: diarrhea, constipation (or their alternation), rumbling in the abdomen, flatulence. With exophytically growing colon cancer (most often left-sided localization), partial or complete obstructive intestinal obstruction may eventually develop.

The appearance of pathological impurities (blood, mucus, pus) in the feces may indicate the development of cancer of the distal sigmoid and rectum. Heavy intestinal bleeding is rare, but prolonged blood loss leads to the development of chronic posthemorrhagic anemia. Violation of the general well-being in colon cancer is associated with intoxication caused by the decay of the cancerous tumor and stagnation of intestinal contents. Patients usually complain of malaise, fatigue, subfebrile condition, weakness, emaciation. Sometimes the first symptom of colon cancer is the presence of a palpable mass in the abdomen.

Depending on the clinical course, the following forms of colon cancer are distinguished:

• toxic-anemic- the clinic is dominated by general symptoms (fever, progressive hypochromic anemia).
• enterocolitic- the main manifestations are associated with intestinal disorders, which requires differentiation of colon cancer with enteritis, colitis, enterocolitis, dysentery.
• dyspeptic- the symptom complex is represented by gastrointestinal discomfort, reminiscent of the clinic of gastritis, gastric ulcer, cholecystitis.
• obstructive- accompanied by progressive intestinal obstruction.
• pseudo-inflammatory- characterized by signs of an inflammatory process in the abdominal cavity, occurring with fever, abdominal pain, leukocytosis, etc. This form of colon cancer can be disguised as adnexitis, appendicular infiltrate, pyelonephritis.
• atypical(tumor) - a tumor in the abdominal cavity is detected by palpation against the background of apparent clinical well-being.

Diagnostics

A targeted diagnostic search for suspected colon cancer includes clinical, radiological, endoscopic and laboratory examinations. Valuable information can be obtained during an objective examination, palpation of the abdomen, percussion of the abdominal cavity, digital examination of the rectum, gynecological examination.

X-ray diagnostics involves survey radiography of the abdominal cavity, irrigoscopy with the use of a contrast agent. In order to visualize the tumor, take biopsies and smears for cytological and histological examination, rectosigmoscopy and colonoscopy are performed. Among the informative methods of topical diagnostics are ultrasonography of the large intestine, positron emission tomography.

Laboratory diagnosis of colon cancer involves the study of a complete blood count, fecal occult blood, determination of cancer-embryonic antigen (CEA). In order to assess the prevalence of the malignant process, ultrasound of the liver, MSCT of the abdominal cavity, ultrasound of the small pelvis, chest x-ray are performed, according to indications - diagnostic laparoscopy or exploratory laparotomy.

Colon cancer requires differentiation from many diseases of the intestine itself and adjacent organs, first of all, chronic colitis, ulcerative colitis, Crohn's disease, actinomycosis and tuberculosis of the colon, benign tumors of the colon, polyposis, diverticulitis, cysts and tumors of the ovaries .

Colon cancer treatment

A radical method of treating pathology involves resection interventions on the colon, sigmoid or rectum. The nature of the operation and the amount of resection depends on the localization and prevalence of tumor invasion. In colon cancer, it is possible to carry out both simultaneous and staged surgical interventions, including bowel resection and colostomy, followed by reconstructive surgery and intestinal stoma closure. So, with damage to the blind and ascending colon, right-sided hemicolectomy is indicated; with cancer of the transverse colon - its resection, with a tumor of the descending section - left-sided hemicolectomy, with cancer of the sigmoid colon - sigmoidectomy.

The surgical phase of colon cancer treatment is complemented by postoperative chemotherapy. In advanced inoperable cases, a palliative operation is performed (imposition of a bypass intestinal anastomosis or intestinal stoma), chemotherapeutic and symptomatic treatment.

Forecast

The prognosis of colon cancer depends on the stage at which the tumor process was diagnosed. If oncopathology is detected at stage T1, the long-term results of treatment are satisfactory, the 5-year survival rate is 90-100%; at the T2 stage - 70%, T3N1-2 - about 30%. Colon cancer prevention involves dispensary observation of risk groups, treatment of precancerous and background diseases, normalization of nutrition and lifestyle, screening studies (fecal occult blood and colonoscopy) for people over 50 years old. Patients operated on for colorectal cancer, for the timely diagnosis of recurrence of colon cancer in the first year, every 3 months should undergo examinations by an oncologist, including a digital examination of the rectum, sigmoidoscopy, colonoscopy or irrigoscopy.