What are the signs of colon cancer. Benign and malignant tumor of the colon. Colon Cancer Symptoms

Colon cancer primarily affects the epithelial lining of its walls.

The anatomical structure of the large intestine, which is the final section of the gastrointestinal tract (starting from the ileocecal valve that separates the large intestine and ending with the anus) is represented by five sections:

• The caecum, ending in a process - the appendix.
• The ascending colon, located on the right side of the abdomen.
• The transverse colon, passing in the transverse direction to the left side of the abdomen.
• Descending colon, continuing the transverse colon and descending down the left side of the abdomen.
• The sigmoid colon, located in the pelvic cavity.
• Relatively short rectum ending in the anus.

Definition and statistics

Colon cancer, called colorectal, is a cancer that develops from epithelial tissues lining the walls of any of its five sections.

Since the large intestine is often referred to in the medical literature as the large intestine, we will immediately say that both these concepts are synonymous and interchangeable.

The data of medical statistics testify to the steady progression of this formidable disease: on a global scale, five hundred thousand new patients (as a rule, residents of industrialized countries) fall ill with colon cancer every year.

The lowest (five people per 100,000 population) incidence rates are in Africa, medium (33 out of 100,000 people) in the southern and eastern regions of Europe, and high (52 per 100,000 inhabitants) in North America and western regions of Europe.

In the structure of male oncology, colon cancer occupies the third position (after and), in the structure of female - the second (yielding). Men are affected by this disease 1.5 times more often than women.

Colon cancer can affect people of any age (including children), but most often it affects older people: in persons over 60 years of age, it is observed in 28% of cases, in patients over 70 years of age - in 18%.

Interestingly, in persons over the age of 80, the incidence of colon cancer drops sharply to the values ​​characteristic of young patients.

It is characterized by late detection: in the majority (up to 70%) of the diseased, it is already detected at the level of 3-4 stages. To date, it has been established that colon cancer develops from adenomas of a certain (villous, tubular and tubular-villous structure). The process of development of a malignant tumor of the colon develops from 10 to 15 years.

Classification

By the nature of growth, malignant tumors of the large intestine are divided into:

• exophytic forms growing into the lumen of the affected intestine;
• endophytic forms that develop in the thickness of the intestinal wall;
• saucer-shaped forms that combine the features of both of the above forms.

Depending on the location of the pathological process and the cellular structure of tumor tissues, cancer is represented by many types.

When localized in the colon, a malignant tumor can be represented by:

• (the frequency of its distribution is more than 80%);
• mucous adenocarcinoma;
• undifferentiated neoplasm;
• mucocellular cancer;
• unclassified cancer.

With a lesion of the rectum, it is represented by all of the above types, characteristic of, as well as:

• basal cell;
• glandular squamous cell carcinoma.

Reasons for the development of pathology

The following risk factors contribute to the development of colon cancer:

• Age over fifty.
• The presence of inflammatory diseases of the colon (nonspecific,).
• Hereditary predisposition (the presence of a similar pathology in close relatives increases the risk of developing colon cancer several times). Approximately a quarter of all cases are due to a genetic factor.
• Ethnicity. Colon cancer is most susceptible to people from the eastern region of Europe who are of Jewish origin.
• Improper nutrition, which boils down to the use of foods that are poor in fiber, but contain a large amount of fat and refined carbohydrates, the abuse of meat dishes and yeast bread.
• Insufficient level of physical activity, provoking a decrease in intestinal motility and the development of constipation.
• Passion for and.
• . A polyp localized on the walls of the colon can eventually degenerate into a malignant tumor.

Clinical manifestations

Colon cancer at the very beginning of its development is completely asymptomatic and can only be detected by chance, during a dispensary examination or during procedures for examining the intestine, performed in connection with another disease (suspected or already identified).

Symptoms of colon cancer in the early stages

As the malignant neoplasm grows, the following first signs develop:

• Pain in the abdomen (abdominal pain syndrome), characterized by a different character and degree of intensity depending on the localization of the tumor process. They can be cramping, aching, pressing.
• Constant discomfort in the abdomen, accompanied by rumbling and increased gas formation.
• Irregular stools characterized by alternating diarrhea and constipation.
• Constant belching, frequent bouts of vomiting.
• Heaviness and feeling of fullness in the stomach.

General symptoms

General symptoms that develop in the later stages of colon cancer indicate a violation of the functioning of other internal organs and systems.

She is characterized by:

• The presence of anemia due to bleeding and malabsorption of iron and vitamin B12, necessary for the formation of hemoglobin and red blood cells.
• Paleness and dryness of the skin, brittle hair, brittle nails.
• Decreased performance, accompanied by severe weakness, the presence of dizziness and headaches.
• Loss of appetite.
• Sudden weight loss.

Signs in women and men

Men are more likely (in about 60% of cases) to develop cancer of the rectum, in women (in 57%) - cancer of different parts of the colon. There are no specific signs in the clinical course of colon cancer in representatives of different sexes.

Stages and their prognosis of survival

In colon cancer, the five-year survival rate of patients is directly dependent on the stage of its detection:

• At stage 1, characterized by a small tumor size that does not leave the mucosal and submucosal layers of the intestinal wall and has not yet spread to the lymph nodes, the survival rate is 95%.
• At stage 2, when a malignant neoplasm that has begun to grow into the muscle layer affects more than half of the intestine (in this case, a single penetration into can be observed), the survival rate is 75%.
• At stage 3, characterized by the germination of the tumor in the serosa or its metastasis to a number of regional lymph nodes, only half of the patients survive.
• At stage 4, when the pathological process has spread to the tissues of nearby organs and the process of distant metastasis has begun, the survival prognosis does not exceed 10%.

Metastasis

Colon cancer most often metastasizes to:

• , which receives most of the blood (75%) entering it from the portal vein, which is fed by internal organs (including the intestines). It is this circumstance that promotes metastasis. Colorectal cancer that has metastasized to the liver manifests itself as exhaustion, vomiting, nausea, jaundice, the development of ascites (accumulation of fluid in the abdominal cavity), pain and itching.
• The peritoneum is a thin connective tissue film lining the inner surface of the abdominal cavity and covering all internal organs. After a malignant tumor grows through the tissues of the intestinal wall, it affects the peritoneum, forming foci that gradually spread to its neighboring areas, simultaneously affecting the adjacent organs covered by it.
• . Colon cancer that has metastasized to this organ is manifested by constant cough, chest pain, shortness of breath, and hemoptysis.

Complications

Along with metastasis, colon cancer gives a number of complications, ending in:

• Complete (due to the overlap of its lumen with tumor tissues).
• Perforation of the intestinal walls, associated with the formation of holes through which cancer cells and intestinal contents can enter the abdominal cavity.
• The formation of a pathological communication between the intestinal loops and adjacent organs.
• Compression of internal organs.
• Difficulty urinating.
• Recurrence of a malignant tumor.

Diagnostics

Early is complicated by the absence of characteristic symptoms at the very beginning of the development of the tumor process.

Endoscopic methods

Endoscopic procedures include:

• . The object of study using a sigmoidoscope is the rectum and the lower parts of the sigmoid colon. Inserted through the anus, a gel-lubricated flexible tube, equipped with powerful optics that can repeatedly magnify the resulting image, makes it possible to detect the presence of the most insignificant pathological changes in the intestinal mucosa.
• Colonoscopy. The colonoscopy procedure is performed using a colonoscope, which also has an optical system and a video camera connected to a monitor. The ability to manipulate the device allows the doctor not only to detect the presence of pathology, but also to remove polyps, as well as take material for a biopsy. Colonoscopy helps to see the condition of the entire large intestine.

X-ray

X-ray methods are represented by procedures:

• Barium enema. Before the procedure, the patient is given an enema containing a suspension of barium sulfate, after which a series of x-rays are taken. The barium suspension, uniformly covering the walls of the intestine, creates a “filling defect” in the picture, which makes it possible to detect the presence of polyps or cancerous neoplasms.
• . This method, used when it is necessary to detect metastases, allows you to perform multiple layered images of the organ under study using x-rays.
• . The MRI procedure is also intended for layer-by-layer visualization of the tissues under study, but only by means of electromagnetic radiation. The absence of ionizing radiation makes it safer.
• Chest x-ray. The procedure is indispensable for the detection of lung metastases.
• . Given the high need of cancer cells for sugar, the PET procedure uses sugar labeled with radioactive substances. The accumulation of these substances in a certain area of ​​​​the body indicates the presence of a cancerous tumor in it. With the help of a special camera, the doctor can determine its location and size.

Genetic testing

This type of examination, aimed at identifying in the patient's genetic code the genes responsible for the transformation of healthy cells into cancer cells, is performed if he has close relatives suffering from colorectal cancer.

Laboratory methods

Laboratory tests for colon cancer in a patient include:

• Study .
• Performance .

Ultrasound procedure

The procedure, which uses ultrasound waves to obtain a volumetric image of the internal organs, allows you to detect a tumor, determine its size and determine the presence of distant metastases.

What tumor markers are determined?

In colon cancer, the level of:

• cancer embryonic antigen;
• produced by cancer cells that have affected the tissues of the pancreas and colon;
• that detects tumors of the gastrointestinal tract and pancreas;
• , appearing in the blood at, colon and.

Test and how much does it cost?

A person who has discovered alarming symptoms in himself can test his feces for the presence of occult blood at home.

To do this, it is enough to go to a pharmacy, purchase a test for colon cancer and perform a series of simple manipulations, guided by the manufacturer's recommendations.

The cost of one home test for colon cancer from Russian manufacturers does not exceed 250 rubles. A foreign-made test will cost 2,200 rubles.

Treatment

• Leading is surgery. Most often, patients undergo radical surgery: partial hemicolectomy or colectomy. The operation can be open (performed through an incision in the abdominal wall) or laparoscopic, performed through several small incisions into which manipulators and a miniature video system are inserted. If the lymph nodes are affected, a lymphadenectomy is performed.
• An equally important method of treatment is the use of drugs that inhibit the division of cancer cells, as a result of which the tumor decreases in size, stops its rapid growth, or reduces the likelihood of its metastasis to other organs. Chemotherapy can be used before surgery, after surgery, and as the primary treatment for inoperable cancers.
• Radiotherapy, which uses X-rays to destroy cancer cells, is the third therapeutic treatment for colon cancer.

Applied in the preoperative period, it can lead to a significant reduction in the cancerous tumor. In the treatment of the operated patient, radiation therapy destroys the atypical cells left after the operation, preventing the recurrence of the malignant neoplasm.

When is a colostomy removed?

A colostomy is an artificially created opening with a section of the large intestine brought into it, designed to remove gases and feces.

Indications for colostomy in rectal cancer are:

• Removal of most of the tumor-affected colon.
• High risk of complications that may occur when suturing the ends of the colon after surgery to remove its fragment.
• The inability to remove the tumor. In this case, it is applied to restore intestinal patency in order to remove gases and feces.
• The presence of complications accompanying the tumor process (the occurrence of fistulas, suppuration).
• Invasion of the tumor into adjacent organs.
• The presence of severe inflammation in the large intestine after radiation therapy.

A colostomy can be temporary or permanent. In the first option, after a certain period of time, another operation is performed, during which the ends of the intestine are sutured and the hole made in the skin is closed.

Patients who have undergone a colostomy are forced to use colostomy bags - special containers for collecting feces.

Diet

High in plant fiber, a therapeutic diet for colon cancer should:

• help cleanse the body;
• prevent constipation;
• significantly accelerate the elimination of toxic substances from the patient's body.

With colorectal cancer, foods high in protein and fat should be completely eliminated from the diet, replacing them with dishes high in vitamins A and C, complex carbohydrates and vegetable fibers.

All these substances are found in vegetables (potatoes, cabbage, tomatoes), cereals (brown rice, wheat and corn flakes) and fruits (avocados, citrus fruits, bananas).

Having completely abandoned yeast bread, the patient should prefer its whole grain or bran varieties.

Prevention

There is no specific prevention of colon cancer.

To reduce the risk of its development, you can use the following actions:

• Individuals at risk need an annual screening for colon cancer.
• People over the age of forty are recommended to undergo an annual digital examination of the rectum.
• Patients over fifty should have a colonoscopy or proctosigmoidoscopy every two years and an occult blood test once a year.
• Regular exercise and constant monitoring of body weight are also useful.

Can I get a disability group?

To obtain a disability for colon cancer, the patient must receive a medical and social examination report.

Before it, the patient must pass:

• chest x-ray;
• x-ray of the intestine;
• biopsy;
• medical examination of a number of specialists (including an oncologist, internist, neurologist, etc.)

In some cases, the patient is examined in stationary conditions.

In addition, the patient must submit:

• urine and blood samples for general and biochemical analysis;
• samples of feces to obtain a coprogram and study them for dysbacteriosis.

During the initial examination at the medical and social examination, 95% of patients receive I or II disability groups. Group III is received by patients with persistent moderate disability.

Video about the prevention and diagnosis of colon cancer:

One of the most common cancers in Russia is colon cancer. The first symptoms, however, the patient does not begin to experience immediately.

Approximately every eighth case of oncology concerns this area. Mostly older people suffer - up to 55 years of colon cancer occurs quite rarely. Such a disease, which occurred before the age of 45, can only be hereditary.

Such a disease does not affect all parts of the intestine equally: most often the tumor occurs 30-40 centimeters from the anus, in the colon or rectum. Otherwise, malignant neoplasms in this area are called colorectal cancer by physicians.

There are special cases of such a disease: cancer of the anal canal and cancer of the small intestine, but they are rare.

Cancer is a general term for all malignant neoplasms. Doctors call them tumors. But not every tumor in the gut is malignant and therefore colon cancer. There are many benign neoplasms, such as polyps in the intestines. However, if left untreated, cancerous tumors can also develop from them, so they are considered as precursors of colon cancer.

Cancer cells are so altered that they divide very quickly. This allows them to grow beyond the tumor - to neighboring tissues and organs. In addition, cancer cells can be transmitted through the blood or lymph to other parts of the body, where they form secondary tumors (metastases).

How does colon cancer develop?

Cancer cells are body cells that divide and grow uncontrollably. Usually the body strictly regulates their growth, but cancer cells avoid this "check". They grow in tissues and gradually destroy them.

When cells divide, DNA (genes) are copied from another cell. The older the person, the higher the risk that the new cell's genes will mutate and become cancerous if the body fails to make it harmless. If the intestinal cell undergoes this, then colorectal cancer occurs.

Causes of colorectal cancer and risk factors

It is very difficult to name the exact causes of this disease. Most often they lie in the way of life of a person: his eating habits and physical activity. The two most important influencing factors are tobacco use and being overweight.

Other risk factors:

• hypodynamia;
• chronic inflammatory bowel disease: ulcerative colitis and Crohn's disease;
• diet low in fiber;
• alcohol abuse;
• regular consumption of red meat or sausages made from it.

People with close relatives who suffer or have suffered from colorectal cancer also have an increased risk of developing such a tumor.

The tumor in most cases slowly develops from benign precursors, such as Their cells can mutate, and a malignant neoplasm will begin to develop. Therefore, it is important to remove polyps immediately after detection.

People with type 2 diabetes have a higher risk of developing colon cancer. Experts see the reasons for this in the typical changes in hormone levels that occur at the beginning of the development of the disease. The cells of the body cease to respond normally to insulin - because of this, the pancreas produces it in large quantities. An excess of this hormone can also lead to bowel cancer.

For people at risk, it is important to be examined regularly. Oncoscreening, or early detection of tumors, will be a good method. Thus, the whole body is checked for the presence of various tumors and metastases.

Oncologists say that the number of cases of colorectal cancer can be significantly reduced if more people choose a healthy lifestyle. This, unfortunately, will not guarantee that the disease will not occur at all, but will reduce the risks of its occurrence.

Colon Cancer Symptoms

Colon cancer often causes no symptoms for a long time. At the beginning, the signs are very atypical - they can indicate various diseases and problems with the intestines. There are no specific symptoms that clearly indicate cancer.

Possible symptoms of colon cancer, which should be considered as the first warning signs:

• pain and cramps in the abdomen;
• strong false urge to defecate;
• constipation, diarrhea or their alternation;
• pain during bowel movements;
• an altered appearance of the stool - for example, the appearance of blood, mucus, thin feces in it (occurs when the intestine narrows with a tumor);
• indigestion accompanying the above signs: flatulence, bloating, rumbling, heartburn, nausea, heaviness in the stomach;
• enlarged lymph nodes in the abdomen.

These first symptoms of colon cancer are very non-specific. They can also occur with irritable bowel syndrome, which is much more common.

Symptoms of irritable bowel syndrome are similar to those of colon cancer

Other symptoms that can occur with both colon cancer and other diseases are:

• decrease in working capacity;
• increased night sweats;
• fever.

Symptoms that may indicate the active development of the disease:

• anemia, if the bowel tumor bleeds regularly;
• pallor;
• fatigue;
• unintentional rapid weight loss;
• compaction in the stomach with a large tumor size;
• intestinal obstruction.

If secondary tumors have formed (cancer “let go” of metastases) in other organs, then other symptoms may develop, which depend on the location of the secondary neoplasm.

Table 1. Symptoms of colon cancer with metastases

Diagnosis of colon cancer

If there is a suspicion of a tumor in the intestine, with the help of diagnostics it turns out:

• its exact location;
• benign or malignant;
• how much the disease has progressed and whether there are metastases in other organs.

Several examinations are required to make an accurate diagnosis.

Primary examination

When complaining of long-term problems with digestion, a person must first contact a local therapist. With prolonged discomfort in the lower abdomen, it is better for women to go to a gynecologist. To complete the history, the doctor asks several questions.

1. What are the complaints: for example, changes in stool, abdominal cramps, nausea?
2. How long do symptoms last?
3. What is your diet? Does it include meat?
4. Do you suffer from any chronic inflammatory bowel disease?
5. Have you previously had colon polyps?
6. Do you have relatives who currently or have suffered from colon cancer?

The answers to these questions can help the doctor build the primary clinical picture. Then the specialist examines the patient, probes the stomach. If rectal or anal cancer is suspected, a specialist will perform a digital rectal examination. Thanks to this, you can feel the tumor itself if it is close to the anus. This examination option is effective, however, with this method it is impossible to determine the nature of the tumor, so additional diagnostics will be required.

Examination by a gastroenterologist

The patient needs to be examined by a gastroenterologist who will check the condition and functioning of the gastrointestinal tract. A fecal occult blood test will be ordered. True, it does not always give a true result: if a person often eats meat products, blood can be found in his stool even in the absence of cancer. In addition, it is possible that the blood came from intestinal polyps, enlarged hemorrhoids, or harmless mucosal injuries in the anus. Therefore, in this case, it is impossible to make an accurate diagnosis without another type of diagnosis.

Colonoscopy

Reference. Colonoscopy is a method of examining the large intestine, which uses an endoscope - an optical device that looks like a flexible hose with a mini-camera at the end. Diagnostics takes place under visual control: the image is displayed on the screen. This method is absolutely safe, since the so-called “cold” light is used during shooting, which eliminates the burn of the mucous membrane.

To obtain reliable results, preparation is needed: during the day, the intestines are cleansed with laxatives or enemas, the patient follows a diet. During the procedure, the doctor inserts the endoscope into the patient's rectum and "pushes" it to the colon. Thus, he can examine the condition of this area, and if suspicious places are found, tissue samples (biopsy) can be taken with an endoscope. If colon polyps were found during the examination, they are removed directly during the colonoscopy. Thanks to this diagnostic method, an accurate diagnosis will be made and the treatment of the disease will begin. However, it is important to be aware of complications, such as bleeding during the procedure, which can occur when polyps are removed. They rarely occur, but for people with blood diseases, this method may be contraindicated.

Other diagnostic methods

With the help of a blood test, the level of tumor markers is checked. If it is elevated, then this may indicate the development of colon cancer, however, their presence can also be detected in a healthy person, so this type of diagnosis is not completely reliable. However, a blood test is necessary to keep abreast of general health.

Ultrasound procedure

Imaging methods of research will also help to draw up a general clinical picture and outline the path of treatment:

• ultrasound examination (ultrasound);
• computed tomography (CT)
• magnetic resonance imaging (MRI);
• positron emission tomography (PET).

Video - Colon cancer: prevention and diagnosis

Preventive examinations

For people who do not belong to any risk group, who do not have complaints and specific suspicions of cancer, the mandatory medical examination includes the following diagnostic methods to rule out colon cancer:

• from the age of five: once a year, a stool test for occult blood (rapid test for colorectal cancer);
• from the age of eighteen: every two years, either a colonoscopy or a fecal occult blood test.

There are several types of stool tests. With a rapid test, stool samples for different days are collected in small containers, and then examined in the laboratory by adding a special solution to them. The appearance of a blue color indicates the presence of blood in the stool. Despite the fact that such an analysis is not completely reliable and it is impossible to accurately determine the presence of a tumor, it can make it clear to the patient that normal processes are disturbed in his body and you should consult a doctor.

Other methods of preventive examination include:

• capsule endoscopy. A person swallows a special capsule equipped with a small camera that transmits a video signal. So you can find out about the state of the gastrointestinal tract;
• virtual colonoscopy. This is an examination of the colon without the introduction of an endoscope using MRI or CT;
• sigmoidoscopy. This is a visual examination of the mucous membrane of the anal canal, rectum and part of the sigmoid colon. It is carried out using a sigmoidoscope.

Colon cancer treatment

In the case of colon cancer, the chances of recovery largely depend on how early the tumor is found. If it has grown only superficially on the mucous membrane, then it is easy to remove it with a colonoscopy. In the future, it will only be necessary to be examined once every six months to check whether the neoplasm will reappear.

If it is not possible to completely remove the tumor with a colonoscopy, further steps are needed. Depending on how far the tumor has spread, different therapies may be used. Typically used:

• operation;
• chemotherapy;
• radiation therapy;
• a combination of chemotherapy and radiation therapy (radiochemotherapy);
• immunotherapy.

If the patient has the last - terminal - stage of cancer, complete disposal of it is unlikely. Doctors can only prolong the life of the patient through intensive care. 30% of patients with the fourth stage of cancer live up to 5 years.

Some colon cancer patients have the opportunity to participate in clinical trials that test new drugs. For people with end-stage metastatic colorectal cancer with little chance of recovery, new drug developments could be a great way to get back to normal life.

Psychological support is also important. For many patients, such a terrible diagnosis causes shock and depression, even when the chances of recovery are very high. This condition can accelerate the development of the disease and worsen the physical condition of a person.

Life after illness

Even after getting rid of colon cancer, it is necessary to undergo regular examinations in order to monitor the state of your body and avoid recurrence.

• undergo a colonoscopy six months after the removal of the tumor, and then with an interval of two years;
• annually conduct a complete examination of the body;
• once every six months to take a general analysis of blood, urine and feces;
• follow a diet.

Diet

Diet plays an important role in colon cancer and after getting rid of it. Cancer and its treatment is a big burden on the body. Therefore, it is important to provide it with the necessary energy.

Many people with colorectal cancer have difficulty maintaining their weight. With such a disease, it is important to control it: it is impossible for it to decrease too much. Patients undergoing chemotherapy or radiation therapy especially often struggle with side effects such as loss of appetite, nausea, or vomiting. In addition, there may be a violation of taste or smell. In this case, it is important to listen to the body and eat what you want.

The doctor will prescribe an individual nutrition plan for the patient, which will help saturate the body with the necessary vitamins and maintain a good physical condition. For those who are unable to feed normally due to rejection or other complications, artificial feeding with a gastric tube may be an option.

Cancer diets are gaining popularity. Often patients ask themselves: will they help improve the condition of the body and stop the development of the disease?

Most often they talk about the so-called ketogenic diet, in which carbohydrates are almost completely excluded. Unfortunately, it has not been proven by doctors that it helps to get rid of such a disease: perhaps this happened only in special cases. In addition, if it is observed, a person most likely will not remain full, which will negatively affect his condition. It is important to remember that each organism is individual, and what can help one person can harm another. Therefore, it is worth discussing your diet with a doctor - he will definitely say what is suitable for a particular patient.

1. Distribute food throughout the day - many small meals (5-6 per day) are easier to digest than several large ones.
2. To ensure good digestion, it is important to drink plenty of water. With diarrhea and vomiting, you can also compensate for the loss of minerals with good mineral water.
3. In case of loss of appetite, it is not recommended to drink water during meals, so as not to fill the stomach.
4. You need to chew your food thoroughly. This will make your bowel work easier.
5. Keep a food diary to monitor the reactions of your body and your condition after a particular product.
6. In case of constipation, it is better to take only natural laxatives.
7. Food and drinks should not be too hot or too cold.
8. Dry foods, such as crackers or crispbread, can help with nausea.

Conclusion

Colon cancer is a dangerous disease, but it is not a death sentence. It is quite possible to get rid of it if treatment is started in time. To completely avoid such a disease, it is recommended to undergo a complete examination of the body at least once a year - this will help to detect possible diseases at an early stage.

Even if a diagnosis such as colorectal cancer has been made, do not despair. It is important to follow the doctor's instructions and seek psychological help. Cancer can be defeated, the main thing is to make an effort. read on our website.

Colon cancer involves the appearance of a malignant type of tumor in the colon, its localization and shape may vary

Unfortunately, modern medicine has not yet learned how to overcome all diseases. This also applies to oncological diseases, which occupy the 2nd place in terms of mortality on the planet.

Colon cancer is a relatively common type of carcinoma. It suggests the appearance of a tumor of a malignant type in the region of the large intestine. Its localization and form in each case may differ.

Forewarned is forearmed. This article will describe the symptoms of colon carcinoma, its classification, prognosis and methods of treatment.

Appearance, development, stages of colon cancer

The number of patients continues to grow. In Russia, every fourth cancer patient is given a disappointing diagnosis of colon cancer. According to scientists, the disappointing increase in cases is directly related to the increased consumption of beef, pork, and a decrease in fiber in the daily diet. Scientists came to this opinion - vegetarians get this form of cancer much less often. At risk were the elderly, residents of states with a good standard of living.

Photo of colon cancer from the inside

How does cancer appear? In most cases, it becomes the result of an adenoma, which is considered a benign tumor. May be large or small. If the tumor is small, it may not manifest itself for several months or even years.

How does the disease develop? Scientists have proven that malnutrition contributes to this. If you eat only meat and disdain fiber, carcinogens begin to form in the intestines. Frequent constipation also negatively affects the "well-being" of the intestines. As a result, ordinary cells are transformed into malignant ones.

Due to the rapid division and subsequent growth, the tumor can occupy the entire intestinal lumen. Obstruction of the intestine is observed, blood vessels are destroyed, bleeding opens.

Subsequently, the tumor can metastasize to nearby organs, which ultimately leads to the death of the patient.

Stages of development of a colon tumor

The appearance, subsequent progression of a malignant tumor occurs gradually. At first, the tumor forms on the walls of the intestine, but then it can affect neighboring tissues. It is extremely important to recognize it in the early stages - then the treatment will be successful, and the prognosis is favorable. Modern medicine uses the following classification of cancer stages:

• First stage. Detection of a tumor both on the mucosa and on the submucosa of the intestine.
• Second stage (A). Malignant formation occupies less than 50% in the intestinal lumen. Until it goes beyond, but it does not penetrate the walls. There are no metastases.
• Second stage (B). Education has dimensions similar to the 2nd stage (A). It does not protrude beyond the limits, but begins to grow into the walls. Metastases are absent.
• Third stage (A). The tumor becomes larger, occupies more than 50% of the lumen. It begins to grow completely into the walls of the colon, but does not yet cause metastases in the lymph nodes.
• Third stage (B). A malignant neoplasm reaches a large size. Metastases can be found in nearby lymph nodes.
• Fourth stage. It is characterized by an impressive focus of tumors. Carcinoma has long sprouted into the walls of the intestine, but now it also affects the connective tissues and organs. Among the numerous metastases, distant ones begin to occur. In the absence of proper treatment, the fourth stage leads to the death of the patient.

What do the stages of colon cancer look like?

Only a professional oncologist can make an accurate diagnosis and determine the stage of cancer development. To do this, a thorough examination of the patient is carried out, a biopsy of suspicious sections of the intestine is made, and lymph nodes are examined.

Classification and types

How to classify this cancer? Medicine in the 21st century has two classifications of cancer. It all depends on the nature of tumor growth and histology. Given the form of neoplasm growth, cancer can be:

• exophytic. The tumor was found in the intestinal lumen.
• Endophytic. A malignant formation is located directly in the thickness of the walls.
• Saucer-shaped. A dangerous tumor, more like an ulcer. Combines exophytic and endophytic forms.

There is also the so-called intra-wall growth. If the patient has exactly this nature of the development of the disease, four types of tumors are distinguished:

• Mucous adenoma. Causes a colloidal form of cancer. It is characterized by a fairly decent appearance of mucus and its large accumulation. This type of tumor is diagnosed more often than others.
• Signet cell carcinoma. It does not have clear boundaries, it occurs inside the walls. Quite often affects men and women under the age of 35 years. It is dangerous for its metastases, which appear quickly enough and affect the surrounding tissues.
• Squamous cell carcinoma. It occurs in a variety of parts of the intestine, but most often in the distal third.
• Glandular squamous cell tumor. It is found extremely rarely.

Why Cancer Occurs: Causes

We have already said that excessive consumption of meat can cause a tumor. However, this is not the only carcinogenic factor, there are others:

• genetic predisposition. If one of the relatives had colon cancer, there is a chance that someone else will develop a tumor.
• Incorrect diet. A person consumes a lot of meat and fat, as well as flour dishes. At the same time, food of plant origin is almost completely excluded from the diet.
• Bad habits.
• Sedentary lifestyle. No wonder they say that movement is life.
• Elderly age. According to statistics, people over the age of 60 suffer from this form of cancer much more often.
• Indigestion, a variety of bowel diseases that occurred earlier.

Of course, only one of the factors listed above can hardly become a catalyst for the appearance of cancer. However, a combination of several has every chance of leading to not the best consequences. Nutrition, predisposition, and chronic diseases are especially influential.

Colon cancer and early symptoms

Like some other forms, a malignant neoplasm in the intestine goes unnoticed for a long time. Nothing bothers a person, there are no unpleasant sensations as such. Unfortunately, tangible symptoms begin to appear when the disease progresses with might and main. Among the adverse signs can be noted:

• Discomfort in the bowel.
• Dull, aching pain that doesn't stop.
• Prolonged intestinal obstruction. By the way, this symptom may indicate that the patient needs immediate surgical intervention.
• Weight loss, appetite completely or partially absent.
• Constant bloating.
• A sharp increase in temperature, weakness and malaise. The person becomes pale and feels unwell.
• There are bloody clots in the stool, as well as mucus.

The larger the tumor becomes, the larger and brighter it begins to declare itself. Subsequently, loss of consciousness and dizziness are added to the symptoms. The color of the stool may change.

It should be understood that the listed symptoms can manifest themselves in completely different ways. You need to look at the stage of the disease, the form of cancer. In the last stages, severe bleeding is noted, along with pus feces. In some cases, ascites is fixed.

Bleeding in the intestines is especially dangerous, so at the slightest manifestation of it, you should immediately consult a doctor. The help of a specialist will also be required in case of severe constipation - the problem is solved by surgical intervention.

Primary symptoms may be similar to other diseases

Forecast and how long patients live (statistics)

No wonder colon cancer is considered a life-threatening disease. If treatment was started at stages 3-4, complications are almost inevitable. The disease begins to affect other organs. Among the most common complications are abscess, peritonitis, phlegmon. The development of fistulas in the vagina or bladder, as well as perforation of the intestine with paraproctitis, is not excluded.

Whatever the complication, it will require additional examination and effective treatment. The prognosis worsens if the patient is diagnosed with several complications at once. Hence the conclusion - the earlier the disease is diagnosed and the fewer complications it gave, the more favorable the prognosis.

However, let's get back to specific numbers. Due to the fact that in most cases the disease is diagnosed in the late stages, every third case ends in death. How effective is surgery? It all depends on the depth of germination of the tumor and its size, as well as the presence or absence of metastases in the organs adjacent to the intestine.

In the first five years after surgery, the likelihood that colon cancer will return is quite high. If no recurrence occurs during this time, the risk of a tumor is very low.

As for the stages of the disease, everything is quite simple here. If colon cancer was detected in the first stage, and treatment was provided in a timely manner, the probability of survival and that the disease will not return is 74%. With the fourth stage, everything is much more complicated - here the survival rate is negligible and amounts to 6%.

In the event of recurrence, metastases most often spread to regional lymph nodes, but may also involve the liver. According to doctors, in 70% of cases of recurrence of colon cancer affected the liver.

Treatment

To date, the main and most effective method of cancer treatment is surgery. Modern medicine has several types of operations. Their choice depends on many factors: the size of the tumor, the stage of the disease, and localization. The following methods are mainly used:

• Intra-abdominal resection.

A piece of the intestine affected by a malignant formation is excised. After that, its ends are sewn together with a special apparatus or manually. Sometimes one end of the intestine is displayed on the abdominal wall.

• Operation according to the Hartmann method.

If it is not possible to sew the ends of the intestine together, the tumor is first removed, and then the “upper” part of the intestine is brought to the abdominal wall. The other end is sutured. Over time, the operation is repeated, the colostomy is sutured.

• Abdominal anal resection.

The affected area of ​​the intestine is excised. After that, both ends are sutured, and the intestine extended into the anus is excised.

• Laparoscopic resection.

Quite a popular method. It is characterized by a lot of advantages, allows you to stop the progression of the disease, improves the quality of life.

Of course, treatment is not limited to surgery alone. Other methods that have proven themselves in the treatment of any form of cancer are also used:

• Radiation therapy.

Successfully applied in the treatment. It is not capable of replacing the operation, but it helps to avoid relapses and consolidate the result. Can be applied at any stage. For example, carrying out therapy before excision can reduce the tumor, simplify the operation. After is used to reduce the risk of relapse.

• Chemotherapy.

Used before and after surgery. Helps to remove metastases, prevents re-development. The quality and length of human life are greatly improved. Among the main drugs, it is worth noting platinum and 5-fluorouracil, leucovarin, calcium folinate. The use of "chemistry" allows you to achieve a favorable prognosis.

Colon Cancer Prevention Measures

Of course, any disease is better to prevent than to try to cure. Diagnosis of cancer is not always possible because it may not manifest itself. On the other hand, the use of preventive measures can reduce the risk of cancer:

• If you are at risk (you are over 40 years old, one of your relatives died of cancer), regularly undergo a check-up with a doctor, take all the necessary tests. For example, checking feces for blood. A colonoscopy or proctosigmoidoscopy is recommended every three years for all people over 40 years of age.
• Always treat polyposis if diagnosed. Do not let the course of the disease take its course if you have been diagnosed with colitis. This and some other diseases can become chronic.
• Normalize your diet. First, review your diet. If it contains too much meat products, remove them. Include foods that prevent constipation in your diet. Do not forget about complex carbohydrates - they should always be in your diet. The same goes for plant foods.
• Give up bad habits.
• Move more, play sports. Try to maintain the content of vitamins at the proper level. First of all, this applies to betacarotene, some antioxidants and A, C.

As you can see, these rules are easy to follow. But their implementation will help prevent cancer in any form, avoid expensive and painstaking treatment. At the first suspicious symptoms, contact a specialist.

If treatment is started in a timely manner, carcinoma can be defeated! But for this you need to be attentive to your health, eat right, regularly undergo an examination with your doctor.

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.

Developing from epithelial tissue.

Epithelial tissue is present throughout the body and covers all internal organs. Also, the mucous membrane of the gastrointestinal tract consists of epithelial tissue.

This pathology in the field of malignant neoplasms occupies one of the leading places in industrialized countries (such as the USA and Japan) and is least common in developing countries in Africa and Asia. The incidence rate is higher in the male population than in the female population. Although colon cancer most often affects the elderly, this pathology can also be detected in young people.

Anatomy and physiology of the large intestine

Anatomically, the large intestine is the terminal (final) section of the gastrointestinal tract, originating from the ileocecal valve (the place where the small intestine passes into the large intestine) and ending in the anus. If you project the large intestine onto the front wall of the abdomen, then its beginning is approximately in the lower right corner, and begins with the caecum.
The large intestine is divided into the following sections:

1. Cecum with a appendix extending from it (the so-called appendix)
2. Ascending colon- goes up the right side of the abdomen
3. Transverse colon- starts just below the right hypochondrium, and goes in the transverse direction to the left side of the abdomen.
4. Descending colon- is a continuation of the transverse colon, goes down, but already on the left side of the abdomen.
5. Sigmoid colon- descends into the pelvic cavity
6. Rectum- is the final section of the large intestine, has a relatively short length and ends with the anus.

Risk factors for colon cancer

1. Age.
The chances of getting colon cancer increase after age 50.

2. Inflammatory diseases of the large intestine.
Bowel diseases such as ulcerative colitis and Crohn's disease increase the risk of colon cancer.
Nonspecific ulcerative colitis is characterized by inflammation and the formation of multiple ulcers, of various shapes and sizes, mainly in the mucosal layer of the large intestine. Clinically, the disease manifests itself:

• Intestinal bleeding
• Loose stool
• Cramping and pain in the abdomen (more often in the left half)
• An increase in body temperature and weight loss.

Crohn's disease is an inflammatory disease that can affect any part of the gastrointestinal tract, but most often the pathological process is localized in the large intestine and in the final section of the small intestine. Unlike non-specific ulcerative colitis, the pathological process, within the framework of Crohn's disease, can affect all layers of the intestinal wall. As a result of chronic inflammation, scar tissue forms on the intestinal wall, which can later lead to stenosis (closing of the lumen) of the intestine.
The danger of these two diseases lies in the fact that chronic inflammation of the intestinal walls contributes to the degeneration of its cells of a normal structure into tumor cells. From the newly formed tumor cells in the future, a cancerous process can develop.

3. Genetic predisposition.
If a person's family has close relatives (parents, brothers or sisters) who have been diagnosed with colon cancer, the risk of developing this pathology in other family members increases significantly. Scientists estimate that 25% of colon cancer cases may be due to a genetic factor. Some gene mutations are hereditary, while others can be acquired during life.
In the human genetic code, there are certain genes (tumor suppressor genes) that can prevent the formation of a cancerous tumor by regulating the growth of human cells. They prevent too rapid and uncontrolled cell division. When these genes mutate, they stop functioning properly, which can lead to the development of cancer.

4. Ethnic factor.
It is noted that colon cancer is much more common among immigrants from Eastern Europe of Jewish origin.

5. Nutritional factor.
A diet high in fats, especially animal sources, as well as refined carbohydrates (common soluble sugar), may increase the risk of colon cancer. Also, food containing insufficient amounts of fiber (dietary fiber) is a predisposing risk factor. Particular attention should be paid to the choice of consumed bread - yeast bread can be a starting point in the formation of an intestinal tumor.

6. Physical inactivity (lack of physical activity).
People who lead a sedentary lifestyle are at a higher risk of developing colon cancer than people who lead an active lifestyle. A sedentary lifestyle lowers the tone of the smooth muscles of the intestine. Violated peristalsis (periodic contractions of the intestine towards the anus). As a result, food stagnates for a long time, constipation occurs, and since many different bacteria live in the large intestine, fermentation processes begin accordingly, harmful toxins are formed, which leads to a violation of the microscopic structure of the mucous membrane and intestinal functions.

7. Smoking.
Recent studies have shown that smokers are 30 to 40% more likely than non-smokers to die from colon cancer. When tobacco is burned, a lot of toxic resins and carcinogens enter the lungs, which, being absorbed into the blood, have a harmful effect not only on the large intestine, but also contribute to the formation of cancer of any organ.

8. Chronic alcoholism.
Alcohol has both a direct damaging effect on the inner wall of the intestine, and through the formation of toxic metabolic products in the liver, under the influence of which normal intestinal cells turn into tumor cells.

9. Colon polyps.
The most serious precancerous condition is the presence of polyps in the large intestine. Normally, the intestinal mucosa is constantly updated. If, due to certain factors, the process of mucosal renewal is disturbed, a polyp (an outgrowth of the mucous membrane) is formed on the intestinal wall. Over time, the polyp can undergo malignant degeneration and transform into a cancerous tumor.

Colon Cancer Symptoms

At the initial stage of the disease, colon cancer can occur without symptoms. However, over time, signs may appear, the severity of which depends on the location and nature of the growth of the tumor.

Clinical symptoms in colon cancer are divided into general, associated with disruption of other organs and systems, and local, that is, those that directly appear with the growth of the tumor-like process.

local symptoms

The appearance of local signs of the disease largely depends on the department in which the primary tumor is located. The final part of the large intestine (descending section, sigmoid colon) is relatively smaller in size. Therefore, the tumor-like process can manifest itself much faster, in which the general symptoms of the disease will gradually appear and increase. While the lumen of the ascending colon and its transverse part are much wider, thus the growth of the tumor remains unnoticed for a long time. The small size of the tumor can compress the walls of the intestine, and the disease will begin to manifest itself much earlier and for the most part with the appearance of local signs.

Local manifestations of colon cancer include:

1. Constant discomfort in the abdomen. Increased gas formation and associated discomfort in the abdomen are signs of a disturbed intestinal microflora.
2. Unsteady stools that may alternate with prolonged constipation.
3. The presence of impurities of blood and mucus in the feces. The symptom is due to the collapse of the tumor and the appearance of erosions and other defects in the intestinal wall.

• If the tumor is located in the sigmoid or rectum, the blood, along with mucus, envelops the feces. With the act of defecation, fresh blood clots can be easily detected.
• If the tumor is located in the initial sections of the large intestine, the blood is mixed with feces. As you move through the intestines, the blood has time to clot and changes its color from red to darker - burgundy.

1. Pain during defecation. Pain may occur when the tumor is localized in the sigmoid or rectum. Painful defecation is caused by the germination of the tumor in the nerve plexuses located in the mucous and submucosal layers of the intestinal wall, as well as mechanical irritation of the intestinal wall.
2. Feeling of incomplete emptying of the bowels. Appears when the tumor grows into the lumen of the intestine and partially closes its lumen. In this case, part of the feces remains inside the intestines.
3. Ribbon-like stools (in later stages). They are the result of infiltrative growth of a tumor located in the rectum. Infiltrative growth means that the tumor does not grow into the intestinal lumen, but spread along the walls. The tumor-like process captures all layers of the intestine. The walls lose their elasticity, thicken, and therefore the intestinal lumen can narrow significantly over a large area. Fecal masses, passing through narrowed passages, acquire a ribbon-like character.

General symptoms

1. Anemia(decrease in the level of hemoglobin and / or the number of red blood cells in the blood). For the formation of hemoglobin, a trace element such as iron is necessary. And for the formation of red blood cells, the presence of vitamin B-12 is necessary. during destructive processes in the large intestine, the absorption of these substances is disrupted, which in turn leads to the appearance of symptoms of anemia.

• There is weakness, dizziness, headache, decreased ability to work.
• Patients look pale. Dry skin, brittle hair, thin weak nails - all this indicates the appearance of anemia.

1. Loss of appetite. Accompanied with weight loss, and is one of its causes.

• Cancer, like any other pathological process in the body, requires the mobilization of all reserve reserves. Eating and digestion is an energy-dependent physiological process. Therefore, one should not be surprised why sick people, and especially cancer patients, refuse to eat.
• Appetite can also be lost while taking chemotherapy. Cytostatics (chemotherapeutic drugs) are very toxic to the body, and besides, they inhibit the vital activity of not only cancer cells, but also normal tissues of the body.

1. Unexplained weight loss. Usually, weight loss accompanies any pathological tumor-like process, in its later stages of development. Colon cancer is no exception. There are several points of view regarding weight loss in cancer. In the later stages of the cancer process:

• Digestion processes are significantly disturbed. The normal mucosa disappears and a tumor grows in its place. Nutrients are simply not absorbed into the body and are not absorbed. Together with a deficiency of vitamins and minerals, the body uses the internal reserves of the body, which, by the way, are not unlimited.
• The collapse of the tumor is accompanied by significant chronic blood loss, the development of symptoms of anemia, which leads to gradual weight loss.
• Also, during the decay of tumor masses, cancer cells spread throughout the body with blood flow, eventually causing a dysfunction of other organs. Toxic substances released into the blood from a decaying tumor poison the body, disrupting the normal course of metabolic processes. The patient gradually begins to lose weight.

Diagnosis of colon cancer

Detection of colon cancer in the early stages of development is difficult due to the lack of characteristic symptoms. As mentioned above, in most cases, cancer develops from adenomatous polyps (glandular tissue), so early detection of colon polyps is extremely important to prevent colon cancer. Clinical manifestations usually appear in the later stages of the disease.

When making a diagnosis of colon cancer, the following diagnostic techniques may be informative:

1) Finger examination of the rectum.
This procedure is carried out in the doctor's office and does not require special equipment. For rectal examination, the patient can take various positions of the body:

• lying on its side with legs bent at the knee and hip joints;
• knee-elbow position;
• lying on your back with knees bent and legs brought to the stomach;

The doctor inserts the index finger into the rectum, after putting on a rubber glove and lubricating the finger with petroleum jelly, and examines the lower rectum for neoplasms. Despite the painlessness and safety of this examination method, it cannot be used to study the upper rectum and overlying segments of the large intestine. In addition, the doctor may not feel small polyps.

Endoscopic research methods

Sigmoidoscopy is used to examine the rectum and lower sigmoid colon
The main instrument is the sigmoidoscope. It is a flexible optical tube equipped with a light fixture. The powerful optics of this device allows you to magnify the image several times and detect the slightest pathological changes in the mucous membrane of the large intestine.
The device is inserted into the anus, previously, being lubricated with a special gel or petroleum jelly. This diagnostic method allows you to detect colon cancer at an early stage, as well as remove polyps in the above sections of the colon.
Colonoscope, similar to a sigmoidoscope, is a long flexible tube equipped with a video camera. During colonoscopy, the image is displayed on the monitor, which allows the doctor to more easily manipulate the device. This procedure is the most sensitive method for diagnosing colon cancer.
Unlike sigmoidoscopy, this examination method allows you to visualize the entire large intestine. If the doctor finds polyps during the procedure, they may remove them immediately or take tissue samples for further histological analysis.

X-ray diagnostic methods

1. barium enema

Barium sulfate is a radiocontrast agent that absorbs X-rays well. A suspension of barium sulfate, which looks like a milky slurry, is introduced into the intestine through the rectum using an enema. The doctor then takes a series of x-rays.

Barium evenly covers the walls of the large intestine and allows you to visualize this area in the picture. The presence of polyps or cancerous growths in the large intestine is manifested in the picture by a characteristic sign called a “filling defect”.

Recently, the use of cancer vaccines has become increasingly important. The principle of the vaccine is to stimulate your own immune system to fight the disease. For example, a new development at Oxford University, the TroVax vaccine, has shown positive results in clinical trials for the treatment of colon cancer.

What are the stages of colon cancer?

As with other malignant tumors, TNM classification is used for colon cancer:

T is the prevalence of the primary tumor in the intestine
TX	There are too few data to estimate the prevalence of the tumor.
T0	The primary tumor in the intestine can not be determined.
Tis	The tumor grows within the mucosa.
T1	The tumor grows into the submucosa.
T2	The tumor grows into the muscular layer of the intestinal wall.
T3	The tumor grows through all layers of the intestinal wall.
T4	The tumor grows into neighboring organs.
N - the presence of cancer cells in regional (located next to the tumor) lymph nodes
NX	Too little data to assess the condition of regional lymph nodes.
N0	There are no signs of tumor spread to regional lymph nodes.
N1	The tumor has spread to 1-3 regional lymph nodes.
N2	The tumor has spread to 4 or more regional lymph nodes.
M - the presence of distant metastases in various organs
М0	There are no distant metastases.
M1	There are distant metastases.

According to these indicators, the prevalence of the tumor, the severity of the disease, and the prognosis for the patient are judged. For convenience, there are 4 stages of colorectal cancer:

Stage	Compliance with the classificationTNM	Description
0	TisN0M0	The tumor grows within the mucosa and does not spread to other layers of the intestinal wall. Such a tumor is called carcinoma in situ or "cancer in situ".
I	T(1-2)N0M0	The tumor grows into the intestinal wall, but does not go beyond it. There are no metastases in regional lymph nodes.
II	T(3-4)N0M0	The tumor grows through the intestinal wall. There are no metastases in regional lymph nodes.
III	T(any)N(1-2)М0	The tumor grows through the entire thickness of the intestinal wall. There are single or multiple metastases in regional lymph nodes.
IV	T(any)N(any)M1	There are distant metastases in other organs.

In the early stages, colon cancer responds better to treatment, the patient has a better chance. But in the beginning, the symptoms are poor, so people with colorectal cancer usually see an oncologist already in the advanced stages.

How does colon cancer progress after surgery? What are the predictions?

Periods after surgery:

• Severe bowel dysfunction. This period usually lasts up to 2 months.
• Psychological and functional adaptation. Lasts 4 to 6 months. The patient gets used to the conditions of life that have changed due to the disease.
• stable adaptation. It occurs in 4-12 months, depending on the volume of the operation.

After treatment, every patient with colon cancer should be observed by an oncologist. Sample monitoring program:

• In the first 1-3 years, you need to visit a doctor every 6 months.
• Then for life you need to be to the oncologist once a year.

During the next visit to the oncologist, the following examination can be carried out:

• medical examination;
• complete blood count and other laboratory tests - if necessary;
• blood test for cancer-embryonic antigen;
• irrigoscopy - if necessary;
• colonoscopy - if necessary;
• chest x-ray;
• Ultrasound of the abdominal cavity and retroperitoneal space;
• computed tomography, excretory urography, laparoscopy and other studies - if necessary;
• consultations of a urologist, gynecologist and other specialists - if necessary.

Like other cancers, colon cancer can recur after treatment. Therefore, it is very important to visit a doctor in a timely manner, undergo examinations and fulfill all appointments.

What is the survival rate for colon cancer?

Survival of patients directly depends on the stage at which colorectal cancer is detected. Five-year survival (percentage of patients who remain alive for 5 years from the time of diagnosis and initiation of treatment) for different stages of colon cancer:

• Stage I - 90-93%;
• Stage II - 70-75%;
• Stage III - 40-48%;
• IV stage - 5-9%.

The overall median five-year survival for all stages is 45%.

After palliative (for incurable cancer in advanced stages) treatment, most patients live no more than 6-12 months.

In general, the outcome of treatment depends on the following factors:

• the stage at which the tumor was diagnosed;
• the presence of intestinal obstruction, perforation of the intestine;
• the presence of tumor recurrence;
• general health of the patient, the presence of concomitant diseases.

Over time, the likelihood of tumor metastasis increases, and this significantly worsens the prognosis. Therefore, it is very important to visit a doctor when the first symptoms appear, it is advisable to regularly undergo preventive screening studies, especially for people from risk groups.

How to prevent colon cancer? What are the preventive measures?

There are factors that cannot be influenced, for example, heredity. However, there are effective preventive measures that help to significantly reduce the risk of colorectal cancer:

• Regular doctor check-ups and examinations. This is especially important for people who have had colon cancer in the past, are over the age of 60, have sick relatives, suffer from precancerous diseases (Crohn's disease, colon polyps, ulcerative colitis).
• healthy eating. Your diet should contain plenty of vegetables and fruits, fiber, high quality carbohydrates. Limit your intake of red meat, fast food, or avoid these foods entirely. Give preference to healthy fats, which are found in avocados, olive oil, nuts, fish oil. But don't get too carried away with vegetarianism: Some studies have shown that people who eat a strict plant-based diet have a higher risk of colorectal cancer than meat eaters.
• go in for sports. Regular morning exercises and a simple set of exercises in general have a good effect on health, including reducing the risk of colon cancer.
• Maintaining normal body weight. It is known that obesity increases the risk of not only colorectal cancer, but also many other serious diseases.

Where can colon cancer metastasize?

Organs in which metastases are most often found in colon cancer:

• Liver. This organ receives up to 75% of the blood from the portal vein, from the intestines. In the liver, blood flow slows down, thus creating favorable conditions for metastasis. Metastatic liver cancer manifests itself in the form of emaciation, loss of appetite, nausea and vomiting, jaundice, pruritus, pain, ascites (enlargement of the abdomen due to accumulation of fluid).
• Peritoneum. It is a thin film of connective tissue that lines the inside of the abdominal cavity and covers the outside of the intestines and other organs. When the tumor invades the intestinal wall, it metastasizes to the peritoneum. First, small foci are formed, gradually they grow, spreading to neighboring areas of the peritoneum, growing into the organs that it covers. Developing peritoneal carcinomatosis,inflammation ( peritonitis).
• Lungs. Metastases of colorectal cancer in the lungs manifest as shortness of breath, chest pain, persistent cough, hemoptysis.

Metastases of colorectal cancer can be detected using ultrasound, radiography, positron emission tomography (PET), multislice computed tomography, magnetic resonance imaging (MRI), angiography, biopsy. Sometimes metastases are found earlier than the primary tumor in the intestine.

The presence of metastases worsens prognosis. However, proper treatment can significantly prolong life and alleviate the suffering of the patient. Approximately 5-10 patients out of a hundred can live another 5 years or more.

What complications can develop with colon cancer?

In addition to metastasis, colorectal cancer can cause a number of other complications:

• Complications directly related to the disease itself:
  • bowel obstruction with complete blockage of its lumen by a tumor;
  • perforation- perforation of the intestinal wall, as a result of which a hole appears in it, tumor cells and intestinal contents enter the abdominal cavity;
  • pathological messages intestinal loops between themselves and with other organs;
  • compression uterus and other internal organs;
  • violation of urination;
  • male potency disorder.


• Complications associated with surgical interventions:
  • bowel suture failure;
  • peritonitis;
  • intestinal obstruction;
  • tumor recurrence.


• Complications associated with chemotherapy and radiotherapy:
  • nausea and vomiting;
  • liquid stool;
  • decreased immunity and changes in blood counts.

How is colon cancer screening done?

Early diagnosis helps to improve the survival of cancer patients, including those with colorectal cancer. The earlier the diagnosis is established, the more effective the treatment, the more likely it is to cure the tumor.

Unfortunately, in the early stages, while the neoplasm is small, it does not show any symptoms. Colon cancer cannot be completely prevented, no one is immune. But there are screening studies, passing which regularly, you can detect a neoplasm in time.

There are three main and three additional tests that can be used to screen for colon cancer:

Screening helps to identify precancerous diseases and colon cancer at an early stage. These studies are especially important to take place after 50 years, as well as for people with risk factors, precancerous diseases.

What is targeted therapy for colon cancer?

In recent years, scientists have learned a lot about changes in the structure of genes and proteins in cancer cells. This allowed the creation of targeted drugs that target specific molecules. Their action is different from the action of chemotherapy drugs. Targeted therapy has a targeted effect on tumor cells and “does not touch” living ones. Due to this, it has a sufficiently high efficiency and fewer side effects.

Targeted drugs targeting VEGF

Bevacizumab (Avastin), Ramicirumab (Cyrasma), and Ziv-Aflibercept (Zaltrap) are drugs whose target is vascular endothelial growth factor (VEGF). This protein helps the tumor form new blood vessels so that it can receive nutrients (a process called angiogenesis).

Bevacizumab and Ramicirumab are monoclonal antibodies. These are artificially created immune proteins. Typically, these drugs are used in combination with chemotherapy to treat advanced colon cancer.

Ziv-Aflibercept - another kind of protein that targets vascular endothelial growth factor. It can also be used in combination with chemotherapy for advanced colon cancer, but only with certain combinations of chemotherapy drugs.

These drugs are given intravenously every 2 or 3 weeks. They help improve the treatment and survival of patients with colorectal cancer, but have some side effects, such as: increased blood pressure, increased fatigue, bleeding, decreased white blood cells, headaches, mouth ulcers, diarrhea, loss of appetite.

Targeted drugs targeting EGFR

Cetuximab (Erbitux) and Panitumumab (Vectibix) are monoclonal antibodies targeting the receptor epidermal growth factor (EGFR). This molecule is often found in large amounts on the surface of cancer cells and helps them grow.

Cetuximab used for metastatic colon cancer, or as a first-line therapy if all other treatments have already been tried and failed.
disability for colon cancer, will have to undergo medical and social expertise (ITU).

Indications in connection with which the doctor can refer the patient to the ITU:

• The course of treatment is completed, the prognosis is favorable, but the person cannot work by profession in the same place due to contraindications.
• The diagnosis is unfavorable or doubtful. The patient cannot work, he constantly needs care.
• After the operation, long-term consequences developed, which make the patient unable to work.

Investigations that must be completed before the medical and social examination:

• general analysis of blood and urine;
• X-ray or fluorography of the chest;
• tumor biopsy;
• examination by an oncologist, neurologist, therapist and, according to indications, other medical specialists.

Also, the doctor may, if necessary, prescribe a general analysis of feces ( coprogram), examination of feces for dysbacteriosis, consultation with a psychologist and other studies. Sometimes an examination in a hospital is required.

Disability groups for colon cancer:

Group	Explanation	Criteria
I	There is a violation of the ability to self-service, the patient needs constant care.	Incurable tumor. The presence of relapses and distant metastases in other organs.
II	Severe disability.	Patients with stage III tumor, after undergoing treatment, with a dubious prognosis. After palliative(relieving) treatment, when the patient does not need constant care. Availability colostomy and violation of its emptying. Impaired function sphincter(muscular sphincter of the rectum, which regulates the process of defecation). Pronounced violation of bowel movements.
III	Moderate permanent disability.	Patients after the treatment, who, due to their state of health, cannot continue to work in their profession (during the initial examination). The presence of a colostomy that works normally, or its function is moderately impaired (when examined after 2-3 years). Moderate dysfunction of the sphincter and bowel movements.

What is a colostomy? When does a surgeon remove a colostomy for colon cancer?

Colostomy- This is a hole in the skin into which a section of the large intestine is brought out. It is designed to expel feces and gases. Colostomy is performed for colon cancer in the following cases:

• Due to the tumor, most of the colon had to be removed.
• The surgeon did not sew the ends of the intestine after removing its section due to the high risk of complications.
• The colon tumor cannot be removed. In this case, a colostomy is applied in order to restore the patency of the intestine, the passage of feces and gases.
• The tumor is accompanied by complications (suppuration, the occurrence of fistulas), grows into neighboring organs.
• After a course of radiation therapy, severe inflammation developed in the intestine.

Depending on the indications, the colostomy is removed temporarily or permanently. In the first case, after some time, a second operation is performed, during which the hole in the skin is closed and the ends of the intestine are sutured.

After a colostomy, patients use colostomy bags- special plastic bags for collecting feces, which are attached to the colostomy area. The colostomy needs to be looked after, the colostomy bag needs to be changed regularly.

What tumor markers are determined in colon cancer?

tumor markers- These are specific proteins that are either not synthesized by normal cells at all, or are synthesized in small quantities, while cancer cells produce them in large quantities.

Tumor markers elevated in colon cancer:

• Cancer Embryonic Antigen (RAE)). Produced by the cells of the fetal digestive system during pregnancy. In adults, it is practically absent in the blood.
• SA 19-9. Oncomarker, the level of which increases in various tumors of the gastrointestinal tract and pancreas.
• SA 242. Tumor marker associated with pancreatic, colon and rectal cancer.
• SA 72-4. A specific antigen, the level of which in the blood rises in gastric carcinoma, tumors of the colon and ovaries.
• Tu M2-RK (tumor pyruvate kinase type M2). Tumor marker used to diagnose precancerous diseases and colon cancer.

Determination of tumor markers in the blood is often used to screen for colon cancer. However, if their level is elevated, this does not mean that a person has cancer. There are cases when patients were diagnosed with colon cancer in the later stages, while the level of tumor markers remained almost normal. Therefore, other screening studies are important in the early diagnosis of the disease.