Colon cancer (colonic and direct)
Colon cancer (colonic and direct). In recent years, there has been a significant increase in the incidence of colorectal cancer. Adenomas, diffuse poly-poses and ulcerative colitis increase the risk of developing cancer and are considered as trans-tumor diseases. Thus, malignancy with diffuse polyposis occurs almost in 100% of cases.
The localization of colon cancer may be different - in the ascending, transverse, colonic, descending, sigmoid colon. Cancer of the rectum is located in the anal, lower, middle, upper ampullar and rectosigmoid section. The tumor grows mainly exophytally (into the lumen of the intestine) or endophyte (into the thickness of the intestinal wall). Often diagnosed adenocarcinomas, rarely the tumor has a structure of cricoid-cell, undifferentiated or squamous cell carcinoma. Metastasizes colorectal cancer in regional lymph nodes, liver, lungs, sometimes in other organs. The classification of this disease is carried out according to the TNM system with the specification of the depth of tumor germination into the intestinal wall and on the basis of the operating data of the operating material.
The clinical picture: discharge from the gut of blood with an admixture of mucus and pus, disorders of the rhythm of defecation (diarrhea and constipation, tenesmus), abdominal pain, general weakness, weight loss, fever, anemia, etc. Clinical symptoms vary depending on the location of the tumor . At the initial stages of the disease, its manifestations may be insignificant (dyspeptic symptoms, anemia with latent blood loss, etc.). Later signs of the disease increase, in severe cases, there are intestinal obstruction, bleeding, inflammatory complications (abscess, phlegmon, peritonitis). With cancer of the rectum, the tumor can germinate into the bladder, vagina with the development of fistulas, cause compression of the ureters, etc.
The diagnosis of colorectal cancer in the early stages is based on data from digital rectal examination, irrigoscopy, sigmoidoscopy and colonoscopy (with biopsy). Clinical risk groups are subject to follow-up. In other cases, the selection of patients for examination is carried out after the analysis of clinical symptoms, the results of the analysis of feces for the presence of blood, the determination of the carcinoembryonic antigen in the blood. To exclude meta stasis in the liver, ultrasound imaging is performed.
Treatment. The main method of treatment of colorectal cancer is surgical. After radical surgery, the 5-year survival rate is 50-60%. With colorectal cancer, a right-sided or left-handed hemicolectomy is performed. When the tumor is localized in the distal third of the sigmoid colon, it is resected. With rectal cancer, an operation is performed with the removal of the terminal apparatus (abdominal-perineal extirpation with colostomy) or its preservation (abdominal-anal resection with or without colon colonization, anterior resection, Hartmann's operation). Palliative surgery can reduce the manifestations of the disease (bypass intestinal anastomosis, colostomy with obstruction, palliative resection with metastases to the liver, bandaging or embolization of the hepatic artery, etc.).
Radiation therapy can cause partial regression of the tumor. More often it is used for primary and recurrent rectal cancer. Chemotherapy is used only in cases of an inoperable tumor and metastases. It is effective in 20-40% of patients. The most commonly prescribed fluoroufur. More effective combinations of ftorafur or 5-fgor-uracil with other drugs (mitomycin C, lomustine, adriamycin, cisplatin).
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