Adenocarcinoma of a thick gut
The adenocarcinoma of a thick gut is the malignant new growth developing from cages of a ferruterous epithelium. At early stages proceeds with the erased clinical symptomatology. When progressing weakness, belly-aches, feeling incomplete depletion of intestines, violation of a chair, tenezma, lack of appetite, weight reduction, temperature increase to subfebrilny figures, slime and blood in Calais are observed. Intestinal impassability is possible. The diagnosis is established on the basis of complaints, the yielded objective survey and results of tool researches. Treatment – surgical removal of a tumor.
Adenocarcinoma of a thick gut
Adenocarcinoma of a thick gut – cancer developing from epitelialny cages. Makes about 80% of total of malignant tumors of a large intestine. In 40% of cases strikes a blind gut. Also the third takes the fourth place on prevalence among oncological diseases at women – at men, conceding only to cancer of a stomach, lung and mammary gland. Arises aged after 50 years more often. The probability of developing of an adenocarcinoma increases at various states and diseases which are followed by violation of a vermicular movement and deterioration in blood supply of a large intestine. At initial stages the disease usually proceeds asymptomatically or with softly expressed nonspecific clinical symptomatology that complicates diagnostics and reduces survival percent. Treatment is performed by experts in the field of oncology.
Reasons and risk factors
Assume that the adenocarcinoma of a thick gut develops as a result of a combination of several adverse factors, somatic diseases, features of a diet, some parameters of the external environment and adverse heredity are basic of which. The increased probability of developing of malignant tumors is noted at polyps of a thick gut. Include ulcer colitis, a disease in number of the somatic diseases provoking an adenocarcinoma Krone, and also the pathologies which are followed by chronic locks and adjournment of kalovy stones.
Many researchers point to importance of dietary factors. The probability of developing of an adenocarcinoma of a thick gut increases at a lack of food of vegetable cellulose and the use of a large number of meat products. Scientists consider that vegetable cellulose increases the volume of kalovy masses and accelerates their advance on intestines, limiting contact of an intestinal wall with the carcinogens which are formed when splitting fatty acids. This theory is very close to the theory of development of an adenocarcinoma under the influence of the carcinogens appearing in food at the wrong heat treatment of products.
Refer too active use of means of household chemicals to factors of the external environment, professional harm, sedentary work and an inactive way of life. The adenocarcinoma of a thick gut quite often arises at hereditarily the caused family cancer syndrome (after 50 years every third carrier of a gene), in the presence of malignant new growths at close relatives gets sick and at some not oncological hereditary diseases (for example, Gardner's syndrome).
The tumor develops under the general laws of growth and distribution of malignant new growths. The fabric and cellular atipizm, decrease in level of a differentiation of cages, a progression, unlimited growth and relative autonomy are characteristic of it. At the same time, the adenocarcinoma of a thick gut has the features. It grows and develops not so quickly as some other malignant tumors, and long remains within a gut.
Development of a new growth often is followed by the inflammation extending to nearby bodies and fabrics. Cancer cells get into these bodies and fabrics, forming nearby metastasises, at the same time the remote metastasis can be absent. The neoplasia most often spreads in a liver and lymph nodes though also other localization of the remote metastasises is possible. One more feature of a disease is frequent simultaneous or consecutive formation of several tumors in a large intestine.
Classification: types and stages
Taking into account the level of a differentiation of cages distinguish three types of an adenocarcinoma of a thick gut: high-differentiated, moderately differentiated and low-differentiated. The level of a differentiation of cages is lower – the growth of a tumor is more aggressive and the tendency to early metastasis is higher. For forecast assessment at an adenocarcinoma of a thick gut oncologists use the international classification of TNM and traditional Russian four-phasic classification. According to the Russian classification:
- 1 stage – a new growth does not go beyond a mucous membrane.
- 2 stage – a tumor sprout an intestines wall, but does not affect lymph nodes.
- 3 stage – a new growth sprout a wall of intestines and affects lymph nodes.
- 4 stage – the remote metastasises come to light.
At early stages the adenocarcinoma of a thick gut proceeds malosimptomno. As pathology often develops against the background of chronic diseases of intestines, patients can treat symptoms as the next aggravation. Violations of a chair, the general weakness, periodic belly-aches, deterioration in appetite, emergence of impurity of slime or blood in kalovy masses are possible. At defeat of the lower departments of a large intestine blood scarlet, is mainly on a surface of fecal masses. At an adenocarcinoma arrangement in the left half of intestines blood dark, mixed with slime and kalovy masses. At localization of a new growth in the right half of intestines of bleeding quite often have the hidden character.
In process of growth of a tumor symptoms become brighter. Patients with an adenocarcinoma of a thick gut are disturbed by intensive pains. The expressed fatigue develops. Anemia, temperature increase to subfebrilny figures and disgust for meat food are observed. Ponosa and locks become constants, do not pass when using medicines. The adenocarcinoma of a thick gut creates a mechanical obstacle to the movement of kalovy masses and causes frequent tenezma.
Pressure a calla on a tumor becomes the reason of its ulceration, and formation of ulcers leads to increase of bleedings and development of an inflammation. In Calais pus appears. Temperature rises to febrilny figures. Symptoms of the general intoxication are found. At many patients yellowness of skin and an ikterichnost a skler are observed. At distribution of inflammatory process on zabryushinny cellulose there are pains and tension of muscles in lumbar area. Intestinal impassability (especially – is possible at adenocarcinomas with ekzofitny growth). At late stages ascites and increase in a liver come to light. Sometimes abdominal symptoms are absent, the tumor is long shown only by weakness, increased fatigue, weight reduction and deterioration in appetite.
Diagnostics and difdiagnostika
Experts in the sphere of clinical oncology establish the diagnosis of an adenocarcinoma of a thick gut on the basis of complaints, the anamnesis, data of the general survey and a manual research of a rectum and results of tool researches. More than a half of tumors settle down in the lower departments of a large intestine and come to light when carrying out a manual research or a rektoromanoskopiya. At high localization of a new growth the kolonoskopiya is necessary. In the course of endoscopy the doctor takes a sample of tumoral fabric for the subsequent histologic research allowing to verify a tumor.
For assessment of the sizes, a form and prevalence of an adenocarcinoma use a X-ray contrast research of a large intestine (irrigoskopiya). For identification of metastasises and in the presence of contraindications to carrying out endoscopic researches, for example, at bleeding, apply ultrasonic techniques. In difficult cases of the patient with suspicion of an adenocarcinoma of a thick gut direct to MSKT of an abdominal cavity. To the patient appoint the general blood tests and urine, biochemical blood test and the analysis a calla to the hidden blood. The final diagnosis is exposed after studying of a bioptat.
Treatment of an adenocarcinoma of a thick gut
Treatment of a neoplasia quick. An important element of treatment is the preoperative preparation allowing to provide a possibility of restoration of a continuity of a large intestine and to minimize quantity of complications. To the patient appoint a besshlakovy diet and depletive. Some days before operation begin to carry out cleaning enemas. In recent years often apply washing of a GIT with use of special medicines.
The volume of radical surgical intervention at an adenocarcinoma is determined taking into account the size and an arrangement of a malignant new growth, existence or lack of regionarny metastasises. Whenever possible carry out a resection of a thick gut, and then create , restoring integrity of intestines. At a considerable tension or a low arrangement of a tumor after a rezetsirovaniye of an affected area impose to kolosty. At inoperable cancer and the phenomena of intestinal impassability carry out a palliative kolostomiya. At the remote metastasises also carry out palliative surgical interventions for prevention of complications (bleeding, intestinal impassability, an intensive pain syndrome).
Forecast and prevention
At detection of an adenocarcinoma of a thick gut at 1 stage five-year survival makes about 90%. If treatment is begun on 2 stages, the five-year threshold of survival is overcome by 80% of patients. On 3 stages survival decreases to 50-60%. At damage of a rectum the forecast worsens. After operation of patients place under observation, recommend to examine regularly kcal on availability of blood and slime. Carry quarterly out a rektoromanoskopiya or a kolonoskopiya. Time in 6 months of patients is directed to ultrasonography of internals for identification of the remote metastasises. About 85% of a recurrence of an adenocarcinoma of a thick gut arise in the first two years after surgery.