Tumors of a large intestine are a group of diseases which are characterized by neoplastic processes in different departments of a thick gut of malignant or good-quality character. Symptoms depend on a look and localization of a tumor. The main manifestations – belly-aches, problems with a chair, a meteorizm, bleedings, anemia. Diagnose pathology by means of an anoskopiya, rektoromanoskopiya, kolonoskopiya, irrigoskopiya with double contrasting. Additional methods – ultrasonography of abdominal organs, KT, the analysis on tumoral markers. Treatment is surgical, at malignant inoperable tumors carry out palliative therapy.
Tumors of a large intestine
Tumors of a large intestine are good-quality or malignant new growths of a different etiology which develop from epitelialny or other fabric of walls of a thick gut and can affect any its departments. Benign tumors are quite widespread, according to different data they come to light at 16-40% of the population. In many cases good-quality process passes into malignant over time. Cancer tumors of a large intestine take the third place among other malignant pathology of a gastrointestinal tract (after cancer of a stomach and tumors of a gullet).
Among all oncopathology malignant tumors of a large intestine on frequency concede only to lung cancer, cancer new growths in a stomach and to a breast cancer. Statistically, in Britain every year about 16 000 thousand patients, and in the USA – 50 000 patients die of this pathology. Men have diseases of this group, especially malignant, reveal slightly more often, than at women. Relevance of tumors of a large intestine increases every year, mainly in the developed countries of the northern hemisphere. Good-quality processes are also dangerous, as well as malignant as they have tendency to a malignization.
Reasons of tumors of a large intestine
The reasons which lead to developing of tumors of a large intestine, are studied long ago, but to a consensus scientists and clinical physicians (proctologists, surgeons) did not come. All agree in opinion that this group of diseases is polietiologichny. The risk of formation of pathology increases with age. The diet rich with animal protein, fats and poor in cellulose is of great importance. Such diet conducts to frequent locks, an imbalance of intestinal flora. Intestines contents with the high content of the bilious acids and phenols having cancerogenic properties contact to walls longer that raises a possibility of development of tumors of a large intestine. Connect bigger spread of tumors of a large intestine in the developed countries with it. Also carcinogens which contain in industrial preservatives, smoked products matter.
In developing of tumors of a large intestine, both malignant, and good-quality character, inflammatory diseases have important value. At a long current (five years and more) they can be complicated by cancer. The most dangerous in this plan is nonspecific ulcer colitis: almost diagnose malignant tumors for a half of patients who are ill more than thirty years. A little smaller percent of a malignization is noted at patients with a disease Krone. Also heredity matters. It is completely proved in case of such diseases as diffusion intestines polyposes, it is partially proved at a colorectal cancer. The virus theory of emergence of good-quality polyps of intestines is still finally not confirmed.
Classification of tumors of a large intestine
Tumors of a large intestine divide on good-quality and malignant, and also into tumors of an epitelialny and neepitelialny origin. On the international morphological classification allocate the following epitelialny benign tumors of a large intestine: tubulyarny adenoma, fleecy adenoma, tubulyarno-fleecy adenoma, adenomatosis. From neepitelialny the following is known: lipoma, leyomioma, leyomiosarkoma, angiosarkoma and Kaposha's sarcoma. Epitelialny tumors the most widespread, they make about 92% of all new growths, have big tendency to malignant regeneration.
Also distinguish opukholepodobny defeats of a thick gut (gamartoma) from good-quality processes: Peyttsa-Egers's polyp, juvenile polyp. Geterotopiya occur among tumors of a large intestine: hyper plastic or metaplastic polyp, good-quality lymphoid, inflammatory and deep cystous polyp. On prevalence distinguish single, multiple (grouped and located it is disseminated) polyps, diffusion polyposes.
Malignant tumors of a large intestine on the nature of growth divide into four types:
- ekzofitno-polipovidny tumors which grow in a gut gleam;
- the endofitno-ulcer tumors extending in a gut wall often give ulcerations;
- diffusion and infiltrative tumors (malignant cages have diffusion distribution in walls of body);
- annulyarny tumors - grow on a gut circle.
In two last cases histologic borders of tumoral process difficult are defined, cages can get into sites which at first sight look healthy.
At classification of malignant tumors of a large intestine the process stage is of great importance. Staging is defined by the international standard classification of TNM where T is extent of germination of a tumor in fabric, N – existence or lack of metastasis in regionarny lymph nodes, M – the remote metastasis.
There is no T0 – signs of tumoral growth
Tx – is impossible assessment reliable primary tumor
Tis – carcinoma in situ, or cancer "on the place", does not sprout mucous
T1– spread of a tumor on a submucous layer
T2 germination tumor of a muscular layer
T3– spread of a tumor on a muscular layer and penetration into the fabrics around a large intestine which are not covered with a peritoneum.
T4 – germination by a tumor of a visceral peritoneum or distribution on the bodies and fabrics located in the neighbourhood.
Nx – cannot estimate a condition of regionarny lymph nodes. There is no N0 – metastasises in regionarny lymph nodes. N1 – metastasises in 1-3 lymph nodes which are around a large intestine. N2 – metastasises in four and more lymph nodes located around a large intestine. N3 – metastasises in lymph nodes which are along vessels. Mx-remote metastasises cannot be defined. There is no M0 – metastasises. M1 – is metastasises in the remote bodies.
According to classification of TNM allocate four stages of cancer tumors of a large intestine. A zero stage - TisN0M0. The first stage - T1N0M0 or T2N0M0. The second stage - T3N0M or T4N0M0. The third stage – any indicators of T and N1M0, any indicators of T and N2M0 or any indicators of T and N3M0. The fourth stage – any indicators of T and N, M1.
Along with this classification, in many European countries and the countries of North America use classification of tumors of S. E. Dukes offered in 1932. Tumors of a large intestine also divide into four stages designated by Latin letters. The stage And – tumoral process extends within a mucous and submucous layer (T1N0M0 and T2N0M0). The stage In – a tumor sprouts in all layers of walls of intestines (T3N0M and T4N0M0). The stage With – a tumor can be any size, but there are metastasises in regionarny lymph nodes. The stage of D – is the remote metastasises.
Symptoms of tumors of a large intestine
Benign tumors of a large intestine often proceed asymptomatically and come to light incidentally. Sometimes patients have a discomfort in a stomach, an unstable chair or blood in Calais. The big size fleecy tumors because of hyperproduction of slime can cause violation of water and electrolytic balance, change of proteinaceous composition of blood, anemia. Also large benign tumors sometimes result in impassability of intestines, provoke invagination. The symptomatology at multiple or diffusion can be more brightly expressed to a polypose.
Cancer tumors of a large intestine develop rather slowly and right at the beginning can clinically not be shown. One of the first symptoms of a disease are bleedings and anemia. At tumors of a rektum and disteel department of a sigmovidny gut blood scarlet, does not mix up with slime. If pathological process affects the descending obodochny gut – blood dark, evenly mixed with slime and a stake. Bleedings at malignant process in proximal departments very often happen hidden and are shown only by anemia.
Except bleedings, at cancer tumors of a large intestine patients can have belly-aches, tenezma, problems with a chair. Locks arise at late stages of process, in the started cases intestinal impassability often develops. Cancer damages of a rectum cause a feeling of incomplete depletion, a tenezma at patients. Patients complain of the general weakness, appetite loss, note sharp loss of weight. With progressing of a disease the liver increases, symptoms of ascites appear.
Diagnosis of tumors of a large intestine
For diagnosis of tumors of a large intestine use a number of techniques. At an anoskopiya and a rektoromanoskopiya find tumors and polyps in a rectum, the disteel site of a sigmovidny gut. After performing endoscopy carry out an irrigoskopiya with double contrasting by introduction to intestines of air and a baric suspension. The technique allows to reveal tumors of a large intestine of the different size; difficulties in diagnostics can arise if process is localized in a blind gut.
The following investigation phase – carrying out a kolonoskopiya which allows to reveal tumors of a large intestine, small by the size, to examine it throughout. Also by means of this method it is possible to take and to remove the small size polyps. Kolonoskopiya has big sensitivity in comparison with an irrigoskopiya, but the most reliable results can be received when using endoscopy and a contrast X-ray analysis.
For identification of metastasises at malignant tumors of a large intestine use ultrasonography of abdominal organs, a computer tomography, scanning of bone system, in the presence of neurologic symptoms – brain KT. Tumoral markers have rather predictive, than diagnostic value. At the low-differentiated new growths the cancer and embryonic anti-gene raises though it is not specific for this purpose like tumors. At detection of primary tumors of a large intestine markers of CA-19-9 and SA-50 are considered as the most informative markers, but at a recurrence they can not be defined.
Treatment of tumors of a large intestine
The only effective method of treatment of tumors of a large intestine in a modern proktologiya – surgical. At small good-quality processes without signs of a malignization carry out removal of a new growth, at multiple defeat – a part of a large intestine. Surgeries at tumors of a rectum carry out by transrectal access.
At malignant tumors of a large intestine operation volume more radical. Delete not only a new growth, but also regional lymph nodes even if in them metastasises are not revealed. Whenever possible during surgical interventions try to keep a natural way of a passage of intestinal contents. If there is no such opportunity, bring kolosty to a forward belly wall. Except expeditious treatment, appoint chemotherapy 5-ftoruratsily, ftorofury, radiation therapy.
Forecast and prevention of tumors of a large intestine
The forecast at tumors of a large intestine not always favorable. Even benign epitelialny tumors or polyps have high tendency to malignant regeneration. In many respects survival of patients depends on timely diagnostics and adequately performed surgery.
Prevention of tumors of a large intestine consists, first of all, in healthy nutrition. It is necessary to use less smoked and preserved foods, meat and animal fats. At the choice of products it is necessary to give preference to those which contain a large amount of cellulose. It is necessary to reconsider a way of life: low physical activity favors to developing of tumors of a large intestine. It is necessary to reveal and treat various inflammatory diseases of digestive tract in time.