Colorectal cancer – malignant tumoral defeat of various departments of a large intestine. At the initial stage flows asymptomatically. In the subsequent it is shown by weakness, an indisposition, appetite loss, belly-aches, dyspepsia, a meteorizm and intestinal frustration. The phenomena of intestinal impassability are possible. The ulceration of a new growth is followed by bleedings, however blood impurity in Calais at a colorectal cancer of the top departments of intestines can visually not be defined. The diagnosis is established taking into account complaints, the anamnesis, data of survey, the analysis a calla on the hidden blood, by kolonoskopiya, irrigoskopiya, ultrasonography and other researches. Treatment – operations, chemotherapy, radiotheraphy.
Colorectal cancer – group of the malignant new growths of an epitelialny origin located in the field of a thick gut and the anal channel. Is one of the most often found cancer forms. Makes nearly 10% of total of the diagnosed cases of malignant epitelialny tumors around the world. Prevalence of a colorectal cancer in various geographical zones strongly differs. The highest incidence comes to light in the USA, Australia and countries of Western Europe.
Experts quite often consider a colorectal cancer as the "civilization disease" connected with increase in life expectancy, insufficient physical activity, the use of a large number of meat products and insufficient amount of cellulose. In the last decades in our country growth of incidence of a colorectal cancer is noted. 20 years ago this disease was in the 6th place on prevalence at patients of both floors, now moved to the 3rd place at men and to the 4th at women. Treatment of a colorectal cancer is performed by experts in the sphere of oncology, gastroenterology, a proktologiya and abdominal surgery.
Colorectal cancer reasons
The etiology is definitely not established. Most of researchers consider that the colorectal cancer is among the polietiologichesky diseases arising under the influence of various external and internal factors basic of which genetic predisposition, existence of chronic diseases of a large intestine, feature of a diet and way of life are. Modern experts are more and more accented for food roles in development of malignant tumors of a thick gut.
It is established that the colorectal cancer is more often diagnosed for people who use a lot of meat and not enough cellulose. In the course of digestion of meat products in intestines a large amount of the fatty acids turning into cancerogenic substances is formed. The small amount of cellulose and insufficient physical activity lead to delay of an intestinal vermicular movement. As a result a large number of cancerogenic agents contacts to an intestines wall for a long time, provoking development of a colorectal cancer. The factor aggravating this circumstance is the wrong processing of meat which is even more increasing amount of carcinogens in food. A part is played by smoking and alcohol intake.
Statistically, patients with chronic inflammatory diseases of a large intestine have a colorectal cancer more often than the people who do not have similar pathology. The highest risk is noted at patients with nonspecific ulcer colitis and disease Krone. The probability of developing of a colorectal cancer directly correlates with a duration of inflammatory process. Lasting disease less than 5 years the probability of a malignization makes about 5%, lasting more than 20 years – about 50%.
At patients polipozy a large intestine the colorectal cancer comes to light more often than on average on population. Single polyps regenerate in 2-4% of cases, multiple – in 20% of cases, fleecy – in 40% of cases. The probability of regeneration in a colorectal cancer depends not only on quantity of polyps, but also on their sizes. Polyps less than 0,5 cm in size practically are never exposed to a malignization. The polyp is larger – the risk of an ozlokachestvleniye is higher.
The colon cancer quite often develops in the presence of a colorectal cancer and other malignant new growths at the immediate family. Such cancer is often diagnosed for patients with a family diffusion polipoz, Tyurko's syndrome and Gardner's syndrome. Among other contributing factors specify age 50 years, the obesity, insufficient physical activity, diabetes, a lack of calcium, hypovitaminoses, immunodeficiency caused by various chronic diseases, weakening of an organism and reception of some medicines are more senior.
Colorectal cancer symptoms
At the I-II stages the colorectal cancer can proceed asymptomatically. In the subsequent manifestations depend on localization and features of growth of a new growth. Weakness, an indisposition, fatigue, appetite loss, unpleasant smack in a mouth, an eructation, nausea, vomiting, a meteorizm and feeling of weight in an epigastriya are observed. The belly-aches which were more expressed at tumors of the left half of intestines (especially – an obodochny gut) become one of the first symptoms of a colorectal cancer often.
The stenoziruyushchy or infiltrative growth which is quickly resulting to chronic, and then and in sharp intestinal impassability is characteristic of such new growths. Pains at intestinal impassability sharp, sudden, skhvatkoobrazny, repeating in 10-15 minutes. Violations of activity of intestines which can be shown in the form of locks, diarrhea or alternation of locks and ponos, a meteorizm become one more display of a colorectal cancer more brightly expressed at defeat of an obodochny gut.
The colorectal cancer located in the right department of a large intestine grows ekzofitno more often and does not create serious obstacles to advance of a himus. The continuous contact with intestinal contents and the insufficient blood supply caused by inferiority of vessels of a new growth provoke frequent necroses with the subsequent ulceration and an inflammation. At such tumors the hidden blood and pus in Calais especially often come to light. The symptoms of intoxication connected with absorption of products of disintegration of a new growth during their passing on intestines are observed.
The colorectal cancer of ampulyarny department of a rectum too often izjyazvlyatsya and inflames, however in similar cases of impurity of blood and pus in Calais easily are defined visually, and symptoms of intoxication are expressed less brightly as necrotic masses does not manage to be soaked up through an intestines wall. Unlike hemorrhoids, blood at a colorectal cancer appears at the beginning, but not at the end of defecation. Typical manifestation of malignant damage of a rectum is the feeling of incomplete depletion of intestines. At new growths of anal department pains at defecation are observed and a taenioid chair.
Because of the repeating bleedings anemia can develop. At localization of a colorectal cancer in the right half of a large intestine symptoms of anemia quite often appear already at the initial stage of a disease. Data of external survey depend on an arrangement and the sizes of a tumor. The new growths of rather big size located in the top departments of intestines manage to be probed at a stomach palpation. The colorectal cancer of a rectum comes to light during rectal survey.
Depending on the prevailing symptomatology distinguish four clinical forms of a colorectal cancer:
- Toksiko-anemichesky form of a colorectal cancer. The main symptom is the progressing anemia in combination with so-called "small signs" (weakness, weakness, fatigue) and an insignificant hyperthermia.
- Enterokolitichesky form of a colorectal cancer. Intestinal frustration prevail.
- Dispepsichesky form of a colorectal cancer. To the forefront there are belly-aches, weight loss, appetite loss, an eructation, nausea and vomiting.
- Obturatsionny form of a colorectal cancer. Symptoms of intestinal impassability prevail.
Colorectal cancer complications
The most widespread complication of a colorectal cancer is the bleeding arising at 65-90% of patients. Frequency of bleedings and volume of blood loss strongly vary. The small repeating blood losses gradually leading to development of iron deficiency anemia are in most cases observed. Less often at a colorectal cancer there are profuzny bleedings posing a threat for the patient's life. At defeat of the left departments of a sigmovidny gut obturatsionny intestinal impassability quite often develops. One more heavy complication of a colorectal cancer is perforation of a wall of intestines.
New growths of the lower departments of a large intestine can sprout the next bodies (a vagina, a bladder). The local inflammation in the field of low located tumor can provoke purulent defeats of surrounding cellulose. The gut perforation at a colorectal cancer of the top departments of intestines involves development of peritonitis. In the started cases the combination of several complications can be observed that significantly increases risk of surgery.
Diagnosis of a colorectal cancer
The diagnosis is established by the proctologist, the gastroenterologist or the oncologist on the basis of complaints, the anamnesis, the yielded general and rectal survey and results of additional researches. The most available screening researches at a colorectal cancer are the analysis a calla on the hidden blood, a rektoromanoskopiya (at a low arrangement of a tumor) or a kolonoskopiya (at a high arrangement of a new growth). At inaccessibility of endoscopic techniques of patients with suspicion of a colorectal cancer direct to an irrigoskopiya. Considering lower informational content of X-ray contrast researches, especially in the presence of small single tumors, in doubtful cases the irrigoskopiya is repeated.
For assessment of aggression of local growth of a colorectal cancer and identification of the remote metastasises carry out a X-ray analysis of a thorax, ultrasonography of abdominal organs, ultrasonography of bodies of a small pelvis, a tsistoskopiya, urography etc. In difficult cases at germination of nearby bodies of the patient with a colorectal cancer direct to KT and MPT of internals. Appoint the general blood test for definition of weight of anemia and biochemical blood test for assessment of violations of functions of a liver.
Treatment and the forecast at a colorectal cancer
The main method of treatment of a colorectal cancer – surgical. The volume of operation is defined by a stage and localization of a new growth, extent of violation of intestinal passability, weight of complications, the general condition and age of the patient. Usually carry out a gut segment resection, at the same time deleting nearby lymph nodes and okolokishechny cellulose. At a colorectal cancer of the lower departments of intestines depending on localization of a new growth carry out a bryushnoanalny extirpation (removal of a gut together with the switching device and imposing of a sigmostoma) or a sfinkterosokhranyayushchy resection (removal of the struck department of intestines with bringing down of a sigmovidny gut at preservation of the switching device).
At spread of a colorectal cancer on other departments of intestines, a stomach and a belly wall without the remote metastasis carry out expanded operations. At the colorectal cancer complicated by intestinal impassability and perforation of intestines will see off two – or three-stage surgical interventions. In the beginning impose to kolosty. The new growth is deleted at once or after a while. To Kolosty close in several months after the first operation. Appoint before - and postoperative chemotherapy and radiotheraphy.
The forecast at a colorectal cancer depends on a stage of a disease and weight of complications. Five-year survival after the radical surgeries which are carried out at the I stage makes about 80%, at the II stage – 40-70%, at the III stage – 30-50%. At metastasis treatment of a colorectal cancer mainly palliative, a five-year boundary of survival is possible to reach only 10% of patients. The probability of emergence of new malignant tumors in the patients who had a colorectal cancer makes 15-20%.