Bowel cancer signs, symptoms, stages and treatment
- What is Colon Cancer?
- Bowel cancer symptoms
- First signs
- Bowel Cancer Causes
- Intestinal metastases
- How long do you live with bowel cancer?
- Colon cancer treatment
What is Colon Cancer?
Bowel cancer is a malignant transformation of the glandular epithelium, predominantly of the colon or rectum. In the first stages, sluggish symptoms are characteristic, distracting from the primary pathology and resembling an upset of the gastrointestinal tract. The leading radical method of treatment is surgical excision of the affected tissue.
In official medicine, bowel cancer is referred to as "colorectal cancer". This is a collective name, consisting of two roots: "columns" and "rectum". It is in the corresponding parts of the intestine that the maximum number of primary malignant tumors is detected.
Colon (Latin colon) is the colon with four consecutive sections:
- ascending, which is located vertically on the right side of the human body;
- descending - vertically on the left side;
- transverse - connects the ascending and descending sections, located in the upper abdominal cavity, just below the stomach and liver;
- sigmoid - forms a kind of short bend in the form of a letter (Σ), is located below on the left side and connects the descending and rectum.
Rectum (Latin rectum) is the rectum (located in the small pelvis).
In the cecum and appendix (third section of the large intestine) and the small section (duodenum, jejunum, ileum), malignant neoplasms are much less common. The average incidence of cancer outside the colon is 0.4-1.0% of all cases of intestinal oncology.
Important epidemiological features of bowel cancer:
- occupies a leading position in the structure of oncological diseases, inferior to: in men - stomach cancer and lung cancer, in women - breast cancer;
- the most common morphological form of this cancer is adenocarcinoma (malignant degeneration of benign polyps of the intestine, consisting of glandular tissue);
- the probability of developing adenocarcinoma in the intestine is 98-99%, the incidence of sarcoma and other types of tumors does not exceed 1-2%;
- the most frequent localization of the tumor: in the rectum (about 50%), in the sigmoid colon (up to 40%), in the descending and ascending colon (about 7%), in the transverse intestine (about 3%);
- in women more often (up to 55%) they are diagnosed with cancer of the colon, in men (up to 60%) - of the rectum;
- the disease occurs at any age, a sharp rise in the incidence is noted after 40 years, the peak falls on the period from 60 to 75 years.
In Russia, about 40 thousand cases of colorectal cancer are diagnosed annually with a mortality rate of up to 30 thousand. High mortality is associated with the state of health of the elderly, almost always with concomitant pathologies.
The paradox is that colorectal cancer does not belong to pathologies with difficult-to-detect symptoms. This disease can be detected by modern instrumental and laboratory methods even at the earliest stages, however, it is distinguished by a significant number of diagnostic errors associated with a variety of clinical manifestations of the disease.
In this regard, it is very important:
- qualification and oncological alertness of doctors who carry out the initial appointment at the district clinic;
- attentiveness of patients (especially older and elderly) suffering from disorders of the gastrointestinal tract and included in the risk groups for colorectal cancer.
Diagnosis of any disease, and especially in the early stages, is always a dialogue between the doctor and the patient. Very often, information from a patient who correctly describes the symptoms of the disease is crucial.
However, the patient's alertness is not the main link in the timely diagnosis of cancer for the following reasons:
- A doctor conducting an appointment at a polyclinic may not pay attention to signs of oncology in the flow of patients. Its symptoms are diverse, possibly erased, especially since increased fatigue, weight loss, diarrhea, blood in the stool, discomfort or pain in the abdomen, heart palpitations (the main signs of the first stages) resemble many diseases, and are effectively, albeit temporarily, eliminated medicines.
- It is sometimes psychologically difficult for a local therapist to replace a previously made diagnosis associated with a banal chronic indigestion with a frightening one - cancer, and promptly refer the patient to a narrow specialist for a highly sensitive examination;
- Only the patient knows about his own predisposing risk factors for oncology in the form of similar diseases in blood relatives, the peculiarities of his personal lifestyle, the nature of work, nutrition, the presence of some individual delicate symptoms.
The knowledge gained in the framework of this educational article will help an ordinary person understand the causes of the disease in an amount sufficient to draw the attention of a polyclinic doctor to this problem during the initial appointment.
Cancer is not always a sentence! This is a situation where it is better to err in the assumption of a formidable diagnosis than to erroneously make a banal diagnosis. For the timely detection of pathology, a prepared patient is needed who does not fall into depression only from suspicion of oncology in his body.
Bowel cancer symptoms
Cancer diagnosis based on clinical symptoms alone is futile due to the many manifestations of the disease. The following description of the symptoms is given to show the variety of manifestations of pathology, and to confirm the importance of competent medical diagnosis with modern methods.
Colorectal cancer has no characteristic (pathognomonic) symptoms. There are several groups of symptoms of intestinal cancer that characterize various pathological processes inside the patient's body.
The initial stages of bowel cancer are accompanied by a violation of the integrity of the mucous membranes of the intestinal walls.
As a result, the gate of infection opens, the contents of the intestine enter the bloodstream, causing intoxication, which manifests itself:
- increased fatigue, weakness, headache, nausea, other signs of intoxication;
- high body temperature, joint pain (a consequence of toxicosis);
- loss of blood from small vessels of the intestinal wall, anemia, pallor of the mucous membranes, a decrease in hemoglobin levels, thickening of blood, a change in its other parameters and, as a consequence, a change in the rhythm of the heart and respiration.
The disease can be confused with a variety of intoxications caused, for example, by inflammatory diseases of the heart, joints or upper respiratory tract.
Enterocolitic inflammation of the large intestine: symptoms
This inflammation is formed mainly with extensive damage to the mucous membranes, when toxins begin to enter the blood from the surface of the damaged membranes, while in addition to intoxication, a disorder of the intestinal function occurs.
Pathology manifests itself:
- an increase in body temperature, resembling an infectious fever;
- constipation and more often - diarrhea;
- increased gas production as a result of putrefaction of the contents of the intestine, bloating and rumbling;
- involvement in the pathogenesis of intestinal sphincters, which regulate peristalsis. The process is accompanied by recurrent abdominal pain (left or right), especially after eating;
- mucus, visible blood and pus in the stool.
In the absence of cancer alertness, the doctor may confuse these symptoms with dysentery, inflammatory processes in the large intestine.
Dyspeptic bowel disorder: symptoms
This disorder is found when a large number of pain receptors are involved in the pathogenesis and irritation as a result of ulceration of the walls of the mucous membranes, as well as at the initial stages of metastasis to the liver.
Symptoms appear as:
- severe abdominal pain;
- unpleasant belching is a sign of damage to the sphincters and liver;
- nausea and vomiting - toxemia;
- diarrhea or constipation - violation of intestinal peristalsis;
- increased body temperature.
Dyspeptic bowel disorder resembles an inflammatory process in the appendix (this is part of the large intestine), as well as in organs adjacent to or functionally associated with the large intestine (pancreas, stomach, small intestine, gallbladder).
Obstructive blockage of the intestinal lumen: symptoms
Blockage is detected when the tumor metastasizes and the formation of inflammatory adhesions around it.
Pathology is usually manifested by signs of partial blockage of the lumen of the colon in the form of:
- long-term constipation, which is not eliminated by enemas and laxatives;
- heaviness in the abdomen;
- increased pain after eating.
Signs of blockage resemble diverticulosis (the formation of pockets filled with feces in the walls of the intestine), adhesions, spastic pain in the intestines, and the presence of fecal stones (calculi) in the lumen of the rectum.
When the small intestine is involved in carcinogenesis, symptoms of acute and complete bowel obstruction, intussusception (protrusion of the walls), and volvulus are formed. These phenomena are manifested by severe pain, indomitable vomiting, sometimes immediately after a meal, and a rapid rate of formation of cancer symptoms.
Pseudo-inflammatory (resembling general inflammation) symptoms
They develop in the late stages of oncology with metastases to the lungs, ovaries, and other organs, very often symptoms are combined with a palpable tumor.
The following signs of the disease are detected:
- severe, persistent abdominal pain, sometimes of unclear localization;
- purulent and bloody discharge from the anus during bowel movements;
- constipation, inability to defecate without an enema, difficulties with evacuating intestinal gases;
- symptoms associated with metastatic organs, for example, cough with involvement of the lungs, dyspepsia with involvement of the liver, discharge from the genitals when they are involved in carcinogenesis.
The first signs of bowel cancer
It is advisable to detect the first signs of bowel cancer using instrumental methods of visual examination of the walls of the large intestine, by probing or by radiation methods, without penetrating the body.
The basis for the appointment of instrumental or laboratory studies are:
- at-risk groups;
- age over 40, but there are cases of the disease at a younger age;
- the presence of some signs indicating damage to the gastrointestinal tract against the background of any other symptomatology, for example, a combination of cardiac and excretory functions against the background of intestinal disorders.
A very important role during this period is played by the competent oncology vigilance of the general practitioner, because it is the therapist in 70-90% of cases that people turn to in the early stages of the disease, often for reasons that have no visible relation to cancer.
The doctor usually thinks about the possible layering of oncology when the following subjective sensations appear or intensify in a patient (at least three at a time), including:
- general weakness;
- fast fatiguability;
- pain in a certain anatomical area of the abdomen (see above the anatomy of the intestine);
- progressive loss of body weight;
- a slight but persistent increase in body temperature;
- blood or mucus in stool;
- feces of dark (black) color;
- pallor of mucous membranes and skin;
- lack of relief after effective therapeutic manipulations.
Naturally, these signs are not an accurate indication of cancer, you should always take into account the suspiciousness of the patient, the individual threshold of pain sensitivity, and other parameters clinically important for diagnosis. When the doctor confirms the patient's complaints, the diagnosis is clarified on the basis of clinical, instrumental and laboratory studies.
It is inappropriate to list the primary macro- and microscopic changes in the intestinal walls that diagnostic doctors detect during examinations, since such knowledge is purely professional.
Bowel Cancer Causes
Colorectal cancer is common among people with a predominant diet of animal proteins and fats, leading a sedentary lifestyle - these are residents of Europe and North America (regardless of race).
In African countries, with a diet predominantly of vegetable proteins and carbohydrates with a high content of vegetable fiber in food, as well as with a high level of physical labor, the incidence rate is 10-20 times less than in developed countries. But long-term Africans in Europe or America make up a significant group of patients with bowel cancer.
This gives reason to believe that it is precisely the excess in the diet of meat food against the background of a deficiency of plant fiber, which is necessary for peristalsis and bowel movement during bowel movements, and a sedentary lifestyle are the main causes of colorectal cancer. The theory of racial resistance to cancer is flawed.
The three most likely pathways leading to bowel cancer (although the true causes of the onset and development of carcinogenesis are not fully known):
I. group of reasons
In some cases, precancerous stages proceed without clinical manifestations in the form of dysplasia (changes at the cellular level). A person feels completely healthy for a long time, periodic disorders are taken for minor violations that are eliminated with minimal effort. Cancer in this case is a surprise for both the patient and the doctor.
II. group of reasons
Another part of precancerous conditions is disguised as chronic pathologies. A fatal link between certain diseases of the gastrointestinal tract and colorectal cancer has certainly been proven.
Some of the most significant diseases most likely preceding cancer are:
Colon polyposes (the probability of malignant transformation (malignancy) is up to 100%), sometimes associated with genetic disorders in close relatives. Not all are precursors of cancer, the most dangerous polyposis:
- diffuse family, has the following clinical signs - frequent bowel movements, more than five times a day, stools mixed with blood, pain or discomfort in the abdomen of varying intensity;
- villous, has the following signs - profuse mucus during bowel movements (up to 1.5 liters per day), other symptoms (see diffuse polyposis);
- Turkot's syndrome is a rare hereditary disease that combines a brain tumor and polyposis of the large intestine, see symptoms of polyposis above;
- Peitz-Jeghers-Touraine syndrome is a combination in relatives of age spots on the face and polyps in the large intestine.
Diseases of the gastrointestinal tract (the probability of malignancy is up to 90%):
- ulcerative colitis - diarrhea, frequency of bowel movements up to 20 times a day, blood or pus in the stool caused by ulcers on the intestinal walls, pain in the lower abdomen, swelling of intestinal loops (protrusion of the lower abdomen);
- Crohn's disease or nodular inflammation of the mucous membranes of any part of the gastrointestinal tract (from the mouth to the rectum) - increased fatigue, weight loss, fever, severe pain that mimics appendicitis, as well as diarrhea and vomiting.
Diseases associated with metabolic disorders (the probability of malignancy is up to 10%):
- type 2 diabetes mellitus (not dependent on insulin) - increased thirst, large volume of urine with a normal frequency of urination, itching, dry skin, obesity, weakness, prolonged healing of skin and muscle damage.
III. group of reasons
Diseases that are not antecedents to cancer, but often overlap with this disease and confuse the clinical picture.
This is relevant if the doctor supervises the patient for a long time, for example, about:
- diverticula (pockets in the intestinal wall)
- chronic intestinal obstruction;
- anal fissures or fistulas;
- other diseases of the lower gastrointestinal tract.
Each disease has its own typical clinical picture with the same or common symptom for all of the listed diseases - difficult, painful defecation.
Bowel cancer stages
The division of the pathogenesis of cancer into different stages is accepted throughout the world. There are various approaches to this issue, but the entire medical community has recognized the feasibility of division. This classification method greatly simplifies the description of carcinogenesis and standardizes its understanding. In our country, it is generally accepted to distinguish four main stages of cancer and several possible variants within each stage.
For the diagnosis of bowel cancer, the following classifications have been proposed, including those used abroad:
- S. Dukes et al., Six stages in total, use the principle of determining the depth of tumor growth and the presence of metastases in the lymph nodes;
- TNM (Latin equivalents of the first letters denoting '' tumor '', '' lymph node '', '' metastasis '') is an international classification widely used by Russian doctors. Only 4 stages of cancer, one stage of precancer. The abbreviation of the classification is based on its principle.
There are also other classifications. We will focus on the TNM classification, as the most common in our country, and describe the characteristic features of each stage.
When there is no reason to consider the established changes indicating signs of cancer, this condition has a symbol - (T x). If there are signs indicating precancerous symptoms, then the designation (T is) is used. To describe the involvement of regional lymph nodes in carcinogenesis, the designation N is used. If, during the examination of the patient, convincing evidence of the involvement of the nodes is not obtained, then the results are denoted by letters (N x), and if it is clearly established that the nodes are not damaged, then this is denoted (N 0). The letter M (metastasis) is not used in the description of precancer.
Colon cancer stage 1
In the medical history, examination protocols and other official medical documents, it is indicated by a combination of letters and numbers (T 1 N 0 M 0). This is the initial stage, clinically, it is manifested by general symptoms of intoxication. On instrumental examination, it is visualized as a small, mobile, dense formation or ulcer (T 1). Changes are found in the mucous membrane or submucosa. Lymph nodes are not affected (N 0). No metastases (M 0).
Colon cancer stage 2
There are two possible options for describing this stage in medical documents with the results of instrumental studies: (T 2 N 1 M 0) or (T 3 N 0 M 0). These options differ in the size of the tumor. Namely - the size of the tumor is described from one third to half the diameter of the intestine (T 2 and T 3). In one variant, there are signs of damage to the nearest lymph nodes (N 1), and in the second, there are no lesions (N 0). Distant metastases are always absent (M 0).
Colon cancer stage 3
This form of colorectal cancer is distinguished by a variety of morphological and cytological forms of carcinogenesis.
There are seven possible descriptions, including lighter manifestations, indicated by:
(T 4 N 0 M 0) - the tumor occupies more than 50% of the intestinal diameter, the lymph nodes are not affected, there are no metastases;
(T 1 N 1 M 0) - a small mobile tumor, the nearest lymph nodes are affected, without distant metastases in the liver;
(T 2 N 1 M 0) - a tumor up to 30% of the diameter, the nearest lymph nodes are affected, there are no metastases;
(T 3 N 0 M 0) - tumor up to 50% of the bowel diameter, no lesions of the lymph nodes, no metastases.
The relatively more severe forms of the third stage are indicated by:
(T 4 N 1 M 0) - a massive tumor encircling the intestine, adhesions are formed with neighboring organs and tissues, the nearest 3-4 lymph nodes are affected, there are no distant metastases;
(T 1-4 N 2 M 0) - the size of the tumor does not matter, more than four intestinal lymph nodes (N 2) are affected, there are no metastases.
(T 1-4 N 3 M 0) - the size of the tumor does not matter, the lymph nodes along the large blood vessels (N 3) are affected, that is, there is a massive spread of cancer cells throughout the body, there are no distant metastases yet.
Colon cancer stage 4
This is the last, most dangerous stage of the disease, characterized by distant metastases in the body. In medical documents it can be designated (T 1-4, N 1-3 M 1). The size of the tumor and the lesion of regional lymph nodes are not of fundamental importance. However, there are always distant metastases, usually in the liver (M 1).
A feature of colorectal cancer is distant metastases to the liver, much less often they are found in the lungs, brain, genitals and omentum. The germination of malignant cells into vital organs greatly reduces the likelihood of successful treatment of patients.
Intestinal metastases in adenocarcinoma are found in 50% of cases, in colloid cancer in 70%, and in anaplastic types of cancer about 82%. When comparing the frequency, squamous cell forms of cancer metastases more often, but they can be found much less often than cancers of the glandular forms.
There is no early cancer prediction system in Russia. The reason is the chronic lack of funding for useful activities. Therefore, there are no highly sensitive cancer detection methods available for mass use.
Occult blood tests, which are widely used in our clinics, give many false results, and DNA diagnostics are still limitedly available for mass research.
Modern forecasting mainly depends on the literacy and oncology vigilance of the doctor, who knows how to find the connection between diseases of the gastrointestinal tract and the precursors of cancer. The prognosis is based on the subjective feelings of the doctor and the results of the visual examination of the patient, therefore, up to 20% of patients in Russia have the primary diagnosis - bowel cancer with distant metastases.
Ways to improve objective forecasting methods are based on the introduction of highly effective instrumental and laboratory techniques into mass medical practice.
In the presence of an already formed tumor, the most promising methods for objectively predicting the rate of development of metastases is the determination of specific protein markers, including the Oncotype Dx colon test and others.
How long do you live with bowel cancer?
The question contains a fatal implication of the deadly danger of cancer. But let's be optimistic, because in the early and sometimes in the later stages of the disease, doctors achieve amazing success in the radical treatment of this form of cancer.
The answer to the question posed about life expectancy can be divided into two parts:
- the first concerns the quality and duration of life after diagnosis;
- the second is the frequency of examinations in order to identify oncology at the earliest possible stages.
Information about the five-year survival rate of patients with bowel cancer, which is often used in scientific research to show the trends and patterns of the disease, is incorrect in the context of a popular article, because the body of each individual person has a different margin of safety, depending on:
- concomitant pathologies;
- bad habits;
- living conditions;
- stress and so on.
Of the above, only age cannot be adjusted. Correct treatment of concomitant pathologies, rejection of bad habits, selection of a diet, elimination of stress, significantly increase the likelihood of not getting sick, and the patient's chances of recovery and significant extension of life with the help of surgeons and doctors of other specialties increase.
A quality life is possible even with significant excision (resection) of a part of the intestine and the imposition of a colostomy (holes for excreting feces outside, bypassing the anus). Having a colostomy with normal care is not a significant factor in reducing quality of life.
On the other hand, the earlier cancer is detected, the better the chances of successful treatment. Following this logic, it can be assumed that extremely frequent examination gives chances for early detection of the disease and prolongation of life. Fortunately, this is not entirely true.
Early confirmation of the diagnosis is possible with examinations at an interval of one year. Indeed, from the first mutations to the onset of clinical stages, on average, it takes two to three years.
For a significant increase in life expectancy and quality of life, screening studies should be carried out annually after the age of forty.
When a disease is detected in the late stages, proper care of the patient and maintaining a good hygienic state of the colostomy play an important role in prolonging life.
If bowel cancer was detected at stage 1, and the tumor has not spread anywhere (which is extremely rare, with a happy coincidence), then the chance of success reaches 99%.
If the cancer is in stage 2, when the tumor begins to grow on the intestinal walls, then the chance of a cure is 85%.
At stage 3, when the tumor affects the nearest lymph nodes, the chance of a cure drops to 65%.
In the later stages of bowel cancer, if distant lymph nodes are affected, the chance of a cure is about 35%.
How long a person will live after cure depends on the neglect of the disease, as well as on other factors listed above.
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Colon cancer diagnostics
The choice of the diagnostic scheme is determined by the doctor. The minimum includes screening studies, first of all - the analysis of feces for occult blood, which is a very simple and widely available method used in the most primitive laboratories.
- Patients at risk should donate feces once a year to exclude hidden bleeding, this method allows you to determine a tumor or polyp with a diameter of 2 cm;
- With a positive test for occult blood, fibrosigmoscopy is prescribed, or rectomanoscopy with video fixation or contrast examination of the colon.
A real breakthrough in the diagnosis of bowel cancer occurred after the widespread introduction of methods of radiation diagnostics into medical practice, for example, contrast radiography or more modern methods:
- computed tomography and its modifications (CT, MSCT);
- ultrasound diagnostics through the abdominal wall and with the help of sensors inserted into the intestine (ultrasound, TRUS, others);
- magnetic resonance imaging and its modifications (MRI)
- positron emission tomography (PET-CT).
A promising method is the laboratory determination of DNA markers of intestinal cancer. After all, this form of the disease is one of the few that can be determined long before the onset of the clinical stage, and, thereby, save life without painful medical procedures.
Colon cancer treatment
Modern methods of treating colorectal cancer are based on radical surgical removal of the tumor, surrounding tissues and metastases. Radiation and chemotherapy are used as adjuncts. In the medical literature, there is information about a significant extension of the life of patients operated on at 3-4 stages of intestinal cancer. Some sources indicate a 3-year survival rate of 50%, and a 5-year survival rate of 30% of surgical patients. The use of combined methods gives hope for better patient survival outcomes.
Chemotherapy for bowel cancer
The main deterrent to the widespread use of chemotherapy in this form of cancer is the resistance of the main forms of intestinal tumors to cytostatic drugs.
Chemotherapy is used systemically, before or after surgery. In some cases, local administration to the blood vessels feeding the metastases is indicated. The main drug used for chemotherapy is 5-fluorouracil. In addition to it, other cytostatics are used - capecitabine, oxaliplastin, irinotecan and others. To enhance their action, immunocorrectors are prescribed (interferogens, stimulants of humoral and cellular immunity).
Surgery to remove a tumor in the intestine
It is generally accepted that it is the only definitive treatment for bowel cancer. There are various techniques including:
- traditional methods of resection of the affected segment of the intestine and surrounding vessels;
- operations through miniature abdominal incisions;
- removal of a tumor with a package of lymph nodes and metastases using a high-frequency knife.
The method and method of surgery is chosen by the attending physician based on the recommendations of the council. It has been proven that the quality of the operation and the likelihood of tumor re-development directly depend on the training of a team of surgeons and the equipment of a specialized clinic.
See also: Other treatments
Bowel Cancer Prevention
Oncological diseases are insidious and unpredictable. Prevention should be considered for people who have a hereditary predisposition to cancer, or have established diseases that can transform into cancer, as well as all people over the age of 40.
General recommendations apply to lifestyle adjustments, including:
- Increased physical activity;
- Fortification of the diet with foods containing fiber;
- Quitting bad habits (smoking, drinking alcohol).
Regular aspirin reduces the likelihood of developing some forms of bowel cancer. It must be taken after meals. Usually, this inexpensive drug is prescribed for hypertension in order to reduce the viscosity of the blood. There is compelling scientific evidence to suppress some forms of colorectal cancer with daily low-dose aspirin intake.
Attention! Aspirin should not be taken in high dosages, since there is a high likelihood of erosions, ulcers, gastroduodenitis and gastric bleeding.
Even simple annual fecal occult blood screening tests reduce the likelihood of developing cancer by 18-20%.
Non-invasive PET-CT diagnostics allows to identify early forms of oncology with a high probability of up to 90%.
Methods of probing and visual assessment of the intestinal walls are limitedly used as a preventive diagnosis.
The author of the article: Bykov Evgeny Pavlovich | Oncologist, surgeon
Education: graduated from residency at the Russian Scientific Oncological Center. N. N. Blokhin "and received a diploma in the specialty" Oncologist"