A malignant tumor of the sigmoid colon refers to tumors that are formed on the tissues of the sigmoid region of the intestine. Such a gut is located in front of the rectum. It is in this department that fecal masses are formed. If a violation of the digestive process occurs in the body, then the stool remains in the sigmoid colon for a long time, as a result of which it stretches, changes its location and becomes more voluminous.
As a result of a delayed feces, intoxication of the body occurs, and a feeling of heaviness in the stomach and discomfort occurs. The sigmoid tumor at the initial stage does not manifest itself at all, which is very dangerous. Symptoms begin to appear only when the disease is in its last stages. Therefore, if there is discomfort in the intestinal area and the presence of characteristic symptoms, you should immediately contact a doctor, as the disease can lead to the death of the patient.
Tumor type classification
A benign sigmoid tumor may eventually develop into a malignant neoplasm. Among the main types of this disease are the following:
- mucous adenocarcinoma,
- well differentiated
- moderately differentiated
- cricoid cancer.
The most aggressive form of a malignant neoplasm is considered to be low-grade adenocarcinoma. It has very pronounced symptoms and rapid development.
Stage of the disease
There are several stages of a sigmoid tumor, which are characterized by various symptoms. In the first stage, the tumor is small and located only in the mucous membrane. With timely treatment, the prognosis is quite good, and a person can live for more than 5 years.
The 4th stage sigmoid tumor is characterized by germination of a malignant neoplasm in other organs and tissues and the formation of metastases. At this stage, the treatment is quite complicated.
Modern medicine has gone a long way in determining the root cause of this disease. From this depends largely on the method of therapy, as well as the outcome of the treatment. There are certain risk factors that affect the occurrence of a sigmoid colon cancer, such as:
- hereditary factor
- food features
- having bad habits
- chronic inflammatory processes.
Most often the disease is associated with a hereditary factor. That is why, in the presence of this disease in close relatives, it is necessary to undergo periodic examination by a doctor, especially during puberty, so that the pathological process can be detected even at the stage when the tumor is benign.
Malnutrition can lead to the occurrence of the disease, in particular the consumption of fast food, foods high in carcinogens, as well as alcohol and tobacco abuse. All this provokes the formation of toxic substances in the body, which, when it enters the intestine, provoke the suppression of beneficial microflora, which causes inflammation in the stomach and intestines.
Chronic inflammatory processes lead to significant changes in the intestinal mucosa. At risk are people suffering from peptic ulcer and colitis. They can provoke complications in the form of malignant neoplasms.
The main symptoms
Symptoms of a sigmoid tumor appear in later stages, so it is very difficult to recognize and treat the disease in a timely manner. Among the first signs can be identified the occurrence of bleeding, which may be due to injury of the neoplasm fecal masses.
The sigmoid pilus tumor at the initial stage can be detected during preventive measures and analysis of the tests. She, like polyps, responds well to therapy and gives quite good predictions after surgery. It is necessary to remove them only with a benign course of the disease in order to prevent the transition to a malignant neoplasm.
With careful and careful attitude to their own health it is quite possible to suspect the presence of signs of a malignant neoplasm. The symptomatology in that case will be characteristic for all intestines and long. It is necessary to consult a doctor if you have symptoms such as:
- violation of digestion,
- bloating and belching,
- feeling of tension in the peritoneum,
- the presence of purulent accumulations in fecal masses,
- painful sensations.
If there is a suspicion of a malignant tumor, the deterioration of well-being cannot be ignored, as they may indicate the 3rd stage of the disease. A sick person has a gray tint, anemia occurs, body weight decreases, he quickly gets tired and becomes weak.
In women, symptoms may be similar to signs of cystitis, as well as inflammatory processes of the urinary organs, as well as ovarian cancer.
Instrumental studies will help determine the cause and stage of a malignant neoplasm. Diagnostic measures include research, with the help of which the doctor can identify the clinical picture of the course of the disease, on the basis of which the scheme of therapy is determined. Initially, he asks the patient about existing complaints, characteristic signs and localization of painful sensations.
- laboratory diagnostics.
In a malignant neoplasm, the patient is shown a colonoscopy, which is carried out with the help of a special device - the colonoscope. This tool is a flexible and thin tube, equipped with a small video camera at the end, which makes it possible to see the state of the affected organ on a computer monitor. The doctor examines the affected area of the intestine, determining the presence of tumors, their location, as well as size. During the study, biological material is taken for biopsy.
Irrigoscopy, or x-ray, is characterized by the fact that pictures of the peritoneum area are taken, on which the tumor is visualized. For this study, a contrast agent is previously introduced into the intestine to allow for more accurate and clear images.
Computed and magnetic resonance imaging is assigned to patients who are suspected of having a tumor. These studies can determine the size of the tumor, its location, how strongly the intestine and nearby organs are affected.
In addition, laboratory diagnostics is carried out. The patient passes a number of required tests, in particular, a blood test, urine and feces for the presence of blood and pus in the event of damage to the malignant cells of the kidneys and urinary system.
Features of treatment
Treatment of a sigmoid tumor is carried out exclusively by surgical intervention. Endoscopic techniques are considered the most effective methods. Laparoscopy helps not only to reduce the level of trauma from a surgical intervention, but also to prevent the occurrence of complications such as the addition of infection or bleeding. In addition, if a sigmoid tumor is removed using endoscopic techniques, the terms of the rehabilitation period are significantly reduced. A few days later, a person may already return to the usual way of life.
In the initial stages of the disease, the removal of the sigmoid colon tumor is performed during a colonoscopy. In this case, it is very well combined with electroplasmic coagulation. Endoscopic techniques are used mainly in the elderly, who are in very serious condition. This is due to the fact that people in this state simply cannot withstand standard surgical intervention, which implies a dissection of the abdominal wall.
Depending on the characteristics of the sigmoid tumor, the operation can be carried out in different ways and its tactics change as the intervention progresses. At the same time, the condition of the intestine is of great importance. If the patient is young and his condition is stable, then doctors recommend performing a standard operation with the removal of a significant part of the intestine.
If there are large sizes of the sigmoid tumor, the operation is not performed by the standard method. Such patients are shown palliative intervention aimed not at treating the patient, but only at alleviating his condition. In the presence of intestinal obstruction, a colostomy is formed.
At the advanced stage of the disease, the removal of the sigmoid tumor is not performed, but chemotherapy sessions are prescribed. In addition, chemotherapy is prescribed to the patient and after surgery to restore the normal process of urination and defecation. Radiation therapy is used quite rarely, since an intestinal wall rupture may occur, since this malignant neoplasm is very sensitive to radiation.
In a malignant neoplasm with localization in the intestinal area, the patient is prescribed a fractional diet 5-6 times a day. Dishes are served exclusively in a warm and ground form.
A diet after a surgical procedure consists solely of juices, liquid vegetable purees and herbal decoctions. This diet must be for 5-6 days. Consumption of any food must be strictly coordinated with the doctor. A subsequent diet for malignant neoplasms implies a decrease in the amount of consumed meat or its complete elimination, fried food, canned food, confectionery, as well as semi-finished products. Be sure to exclude from the usual diet of sharp and hard foods.
Traditional methods of therapy
Therapy of intestinal cancer through the use of folk techniques complements the surgical intervention, as well as chemotherapy. Folk techniques for malignant tumors help strengthen the immune system, alleviate health after chemotherapy, normalize the functioning of the intestines, prolong the patient's life. Treatment of folk remedies and techniques implies the use of:
- poisonous herbs,
- tinctures on alcohol,
- soda, minerals, goji berries.
Combined therapy of sigmoid cancer gives a good chance for a successful and quick recovery. Folk anticancer drugs are included in the complex therapy and help to normalize well-being after the operation and a course of chemotherapy. It is important to remember that many herbs are highly poisonous, therefore strict adherence to the preparation of the drug is required.
With a sigmoid tumor, the prognosis largely depends on the stage of the disease, as well as the characteristics of the malignant lesion. The survival prognosis depends on several factors, in particular, such as:
- stage of cancer
- the age of the patient and the severity of his condition,
- Are there additional diseases?
A malignant tumor manifests itself in the later stages, and in this case the course of the disease has a very unfavorable prognosis. In this case, patients do not undergo surgery, and they can only rely on the effect of chemotherapy.
In order to prevent the occurrence of a tumor, you need to worry about preventive measures. To do this, it is imperative to adhere to the proper diet, timely conduct therapy of inflammatory processes, lead an active lifestyle, regularly undergo examination, and also give up bad habits.
In addition, if there are problems with the digestive tract, it is imperative to undergo periodic examinations for the timely detection of the problem.
Causes of sigmoid tumor
The causes of the sigmoid tumor are primarily due to the structure of this part of the intestine. It is located in the left part of the abdominal cavity and forms the letter S. If the digested food for some reason passes through the intestine slowly, then it is in the sigmoid region that it lasts the longest. Toxic substances contained in chyme for a long time in contact with the walls of the intestine, causing inflammatory processes that are the basis for the further development of a malignant tumor.
Factors provocateurs that increase the risk of tumor formation are:
Lack of adequate physical activity, sedentary lifestyle.
Improper diet, the prevalence in the diet of fatty, fried and spicy foods, animal fats and light carbohydrates. The less in the diet of plant fiber, the higher the risk of developing the disease. Such a menu leads to a slowdown of intestinal motility and to the fact that in its intestinal contents the amount of carcinogenic substances will be increased.
Chronic constipation is another reason for the formation of a tumor. They lead to the fact that harmful substances are not removed from the body for a long time, and the solid feces themselves injure the intestinal mucosa.
Alcohol abuse increases the risk of developing a tumor.
Any inflammatory bowel disease, as well as precancerous conditions, including polyps, diverticula, etc., are dangerous.
Genetic predisposition to the development of the disease exists in people whose close relatives have suffered a similar pathology.
Symptoms of a sigmoid tumor
Symptoms of a sigmoid tumor in the early stages of the disease are almost impossible to notice. This is the main danger of the disease. Asymptomatic progression often leads to the fact that the tumor can be detected in the late stages of its development.
The signs that may indicate a tumor process in the sigmoid colon are as follows:
Discomfort in the intestines, bloating, rumbling and play, symptoms of flatulence. Sometimes they are hardly noticeable, and sometimes they are capable of seriously disturbing the patient’s quality of life.
If in the early stages of the development of the disease the stools are most often unstable (constipations are replaced by diarrhea), then as the tumor grows, constipation begins to predominate in people.
In the fecal masses there may be visible streaks of blood, impurities of pus and mucus.
Cramping pain in the left half of the abdomen may indicate that the tumor has grown into the intestinal wall and interferes with the normal movement of fecal masses. Sometimes the disease is detected during the treatment of the patient about the developed intestinal obstruction.
Patients experience general weakness and malaise. As the disease progresses, fatigue increases, appetite disappears, weight goes away. The skin gets an unhealthy grayish tint, the body temperature for a long time remains at subfebrile marks.
Tumor intoxication of the body is slowly but steadily progressing.
If a person has intestinal obstruction, then he experiences severe pains like contractions.They occur in seizures that recur on average every 10 minutes. Gases cease to depart, the chair is absent, the stomach increases in size. Sometimes vomiting occurs.
Peritonitis is a dangerous complication of the tumor process, which develops against the background of destruction of the sigmoid colon wall.
An enlarged liver in size, yellowing of the skin, anemia — all these symptoms develop during advanced stages of the disease.
Other signs of the tumor process will occur depending on which organ is affected by metastases.
Classification of sigmoid tumors
Depending on the structure of the tumor, the following types of tumor are distinguished:
Adenocarcinoma, represented by glandular cells. This is the most common type of tumor, which is detected on average in 80% of cases. There are three degrees of differentiation of adenomatous neoplasms (high-, medium- and low-differentiated tumors); the lower it is, the lower the survival rate of patients with cancer.
Mucosal adenocarcinomas, represented by mucinous cells producing a large amount of mucus. These neoplasms grow rapidly and metastasize early.
A ring-shaped tumor is characterized by an unfavorable course, but is rarely detected, in no more than 4% of cases.
Diagnosis of sigmoid tumor
Diagnosis of a sigmoid tumor begins with examining a patient, taking anamnesis and patient complaints. Maximum information about the tumor can be obtained after a colonoscopy and rectoromanoscopy. These methods allow you to visualize the tumor, assess its size, determine the exact location. During the study, the doctor collects tumor tissue for subsequent histological analysis.
It is mandatory to give stool for occult blood, as well as an irrigoscopy. However, the final diagnosis can only be made according to the results of a histological examination of the tumor. Metastases in other organs are detected by ultrasound, radiography, MRI and CT.
Sigmoid Tumor Treatment
Treatment of a sigmoid tumor should be complex. It includes surgery, chemotherapy and radiation therapy. In this case, the leading role is assigned to the operation, during which the most possible removal of the tumor is carried out. The amount of intervention depends on how widespread the tumor is. If a neoplasm was detected at the early stages of development, then endoscopic manipulations on the intestine are possible.
Resection of the sigmoid colon is performed when tumors of considerable size are detected. In parallel, lymph nodes located regionally, as well as the site of the mesentery are removed. In addition to the affected tissues, it is mandatory to seize 5 cm of unchanged tissue (proximal and distal). It is possible to perform a two-step and one-step operation. If the intervention is carried out in one stage, then the patient is removed the tumor, and then anastomosis is applied. This manipulation preserves the integrity of the intestines. When the tumor is widespread, the sigmoid colon is completely excised and forms a colostomy. At the same time, part of the colon is excreted through the anterior abdominal wall. The second stage of the operation is the formation of the inter-intestinal anastomosis through which part of the large intestine is connected to the rectum. This procedure is performed several months after the first surgery.
Before and after surgery, patients are recommended for chemotherapy and radiation therapy. If the disease has an advanced stage, the patient is provided with palliative treatment designed to reduce pain and prolong his life. Emergency operations are performed during the formation of intestinal obstruction, with peritonitis and other conditions that carry a direct threat to the life of the patient.
As for the prognosis, it depends on the extent of the tumor process at the time of the start of treatment. The average percentage of five-year survival of such patients is 65%, and if the disease is diagnosed in the first stage, then this figure equates to 93%, and in the second stage to 82%. It is indicative that with a quarter-stage tumor, the percentage of five-year survival is only 8%.
Education: He graduated from the residency in the "Russian Scientific Oncological Center named. N. N. Blokhin "and received a diploma in" Oncologist "
Examines the structure and origin of education at the microscopic level. There are the following varieties:
- Squamous cell carcinoma
- Ring-shaped cellular.
- Mucous (mucinous).
An important point from a histological point of view is to determine the degree of maturity of tumor cells. They can be highly, moderately, poorly differentiated.
The worst prognosis is cancer with low differentiation cells. Such a tumor progresses much faster and has an unfavorable course.
When examining the intestinal walls visually using an endoscope, the doctor makes an assumption about the macroscopic nature of the tumor, taking into account the shape and direction of growth of the formation.
There are 2 types of tumors:
- Exophytic - growth occurs in the lumen of the intestinal tube. Externally, the cancer looks in the form of protruding nodes of various shapes and sizes on the leg into the intestinal lumen.
- Endophytic - growth takes place deep into the walls of the body. Such formations are more characteristic of the sigmoid colon.
TNM - classification
Reflects the prevalence of lesions in three levels:
- T is local.
- N - reflects the involvement of the regional lymphatic apparatus in the pathological process (whether there are metastases to nearby lymph nodes).
- M – indicates whether there are distant hematogenous metastases.
Taking into account the above data, a tumor stage is formed, which reflects its prevalence, as well as an approximate prognosis for cancer.
The first symptoms and signs of sigmoid cancer
The insidiousness of this pathology lies in the fact that for a long time it may not manifest itself in any way, and the first clinical manifestations often arise already at the advanced stages of the disease.
Clinical signs at first may be so scarce and unremarkable that patients can write them off for intestinal upset, temporary discomfort.
However, you should be wary if the following symptoms appear:
- Blood and mucus in stool.
- Impurities of pus in feces.
- Disorders of the bowel: a change in the rhythm of defecation, frequent alternation of constipation and diarrhea.
- False urge to defecate - tenesmus.
Patients may experience non-specific symptoms of general intoxication:
- Sharp, unmotivated weight loss.
- Increased fatigue.
- Pallor or yellowness of the skin.
- Loss of appetite.
- Increased body temperature.
If more than two symptoms are detected, consult a doctor immediately! No need to "pull to the last", underestimate the signs of malaise. It is better to undergo an examination of the body and know everything about your state of health, than to consult a doctor at the stage when the disease goes into neglected form.
Symptoms of sigmoid cancer in women and men
The first signs of oncology of this colonic department are not too specific and often neither doctors nor patients pay proper attention to them.
But as the cancer progresses, the clinic becomes more pronounced. Clinic of oncopathology depends on the size of the tumor, the presence / absence of metastases.
Blood in feces
Up to 75% of patients with an established diagnosis mark this symptom. Slightly less common mucus and pus in the feces found after defecation.
Bleeding can be hidden and not visually manifest. Its presence is established by means of diagnostic tests, as well as on the basis of the clinic and laboratory-confirmed anemic syndrome.
At first, unstable stools may occur in the form of alternating diarrhea and constipation, with the progression of the disease, patients show a clear tendency to increase constipation, discoloration, and form of feces.
Many inconveniences give patients the urge to defecate - tenesmus. They can occur up to 20-40 times a day. There is a feeling that you need to go "big", but when you visit the restroom emptying does not occur.
Gases, mucus, a small amount of blood or pus can depart. Tenesmus is caused by the irritation of the gut receptors by the expanding tumor.
The sigmoid region of the large intestine is located in the left ileal region, the diameter of the hollow organ on the left is less than the diameter of the intestinal loops on the right.
Therefore, often one of the symptoms of distal gastrointestinal cancer becomes obstruction due to blockage of the lumen of the body with fecal masses, tumor tissue.
Pain in the left half of the abdomen at the level of the navel or below can be moderately tolerant, inconstant.
And they may be cramping, intolerable, with developing intestinal obstruction. Pain may be accompanied by nausea, vomiting, increased gas formation, increased body temperature.
In this connection, the patient mistakenly assumes poisoning or the development of an intestinal infection. Prefers to be treated at home and postpones a visit to the doctor. This is not worth doing.
Any of the above symptoms require a visit to a medical institution or a call to the doctor at home.
Stage Sigmoid Cancer
Depending on the prevalence of the oncological process, there are four stages of the disease:
- Stage 1 - the tumor is located locally, in the mucous and submucosal layer. There are no regional or distant metastases.
- Stage 2 - the pathological process occupies no more than half of the diameter of the sigma, the entire intestinal wall of the organ does not germinate, but single metastases appear in nearby lymph nodes.
- Stage 3 - the tumor grows more than half the diameter of the intestinal tube during exophytic growth, or with the endophytic spread the entire wall of the organ grows. There are metastases, both regional and distant.
- Stage 4 - characterized by multiple metastases in distant organs, as well as in regional lymph nodes. The oncological process extends beyond the distal GI tract and can spread to adjacent tissues and organs.
When diagnosing cancer at stage 1 and timely treatment, the survival rate is about 90%, at stage 2 with successful surgery - 50-60%.
Cancer stage 3
If the patient went to the doctor and was diagnosed with stage 3 cancer, this means that the patient turned for help late: the tumor has spread in the body and has given both regional and distant metastases.
If the tumor is diagnosed in 3 stages, the survival rate is much lower than in the first two: less than 40%. Patient survival prognosis worsens with an increase in the oncological process stage.
Cancer Stage 4: Prediction for Life
Grade 4 is characterized by neglect of the process and the lack of the possibility of surgical intervention. Diagnosing the disease in stage 4 has a very poor prognosis for life, 20-30% of patients live for several years.
At this stage of the disease, only supportive, palliative treatment is indicated. Due to multiple distant metastases, surgery is not performed.
The goal of maintenance therapy is to reduce pain, the clinical symptoms of the disease, to improve the quality of life, as far as possible in this pathology.
Cancer of the distal sigmoid colon
At this location, the tumor is located near the rectal region, on the border of the sigma and the rectum. The most frequent manifestations of pathology are: violation of the passage of fecal masses, a tendency to constipation, blood in the feces, false desires.
The tumor is often located in the transitional rectosigmoid junction and extends to the lower rectal sections.
You should be attentive to such "alarm bells" as:
- The appearance of constipation.
- Blood streaks in feces.
- The appearance of mucus in the stool.
- The presence of frequent false urges to defecate.
When they appear, you should immediately consult a doctor and undergo the necessary diagnostic examinations to rule out distal cancer.
Stenotic sigmoid colon cancer
This is a type of exophytic growth of cancer, when the tumor grows into the lumen of the intestinal tube, closing it and interfering with the passage of fecal masses. Stenosis develops, the manifestations of which are:
- Pain, bloating intestinal loops.
- Changes in peristalsis waves.
- Violation of discharge of gas and feces.
- The development of intestinal obstruction.
Full stenosis of the organ threatens acute obstruction, which is an acute surgical pathology and requires immediate surgical intervention.
The following types of metastases are characteristic of this pathology:
- Lymphogenous (cancer cells spread through the lymphogenous pathways): to the lymph nodes located next to the pathological focus.
- Hematogenous (migration occurs through the blood): distant metastases to the liver, lungs, spine.
- Peritoneal (distribution occurs by contact through the peritoneum): in the ovaries - Krukenberg metastases, Schnitzler metastases (in the lowest place in the abdominal cavity).
The spread of a malignant process causes pain and clinical manifestations in the organ where metastases are located.
There may be pain in the spine, heaviness in the liver, bitter taste in the mouth, progressive coughing and shortness of breath.
When an oncological process is detected, a complete examination of the body is necessary in order to identify or exclude metastatic foci.
Treatment of the disease
In the treatment of sigmoid cancer, surgical treatment is used (it is the main one at operable stages of cancer), radiation therapy and chemotherapy. Often used several ways - the combined treatment.
The principle of surgical intervention is to remove the tumor with a maximum stock of a visually healthy organ.
In order to eliminate possible metastatic foci in regional lymph nodes, removal of lymph nodes in the mesentery. Surgery should be carried out by oncologists with special training and a high degree of qualification.
All patients to be intervened should be informed about the upcoming course of the operation, possible complications.
Radiation and chemotherapy treatment is most often used in conjunction with surgery, preceding it or supplementing it. Either as monotherapy as palliative methods in patients with stage 4 cancer.
Sigmoid surgery for cancer
Surgical interventions consist in the removal of part of the intestine affected by the tumor, as well as its visually healthy area. Such interventions are called radical.
Left-sided hemicolectomy and resection of the tumor are the so-called common operations for cancer with localization in the sigmoid colonic department.
After the removal of a part of the organ, the doctors must impose an anastomosis without fail - connect the remaining intestinal loops so as to restore the integrity of the gastrointestinal tract.
Moreover, the variations of anastomosis and the volume of surgical intervention also depend on which department of the sigmoid colon is localized to cancer.
When the tumor is located in the proximal (initial) part of the sigma, doctors produce a left-sided hemicolectomy with an anastomosis between the transverse colon and the rectum.
With the location of the oncological focus in the middle section, complete removal of the organ is necessary. If the pathological process has affected the distal (final) portion of the sigma, then, if possible, surgeons retain its initial section and connect it to the rectus.
Chemotherapy for cancer after surgery
After surgery, doctors often recommend cytotoxic drug therapy to prevent a recurrence of the disease.
Today, there are many effective and modern anticancer drugs that, in combination with surgical treatment, give a good effect.
The following drugs are used:
- Calcium folinate.
The selection of drugs and treatment regimens is carried out by experts individually.
The optimal course of chemotherapeutic drugs and the treatment regimen allows in many cases to achieve a long and stable remission, which is an absolute success in the fight against cancer.
Nutrition and diet for cancer of the sigmoid colon
Food should be balanced, contain adequate amounts of protein and vitamins. Food should be easily digestible, not injure the mucous wall of the organ, not irritate the gastrointestinal tract either mechanically or chemically.
All spicy, spicy, salty, pepper dishes are contraindicated, like alcohol, carbonated drinks. It should limit the consumption of meat, especially pork and beef, refined products, chocolate, strong coffee and tea.
It is necessary to saturate the diet with fiber, plant foods, fruits and vegetables, both fresh and boiled. Porridges, vegetable soups, stewed or baked vegetables, fermented milk products normalize intestinal peristalsis and relieve constipation.
Eat food should be fractional, in small portions, but often, 5-6 times a day. Too cold or too hot dishes are contraindicated, you should eat room temperature dishes.
Diet after cancer surgery:
- In the early postoperative period, for the first time 5-6 days after the intervention, the patient is forbidden to eat food through the mouth, you can only drink.
- The patient should receive food parenterally, by intravenous administration of amino acid and vitamin mixtures, glucose. Perhaps the use of fluids, warm unarranged broth.
- After 1-1.5 weeks after the operation, the diet gradually expands: vegetable and fruit mashed potatoes can be eaten, mucous homogeneous porridges, low-fat yogurts and kefir. Such a diet should be followed for at least a month, after which gradually coarser food should be introduced: fruits, vegetables, cereals, freshly squeezed juices, boiled fish, eggs, lean meat.
- Eat should be fractional, but often, every 2 hours. Food should be boiled or baked. All fried foods adversely affect the work of the intestines.
- Also, patients should forget about fatty foods, pork, beef, convenience foods, refined products, pickles and spices. Exclude coffee, soda, milk, strong tea and alcohol. Herbal teas, fruit drinks from berries, drinking water without gas should form the basis of the drinking regime.
A blood test for cancer tumor markers allows in many cases to prevent the disease (the analysis is used as a screening diagnosis) and to take measures for its early detection.
And also to control the postoperative period, the remission stage of an existing disease. The most well-known markers for sigmoid colon tumors are CEA (cancer embryonic antigen) and CA 19-9.
Often, with the progression of oncopathology, the level of markers in the blood increases. However, this does not always happen, in 40% of patients the level of these proteins remains unchanged, despite the identification of a tumor.
Therefore, this study can not reliably assess the patient's condition, it is used in conjunction with other diagnostic methods - endoscopy, ultrasound, CT, MRI, laboratory and clinical indicators.
How to prepare for ultrasound
In the diagnosis of tumors, an important role is played by both endoscopic examinations - colonoscopy, rectoromanoscopy, and ultrasound.
Recently, an increase in the popularity of the local prevalence of the tumor process, the presence of distant metastases has been obtained by ultrasound of the large intestine, abdominal cavity and small pelvis.
Under the control of ultrasound, it is possible to conduct puncture of suspicious areas with subsequent histological examination. In order for the intestinal ultrasound to be informative, special training is required before this study:
- 3 days prior to the procedure, all products that enhance the formation of gases should be excluded from the diet: legumes, mushrooms, milk, sweets, fresh juices, raw vegetables and fruits.
- 3 days should be taken "Espumizan" or its analogs to reduce gas.
- On the eve of the study, the last meal should be made no later than 6:00 pm;
- In the evening, you should perform a bowel cleansing procedure with an enema or a special drug "Fortrans".
- A few hours before the test, one should drink activated charcoal at the rate of 1 tablet per 10 kilogram of weight.
- Immediately before the ultrasound should drink at least 500 ml of non-carbonated water to fill the bladder.
It should be remembered that without proper preparation, the procedure will be not informative. Therefore, the above activities should be approached with all responsibility.
Despite the fact that the intestine is a hollow organ, ultrasound is possible when it is filled with a special liquid, which serves as a kind of contrast during the study. Fluid is introduced through a small catheter through the anus.
Ultrasound - painless, safe manipulation, quite informative. It can serve as an auxiliary and main method as a diagnosis of cancer of the sigmoid colon.
Particularly, ultrasound of the intestine is indicated for elderly, debilitated patients, children and all those who are not shown endoscopic diagnostic procedures.
As cancer progresses, symptoms begin to become more specific for the disease. If cancer has developed on the background of precancerous pathology, it is difficult to trace the initial symptoms of a malignant neoplasm.
The classification of precancerous diseases of the sigmoid colon includes four diseases:
- Nonspecific ulcerative colitis.
- Crohn's disease.
- Intestinal polyps.
- Sigmoid diverticula (hereditary pathology - diffuse familial polyposis).
The same clinical picture depends on the nature of the growth of education:
- Exophytic growth - when a tumor grows in the intestinal lumen, it is also called polypous, villous tumor or villous - papillary.
- Endophytic growth - cancer grows in the thickness of the intestinal wall. It is divided into infiltrative, circular-structuring, ulcerative-infiltrative.
When analyzing the symptoms, the tumor size, prevalence, morphological characteristics of cancer are taken into account. It should be said that if a patient has a small tumor of the sigmoid colon, the symptoms may not be pronounced, and the detection of the disease will occur at a late stage.
The main symptoms that are alarming about the sigmoid tumor are:
- Pain syndrome. The first thing that really alarming the patient. The intensity of pain can range from low-intensity discomfort to excruciating pains that cause the patient to scream.
- Dyspeptic disorders manifest in belching, nausea, vomiting, loss of appetite, and heaviness in the stomach.
- Pathological impurities in feces. Most often - this is blood. Usually the blood is of a dark color, of a changed character, but not black liquid stools and not bright scarlet blood. Impurities can be seen with the naked eye, and may be revealed in the analysis of fecal occult blood.
- Disorders of the chair. Diarrhea is characteristic of the initial stage of sigmoid cancer. When a tumor with its size makes it difficult for the feces to move along the tract, then constipation appears, up to the development of mechanical obstructive intestinal obstruction.
- Asthenization of the patient, that is, malaise, weakness, instability of blood pressure, weight loss, the formation of cachexia is possible. Cancer patients are often worried about low-grade fever. These symptoms are associated with intoxication syndrome, which develops as a result of tumor metabolism.
- In the case of massive cancer and cachexia of the patient, it is possible to palpate the tumor through the abdominal wall. Localization of pathology in the left iliac region.
The clinic of the disease can vary depending on the form of the disease:
- Toxico - anemic - is characterized by the formation of anemia on the background of insufficient absorption of iron, as well as the development of intoxication syndrome.
- Obstructive-stenotic - when a cancer (villous tumor) overlaps the intestinal lumen, the formed feces cannot pass further along the tract, mechanical intestinal obstruction develops. Its manifestations consist in prolonged constipation, expansion of the intestine to the site of obstruction and its narrowing at the site of tumor growth. The patient complains of intense abdominal pain, nausea, belching, possibly with a fecal odor. Objectively, in the left half of the abdomen can be palpated enlarged intestine, dense education. With the progression of intestinal obstruction, intestinal peritonitis develops - a rupture of the intestinal wall with the release of feces into the abdominal cavity. With prolonged stagnation, the intestinal contents begin to be absorbed in the blood, causing pronounced intoxication.
- Dyspeptic - impaired digestion and absorption of substances, slowing or increasing motility and intestinal motility.
- The pseudo-inflammatory form is diagnosed in case of positive symptoms of peritoneal irritation.
Also, the symptoms of the expanded process will complement the clinic on the part of organs affected by metastases of colon cancer, if they exist.
Screenings are distributed in three ways:
- With lymph flow to the lymph node groups:
- Epi - and paracolytic.
- With the blood flow, the internal organs are affected, and stage 4 cancer is put:
- Cancer of the sigmoid colon with liver metastases.
- Cancer of the sigmoid colon with metastases to the lungs.
- Cancer of the sigmoid colon with bone metastases: usually in the spine, sacrum, tailbone.
- Cancer of the sigmoid colon with metastases to the brain.
- Contact path causes the development of damage to the peritoneum by cancer cells - carcinomatosis and consequently ascites. Cancer can also invade the bowel invasion.
Staging of sigmoid cancer is made according to the international classification of TNM.
T - Tumor - a tumor.
T1 - a tumor occupying a small area, germinating mucosa and partially submucosa.
T2 is a cancer that affects the muscle layer.
T3 - a tumor that invades all layers of the sigmoid colon, more than half the circumference of the intestinal lumen.
T4 - a tumor that occupies the entire circumference of the intestinal lumen.
N - Nodus - node (meaning lymphatic).
N0 - regional lymph nodes are not affected by the process.
N1 - there are metastases of cancer in no more than three lymph nodes.
N2 - 4 or more lymph nodes are involved.
N3 - numerous metastases, conglomerates of lymph nodes.
M - Metastasis metastases.
M0 - no clinically and instrumentally identified distant metastases.
M1 - there are confirmed distant metastases.
Having information about the size and extent of tumor invasion, the damage to regional lymph nodes and the presence of screenings in distant organs and tissues, you can set a diagnosis, according to ICD-10.
Sigmoid cancer, T1 (T2) N0M0 stage I, clinical group II.
Sigmoid cancer, T3 (T4) N0M0 stage II, clinical group II.
Sigmoid cancer, T (any) N1 (N2, N3) M0 stage III, clinical group II.
Cancer of the sigmoid colon T (any) N (any) M1 IV stage II clinical group.
Malignant neoplasms of the colon have a code - C18. The sigmoid colon is encoded with C18.7.
Endoscopic methods of surgical intervention today are considered the most advanced. Laparoscopy can not only reduce the invasiveness of the operation, but also prevent the development of complications such as bleeding or infection. In addition, the terms of the rehabilitation period are reduced. People who have undergone laparoscopic surgery to remove a tumor, after a few days may already return to normal life.
With the help of endoscopy, you can remove the affected part of the intestine through a small incision, no larger than 1.5 cm, and at the same time follow the rules of ablastics, protect adjacent organs from cancer cells.
Compared with laparotomy, the operative wound after laparoscopy will be much smaller, which from an aesthetic point of view looks much more attractive. Also reduces the risk of formation of connective tissue adhesions, leading to a violation of peristalsis in the future.
If the cancer is located in the lower intestine, it is possible to carry out the operation without removing the intestinal loops on the anterior abdominal wall.
In the early stages of carcinoma development, it is possible to perform intrasure intervention with the removal of the tumor during colonoscopy. In this case, the colonoscopy is well combined with electroplasmic coagulation.
Endoscopic techniques are mainly used in the elderly and in patients who are in serious condition. This is due to the fact that such patients will not be able to withstand standard surgical intervention, which includes dissection of the anterior abdominal wall.
The tactics of the operation can vary directly on the operating table, depending on the state of the intestine. If possible, the patient is stable and young people are advised to perform a radical operation with the removal of a large part of the intestine, followed by the formation of an anastomosis between the intestinal loops. As a rule, the anastomosis is performed using an end-to-end or end-to-side technique.
When the patient is in serious condition, it is preferable to perform not a radical operation, but a palliative. Palliative surgery is a surgical procedure aimed not at treating the patient, but at alleviating his condition. In the presence of intestinal obstruction, the best solution for such a patient is the formation of a colostomy.
In the case of a far-reaching tumor process, a “double-barbed stoma” is best suited - an operation in which both the abductor segment of the intestine and the abductor are brought to the anterior abdominal wall. "Double-barreled stoma" solves several problems at once:
- Emptying the intestines from feces, blood clots, decay products
- Prevention of intoxication
- Preventing gut wall rupture
- Elimination of obstruction
Also, in addition to the formation of colostomy, to solve the problem of obstruction, you can create a bypass anastomosis. A bypass anastomosis is a surgical procedure in which the intestine is dissected above the obturation site, then the distal end is sutured blindly, and the underlying intestinal loop is sutured to the proximal end. This technique allows to preserve the intestinal permeability and at the same time not to form a colostomy.
When endophytic (inside the lumen) tumor growth of the sigmoid colon very often there is a violation of permeability. If this condition is stopped, a rupture of the intestinal wall and an outflow of feces into the abdominal cavity may occur. To prevent this, the surgeon performs an operation called colostomy.
Despite the fact that colostomy is often a salvation for patients, many patients have a bias towards this operation. Today, there are special colostomy care products. Special kalopriyemniki can not only facilitate hygiene in such a patient, but also socialize them. Sometimes these patients can find work with lightweight labor. Whatever it was, in many cases, it turns out, to restore the continuity of the intestine with the help of re-operation.
Not for all forms of sigmoid cancer requires the formation of a colostomy. It depends on the shape of the tumor, its location and the type of growth. For the most part, a colostomy is needed when it is not possible to completely remove the oncogenesis and at the same time maintain the normal intestinal permeability.
Many clinics use a two-step technique. The first is the resection of the affected area of the intestine, with the subsequent formation of a colostomy. At the second stage, the colostomy is sutured, and the proximal and distal section of the intestine are joined together.
In cancer of the sigmoid, it is best to use a Hartmann operation. This type of surgery is used when it is impossible to create an anastomosis. The essence of the operation is to remove the intestine with the primary tumor and with the subsequent formation of a single-barreled colostomy. In the future, it turns out to restore the integrity of the intestine.
When a patient is in a serious condition and he does not show a radical operation, it is recommended to conduct intestinal decompression in order to alleviate the condition. Stenting is the most convenient way to restore intestinal passage. The permeability is restored by endoscopic stent placement in the sigmoid colon.
Before the operation, the doctor tells the patient about the features of the manipulation, possible complications, and the risks that arise if you do not treat the sigmoid colon cancer. Also, the patient is explained about the anesthesia, the duration of the surgery and the estimated timing of the recovery period. To prepare for the surgical manipulation of the patient for a few days prescribed a diet that excludes food, contributing to the formation of gas and delayed stool. Also, the day before the operation, the patient is given a cleansing enema to remove toxins accumulated in the intestinal lumen.
In the postoperative period, nutrition for cancer of the sigmoid colon consists in the use of large quantities of fruits and vegetables. It is also recommended to reduce the amount of animal fat in your diet. It should be understood that after the removal of a part of the intestine, the assimilation of nutrients will be worse, therefore, easily digestible foods that do not require large energy consumption during splitting should prevail in the diet.
If the tumor is large, the radical surgery will be too traumatic for the patient. In such situations, chemotherapy comes to the rescue. With the help of pharmacological drugs, in some cases, it turns out to significantly reduce the size of the tumor and then to remove it.
The prognosis of the disease depends on a number of factors.
- First, the stage of cancer plays an important role, when it was discovered and what were the first symptoms
- Secondly, the age of the patient and the severity of his condition are of great importance.
- Thirdly, does the patient have associated diseases
If we consider the problem in general, then it is necessary to say that oncogenesis in the sigmoid colon give a late effect. Sigmoid cancer has an unfavorable prognosis if it is in 4 stages of development. In this case, patients do not receive radical treatment and can only rely on the effect of chemotherapy treatment.
After radical treatment, the five-year survival rate among the diseased averages about 30% - 60%. With malignant processes that were in stages 1-2 of progression, the survival rate is about 90%.
A very important prognostic sign is a metastatic lesion of a regional group of lymph nodes. In the absence of screenings - the survival rate is approximately 80%. If the patient has metastases, then about 40% of patients experience the 5-year mark.
Tumors of the sigmoid colon include a group of neoplasms that grow from the walls of the final section of the colon colon. The prevalence of sigmoid cancer is only slightly inferior to stomach cancer, lung cancer, prostate cancer and breast cancer. Mortality from malignant tumors of the sigmoid colon is relatively high, as the disease is rarely diagnosed in its early stages. In the structure of oncological pathology of the large intestine, tumors of this localization occupy 17%, second only to rectal cancer. At the same time, men suffer from sigmoid cancer more frequently than women. Benign tumors localized in the sigmoid colon have a relatively favorable prognosis. Specialists in the field of surgical oncology and proctology are studying the characteristics of the course of sigmoid tumors.
To date, scientists have not identified unambiguous causes of the formation of sigmoid tumors. Recently, however, risk factors have been identified for the development of this group of neoplasms, which include the presence of large amounts of meat and fats in the diet, smoking, excessive alcohol consumption, increased weight and hypodynamia, chronic hypotension of the intestine, constant trauma to the epithelium in dense fecal masses, the effect of endogenous carcinogens (indole, skatole, steroid hormone decomposition products). Hereditary mechanisms play an important role in the development of sigmoid tumors (in 15% of cases, the disease is caused by them).
Malignant neoplasms of this localization often develop on the background of chronic inflammatory bowel disease, especially Crohn's disease and ulcerative colitis, sigmoid diverticulitis. The risk of sigma cancer is much higher in people with intestinal polyps (familial, sporadic and mixed polyposis, Kronkheyta-Canada syndrome, Peutz-Jeghers, Turk, etc.).
Symptoms of tumors
For a long time, tumors of the sigmoid colon may not manifest in any way or have unexpressed symptoms. As a rule, it takes more than a year from the initial appearance of discomfort in the colon to the final diagnosis. Malignant tumors of the sigmoid colon are most often manifested by progressive constipation, which ultimately ends in intestinal obstruction. This symptom is due to intestinal stenosis. In addition, in the early stages of the development of the disease may alternate constipation and diarrhea. Tumors of large sizes are characterized by a violation of the general condition: the appearance of general weakness, subfebrile body temperature, dizziness, and so on. Also in patients with sigmoid tumors, an aversion to meat, loss of appetite and weight loss are detected. All these symptoms are due to tumor intoxication. With malignant tumors of the sigmoid colon, blood appears in the feces.
Benign tumors of the sigmoid colon in most cases occur without severe clinical symptoms. In some situations, there may be bleeding, signs of intestinal obstruction and symptoms of intussusception. Lipomas can cause chronic partial intestinal obstruction, with which patients go to a doctor. However, in most cases, such benign tumors, such as lipomas and fibromas, are found by chance during endoscopy or laparotomy. The main symptom of hemangiomas are substantial bleeding from the rectum.
Treatment of sigmoid tumors
The main method of treating neoplasms of this localization is surgery. In malignant tumors, the entire sigmoid colon is removed with nearby tissues. In the event that intestinal obstruction has already developed on the background of the tumor, operative treatment begins with colon plasty and an artificial anus (colostomy). After successful removal of the tumor, the colostomy is subject to elimination with subsequent restoration of the intestinal integrity. After such an operation, patients will be able to return to their normal lifestyle.
Radiation therapy is an additional method of treating sigmoid tumors, which allows to improve the results of surgical intervention. In most cases, it is performed prior to surgical treatment to reduce the size of the neoplasm. Also, this therapy makes it possible to reduce the probability of abdominal colonization by tumor cells. Radiation treatment may also be prescribed after surgery to prevent the occurrence of recurrence of the malignant process.
The next additional treatment for sigmoid tumors is chemotherapy. It is used to increase the eradication efficiency of malignant cells. Chemotherapy suppresses tumor metastasis. In modern oncology, chemotherapy courses are conducted according to special protocols. The treatment plan is selected individually for each patient.
Treatment of benign sigmoid tumors consists in removing the tumor. The method of surgical intervention is determined by the localization of the tumor, the size and extent of the process. When single sigmoid colon polyps are detected, endoscopic excision is performed. Distal neoplasms are removed through transrectal access. In some cases, for example, when diagnosing a diffuse polyposis, resection of the sigmoid colon is required.
Prognosis and prevention
The prognosis for sigmoid tumors depends on the malignancy and the stage of the neoplastic process. With malignant intestinal neoplasms, the prognosis is mostly unfavorable. At the same time, with timely diagnosis in the early stages of the disease a complete cure is possible. Patient survival significantly decreases with progression. In the presence of distant metastasis, only palliative therapy is performed. Benign sigmoid tumors generally have a favorable prognosis.
For the prevention of sigmoid tumors, it is necessary to maintain a healthy lifestyle, which includes quitting smoking and taking excessive amounts of alcohol. An important role in the prevention of tumors of the sigmoid colon is played by proper nutrition: the diet should include a sufficient amount of fruits and vegetables. In addition, timely and adequate treatment of chronic inflammatory bowel disease, which is a precancerous condition, plays an important role in the prevention of the disease. People who have chronic bowel disease are advised to undergo regular medical examinations with a colonoscopy with a biopsy.