Most Common and Rare Forms

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science.

This page was updated on August 11, 2022.

Colorectal cancer develops in the colon or in the rectum. If it starts in the colon, it may be referred to as colon cancer. If it starts in the rectum, it may be called rectal cancer. Regardless of where they start, however, these cancers share a lot in common, which is why they’re together known as colorectal cancer.

The most common type of colorectal cancer is adenocarcinoma. Adenocarcinomas of the colon and rectum make up 95 percent of all colorectal cancer cases. In the gastrointestinal tract, rectal and colon adenocarcinomas develop in the cells of the lining inside the large intestine. These adenocarcinomas typically start as a growth of tissue called a polyp. A particular type of polyp called an adenoma may develop into cancer. Colorectal polyps are often removed during a routine colonoscopy before they may turn cancerous.

While other types of tumors may develop in the colon or rectum, they’re much more rare. Less common types of colorectal cancer include:

• Primary colorectal lymphomas
• Gastrointestinal stromal tumors
• Leiomyosarcomas
• Carcinoid tumors
• Melanomas

This article will cover:

• Types of colorectal cancer
• Rare types of colorectal cancer
• Genetic risks

Types of colorectal cancer

Colorectal adenocarcinoma

“Adeno” is a prefix meaning gland. “Carcinoma” is a type of cancer that grows in epithelial cells, which line the surfaces inside and outside the body. Adenocarcinomas develop in the lining of the large intestine (colon) or the end of the colon (rectum). They often start in the inner lining and spread to other layers.

There are two less common subtypes of adenocarcinomas:

• Mucinous adenocarcinoma is made up of about 60 percent mucus. The mucus may cause cancer cells to spread more quickly and become more aggressive than typical adenocarcinomas. Mucinous adenocarcinomas account for 10 percent to 15 percent of all rectal and colon adenocarcinomas.
• Signet ring cell adenocarcinoma accounts for fewer than 1 percent of all colon cancers. Named for its appearance under a microscope, signet ring cell adenocarcinoma is typically aggressive and may be more difficult to treat.

Most information about colorectal cancer refers to colorectal adenocarcinoma, the most common type. Estimates suggest that 4.1 percent of people may develop colorectal cancer during their life, according to the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program.

Colorectal adenocarcinoma symptoms generally include:

• Abdominal pain and tenderness
• Blood in stool
• Changes in bowel habits, such as diarrhea or constipation
• Thin stools
• Unexplained weight loss

Getting screened for colon cancer may detect the disease before it starts causing symptoms. The American Cancer Society (ACS) and the U.S. Preventive Services Task Force both recommend adults start colon cancer screening at age 45.

Diagnosing colorectal cancer starts with a colonoscopy, which lets doctors see inside the rectum and colon. If signs of colorectal cancer are discovered during a colonoscopy, other tests will follow. A biopsy may be performed, which involves removing a small piece of potentially cancerous tissue (sometimes during a colonoscopy) and analyzing the sample for the presence of cancer. Once a diagnosis is confirmed by a colonoscopy and a biopsy, blood tests and imaging tests, such as computed tomography (CT) scans and magnetic resonance imaging (MRI) scans, may be used to help learn more about the cancer and whether it’s spread.

Common treatment options for colorectal adenocarcinomas include:

• Surgery
• Chemotherapy
• Radiation therapy
• Targeted therapy

Gastrointestinal carcinoid tumors

Carcinoid tumors develop in nerve cells called neuroendocrine cells, which help regulate hormone production. These tumors are among a group of cancers called neuroendocrine tumors (NETs). Carcinoid tumor cells are slow-growing and may develop in the lungs and/or gastrointestinal tract. They account for about 1 percent of all colorectal cancers and half of all cancers found in the small intestine.

Potential symptoms differ depending on where the tumor grows. A carcinoid tumor in the appendix typically doesn’t cause symptoms, unless it begins to block the pathway from the appendix to the intestine, leading to appendicitis symptoms such as fever, nausea and vomiting.

Tumors in the small intestine or colon may cause stomach cramps and pain, weight loss, tiredness, bloating and other stomach problems. Carcinoid tumors in the rectum may cause pain, bleeding and constipation. In the stomach, carcinoid tumors typically don’t cause symptoms.

Carcinoid tumors also sometimes produce hormones that may lead to various symptoms, depending on the type of hormone. For example, 10 percent of people with these tumors may experience flushing in the face, diarrhea, wheezing and rapid heartbeat due to certain hormone-like substances that are released by the tumor, according to the ACS.

Depending on where they develop, gastrointestinal carcinoid tumors may be discovered in various ways. For example, a tumor in the appendix may be found after it causes appendicitis, and the appendix is removed. Rectal tumors may be detected during routine checkups.

Several tests are used to diagnose carcinoid tumors in the abdominal tract, including blood tests, urine tests, imaging scans, endoscopy and colonoscopy.

Gastrointestinal carcinoid tumor treatment options include:

• Surgery
• Radiation therapy
• Chemotherapy
• Hormone therapy

Rare types of colorectal cancer

Other types of rare colorectal cancers combined account for less than 5 percent of all cases:

Primary colorectal lymphomas

A type of non-Hodgkin lymphoma, this cancer type develops in the lymphatic system, specifically in cells called lymphocytes. Lymphocytes are a type of white blood cell that helps the body fight infections. Lymphoma may develop in many parts of the body, including the lymph nodes, bone marrow, spleen, thymus and the digestive tract. Primary colorectal lymphomas account for 0.5 percent of all colorectal cancers and about 5 percent of lymphomas. This colorectal cancer type usually develops later in life and is more common in men.

Symptoms may include indigestion, bloating, unexplained weight loss, stomach pain, vomiting, diarrhea and other stomach issues. Diagnosis may involve biopsy and endoscopy.

Treatment options vary but may include:

• Chemotherapy
• Radiation therapy
• Surgery

Gastrointestinal stromal tumors

Gastrointestinal stromal tumors are a rare type of colorectal cancer that forms in special cells found in the lining of the gastrointestinal (GI) tract called interstitial cells of Cajal (ICCs). More than 50 percent of GISTs develop in the stomach. While most other GISTs form in the small intestine, the rectum is the third most common location. GISTs are classified as sarcomas, or cancers that begin in the connective tissues, which include fat, muscle, blood vessels, deep skin tissues, nerves, bones and cartilage.

While estimates are uncertain, about 4,000 to 6,000 cases of GIST are diagnosed in the United States every year, according to the ACS. These tumors tend to take a while to grow large enough to start causing symptoms. However, they may cause bleeding in the gastrointestinal tract. Depending on the location of the tumor, blood may show up in vomit or bowel movements. Over time, slow bleeding may lead to a decrease in the amount of red blood cells, a condition called anemia, which causes fatigue and weakness.

Other potential symptoms include:

• Abdominal pain
• Abdominal mass or lump
• Nausea
• Vomiting
• Poor appetite
• Weight loss
• Swallowing problems

The diagnostic process may involve an endoscopy, colonoscopy, biopsy and various imaging tests.

Some smaller GISTs may not need to be treated right away, while others are typically treated with surgery and targeted therapy.

 Colon and rectal leimyosarcomas

Another form of sarcoma, leiomyosarcoma essentially means “cancer of smooth muscle.” The colon and rectum have three layers of the type of muscle affected by leiomyosarcoma, and all three work together to guide waste through the digestive tract. This rare type of colorectal cancer accounts for about 0.1 percent of all colorectal cases.

In the early stages, leiomyosarcomas in the colon or rectum may not cause symptoms. As the cancer progresses, symptoms may include fatigue, weight loss, vomiting blood, changes in stools and other stomach problems. Diagnosis generally includes standard measures, such as a biopsy, blood tests and imaging tests. Treatment typically starts with surgery to remove the tumor. Other treatment options include radiation therapy and chemotherapy.

Colon and rectal melanomas

Most commonly associated with skin cancer, these may start to develop anywhere, including in the colon or rectum, or may spread to the GI tract from the primary melanoma site. Melanomas account for 1 percent to 3 percent of all cancers that develop in the digestive system, according to research published in BMJ Case Reports. How melanomas develop in the colon isn’t well understood, as it’s extremely rare. Diagnosis may involve a biopsy and other tests to determine whether the cancer spread from elsewhere in the body or started in the colon or rectum.

Colorectal melanoma treatment may include:

• Surgery
• Immunotherapy
• Chemotherapy
• Radiation therapy

Colorectal squamous cell carcinoma

This cancer, also known as SCC, is extremely rare in the colon, with fewer than 100 cases reported in the literature as of a 2017 case report in the Journal of Community Hospital Internal Medicine Perspectives. Squamous cell carcinoma is typically associated with skin cancer—it’s the second most common type of skin cancer. Squamous cells are a particular type of cell present in many areas of the body. Squamous cell carcinoma occurs when these cells start growing uncontrollably and become cancerous. The reason why this rarely occurs in the colon and rectum isn’t well understood.

Symptoms may resemble colorectal adenocarcinoma, including stomach issues and changes in stool or bowel habits. Colonoscopy and other tests are used to diagnose this cancer. It’s important to determine whether the cancer started in the colon or rectum, or whether it spread to this region from another area of the body. Treatment isn’t standardized but may include surgery, chemotherapy and radiation therapy.

Familial adenomatous polyposis (FAP)

This accounts for about 1 percent of all cancers in the colon or rectum, according to the ACS. People with this syndrome may develop hundreds or even thousands of colon or rectal polyps. These polyps tend to occur when people with this syndrome are 10 to 12 years old. Nearly all people with FAP develop colorectal cancer during their lifetime, and as a result, some people have their colon removed as a preventative measure.

Genetic risks

If an inherited syndrome associated with colorectal cancer is suspected, the patient may consider undergoing genetic testing. Genetic testing involves taking a sample of blood, hair or other bodily fluids to analyze for DNA mutations linked to cancer or a genetic syndrome. The patient also may be advised to get regular colonoscopies to look for colorectal cancer and to begin screening early.

Peutz-Jeghers syndrome (PJS): This condition causes a particular type of polyp to develop in the gastrointestinal tract, called a hamartoma. This syndrome is inherited from one’s parents and is caused by mutations in a particular gene (STK11). It comes with an increased risk of colorectal cancer and others including breast cancer, ovarian cancer and pancreatic cancer. If colorectal cancer does occur in individuals with PJS, it tends to develop at a younger than average age.

Familial colorectal cancer: Some people inherit genetic syndromes from their parents that increase their risk of getting colorectal cancer. These syndromes come with mutations—in particular, genes that make it more likely that cancer will develop. Examples include Lynch syndrome, familial adenomatous polyposis and other rarer syndromes. Lynch syndrome is associated with about 2 percent to 4 percent of all cancers in the colon or rectum, according to the ACS. People with Lynch syndrome have a high risk of getting colorectal cancer at some point in their lifetime—up to 50 percent. Those who have Lynch syndrome and go on to develop colorectal cancer tend to get the cancer at an earlier than average age.

Does it matter if colon cancer is on the left or right side? | Roswell Park Comprehensive Cancer Center

Roswell Park’s new colon and rectal surgeon, Anthony Dakwar, MD, explains the differences between colon cancers that arise in the right side of the colon compared to those in the left side.

Yes, it does. Several differences can be seen in the colon cancers that begin on the left side, in the descending and sigmoid parts of the colon, compared to those that occur on the right side, in the ascending and cecum portions of the colon, explains Roswell Park Comprehensive Cancer Center’s new colon and rectal surgeon Anthony Dakwar, MD. (Cancers can also develop in the middle, transverse section of the colon, although less commonly.)

The location in the colon where cancer develops is one of the factors that’s considered when developing your customized treatment plan.

The differences between left-sided and right-sided colon cancers include why and how the cancer developed, whether it produces noticeable symptoms, and the cancer’s aggressiveness and how well it responds to usual chemotherapy regimens. “While polyps can occur anywhere in the entire colon, their incidence and their predisposition to turn into cancer can differ depending on where in the colon they arise,” says Dr. Dakwar

Left-sided colon cancers are often ordinary

The cancers that develop on the colon’s left side are more likely to be unremarkable, garden-variety colorectal cancers. These tend to develop in a traditional pathway, Dr. Dakwar explains. “Simple colon polyps, abnormal growths of tissue, experience a sporadic chromosomal change in their cells that, in time, can convert into a cancerous tumor. This process is slow and can take several years, which is why screening with colonoscopy can be performed at several-year intervals.”

Right-sided colon cancers are more unusual

Polyps that develop in the right side of the colon are more likely to occur in people with a genetic predisposition for developing cancer, such as Lynch Syndrome and microsatellite instability. Right-sided polyps are more likely to develop into cancers — which often grow rapidly and have a higher risk for metastasis, spreading to distant body areas.

Right-sided colon cancers also tend to develop from flat polyps rather than the usual mushroom-shaped ones, and are genetically atypical, too. “Differences in the genetic makeup of these tumors often means these cancers are more aggressive and can be resistant to current chemotherapy treatment regimens,” he says.

Both types need multidisciplinary care

The location of your cancer is just one aspect of it that’s contemplated in developing your treatment plan. “For both left- and right-sided colon cancers, unless they are metastatic, upfront surgery is the typical first-line treatment,” says Dr. Dakwar. “However, the key to having successful treatment is a multidisciplinary approach with regards to obtaining personalized and individualized cancer care.” At Roswell Park, your care team will include physicians from various medical disciplines — surgical, medical and radiation oncologists, plus gastroenterologists and pathologists — each bringing their respective expertise to the table.

“Our team ensures that every patient gets evaluated systematically and receives a customized treatment plan. We are able to get patients on cutting-edge clinical trials in order to enhance their treatment plan and provide opportunity for being cancer-free.”

Don’t wait for symptoms — get your screening!

Screening tests look for signs of cancer before it progresses to the point where symptoms may arise. Abdominal symptoms such as pain, bloating or rectal bleeding are often signs of an abnormal process in the left side of your colon. “Right-sided colon cancers tend to be asymptomatic or cause these symptoms only when they are at an advanced stage and fairly large. Right-sided cancers are more likely to be diagnosed at a later stage and this alone makes for a poorer prognosis,” Dr. Dakwar says.

The good news is that screening with colonoscopy can detect polyps and early cancers anywhere in the colon. Getting a colonoscopy screening on time, according to the recommended guidelines, can find and treat precancerous polyps and prevent cancer from forming. “There is no other screening test that can substitute for a colonoscopy,” says Dr. Dakwar.

What is “on time” for your colonoscopy? Most people at average risk should begin regular colon and rectal screening at age 45. But several factors mean you should begin sooner, such as being African American or having a family history of gastrointestinal cancer. Talk to your healthcare provider to learn when you need to schedule your screening.

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symptoms, stages, prognosis, survival, diagnosis, treatment of sigmoid colon cancer

Contents

• Causes and risk factors
• Signs of cancer of the sigmoid colon
• Types of sigmoid colon cancer
  • Histological classification
  • Growth classification
  • TNM classification and stages
  • ICD-10 code
• Diagnosis of oncology of the sigmoid colon
• Treatment of sigmoid colon cancer
• Prognosis in cancer of the sigmoid colon
• Prophylaxis

Sigmoid colon cancer is a malignant tumor of the intestine that grows from mucosal epithelial cells. Among all oncological diseases of the intestine, it ranks third, and is diagnosed in 34% of patients. The predominant number of cases is in the age group of 40-60 years, men get sick 1.5 times more often than women. At the initial stage, cancer does not give symptoms, so early diagnosis is possible only with the help of regular screening. The progression of the disease is accompanied by metastasis of the tumor to other parts of the intestine, liver, lungs. Given the small number of early diagnosed cases, cure for sigmoid colon cancer is possible only in 50-60% of patients. The median five-year survival rate is 65%. Treatment of sigmoid colon cancer is carried out by surgical methods, radiation and targeted therapy, chemotherapy.

Causes and risk factors for the development of sigmoid colon cancer

The cause of atypical degeneration of epithelial cells of the intestinal mucosa is the negative influence of external and internal factors. The anatomical features of the sigmoid colon increase the risk of malignancy. The intestine has an S-shape, which is why feces move more slowly through it. This leads to a longer contact with the mucosa of carcinogenic food products. The longer this contact, the higher the likelihood of malignancy of epithelial cells.

Causes and risk factors for the development of sigmoid colon cancer:

• sedentary work, low physical activity;
• predominance in the diet of fried, spicy foods, products of animal origin;
• chronic bowel disease;
• anomalies of intestinal development;
• chronic constipation;
• alcohol abuse, smoking;

90,005 cases of colorectal cancer in the family;

• colon polyps;
• unfavorable ecological situation;
• harmful production factors.

Symptoms of sigmoid colon cancer

The initial stage of sigmoid colon cancer, until the tumor has reached a large size, proceeds without obvious symptoms. As the neoplasm grows, the patient complains of:

• weakness, excessive fatigue;
• rumbling, bloating;
• alternating diarrhea and constipation;
• pain in the lower abdomen;
• mucus in stool, discoloration;
• nausea, loss of appetite.

When the first signs of sigmoid colon cancer appear, you should contact your general practitioner or proctologist. Laboratory and instrumental examination reveals the disease at an early stage, when the most sparing surgical treatment can be dispensed with.

When the tumor reaches a large size, begins to disintegrate, signs of intestinal obstruction appear. Constipation begins to predominate in the patient up to the complete absence of stool, feces acquire a ribbon-like or pea-like shape. Blood and pus appear in the feces. Pain in the abdomen bothers a person more and more often, they have a cramping character.

Advanced cancer leads to severe intoxication. Cancer patients have a characteristic appearance:

• gray-earthy skin color;
• weight loss up to cachexia;
• large belly and thin limbs.

When metastases spread to other organs, symptoms appear that indicate a violation of their function. Metastasis of a malignant neoplasm occurs in three ways:

• lymphogenous – through the lymphatic vessels and nodes;
• hematogenous – with the blood flow, atypical cells are carried to different organs, most often to the lungs, liver, bones;
• implantation – a tumor that has sprouted into the intestinal wall passes to the mesentery, fiber, and peritoneum located nearby.

Classification of cancer of the sigmoid colon

Tumors of the sigmoid colon are classified by cellular origin:

• adenocarcinoma is the most common variant, it is formed from cells of the glandular epithelium, the severity of the course depends on the degree of differentiation of atypical cells;
• cricoid cell carcinoma is a rare form, formed by mucinous cells, characterized by an unfavorable course;
• mucoid cancer – formed by mucinous cells, characterized by low differentiation, rapid growth and metastasis.

Classification according to the nature of tumor growth includes two options – exophytic and endophytic. An exophytic tumor is similar to a polyp with a stalk, growing into the intestinal lumen. Endophytic cancer spreads inside the intestinal wall, has an annular shape.

Classification by TNM and stage

The TNM classification of sigmoid colon cancer generally accepted in oncology takes into account the size of the primary tumor, metastases of lymph nodes and other organs:

• Tis – the beginning of the formation of a malignant process, damage to the mucosal lamina propria;
• T0 – defeat of the entire submucosal layer;
• T2 – damage to the muscle layer;
• T3 – germination of the tumor throughout the intestinal wall, spreading into the fiber;
• T4 – tumor invasion of surrounding tissues;
• N0 – no damage to the lymph nodes;
• N1 – metastasis to 1-3 nearest lymph nodes;
• N2 – defeat of more than 3 regional lymph nodes;
• M0 – no metastases;
• M1a – metastases in one organ;
• M1b – metastases in several organs;
• M1c – metastasis in the peritoneum.

The following stages of sigmoid colon cancer are distinguished:

• 1 – the tumor is not more than 2 cm, does not extend beyond the mucosa, does not give metastases;
• 2A – formation up to 5 cm, germinates the intestinal wall, does not give metastases;
• 2B – the same as in 2A, but with metastases to the nearest lymph nodes;
• 3A – mass more than 5 cm, metastases to the nearest lymph nodes;
• 3B – widespread tumor with metastases to distant lymph nodes;
• 4A – the tumor blocks the intestinal lumen, metastasizes with blood flow to other organs;
• 4B – spread of cancer to nearby organs with the formation of fistulas, multiple metastasis.

Disease stages according to TNM classification:

• 0 — Tis, N0, M0;
• 1 – T1-2, N0, M0;
• 2 – T3-4, N0, M0;
• 3 – T1-4, N1-2, M0;
• 4 – T any, N any, M0.

ICD-10 code

ICD 10 code for sigmoid colon cancer (International Classification of Diseases) – C18. 7.

Diagnosis of oncology of the sigmoid colon

Diagnosis of cancer of the sigmoid colon is carried out by a coloproctologist. When communicating with the patient, the doctor specifies the nature of health complaints, the conditions for their occurrence and the duration of their existence. With a digital examination of the rectum, the proctologist cannot detect the tumor itself, since it is located much higher. However, traces of blood and pus remain on the glove, which indicates a pathological process in the intestines.

Instrumental and laboratory methods are used to clarify the diagnosis of sigmoid colon cancer. Blood and urine tests indirectly indicate oncopathology:

• moderate or severe anemia;
• increase in ESR and CRP;
• increased liver enzymes;
• vitamin B deficiency;
• bleeding disorder;
• blood in feces.

Imaging methods allow determining the exact position of the tumor, its size and metastasis:

• sigmoidoscopy, colonoscopy allow the doctor to visually assess the condition of the sigmoid colon mucosa, the size and nature of tumor growth, and also take a tissue sample for histological examination;
• computed tomography provides more accurate information about the prevalence of neoplasm in the intestine;
• radiography, ultrasound and magnetic resonance imaging help to identify immediate and distant metastases.

Histological examination provides information about the cellular origin of the tumor, helps to plan treatment and predict the chances of recovery.

Treatment of sigmoid colon carcinoma

An effective and reliable method of cancer treatment is surgery. Removal of part of the intestine with a tumor and adjacent tissues gives a high chance of a full recovery. However, this method works only at stages 1 and 2A of the disease, until the tumor has metastasized. It is extremely rare to detect cancer at these stages, therefore, in most cases, the patient must be treated in combination. Surgical intervention is combined with radiation and targeted therapy, chemotherapy.

During the operation, the surgeon removes the cancerous part of the sigmoid colon, mesentery and adjacent tissue with lymph nodes. The volume of intervention depends on the prevalence and localization of the pathological process. A prerequisite is the removal of 5 cm of apparently unchanged tissue on both sides of the tumor. This is the prevention of the preservation of atypical cells and the recurrence of the disease in the future.

It is important not only to remove the tumor, but also to restore the anatomical structure of the intestine for its full functioning. With a small size of the neoplasm, the surgeon forms an intestinal anastomosis immediately. Such an operation is called a single-stage operation. In severe cases with a large amount of tissue removed, the surgeon first brings the colostomy to the anterior abdominal wall. Anastomosis is formed after a few months, such an operation is called a two-stage operation.

Before and after surgery, the patient receives radiation therapy and chemotherapy. The purpose of their appointment before the operation is to reduce the size of the neoplasm, to suppress the reproduction of atypical cells. After surgery, radiation therapy and chemotherapy destroy the remaining cancer cells and affect distant metastases.

Chemotherapy is used as an independent method of treatment in patients with inoperable tumors, as well as in patients with contraindications to surgery.

Inoperable patients with sigmoid colon cancer undergo palliative therapy, which increases life expectancy and improves its quality:

• irradiation;
• operations to restore bowel function;
• analgesics;
• treatment of concomitant diseases.

Sigmoid colon cancer: prognosis

The prognosis for life and recovery in sigmoid colon cancer depends on the histological type of neoplasm, stage, timely diagnosis and treatment. The median five-year survival rate after combined treatment is 65%. Sigmoid colon carcinoma has a better prognosis than cricoid and mucosal carcinoma.

If treatment for sigmoid colon cancer was started at stage 1, then 5 years or more live 95% of patients. The prognosis for stage 2-3 sigmoid colon cancer is a five-year survival period in 30-50% of patients. At stage 4, five-year survival is possible only in 8%. This is why regular check-ups with colonoscopy are so important. People at risk for developing cancer should be screened annually.

Cancer of the sigmoid colon is completely curable at the first stage; for this, surgical removal of the neoplasm with part of the intestine is used. Starting from the second stage, the effectiveness of treatment decreases, a complete cure cannot be achieved already at stages 3B-4.

Prevention of cancer of the sigmoid colon

Prevention consists in timely detection and removal of risk factors:

• obligatory removal of all intestinal polyps, as they are absolutely precancerous conditions;
• annual examination of people over 40 for fecal occult blood, colonoscopy;
• rational, healthy diet with restriction of carcinogenic products;
• daily intake of fiber in the form of fresh fruits and vegetables;
• prevention of constipation;
• adequate exercise;
• cessation of smoking, alcohol.

Sources:

1. Zakharenko A.A. Staged surgical treatment of a patient with complicated locally advanced cancer of the sigmoid colon / A. A. Zakharenko [et al.] // Bulletin of Surgery. – 2015. – No. 1. – S. 67-70.
2. Demidov S.M. Colorectal cancer and rectal cancer / S.M. Demidov // Textbook. – 2016. – S. 6-36.
3. Davydov M.I. Oncology / M.I. Davydov, Sh.Kh. Gantsev // Textbook. – 2010. -S. 920.
4. Burtsev D.V. The effectiveness of screening for colon tumors on the basis of the regional consultative and diagnostic center / D.V. Burtsev // PM. – 2012. – No. 2. – S. 214-217.

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The information in this article is provided for reference purposes and does not replace the advice of a qualified professional. Do not self-medicate! At the first sign of the disease, you should consult a doctor.

first symptoms of adenocarcinoma, prognosis and treatment of the tumor

Sigmoid colon cancer often does not show clinical symptoms for a long time. For this reason, the diagnosis is often made at a late stage of the tumor process. Doctors at the Yusupov hospital recommend that even with minor manifestations of intestinal discomfort, seek help immediately.

In the Yusupov hospital, oncologists use the latest methods for diagnosing diseases of the sigmoid colon. Examination of patients is carried out using the latest equipment from leading world manufacturers. Laboratory assistants perform the study of blood, feces and other biological materials using high-quality reagents, which allows you to get accurate test results.

Oncology clinic surgeons masterfully perform traditional and innovative surgical interventions. Chemotherapists prescribe to patients the most effective anticancer drugs that have minimal side effects. Radiologists perform radiation therapy with modern devices that allow them to target the pathological focus without damaging the tissues surrounding the tumor.

Causes of tumors

Sigmoid colon cancer originates from cells of the glandular epithelium. It accounts for 34% of the total number of cases of colorectal cancer. In 60% of cases, a malignant tumor is detected in patients aged 40-60 years. Men are affected 1.5 times more often than women.

The high probability of developing sigmoid colon cancer is due to the characteristics of the organ. The sigmoid colon is located on the left side of the abdomen, above the rectum. It has an S-shape. If the progress of the contents through the intestines slows down, it remains in the sigmoid colon for a long time. This increases the contact time of toxic food processing products with the mucous membrane of the organ.

Cancer of the sigmoid colon can develop under the influence of the following adverse factors:

• Unbalanced diet – eating a large amount of fatty and meat foods, insufficient intake of fruits and vegetables, foods rich in fiber;

• Confounded heredity – the risk of developing a malignant neoplasm increases if close relatives had sigmoid colon cancer;

• Chronic inflammatory processes in the intestine – ulcerative colitis, diverticulosis, Crohn’s disease;

• Sedentary lifestyle, which slows down the evacuation of intestinal contents;

• Multiple intestinal polyps that are prone to degeneration into a malignant tumor; Constipation, in which the mucous membrane is not only in contact with carcinogens for a long time, but is also injured by the solid contents of the intestine;

• Age-related atony of the intestine.

The development of sigmoid colon cancer leads to smoking, alcohol abuse, consumption of foods containing carcinogenic food additives.

Classification

Taking into account the characteristics of tumor growth, oncologists distinguish two types of sigmoid colon cancer: exophytic and endophytic. Exophytic tumors grow into the intestinal lumen. They are protruding knots on a thick stem. With the progression of the pathological process, sigmoid colon cancer often ulcerates. There is bleeding and infection.

Endophytic cancer of the sigmoid colon grows predominantly deep into the intestine. The tumor spreads along the intestinal wall and may circularly cover the intestine. In its center there are areas of ulceration. Due to the circular growth of sigmoid colon cancer, the intestinal lumen narrows, and the movement of feces becomes difficult. This type of growth is most characteristic of sigmoid colon cancer.

Histologists distinguish three types of sigmoid colon cancer:

• Adenocarcinoma originates from cells of the glandular epithelium. It happens highly differentiated, moderately differentiated and low-differentiated;
• Mucosal (mucosal) adenocarcinoma is a type of poorly differentiated adenocarcinoma, represented by mucinous cells that secrete a large amount of mucus. The tumor grows rapidly and metastasizes early;
• Crico-cell carcinoma of the sigmoid colon is represented by atypical cricoid-shaped cells, which are formed as a result of intracellular accumulation of mucin, pushing the cell nuclei to the periphery. Ouchol is aggressive, proceeds unfavorably.

Cancer of the recto-sigmoid colon is represented by two forms: scirrhus and adenocarcinoma.

Stages

Oncologists distinguish 4 stages of sigmoid colon cancer:

In the first stage of the tumor, the size of the neoplasm does not exceed two centimeters. The tumor is located within the submucosal layer or mucous membrane. Regional lymph nodes are not affected by atypical cells.

The tumor in the case of the second A stage of cancer occupies less than half of the circumference of the intestine, does not germinate the wall. There are no metastases in the lymph nodes and internal organs. A cancerous tumor in stage 2B is located in the intestinal wall, but does not go beyond it. Oncologists detect metastases in the lymph nodes. There are no distant metastases.

In stage 3A sigmoid colon cancer, the size of the tumor is greater than half the circumference of the colon. There are no atypical cells in the regional lymph nodes. At 3B stage of the tumor, regional lymph nodes are affected by metastases.

A tumor at stage 4 of cancer blocks the lumen of the sigmoid colon. Hematogenous metastases are found in other organs. At stage 4 sigmoid colon cancer, nearby organs are affected, enterovesical fistulas and conglomerates are formed.

Symptoms

Initially, sigmoid colon cancer is often asymptomatic or has few symptoms, which complicates timely diagnosis. With progression, the tumor spreads to nearby organs, gives regional and hematogenous metastases (to the liver, lungs, spine, less often to other organs).

In the lower part of the intestine – the sigmoid colon – feces are finally formed, water and nutrients are absorbed. With improper nutrition, feces linger in this segment of the large intestine. The accumulated feces press on the walls of the intestine, as a result of which blood circulation is disturbed, toxic substances enter the body through the walls of the sigmoid colon. Constant constipation negatively affects the entire body. As a result of stagnation of intestinal contents, precancerous diseases, malignant tumors of the sigmoid colon develop.

Quite a long time the tumor of the sigmoid colon does not show clinical symptoms, which complicates the timely diagnosis. The first symptom of sigmoid colon cancer is intestinal discomfort. At first, it occurs periodically, and with the growth of the neoplasm it becomes pronounced. Later stages of sigmoid colon cancer are manifested by the following symptoms:

• Flatulence, belching, nausea, constipation or diarrhea, pain;

• The appearance of streaks of mucus and blood in the stool;

• Intense, dull or cramping pains, not dependent on food intake;

• Development of intestinal obstruction;

• Abscess of the abdominal cavity, bleeding, peritonitis (inflammation of the peritoneum).

Patients suffer from diarrhea alternating with constipation. Often, in the left half of the abdomen, doctors manage to feel a tumor-like formation. Sometimes the first manifestation of the tumor process is the development of intestinal obstruction. With progression, the tumor spreads to nearby organs, gives regional and hematogenous metastases (to the liver, lungs, spine, less often to other organs).

In patients with sigmoid colon cancer, doctors detect the following symptoms:

• Weakness;
• Fatigue;
• Pale or greyish skin tone;
• Hyperthermia;
• Loss of weight and appetite due to cancer intoxication.

With the development of intestinal obstruction, there are paroxysmal cramping pains that recur every 10-15 minutes, there is bloating, gas and stool retention. Possible vomiting. In case of destruction of the intestinal wall, peritonitis develops. Sigmoid cancer of the 4th degree with liver metastases is manifested by cachexia (cancerous depletion), anemia (anemia), jaundice and liver enlargement. With the appearance of hematogenous metastases, symptoms are added that indicate a violation of the functions of the affected organs.

Diagnosis

Diagnosis of a tumor of the sigmoid colon oncologists of the Yusupov hospital is established taking into account the anamnesis, complaints, objective examination data and the results of additional studies. The most informative for cancer of the sigmoid colon are endoscopic methods (sigmoidoscopy and colonoscopy). They allow you to visually assess the volume and localization of the neoplasm, take material for subsequent histological examination.

When examining patients with suspected sigmoid colon cancer, Yusupov hospital doctors use irrigoscopy (X-ray examination using barium suspension) and fecal occult blood analysis. To detail the stage of the tumor process, magnetic resonance and computed tomography are performed. All instrumental research methods are performed using the latest equipment from leading manufacturers in the USA, Japan and European countries.

Other diagnostic methods are used to detect metastases:

• Ultrasound examination of the abdominal organs;
• X-ray of the spine;
• Chest x-ray.

Yusupov hospital oncologists make the final diagnosis based on the results of histological examination. Differential diagnosis of malignant neoplasms of the sigmoid colon with precancerous and inflammatory bowel diseases, immobile tumors of the retroperitoneal space and mobile neoplasms of the mesentery is carried out.

Complex therapy

Oncologists of the Yusupov hospital carry out combined treatment of malignant tumors of the sigmoid colon. It includes surgery, radiotherapy and chemotherapy. The leading role is given to surgical treatment, which is aimed at radical removal of the tumor. The volume of surgical intervention depends on the prevalence of sigmoid colon cancer. In the early stages of the disease, in some cases, endoscopic techniques are used. For this, resection of the sigmoid colon is used.

In case of widespread tumor processes, surgeons perform a resection of the sigmoid colon with a portion of the mesentery and nearby lymph nodes. The affected area of ​​the sigmoid colon is removed with five centimeters of the unchanged intestine located above and below the tumor. Surgery for sigmoid colon cancer can be one-stage or two-stage. When carrying out one-stage operations after removal of the tumor, the surgeon restores the continuity of the intestine by applying an anastomosis. In advanced cases, the intestine is resected and a colostomy is formed. The integrity of the intestine is restored after a few months from the time of the first operation.

Surgery can be typical, combined, extended or combined. A typical operation is a resection of a section of the intestine with a tumor. The combined method of treatment is used, if necessary, to perform an operation on the segment of the intestine affected by cancer and other organs into which the tumor has grown. An extended operation is performed with tumor growth or the presence of synchronous neoplasms. Combined surgery involves the removal of the affected segment of the intestine along with other organs due to concomitant diseases.

In the presence of cancer metastases, doctors at the oncology clinic perform chemotherapy. Treatment with anticancer drugs for sigmoid colon cancer after surgery is used with caution – in some cases, it can cause negative results. Most often, the use of chemotherapy is advisable for inoperable tumors – it helps to reduce the size of the neoplasm. Cancer of the sigmoid colon does not respond well to radiation treatment. Radioactive rays can damage normal tissue, so this method is not used in the treatment of sigmoid colon cancer.

In advanced cases of cancer, palliative therapy is performed to reduce pain and ensure intestinal patency. Sometimes emergency surgery is performed for cancer of the sigmoid colon. They are aimed at sanitation of the abdominal cavity with peritonitis, elimination of intestinal obstruction.

Nutrition after surgery

After surgery on the sigmoid colon, patients of the Yusupov hospital are provided with dietary nutrition. The chefs prepare dishes from quality ingredients. They have a sufficient amount of vitamins and minerals. The menu includes kefir, yogurt, bifidus products, fresh vegetables and fruits. All dishes are prepared using gentle technologies: steamed, boiled, baked in the oven or on the grill. If indicated, the food is crushed. Patients eat regularly, fractionally, in small portions.

In the process of rehabilitation, the patient should follow certain rules:

• eat only fresh food;
• products must contain a sufficient complex of vitamins and minerals;
• minimize meat consumption;
• use kefir, yogurt, bifidus products more often;
• eat more fresh vegetables and fruits;
• include in the menu cereals, wholemeal products with bran;
• periodically include boiled or steamed sea fish in the menu;
• take food in crushed form, chew thoroughly;
• do not overeat, eat fractionally and regularly.

Prognosis

Prognosis of survival of patients with sigmoid colon cancer depends on the histological type of neoplasm, the level of cell differentiation, the prevalence of the malignant process, the presence of concomitant diseases and the age of the patient.

The average five-year survival rate is 65.2%. A more optimistic prognosis after surgery for sigmoid adenocarcinoma, since the tumor grows slowly and practically does not metastasize. When sigmoid colon cancer of the first stage is detected, 93.2% of patients overcome the five-year milestone, the second – 82.5%, the third – 59.5%. Up to five years, 8.1% of patients with stage 4 sigmoid colon cancer survive. Therefore, consult a doctor at the first signs of bowel dysfunction.

To establish an accurate diagnosis in the early stages of sigmoid colon cancer, when the first signs of intestinal disorders appear, call the Yusupov hospital. After a comprehensive examination, if the diagnosis is confirmed, oncologists will conduct adequate therapy.