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Malignant neoplasm of transverse colon: [Carcinoma of the transverse colon]

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[Carcinoma of the transverse colon]

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Review

. 2006 Sep-Oct;143(5):285-93.

doi: 10.1016/s0021-7697(06)73693-6.

[Article in

French]

P Lê 
1
, L Mehtari, C Billey

Affiliations

Affiliation

  • 1 Service de Chirurgie Générale, Centre Hospitalier de l’Agglomération Montargoise, Montargis.

  • PMID:

    17185954

  • DOI:

    10.1016/s0021-7697(06)73693-6

Review

[Article in

French]

P Lê et al.

J Chir (Paris).

2006 Sep-Oct.

. 2006 Sep-Oct;143(5):285-93.

doi: 10. 1016/s0021-7697(06)73693-6.

Authors

P Lê 
1
, L Mehtari, C Billey

Affiliation

  • 1 Service de Chirurgie Générale, Centre Hospitalier de l’Agglomération Montargoise, Montargis.

  • PMID:

    17185954

  • DOI:

    10.1016/s0021-7697(06)73693-6

Abstract

Carcinoma of the transverse colon accounts for 10% of all colorectal cancer. Diagnosis is often delayed and complicated forms (perforation, fistulization, obstruction) occur in 30-50% of cases. The progression of symptoms is often insidious and tumors may be voluminous by the time of diagnosis. Right sided tumors are typically bulky and late-stage; perforation may lead to abdominal wall or retroperitoneal abscess. Tumor can also extend or fistulize into adjacent organs. Distal transverse cancers may be small annular lesions which are prone to obstruction. Cancers present as T4 lesions in 20-40% of cases. Abdominal CT is the best test to evaluate the loco-regional extension of advanced tumors. Their central location and advanced stage at presentation results in an extensive differential diagnosis. This central location also poses difficult surgical choices for lymph node dissection, extent of resection, and re-establishment of intestinal continuity. Surgical series which focus on transverse colon cancer date from the 1970-80’s; they show curative resections in only 50% with morbidity/mortality of 20% and a global five year survival of less than 35%; they were considered to have a particularly poor prognosis.

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What is the best surgical procedure of transverse colon cancer? An evidence map and minireview

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symptoms and treatment of cancerous tumors in the Federal Scientific and Practical Center of the Federal Medical and Biological Agency

Colon cancer is the most common type of malignant tumor of the gastrointestinal tract. This is a multifactorial disease, which is based on genetic factors, environmental factors, as well as inflammatory pathology of the gastrointestinal tract.

Colon cancer often develops in older patients, against the background of polyps and other changes in the large intestine. In the presence of certain provoking factors, polyps can eventually transform into a malignant tumor. The recommendation to undergo an annual medical examination is due to the timely diagnosis of polyps and other benign neoplasms before their malignancy.

In the treatment of colon cancer, surgical methods, radiation and drug therapy are used. Drug treatment includes chemotherapy, targeted therapy, immunotherapy.

Departments and functions of the colon

The colon, together with the rectum, forms the large intestine, the last section of the digestive tract. In turn, the colon consists of several sections: the caecum with the appendix, the ascending colon, the transverse colon, the descending colon, and the sigmoid colon.

The wall of the colon consists of three layers: mucous, muscular and serous. The growth of the polyp begins from the innermost shell – the mucous layer.

From the small intestine, the digested food bolus enters the colon. The job of the colon is to form stool. At this stage, the bacteria living in the large intestine complete the chemical process of digestion.

Colon cancer symptoms

Colon cancer often causes no symptoms in the early stages. As it progresses, it is accompanied by the following symptoms:

  • Prolonged diarrhea or constipation
  • Change in character, color, shape of stools, band-like stools, dark brown or black bloody stools
  • Bleeding from the rectum
  • Persistent abdominal pain, gas, bloating, cramps
  • Nausea, vomiting
  • Persistent urge to defecate after defecation
  • Feeling of incomplete emptying of the bowels after going to the toilet
  • Rapid weight loss
  • Anemia due to intestinal bleeding
  • Fatigue, weakness (symptoms of anemia and tumor intoxication)

Tumor metastases that spread to other organs can give characteristic symptoms of the lesion. Thus, colon cancer metastases to the liver cause jaundice.

Cancer that grows large can close the colon and cause an obstruction. Intestinal obstruction is a life-threatening emergency. If you suspect an obstruction, it is recommended to immediately call an ambulance or consult a doctor.

Obstruction symptoms include:

  • Severe, cramping pains in the abdomen that bother regardless of eating
  • Absence of stool and passing flatus
  • Sharp, sudden swelling, rumbling in the abdomen
  • Multiple vomiting

Tumor stages

It is possible to determine the stage of colon cancer only after examining the patient.

Doctors use the TNM staging system, where T (tumor) is the size of the tumor, N (nodus) is spread to the lymph nodes, M (metastasis) is the presence of metastases in other organs and structures of the body. The stage of the cancer indicates the extent of spread and size of the tumor.

There are five stages of colon cancer:

  • Stage 0 (carcinoma in situ) . This stage identifies abnormal or precancerous cells in the mucosal layer, the innermost layer of the colon.
  • Stage 1. The tumor has invaded the mucosa but has not spread beyond the muscle layer or to nearby lymph nodes.
  • Stage 2. The cancer has spread beyond the muscle layer to the outer serous layer of the colon wall, and possibly to adjacent organs.
  • Stage 3. Growth of a cancerous tumor through all layers with spread to the lymph nodes.
  • Stage 4. Metastasis of a cancerous tumor to the liver, lungs, ovaries.

Causes

Colon cancer occurs when abnormal (abnormal) cells grow and divide uncontrollably. In this case, the process of programmed cell death is disrupted. Cancer is growing steadily. Until the end, the causes of the appearance of abnormal cells and precancerous polyps, from which cancer is formed, remain unclear. Certain factors increase the risk of polyps turning into cancer. These factors include certain diseases, including hereditary, as well as lifestyle.

Lifestyle factors:

  • Smoking. Tobacco use, including e-cigarettes, increases the risk of developing cancer
  • Alcohol. Alcohol abuse increases the risk of colon cancer
  • Obesity. Obese people have a higher risk of developing cancer and dying from colon cancer
  • Insufficient physical activity. Regular physical activity reduces the risk of colon cancer
  • Low fiber diet , high fat, red meat.

Medical factors in the development of cancer:

  • Inflammatory bowel disease. It includes ulcerative colitis, Crohn’s disease, conditions that increase the risk of developing cancer. The risk increases if the duration of the inflammatory disease in history is seven years or more.
  • Hereditary syndromes that increase the risk of developing a tumor of the colon, such as familial adenomatous polyposis, Lynch syndrome (hereditary non-polyposis colorectal cancer). A small percentage of cancers are associated with gene mutations.
  • Diabetes mellitus. People with diabetes have an increased risk of developing cancer.
  • Cases of bowel cancer in a relative of the first line – mother, father, brother, sister
  • Radiation therapy. Radiation therapy for previously diagnosed abdominal cancer increases the risk of colon cancer

Colon cancer diagnostics

If colon cancer is suspected, the doctor conducts a survey, performs a standard physical examination. The examination also includes performing a digital rectal examination, as well as palpation of the abdomen for seals.

The doctor orders laboratory blood tests, such as a complete and biochemical analysis, to determine or rule out iron deficiency anemia. Anemia occurs as a result of bleeding from the tumor.

Laboratory tests also include the study of feces for occult blood, the determination of the level of cancer embryonic antigen (CEA). Cancer embryonic antigen is a protein-based chemical that is synthesized in colon cancer. It is a marker of cancer. Controlling the level of CEA over time helps to assess the prognosis and understand how the cancerous tumor responds to treatment.

Flexible sigmoidoscopy

Flexible sigmoidoscopy – examination of the anus, rectum and sigmoid using a sigmoidoscope. The device is a flexible endoscope equipped with a video camera for visualizing the mucous layer, no more than sixty centimeters long.

Colonoscopy

Colonoscopy is an invasive endoscopic examination of the inside of the large intestine using a flexible, thin endoscope. The endoscope is equipped with a camera for examining the mucosa. If any suspicious areas are found, the doctor inserts surgical instruments, takes a tissue sample for histological examination, and also removes polyps. Colonoscopy requires careful preparation, taking medications to cleanse the intestines. It is performed both at the screening stage and when a malignant tumor of the colon is suspected.

Colonoscopy is a highly effective diagnostic and treatment method. Unlike sigmoidoscopy, colonoscopy examines all parts of the large intestine.

CT colonography

CT colonography, also known as “virtual colonoscopy”. The method is based on the use of a CT scanner to create a three-dimensional image of the colon and rectum. During the test, gas is used to inflate the intestines with a thin, flexible tube. Then perform computed tomography in different projections. As before a colonoscopy, you need preparation in the form of bowel cleansing. This study is indicated for patients who, for whatever reason, are contraindicated in performing a colonoscopy.

Prevention

Knowing about cases of colon cancer in the family is important for timely screening. If risk factors are present, doctors recommend screening at age 45, or 10 years younger than the age at which a relative was diagnosed with colon cancer. People at increased risk, such as those with a history of familial polyposis, should consider screening earlier. Screening includes performing a colonoscopy, taking a stool test for occult blood. Colonoscopy is recommended every 10 years. The study of feces for occult blood is carried out 1 time in 2 years.

Lifestyle recommendations include:

  • Complete, balanced nutrition. Inclusion in the diet of fiber, vegetables, fruits, whole grains
  • Smoking cessation
  • Drinking a reasonable amount of alcohol
  • Active lifestyle with regular moderate to vigorous exercise
  • Maintaining a healthy weight

Colon cancer treatment at FNCC

The Federal Research and Clinical Center for the treatment of colon cancer uses surgical methods and drug therapy. Drug treatment includes chemotherapy, targeted therapy, immunotherapy. When choosing a method, a multidisciplinary team of doctors takes into account the location, stage of the tumor, the aggressiveness of the cancer, the degree of spread, general health, and also takes into account chronic comorbidities.

Early treatment

Surgery at an early stage of cancer involves a minimally invasive procedure:

  • Removal of polyps during colonoscopy. Cancer localized in the polyper at an early stage and without spread is removed completely during endoscopy.
  • Endoscopic mucosal resection. The procedure involves the removal of a larger polyp and part of the submucosa using endoscopic instruments.
  • Laparoscopic intervention. During laparoscopy, polyps are removed that are difficult to remove endoscopically

Treatment of common forms

If a cancerous tumor grows through all layers, an operation is performed to remove a section of the large intestine – resection of a part of the large intestine with a tumor:

  • Open colon resection. During the operation, the surgeon makes an incision on the anterior abdominal wall and removes the area of ​​the colon affected by the tumor, with certain groups of lymph nodes.
  • Laparoscopic colon resection. The difference with the open type of operation is only in online access. Laparoscopy involves the creation of several accesses – incisions with the introduction of laparoscopic surgical instruments and a video camera. During the operation, in both cases, nearby lymph nodes are removed. Laparoscopy is currently the preferred surgical method, routine in most medical organizations. It is less painful, provides faster patient recovery compared to open surgery.

The operation to remove a section of the colon is completed either by suturing the two ends of a healthy intestine, or by creating a stoma. The formation of a stoma involves the creation of an opening in the abdominal wall and the opening of the intestinal lumen into the opening to preserve the passage of the stool. The stoma may be temporary until it heals, or permanent if stitching is not possible.

Chemotherapy

Chemotherapy for bowel cancer, which consists in taking drugs against cancer cells, is performed at different stages of treatment:

  • Before surgery in combination with radiotherapy to reduce the initial size of the tumor
  • After surgery to reduce the risk of recurrence
  • Palliative chemotherapy to slow the progression of advanced cancer, reduce symptoms

Chemotherapy can be oral, intravenous, or combined. It is carried out in courses lasting 2-3 weeks, depending on the stage of the disease.

Side effects of chemotherapy include:

  • Fatigue, weakness
  • Diarrhea
  • Nausea, vomiting
  • Mouth ulcers
  • Hair loss
  • Numbness, tingling, burning sensation in arms and legs
  • Weakening of the immune system, increased susceptibility to infectious diseases

These symptoms disappear gradually after the completion of the course of treatment.

Radiotherapy

Radiation therapy is based on energy sources, such as X-rays, that can destroy a cancerous tumor. Radiotherapy is used before surgery to reduce the size of the tumor. When surgery is not possible, radiation therapy is given as palliative care to relieve symptoms.

Targeted therapy

Targeted therapy involves taking drugs that affect the biological processes of cancer cells, blocking their spread in the body. The drugs target receptors located on the surface of cancer cells. Blocking the receptors stops tumor growth.

Immunotherapy

Immunotherapy involves the administration of drugs that act on the immune system to stimulate the fight against cancer. Cancer cells synthesize substances that make the tumor “invisible” to the immune system. Immunotherapy stimulates antibodies to recognize molecules on the surface of cancer cells and bind to them.

In the Department of Surgery No. 1 of the Federal Research and Clinical Center of the Federal Medical and Biological Agency of Russia, all types of surgical treatment of colon cancer are performed, including the minimally invasive method. The employees of the department are certified in the specialty “oncology” and “coloproctology”, they are proficient in all methods of surgical treatment. For the development and introduction into clinical practice of new minimally invasive methods in oncology, in 2018 the staff of the department was awarded the Prize of the Government of the Russian Federation in the field of science and technology.

Treatment prices

Chemotherapy

Surgery

Primary appointment (examination, consultation) with an oncologist

2,250 ₽

Repeated appointment (examination, consultation) with an oncologist

1,950 ₽

Medical colonoscopy. Endoscopic resection of the mucous membrane

47 450 ₽

This article is informational material and is not intended for self-diagnosis and self-treatment. If signs of discomfort appear, you should contact your doctor.

Colon cancer – symptoms and signs, diagnosis

Table of contents

Colon cancer is an oncological disease that affects part of the intestine, the functions of which include the reabsorption of fluid and the formation of feces.

Colon cancer is classified into adenocarcinoma, neuroendocrine and squamous cell tumors. It is possible to determine the histological form of the disease only after the diagnosis of the neoplasm using endoscopy and surgery.

Colon cancer – stages

Colon cancer is classified by a single international methodology that determines the course of the disease depending on the symptoms and signs of the development of the disease. A common designation for the development of colon cancer is used to predict effective treatment among physicians and scientific research.

The staging of the disease depends on the spread of cancer cells in the body. From the site of the tumor to its metastasis to other organs.

Stage 1 – a neoplasm is diagnosed only in the tissues of the colon,

Stage 2 – germination of cancer cells in the intestinal cavity,

Stage 3 – the tumor spreads to the lymphatic vessels and nodes,

Stage 4 – metastasis to other organs.

Colon cancer – symptoms

This dangerous disease in the early stages is asymptomatic. Signs of colon cancer appear as early as stages 3 and 4. Symptoms include pain in the middle of the abdomen, indigestion, and discharge of blood and mucus. The general well-being of a person is also deteriorating. Intoxication of the body with cancer cells is detected by such signs as fever, weakness, fatigue, loss of appetite and, as a result, weight loss.

Diagnosing the general condition of the body and conducting preventive examinations allows you to identify colon cancer before the onset of symptoms and signs, which helps to organize the correct treatment regimen.

Colon cancer – causes of development

The causes of colon cancer are:

  • genetic heredity,

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  • chronic inflammatory bowel disease,
  • bad habits,
  • sedentary lifestyle.

Colon cancer – diagnosis

The patient’s complaints and symptoms of the disease usually begin with intestinal colic. At a consultation with a specialist, the reasons for the occurrence of signs of disruption of the internal organs and general condition are clarified.

Colon cancer in some cases can be identified at the initial examination by palpation of the abdominal cavity. After that, endoscopic examinations are prescribed with the taking of biomaterial. This study allows the doctor to determine the size, nature and stage of the tumor, which is extremely important for the percentage of possible recovery.

If it is impossible to use the endoscopic method of treatment, irrigoscopy is prescribed, which also helps to assess the nature of the neoplasm. Computer diagnostics allows you to determine the stage of the disease and the spread of cancer cells in the body. Colon cancer can be complicated by concomitant pathologies, so it is necessary to prescribe examinations of blood vessels, lymph nodes, lungs and heart, as well as blood and urine tests.

Colon cancer – treatment

Colon cancer is treated by available combined methods, with the use of surgery and chemotherapy.

Depending on the signs of the tumor and the symptoms of the patient, several types of treatment are selected. The staging of colon cancer allows you to either immediately perform a radical removal of the tumor site, or to carry out a complex of supporting procedures.

In the first and second stages, only part of the intestinal cavity can be removed. If the colon cancer has progressed to the lymph nodes, then they are removed too. After resection of part of the intestine, chemotherapeutic treatment is performed. Taking specialized drugs reduces the risk of relapse, and also helps to relieve a large number of symptoms of the disease. But after taking chemotherapy, side effects may occur. Inflammatory processes in the oral cavity, reactions on the skin, digestive disorders and a decrease in blood sprouts. Such side effects are corrected by changing drugs to reduce symptoms.

Colon cancer is also treated with modern treatments such as HiFu therapy. This is an improved analog of radiation therapy, which allows high-frequency ultrasound exposure to the intestinal cavity through the peritoneum.

A feature of the rehabilitation period of colon cancer is the setting of an intestinal stoma. Such a measure is necessary for the healing of the resection site and is removed after 3-6 months from the date of the operation.