The sigmoid colon, whose shape resembles the Latin letter S on its side, is an extremely important part of the large intestine, in which the final mass of fecal matter takes place.
It is here that they part with nutrients and water that are absorbed into the blood, and the feces enter the rectum( which is a continuation of the sigmoid) and is excreted from the body.
Concept of the disease
Sigmoid colon cancer is called a malignant tumor that develops from the epithelial tissues of the mucous membrane of this organ.
This is explained by the fact that, due to the peculiarities of its anatomical location, the sigmoid colon often becomes a stagnation site for stool masses. This occurs when there is a shortage of substances in the body that can stimulate normal intestinal peristalsis.
Stagnant feces are distributed along the entire length of the sigmoid colon, disrupting the process of normal circulation in it. At the same time toxins are being absorbed into the intestinal walls, which are present in large quantities in the feces.
Due to stagnant processes, the epithelium proliferates, leading to the formation of adenomatous polyps and the development of precancerous diseases. Slowed blood circulation, characteristic of this part of the intestine, contributes to the equally slow development of a cancerous tumor.
A thick peritoneum, a tight gut on all sides, smooths the manifestations of anxiety symptoms, making them invisible to the patient.
Absence of pronounced symptoms, carelessness of the patients themselves, who do not pay special attention to the irregularity of the stool, the appearance of pain in the late stages of the oncological process are the main reasons for the late treatment of the sick for medical help.
Risk Factors
Sigmoid colon cancer belongs to the number of polytheological diseases, as the impetus for its occurrence can give a variety of reasons.
Most often this is due to fault:
- Genetic predisposition. Patients with close relatives who have ever had colorectal cancer, automatically fall into the risk group for this disease.
- Chronic diseases of the colon( chronic colitis, diverticulosis, Crohn's disease, ulcerative colitis).
- Propensities to the formation of multiple polyps in the large intestine, caused by the mutation of the gene of the family adenomatous polyposis. Being originally benign neoplasms, they have a high capacity for malignancy. That is why most oncologists consider polyposis as a precancerous condition.
- Stary atony of the intestine.
- Diabetes mellitus type 2 and obesity due to it.
- Disturbances of intestinal motility caused by a sedentary lifestyle or resulting from a number of postoperative operations. Deterioration of intestinal peristalsis can also be facilitated by long-term administration of a number of medications.
- Unbalanced power supply. The development of sigmoid colon cancer is facilitated by eating foods that are full of animal fats, proteins and fast carbohydrates.
- Intoxication of the body as a result of the abuse of carcinogenic food additives, alcoholic beverages, smoking.
The first symptoms of sigmoid cancer in women and men
The main danger of sigmoid colon cancer is either complete absence or in the erasure and mild expression of the initial symptomatology. Not being specific, the first signs of the oncological process can be taken for manifestations of other, more harmless ailments.
Every person should be alerted by noticing some disorders of intestinal peristalsis, manifested in:
- elevated flatulence, characterized by irregular discharge of gases and inability to control this process;
- appearance of eructations, accompanied by a repulsive odor from the mouth;
- rumbling of the abdomen;
- painful urge to defecate;
- frequent changes in the nature of the stool( alternating diarrhea and constipation).
Occurrence of blood veins or small blood clots in feces, often mistaken for hemorrhoids, may be a consequence of trauma to the malignant adenomatous polyp.
Initial signs of sigmoid cancer in both women and men are completely identical.
General Symptoms of
General symptoms that develop in the late stages of the disease, when the cancer has already metastasized into the liver and lymph nodes, is expressed in:
- strong physical weakness;
- increased fatigue;
- appearance of signs of chronic intoxication( persistent nausea, frequent vomiting, rising body temperature to subfebrile values, headaches and dizziness, persistent loss of appetite);
- development of jaundice;
- earthy-gray color of the skin;
- anemia and drop in hemoglobin( due to constant blood loss through wounded mucous membranes);
- development of ascites( a large amount of fluid secreted by the affected tissue, filling the abdominal cavity);
- a sharp decrease in weight( down to total exhaustion);
- abdominal distention due to obstruction of feces;
- increased liver.
Stages and their prognosis
There are four stages in the clinical course of sigmoid colon cancer:
- During the 1st stage, the cancerous tumor is confined to the outside of the mucosa of the affected bowel. In detecting and treating the tumor at this stage, the five-year survival rate of patients is 97 to 100%.
- Stage 2 is divided into subspecies: stage IIA is characterized by the presence of a tumor that overlaps not more than half the circumference of the intestine and grows inside its lumen. Stage IIB is marked by the onset of tumor germination into the intestinal wall. Metastases at the level of the second stage of the oncological process are absent. The five-year survival rate of patients is quite high: it is 95% and 83% respectively.
- There are two stages in the development of the tumor of stage 3: stage IIIA is characterized by the presence of a tumor that does not give metastases and occupies no more than half the diameter of the intestinal lumen. At this stage of the oncological process, 59% of patients survive. The tumor, which passed to stage IIIB, gives single metastases to the regional lymph nodes. The presence of metastases reduces the level of five-year survival of patients to 40%.
- Malignant neoplasm of 4 stages is characterized by germination in the tissues of adjacent organs and multiple metastases to lymph nodes and distant organs. With qualified treatment, the chance of survival remains in 8% of patients.
Metastases and other complications of
In cancer of the sigmoid colon, metastases go to the tissues:
- of the liver;
- of the lung;
- of the spine.
The stage of metastatic cancer is associated with a significant pain syndrome caused by the germination of a cancerous tumor in the rectum, bladder, uterus, a number of located nerves, blood vessels and metastatic damage to distant organs.
Sigmoid cancer can lead to a number of complications:
- Intestinal obstruction( complete or partial), caused by the gradual narrowing of the lumen of the affected bowel with the tissues of a growing malignant neoplasm.
- Perforation of the intestinal wall followed by the development of peritonitis. This condition is often mistaken for manifestations of a perforated stomach ulcer or acute appendicitis.
- Tumor germination in the tissues of adjacent organs.
- The formation of retroperitoneal abscesses that develop as a result of microperforation of the affected intestinal wall or purulent inflammation of retroperitoneal lymph nodes.
- The formation of thrombophlebitis in the veins of the pelvis.
Diagnosis
During the initial examination of a patient who has consulted a specialist with complaints the symptoms of which coincide with the manifestations of sigmoid cancer, the doctor is obliged to perform a finger examination of the sigmoid colon and palpation of the abdomen.
A tumor of a certain size can be identified already at this stage.
To confirm the preliminary diagnosis, it is necessary to carry out a whole complex of laboratory and endoscopic studies.
Patient assigned:
- Recto-manoscopy or colonoscopy - procedures performed with an endoscope equipped with an optical fiber system. In the course of the study, allowing to examine the sigmoid colon from the inside, the specialist can detect the presence of polyps, papillomas and malignant neoplasms, and also take samples of tumor tissues for subsequent histological examination to establish the type of oncology.
- Irrigoscopy is an X-ray study in which a contrast agent, barium solution, is introduced into the body. After the barium has filled the lumen of the intestine, a number of pictures are taken, allowing the tumor to be detected.
- Magnetic resonance therapy, which allows to detect a tumor, to establish its size, the location of localization, the presence of metastases in adjacent and remote organs and tissues.
- Ultrasound of the abdominal cavity, allowing to establish the presence or absence of metastases.
Treatment of
Sigmoid colon cancer treatment in modern oncology can only be complex, involving surgical treatment, chemotherapy and radiotherapy.
- The leading importance is attached to surgical intervention: it is impossible to cure this ailment without it. In the presence of small cancers with clear boundaries, they are removed( resected) together with part of the affected bowel and adjacent lymph nodes. After this, the integrity of the intestinal tube is restored.
Small tumors with a low level of malignancy can be removed by a gentle( endoscopic) method - without performing a cutaneous incision.
During the laparotomy, the specialist performs several small punctures through which fiber-optic tubes are inserted into the abdominal cavity of the patient, equipped with a miniature video camera and endoscopic instruments.
Sometimes the colostomy is temporarily withdrawn, only to improve the results of the operation. A few months later the colostomy is removed, restoring the natural output of stool through the anus.
In some cases, colostomy is made permanent. With this option, the patient is forced to walk with the hospital for life.
- Chemotherapy - cancer treatment with drugs that destroy cancer cells and depress their ability to rapidly divide - comes to the rescue even for patients with advanced disease and can be used both before the operation and after it. With the use of one drug, one speaks of monochemotherapy, with the use of several drugs - about polychemotherapy. Unfortunately, she can not replace surgical treatment. With its help, doctors only reduce the size of cancer tumors and slow down their growth. As an independent therapeutic method, it is used only in relation to inoperable patients.
- Radiotherapy of sigmoid colon cancer is performed very cautiously, since there is a high risk of perforation of the walls of this organ. In addition, most species of colorectal cancer have low sensitivity to this therapeutic method. Nevertheless, the use of radiation therapy can give good results in reducing the size of the tumor prior to surgery and for the destruction of cancer cells that could remain on the border of healthy and diseased tissues.
Post-operation prognosis
The prognosis( most often moderately favorable) for sigmoid colon cancer primarily depends on the level of differentiation of tumor cells: highly differentiated malignant tumors are treated better.
It is equally important early detection of cancer and its immediate treatment.
- Complex treatment of patients( combining surgical intervention with chemoradiotherapy) with single metastases in regional lymph nodes gives a five-year survival rate of 40% of patients. In the absence of such therapy, less than a quarter of patients survive.
- If the cancer of the sigmoid colon is limited only to the limits of its mucous membrane, after the operation of resection of tumor tissues, the five-year survival rate is not less than 98%.
Since sigmoid colon cancer is one of the least aggressive and most sparing forms of malignant neoplasms, with timely access to medical care, patients retain very high chances of complete cure.
Dietary nutrition in sigmoid colon cancer
Postoperative diet is of great importance in the treatment of sigmoid cancer. During the first day, the patient is shown fasting( his nutrition is carried out by intravenous injection of nutrient solutions containing amino acids and glucose).
For six days after surgery, any solid food is contraindicated. Its diet should consist of juices, broths, thin cereals, vegetable purees and herbal decoctions, and after a mandatory consultation with the doctor.
Ten days after the operation, the patient's diet is varied with low-fat meat, fish and sour-milk products. The ideal ratio of nutrients in the diet: 50% should be carbohydrates, 40% - proteins, and only 10% - fats.
The patient should completely stop using:
- fatty meat and fish;
- fried foods;
- pickles, marinades and canned food;
- of sausages and smoked products;
- cakes, chocolate and sweets;
- coffee, strong tea, alcoholic and carbonated beverages;
- eggs, cheese and whole milk;
- freshly baked bread;
- vegetables containing coarse fiber;
- of leguminous crops.
Very useful vegetables, cereals, sour-milk products, lean varieties of fish and meat, fruit, biscuits, dried bread, crackers.
The video shows sigmoid colon cancer with the help of a colonoscopy: