Intestinal cancer that affects the glandular epithelium of the intestinal walls, occupies the third position in the total mass of oncological pathologies that occur in Russians.
Since malignant neoplasms most often form in the tissues of the rectum and colon, in the medical literature, intestinal cancer is called colorectal( the term is formed by the fusion of the Latin words "column" and "rectum", which designate these parts of the intestine).
The success of the treatment of colorectal cancer primarily depends on the timeliness of its detection. Unfortunately, many Russian patients seek medical help at a time when the tumor has already metastasized into lymph nodes and distant organs.
Nevertheless, the malignant neoplasm, even reaching a fairly solid size, remains operable up to the third stage.
Types of treatment of bowel cancer
The leading role in the treatment of colon cancer is a radical surgical intervention consisting in the removal of malignant neoplasm, affected tissues of adjacent organs and metastases.
Surgical
Surgical intervention for intestinal cancer can be:
- Radical , which involves the removal of not only a malignant tumor but also adjacent healthy tissue.
- Local , which reduces to the removal of only a tumor neoplasm together with a narrow strip of unaffected tissues.
The choice of the method of surgical intervention depends on the stage of development of the tumor and its localization. Small malignant neoplasms, identified at the earliest stages, are removed by performing the most sparing operations:
- Laparoscopy. During the operation, three miniature incisions are performed in the patient's abdominal wall, one of which is inserted into a flexible metal tube - a laparoscope equipped with an optical fiber, an optical system and a small video camera that displays the image on the screen. Tissues of the tumor and affected lymph nodes are excised, and modern staplers, staplers, are used for stitching in leading oncological clinics. The operation of laparoscopy is performed under general anesthesia.
- Colonoscopy. During this operation, a specialist through the anus introduces a special probe - a colonoscope into the lumen of the intestine. For the spread of this lumen, carbon dioxide is introduced into the body of the patient( it will be discharged through a special canal of the colonoscope after the end of the operation).Colonoscopy is used to remove small, malignant polyps localized in the rectum or large intestine. Removal of a malignant tumor located in the lower part of the rectum is performed without the use of a colonoscope( through the anal canal).
In the surgical treatment of malignant tumors, which are already detected in the late stages and require extensive interventions, laparotomy is used - an open surgery requiring an opening of the abdominal cavity.
Any operation with colorectal cancer refers to one of two types of surgical interventions:
- With the implementation of a colostomy( artificial anus), consisting of excreting the intestine on the anterior wall of the abdomen. Despite the fact that excretion of fecal masses after colostomy occurs unnatural way, requiring the use of a plastic kologopriemnika, in some cases without the formation of colostomy( permanent or temporary), it is impossible to do. Indications for such surgery are: chronic intestinal obstruction, excessively large dimensions of a cancerous tumor( after removal of which it is impossible to pull off the walls of the operated gut) and complete removal( extirpation) of the rectum together with an anus. If the surgeon decides that the restoration of a natural method of defecation is possible, a few months later perform a reconstructive operation. The tenth part of the operated patients continues to live with the withdrawn colostomy.
- With the application of anastomosis. This variant of surgical treatment consists in restoring the natural method of excretion of fecal masses after removal of the cancer tumor by stitching the remaining ends of the intestine.
Risks and consequences
Surgery for colorectal cancer involves a number of risks and complications:
- The development of abdominal hemorrhage.
- Poor healing of joints or infection of postoperative wounds.
- Insufficient strength of connection of two anatomical structures, fraught with weakening or rupture of superimposed seams. It is possible to penetrate the contents of the intestine into the abdominal cavity, which entails the development of peritonitis.
- Removing a piece of large intestine can disrupt the hardening of stool and lead to diarrhea, bloating, a strong odor, and in patients with an ostomy, constipation.
- Incontinence of fecal masses, development of bladder dysfunction and impotence.
- The formation of painful adhesions.
Nutrition
Removal of a malignant tumor of the intestine is not a reason for refusing the operated patient from the usual diet, however, to smooth out the effects of digestive disorders( diarrhea, constipation, a feeling of raspiraniya in the abdomen), he should definitely do the normalization of the stool.
For this, the patient needs to act in accordance with a number of rules:
- It is essential to reduce the usual amount of servings by switching to a fractional food that provides 6 meals a day.
- During breaks between meals, drink as much liquid as possible.
- The meal should be unhurried. Of particular importance is the very thorough chewing of each piece.
- It is necessary to refrain from using both excessively hot and very cold dishes.
- Eating should be regular, not involving compliance with diets.
- While doing cooking, you should give preference to boiling and boiling.
- The patient will benefit from the refusal to eat very sweet, fried, salty and smoked food, as well as from products that provoke bloating.
How many patients live after the operation
The five-year survival rate of operated patients with bowel cancer largely depends on the stage of the pathological process:
- in I stage survives 96% of the diseased;
- at the II stage - 75%;
- at the III stage - no more than 50%;
- in IV stage - less than 3%.
Radiotherapy
Radiotherapy for the treatment of colorectal cancer can use radioactive isotopes, high-power X-rays or electron beams.
It can be used:
- as a stand-alone method of treatment;
- in combination with chemotherapy to reduce the size of the tumor before surgery;
- as an additional treatment after a course of chemotherapy in the postoperative period;
- to alleviate the condition of patients with an inoperable tumor.
Radiotherapy can be internal and external. With external radiotherapy, the beam of rays is directed to certain points pre-tattooed on the patient's body.
With internal radiotherapy, radioisotopes are administered either to the vein or to the tissues of the affected organ. During intracavitary radiotherapy, radiation sources placed in special applicators are located at the site of exposure and remain there for several hours. After a certain time, they are removed.
Chemotherapy
Chemotherapy for bowel cancer consists in the use of potent cytotoxic drugs that prevent the division and contribute to the destruction of cancer cells.
In the early stages of colorectal cancer,
- adjuvant chemotherapy is used( prescribe after surgery to reduce the risk of relapse);
- neo-adjuvant chemotherapy ( performed in the pre-operative period, to reduce the number of atypical cells);
- neo-adjuvant chemoradiotherapy ( preoperative therapeutic method combined with radiotherapy).
Chemotherapy after surgery
Adjuvant bowel cancer treatment with cytostatics begins after the patient recovers after surgery. Usually this happens by the end of the eighth week. The duration of such treatment is at least six months.
Chemotherapy drugs can be either tableted( eg capecitabine) or injected intravenously( folfolox, fluorouracil, xelox) through a central catheter, cannula, or cat-port.
Consequences of
The use of a combination of cytostatics in intestinal cancers can cause a range of side effects:
- attacks of vomiting and nausea;
- loose stool;
- ulceration of the mucous membranes of the oral cavity;
- a sharp decrease in the number of leukocytes in the blood( fraught with the development of infection);
- in rare cases, hair loss( alopecia) and the appearance of rashes on the limbs;
- the patient can feel numbness or slight tingling in the fingers and toes.
How to treat intestinal cancer 4 degrees
Treatment of colorectal cancer of the fourth degree, characterized by extensive tissue damage and the presence of distant metastases to other organs, is symptomatic or palliative in nature.
The objectives of the therapy are reduced to:
- restriction of the spread of the tumor process;
- maintaining the health of internal organs and systems;
- inhibiting the growth of malignant neoplasm;
- prevention of stroke, thromboembolism and heart attack.
The main methods of treatment of stages 3 and 4 of intestinal cancer are:
- palliative surgery;
- chemotherapy;
- radiotherapy;
- immunotherapy;
- hormone therapy.
In addition to traditional therapeutic methods, the use of individual antitumor vaccines, monoclonal antibodies, modern chemoembolization methods( cessation of blood flow in tumor tissues with the simultaneous delivery of chemotherapeutic drugs), radioembolization and radiofrequency ablation is widely practiced.
Features of nutrition at different stages of the disease
Since intestinal cancer is always associated with problems in the patency of the nutritional coma, unsatisfactory absorption of nutrients and difficulties with excretion of stools, the importance of organizing dietary nutrition becomes clear.
The total weight of the food that makes up the patient's daily diet should not exceed three kilograms, and the volume of the liquid( including that which is a part of cooked dishes, vegetables and fruits) should be limited to 1.5 liters.
Carefully watching the manifestations of the disease and timely adjusting the diet, you can significantly improve the patient's condition:
- With diarrhea, care should be taken to ensure that the amount of liquid used can interfere with dehydration. Nutritionists are advised to drink fruit tea, mineral water and vegetable juices.
- Constipation is a testimony to the consumption of fresh fruits, vegetables and coarse grains.
- During the postoperative period, the patient's diet should include dishes from rice, vegetables, ground flaxseed and pectin-containing fruits. During this period, you should avoid eating foods that contribute to bloating: mushrooms, wheat bran, nuts, tomatoes, citrus, legumes, coarse meat.
Doctors advise patients to keep a diary in which they should make their observations of the body's reaction to the foods consumed. With the help of these records, the patient can determine which dishes are good for him, and which are contraindicated.
Recipes of dietary dishes
Cream soup from vegetables. Boil 100 g of cauliflower, let in and cool 80 g of chopped carrots. Milk sauce is prepared from 600 ml of hot milk, thickened with a teaspoon of flour, pre-fried in 20 g of butter until creamy. Prepared vegetables along with 20 g of canned green peas are wiped through a sieve, mixed with a ready-made milk sauce and a glass of hot vegetable broth. After boiling for ten minutes, the dish is filtered and poured into 100 ml hot cream.Prevention
There are no specific methods for the prevention of intestinal cancer. Particular caution should be exercised for individuals who are genetically predisposed to this type of oncology or precancerous diseases prone to malignancy.
The complex of nonspecific preventive measures is mainly concerned with amendments introduced into the habitual way of life. To reduce the risk of developing bowel cancer, it is necessary:
- to increase motor activity;
- enrich your diet with high-fiber foods;
- completely abandon the use of alcohol and smoking;
- daily take small doses of aspirin( strictly according to the doctor's prescription).