The cecum, which is the first part of the large intestine and located at the junction of the connection of the small and large intestines, often becomes the site of malignant neoplasm localization. The reason for this - the anatomical and physiological features of its location and structure.
The site of the localization of the cecum, outwardly resembling a small wide sac, is the right iliac cavity. From the narrow appendix( appendix), the cecum is separated by a sphincter( Gerlach valve), which prevents the contents of the intestine from entering its lumen.
What is cancer of the caecum?
Cancer of the cecum is commonly referred to as a malignant tumor that develops from the tissues of the mucous membrane of this organ.
The photo shows a recurrence of the colon cancer
Given the slow growth and moderately aggressive nature of the malignant neoplasm of the caecum, as well as the relatively late appearance of distant metastases, it can be argued that patients who have noticed anxious symptoms and immediately seek medical help have everythingchances of a full recovery.
Symptoms of
The symptoms of cecal cancer depend on the location of the tumor process, the size of the malignant neoplasm and the concomitant diseases of the digestive tract.
- Most often, oncology of the cecum, the presence of blood in the feces of a sick person is noted. Due to the constant blood loss in the patient, frequent dizziness, severe weakness and severe pallor of the skin are observed. Noticing the blood in the feces, many patients consider this to be a manifestation of hemorrhoids and, after self-medication of a thought up illness, do not go to the doctor for a long time, losing precious time that could be spent on successful treatment of only the emerging cancer.
- Another characteristic symptom of this ailment is a constant aching pain on the right side of the lower abdomen. At the same time, intestinal obstruction in patients does not develop, since the cecum has a fairly wide lumen, and the feces on this segment of the intestine do not have time to form completely, so that patients do not suffer from constipation.
- Cancer of the cecum, reaching the last stages, leads to a complete disruption of the functioning of the digestive system. Due to the squeezing of neighboring organs with the tissues of an overgrown tumor, patients often experience uncomfortable sensations inside the stomach, they completely lose their appetite, they are exhausted by constant nausea and increased flatulence.
- In the advanced stages of the cecum cancer, the patient develops the cancer intoxication manifested in severe jaundice of the skin, as well as hepatomegaly( a significant increase in the liver due to tumor metastasis in her tissue), leading to complete depletion of the patient.
- Malignant neoplasm of considerable size, compressing adjacent organs, often causes the onset of edema .
Types of
Histological forms of malignant tumors of the cecum are represented by:
- Adenocarcinomas , developing from epithelial cells constituting the mucous membranes of the cecum.
- Ring-like cell carcinoma , cells of which resemble vesicles.
- Squamous cancer, affecting cells of flat epithelium.
- The glandular squamous is a cancer that contains cells of both glandular and flat epithelium.
- Undifferentiated cancer is the most aggressive type of cancer, the cells of which can not be recognized.
- Unclassified cancer. The malignant tumor of this species does not resemble any of the described histological forms.
Causes of tumor development
A number of factors contribute to the onset of colon cancer:
- the presence of a genetic predisposition and heredity;
- chronic diseases of the intestine and stomach( especially ulcerative);
- Presence of precancerous diseases of the rectum: villous and adenomatous polyps with a high probability of degeneration into malignant neoplasms;
- propensity to chronic constipation and extremely irregular stools;
- alcohol abuse and smoking often provoke the onset of cancer;
- is a sedentary lifestyle;
- improper diet( abuse of red meat, low content of fresh vegetables and fruits, cereals, poultry meat and fish dishes in the daily diet).
Stages and their prognosis
According to the Russian classification, in the development of the malignant neoplasm of the cecum, it is common to distinguish 5 stages.
- At the zero stage of ( often referred to as in situ cancer), the tumor that affects the outer layers of the intestinal wall is small in size, does not extend to the adjacent lymph nodes and has no distant metastases. Malignant neoplasm can be removed during colonoscopy. Timely treatment ends with the cure of 100% of patients.
- Stage 1 of is characterized by the presence of a small( up to two centimeters in diameter) mobile tumor with distinct boundaries developing in the tissues of the mucous membrane and the submucosal layer of the affected bowel. There is no metastasis to regional lymph nodes at this stage. The five-year survival of patients after surgical excision of the tumor is 94%.
- Cancer of the 2nd stage of sprouts all layers of the intestinal wall, but does not leave the limits of the affected intestine yet. The defeat of regional lymph nodes and distant organs has not yet been observed. After surgery for at least five years, 85% of the sick survive.
- Tumor process of stage 3 of is characterized by the spread of malignant neoplasm to nearby tissues and organs and lymph node involvement. Remote metastasis has not yet begun. When one to three lymph nodes are afflicted, 64% of operated patients survive within five years, with lesions of four or more - only 45%.
- Stage 4 of begins with the germination of a cancerous tumor into the tissues of adjacent organs. The defeat of the lymph nodes is of a multiple nature. The process of metastasizing cancer cells to distant organs begins. If as a result of distant metastasis only one organ( lung or liver) was affected, within 5 years no more than 5% of patients survive. Metastasis of the tumor into more organs practically leaves no chance of survival.
Diagnosis and treatment of the world
In order to rule out the possibility of making an erroneous diagnosis, the diagnosis of cecal cancer should be comprehensive.
- Diagnosis of the initial phase consists in the collection of anamnesis, physical examination of the patient and digital examination of the rectum.
When examining a patient, a specialist performs percussion or percussion of the abdominal cavity in order to reveal the presence of free liquid in it. Further probing of the abdomen allows us to establish the localization and the momentary state of the tumor.
Endoscopy is performed by performing the following procedures:
- Recto-manoscopy. This procedure consists in examining the condition of the rectum with the aid of a special device called a sigmoidoscope. The purpose of the study was to clarify the localization of the tumor, to assess its condition and the degree of prevalence of the tumor process.
- Colonoscopy - a painful procedure performed with mandatory anesthesia using an optical device - a colonoscope. This study allows you to verify the presence of malignant neoplasm, to clarify its size and location of exact localization, as well as to study the state of the mucous membranes of any part of the large intestine. During the procedure, a biopsy is taken - a small piece of tumor tissue for laboratory histological examination. Colonoscopy is prescribed only if all previously used diagnostic methods did not provide exhaustive information.
- Irrigoscopy is an X-ray examination of any part of the large intestine and ileum loops. Before the study, an enema is performed, with the help of which the above-mentioned departments are very tightly filled with a contrast medium that allows to determine the diameter of the intestinal lumens, to reveal the presence and size of volumetric neoplasms, and also the extent of their spread beyond the cecal boundaries.
- Ultrasound of the abdominal cavity, magnetic resonance imaging and computed tomography of internal organs. These studies can verify the presence or absence of distant tumor metastasis.
Modern treatment for cecal cancer consists of combining three therapeutic methods: surgical intervention, radio and chemotherapy.
- The leading role in the therapy of any cancer is assigned to surgical intervention.
Its volume is determined by the localization of a cancerous tumor and the degree of development of the tumor process. Depending on the results obtained during the examination of the patient, the tumor can be completely removed;sometimes it is advisable to perform its resection or superimpose an anastomosis by stitching different parts of the large intestine.
The affected lymph nodes are removed during lymphadenectomy surgery. With inoperable tumors, artificial anastomosis is applied to restore impaired intestinal permeability bypassing the site affected by the tumor.
- radiotherapy is used both before surgery( in order to reduce the size of the tumor) and after it( to destroy the cancer cells left after the operation and thereby prevent a relapse of the disease).
- Treatment with chemical preparations of that destroy cancer cells, and also suppress their ability to control uncontrolled division, may involve the use of either one( fluoroufur or fluorouracil) or a combination of several drugs( eg, fluorouracil and calcium folinate).
Chemotherapy is often used in combination with radiotherapy. This effect improves the effectiveness of the destruction of cancer cells and the likelihood of metastasis. If it is impossible to perform the operation( for example, if there is a serious concomitant disease or if the tumor itself is inoperable), chemotherapy can be prescribed to the patient as the only method of treatment.
Rehabilitation after surgery for a colon cancer tumor
- If a fistula is applied to the patient to restore an intestinal obstruction to an operated gut, he will need frequent bandages. This will prevent irritation and inflammation of the skin around the fistula.
The dressing should be applied so that it does not slip when moving. After each emptying of the intestine through an unnatural anus, a sterile gauze cloth impregnated with paraffin oil is applied to its protruding mucosa, covered with several gauze napkins and a layer of cotton wool.
To strengthen the bandage use special bandages or bandages. The use of a plaster that can damage the skin with frequent dressings is unacceptable.
- Skin care around the fistula involves the use of pastes and ointments with the addition of lactic acid, as well as lubricating the inflamed areas with 10% tannin solution.
To create a crust that prevents the effects of intestinal contents on the skin, all kinds of powders are used: talc, kaolin, dry tannin.
- After healing the surgical wound and forming a fistula, the patient is advised to take daily baths.
Since then, the medical staff is beginning to teach him how to use the kalospriemnikom.
- When the stool is delayed, the patient is given an enema with vaseline oil.
- An important condition for successful recovery is strict adherence to the diet.
For six days after the operation, the patient is not allowed to eat solid food and is allowed to consume large amounts of liquid. The patient's strength is maintained by broths, juices, liquid porridges and equally liquid vegetable purees, juices and herbal decoctions.
Over the next few days, the consistency of the food becomes slightly thicker;all meals( in very small portions, every three hours) are served only in a grated form.
- Ten days after the operation, it is allowed to introduce high-protein foods ( lean fish and meat, eggs) into the patient's diet.
Fresh vegetables and fruits( especially beets, carrots and apples) are extremely useful, as well as dairy products: yoghurts, kefir, low-fat sour cream. When you feel better( it usually comes after a month of dieting), the patient is allowed to switch to normal food, not forgetting the fractional diet.
- Patients who underwent surgery for the caecum are recommended to include in their diet: veal, fresh herbs, berries, fruits and vegetables, vegetable oil, lean varieties of fish, lamb, bezdozhzhevoy bread, various types of pasta, cereal cereals.
All dishes should be freshly prepared and warm( both hot and cold food are not equally suitable).The main methods of cooking should be steaming and quenching.
- Prohibited products are: soybeans, all kinds of sweets, processed cheese, chicken, peanuts, all varieties of crab sticks, raw chicken eggs, coffee( soluble).
Forecast
In preparing a prognosis for a patient with cecal cancer, the specialist takes into account the results obtained during his preliminary diagnostic examination.
Priority is given to:
- growth rates and the size of malignant neoplasm;
- histological study data;
- depth of tumor germination in the intestinal wall;
- the presence of metastasis in the lymph nodes and other organs;
- level of differentiation of tumor tissues.
The survival forecast also includes the history of the disease, the success of the operation and the age of the patient.
Video on the palpation of the cecum: