Sigmoid colon cancer: first symptoms of adenocarcinoma, prognosis and treatment of the tumor in Moscow

Sigmoid colon cancer often does not manifest 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, immediately seek help.

At the Yusupov Hospital, oncologists use the latest methods for diagnosing diseases of the sigmoid colon. Patients are examined using the latest equipment from leading global manufacturers. Laboratory technicians examine blood, feces and other biological materials using high-quality reagents, which allows you to obtain accurate test results.

Surgeons at the Oncology Clinic masterfully perform traditional and innovative surgical interventions. Chemotherapists prescribe patients the most effective antitumor drugs that have minimal side effects. Radiologists conduct radiation therapy with modern devices that allow them to target the pathological focus without damaging the tissue surrounding the tumor.

Causes of tumors

Sigmoid colon cancer originates from glandular epithelial cells. Accounts for 34% of the total number of colorectal cancer cases. In 60% of cases, a malignant tumor is detected in patients aged 40-60 years. Men suffer 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 movement of contents through the intestines slows down, it remains in the sigmoid colon for a long time. This increases the time of contact of toxic food processing products with the organ mucosa.

Sigmoid colon cancer can develop under the influence of the following unfavorable factors:

Unbalanced diet - eating large amounts of fatty and meat foods, insufficient consumption of fruits and vegetables, foods rich in fiber;
Compounded heredity - the risk of developing a malignant neoplasm increases if close relatives had sigmoid colon cancer;
Chronic inflammatory processes in the intestines - nonspecific ulcerative colitis, diverticulosis, Crohn's disease;
A sedentary lifestyle, as a result of which the evacuation of intestinal contents slows down;
Multiple intestinal polyps, which are prone to degeneration into a malignant tumor; Constipation, in which the mucous membrane not only comes into contact with carcinogens for a long time, but is also injured by the solid contents of the intestine;
Age-related intestinal atony.

Smoking, alcohol abuse, and consumption of foods containing carcinogenic food additives lead to the development of sigmoid colon cancer.

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What is colon cancer?

This is a malignant tumor that is one of the top three among other cancers in terms of incidence and mortality throughout the world.
Colon cancer originates from the mucous membrane of the colon and can spread to all layers of the intestinal wall and affect nearby organs and structures. Colon cancer affects men more often. Most often, this disease is diagnosed between the ages of 50 and 75 years, but recently it has been detected more often than before in young patients.

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 nodes on a thick stalk. As the pathological process progresses, sigmoid colon cancer often ulcerates. Bleeding and infection occurs.

Endophytic cancer of the sigmoid colon grows predominantly deep into the intestine. The tumor spreads along the intestinal wall and can cover the intestine circularly. In its center, areas of ulceration appear. 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 glandular epithelial cells. It can be highly differentiated, moderately differentiated and poorly differentiated;
Mucous (mucosal) adenocarcinoma is a type of poorly differentiated adenocarcinoma, represented by mucinous cells that secrete large amounts of mucus. The tumor grows quickly and metastasizes early;
Signet ring cell carcinoma of the sigmoid colon is represented by atypical signet ring-shaped cells, which are formed as a result of intracellular accumulation of mucin, pushing the cell nuclei to the periphery. The tumor is aggressive and has an unfavorable course.

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

1.General information

Thanks to active educational and preventive activities carried out by the World and national health organizations in developed countries, the population is gradually realizing the reality and individual significance of the danger posed by intestinal cancer. This danger is not at all exaggerated; rather, on the contrary: it is greatly underestimated due to inertia of thinking and a tendency to take an attitude (“What happens, cannot be avoided, but there is no time to run around and just get examined anyway”), due to distrust of doctors (who supposedly “just want to cut”); due to the abundance of all kinds of “advisers” on the Internet and the availability of over-the-counter pills, as well as other means, so to speak, fast medicine - which, by the way, are sometimes more dangerous than the disease itself.

Meanwhile, colorectal cancer occupies one of the leading positions in cancer statistics, and in the absence of adequate radical treatment is characterized by high mortality, along with such deadly types of pathology as heart disease and vascular accidents of the brain. Any adult living in the modern world is at risk - a world that is very comfortable, but which no longer has practically anything in common with the natural human environment.

The large intestine consists of several sections that differ in morphological and functional aspects.

The longest section is called the colon; in turn, it is divided into the ascending, transverse, descending and sigmoid colon; the latter is the transition to the final, distal section of the gastrointestinal tract - the rectum. The sigmoid colon has a characteristic curved shape (which is why it got its name) and serves as a compartment for the final thickening and formation of feces, which slow down somewhat when passing through the gastrointestinal tract. The anatomical and functional features of this section of the large intestine determine the increased (compared to other sections) likelihood and clinical uniqueness of tumor processes, benign or malignant neoplasms.

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Stages

Oncologists distinguish 4 stages of sigmoid colon cancer:

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

In the case of the second A stage of cancer, the tumor occupies less than half the circumference of the intestine and does not grow into the wall. There are no metastases in the lymph nodes and internal organs. A cancerous tumor at stage 2B is located in the intestinal wall, but does not extend beyond its boundaries. Oncologists detect metastases in the lymph nodes. There are no distant metastases.

With stage 3A sigmoid colon cancer, the size of the tumor exceeds half the circumference of the intestine. There are no atypical cells in the regional lymph nodes. In stage 3B tumors, regional lymph nodes are affected by metastases.

The tumor in stage 4 cancer blocks the lumen of the sigmoid colon. Hematogenous metastases are detected in other organs. In stage 4 sigmoid colon cancer, nearby organs are affected, and enterovesical fistulas and conglomerates are formed.

Metastasis

The following methods of metastasis are typical for malignant tumors of the sigmoid colon:

Lymphogenic - through lymphatic vessels, malignant cells first reach regional lymph nodes, and then spread further to more distant groups. For example, the supraclavicular nodes may be affected.
Hematogenous route - malignant cells spread through blood vessels. The liver and lungs are the first to be affected. If the patient has undifferentiated cancer, bone marrow metastases may occur.
Implantation metastasis - when a tumor extends beyond the intestinal wall, nearby organs and tissues can be affected. In this way, multiple peritoneal metastases, or peritoneal carcinomatosis, are formed.

Symptoms

At first, sigmoid colon cancer is often asymptomatic or minimally symptomatic, which complicates timely diagnosis. As the tumor progresses, it spreads to nearby organs, giving regional and hematogenous metastases (to the liver, lungs, spine, and 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 are retained in this segment of the large intestine. The accumulated feces presses on the intestinal walls, as a result of which blood circulation is disrupted and 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.

For quite a long time, a tumor of the sigmoid colon does not manifest clinical symptoms, which complicates timely diagnosis. The first symptom of sigmoid colon cancer is intestinal discomfort. At first it occurs periodically, and with the growth of the tumor it becomes more 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 pain that does not depend on food intake;
Development of intestinal obstruction;
Abdominal abscess, bleeding, peritonitis (inflammation of the peritoneum).

Patients have diarrhea alternating with constipation. Doctors are often able to palpate a tumor-like formation in the left half of the abdomen. Sometimes the first manifestation of the tumor process is the development of intestinal obstruction. As the tumor progresses, it spreads to nearby organs, giving regional and hematogenous metastases (to the liver, lungs, spine, and less often to other organs).

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

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

With the development of intestinal obstruction, paroxysmal cramping pain occurs, which is repeated every 10-15 minutes, bloating, gas and stool retention are noted. Possible vomiting. If the intestinal wall is destroyed, peritonitis develops. Stage 4 sigmoid colon cancer with liver metastases is manifested by cachexia (cancer exhaustion), anemia (anemia), jaundice and liver enlargement. When hematogenous metastases appear, symptoms appear that indicate dysfunction of the affected organs.

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Symptoms

The insidiousness of malignant tumors of the sigmoid colon is that in the initial stages there are no signs of the disease. The clinical picture unfolds when the process enters stages 3-4.

In this case, general and local symptoms are distinguished. Common symptoms include weight loss, chronic fatigue, increased fatigue, pallor and pasty skin (against the background of chronic iron deficiency anemia).

Local symptoms include:

Abdominal pain. Pain can have various causes, from impaired intestinal motility to tumor growth into adjacent tissues and organs.
Impaired stool regularity. Patients are bothered by chronic constipation, which is replaced by foul-smelling diarrhea. This occurs due to the fact that feces accumulate above the tumor site, which, in turn, leads to increased fermentation and putrefaction processes, the intestinal contents liquefy, and constipation is replaced by diarrhea. Due to inflammation of the intestinal wall and injury to the tumor, there may be streaks of blood in the stool. When the intestinal lumen is obstructed (blocked) by a tumor, intestinal obstruction develops, which is accompanied by cramping pain, bloating, increased symptoms of intoxication, nausea and vomiting. This condition requires emergency hospitalization in a surgical hospital for immediate medical care.

In addition, signs of sigmoid colon cancer may include:

Increased gas formation.
Nausea and bloating.
Discharge of mucus, blood or pus from the anus.

Diagnostics

The diagnosis of a sigmoid colon tumor is made by oncologists at the Yusupov Hospital taking into account the medical history, complaints, objective examination data and the results of additional studies. The most informative methods for sigmoid colon cancer are endoscopic methods (sigmoidoscopy and colonoscopy). They allow you to visually assess the volume and location of the tumor and take material for subsequent histological examination.

In the process of examining patients with suspected sigmoid colon cancer, doctors at the Yusupov Hospital use irrigoscopy (X-ray examination using a barium suspension) and stool analysis for occult blood. 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 techniques are used to detect metastases:

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

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

Treatment methods

Radiography is one of the ways to diagnose this disease.

Treatment by a specialist is prescribed only after receiving the conclusion of all necessary diagnostic examinations - colonoscopy, radiography, sigmoidoscopy, magnetic resonance therapy of the abdominal organs. Having assessed the results obtained and the degree of development of the disease, the attending physician may prescribe one of the following treatment methods:

Removal of the tumor in a surgical, minimally invasive manner using a rectromanoscope, which is inserted into the sigmoid colon through the anus. This type is effective only if the neoplasm has not yet metastasized to the lymph nodes, but has only grown into the wall of the intestinal segment.
A traditional surgical operation in which the surgeon removes a segment of the intestine along with the tumor formed on it. During the operation, it may also be necessary to remove the affected lymph nodes. In severe cases of the disease, the sigmoid and rectum must be completely removed. The removed sections of intestine are replaced with a colostomy (artificial anus), which is removed through the anterior abdominal wall. In this case, the ability to control the process of excretion of metabolic products in a person disappears, but later, after treatment, it becomes possible to restore normal excretion of feces and gases through the anus.
After surgery, the patient may be given chemotherapy to stop the growth and division of malignant cells. It is also mandatory to introduce a diet, the basis of which is the refusal of solid food and the consumption of only herbal teas, juices, liquid vegetable purees, and then only by prior agreement with the doctor.

Successful treatment of oncology of the sigmoid colon implies a further reduction or even refusal of meat dishes, a complete exclusion from the diet of fried, canned food, confectionery and semi-finished products.

Excluded foods should be replaced with healthy ones - cereals, dairy products, cauliflower, vegetables and fruits that are yellow or orange in color, products containing vitamin C. All foods consumed must be natural and fresh.

Complex therapy

Oncologists at the Yusupov Hospital provide combined treatment for 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 extent of surgical intervention depends on the extent of sigmoid colon cancer. In the early stages of the disease, endoscopic techniques are used in some cases. For this purpose, resection of the sigmoid colon is used. In case of widespread tumor processes, surgeons perform resection of the sigmoid colon with a section of the mesentery and nearby lymph nodes. The affected area of the sigmoid colon is removed along with five centimeters of intact intestine located above and below the tumor. Surgery for sigmoid colon cancer can be one-stage or two-stage. When performing one-stage operations after tumor removal, the surgeon restores intestinal continuity by performing an anastomosis. In advanced cases, the intestine is resected and a colostomy is formed. The integrity of the intestine is restored several months after the first operation.

Surgery can be typical, combined, extended or combined. A typical operation involves resection of the area of intestine containing the tumor. A combined treatment method is used if it is necessary to perform surgery on the cancer-affected segment of the intestine and other organs into which the tumor has grown. Extended surgery is performed when the tumor grows or there are synchronous neoplasms. A combined operation involves removing 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 administer chemotherapy. Treatment with antitumor 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 tumor. Sigmoid colon cancer does not respond well to radiation treatment. Radioactive rays can damage normal tissue, so this method is not used to treat sigmoid colon cancer.

In advanced cases of cancer, palliative therapy is carried out to reduce pain and ensure intestinal patency. Sometimes emergency surgery is performed for sigmoid colon cancer. They are aimed at sanitizing the abdominal cavity in case of peritonitis and eliminating intestinal obstruction.

Chemotherapy treatment of sigmoid colon cancer

Chemotherapy for sigmoid colon cancer can be used as part of a combination treatment. In addition, it can be used as an independent method of therapy for unresectable tumors or when it is impossible to perform surgery due to general contraindications.

As part of combination treatment, adjuvant chemotherapy is performed. The feasibility of its use is determined based on the stage of the tumor and the results of an urgent intraoperative examination of the removed intestinal fragment for the presence of malignant cells.

As part of adjuvant chemotherapy, fluoropyrimidine therapy (5-fluorouracil, then 5 FU) is used together with 3rd generation platinum drugs (oxaliplatin). If the patient develops severe complications from two-component regimens, therapy is continued with fluoropyrimidines in monotherapy. The goal of adjuvant chemotherapy is to destroy remaining tumor cells and prevent relapses of the disease.

Independent chemotherapy is palliative in nature and is aimed at containing the tumor process, prolonging the patient’s life and improving its quality.

In addition to regimens with oxaliplatin and 5-FU, regimens with irinotecan are used. Treatment may be supplemented with targeted drugs. In the absence of BRAF and RAS mutations, cetuximab and panitumumab are used. Bevacizumab can be prescribed regardless of the presence of mutations, but it is effective only in conjunction with cytostatic therapy. Cetuximab and panitumumab can be used as 3rd line monotherapy.

Nutrition after surgery

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

During the rehabilitation process, the patient should follow certain rules:

eat only fresh foods;
products must contain a sufficient complex of vitamins and minerals;
reduce meat consumption to a minimum;
consume kefir, yogurt, and bifido products more often;
eat more fresh vegetables and fruits;
include cereal porridges and products made from wholemeal flour with bran in the menu;
periodically include boiled or steamed sea fish in the menu;
Take food in crushed form, chew thoroughly;
do not overeat, eat small meals and regularly.

Causes and risk factors for development

Among the risk factors for developing colon cancer are: a diet high in fat, red meat and low fiber, alcohol consumption, smoking, low physical activity, diabetes, chronic inflammatory diseases of the colon (ulcerative colitis, Crohn's disease), presence of a family history of colorectal cancer.

In 3-5% of patients, colon cancer is associated with the presence of hereditary syndromes (familial adenomatosis of the colon and MUTYH-associated polyposis, Lynch syndrome).

Forecast

The survival prognosis of patients with sigmoid colon cancer depends on the histological type of the tumor, 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 adenocarcinoma of the sigmoid colon, 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 mark, the second - 82.5%, the third - 59.5%. 8.1% of patients with stage 4 sigmoid colon cancer survive up to five years. Therefore, consult a doctor when the first signs of intestinal dysfunction appear.

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 provide adequate therapy. After treatment, doctors at the oncology clinic conduct clinical observation, the purpose of which is the timely detection and treatment of early metastases. This makes it possible to improve the quality and increase the life expectancy of patients diagnosed with sigmoid colon cancer.

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Prevention

Early detection of precancerous conditions and initial forms of cancer. An annual stool test for occult blood for persons over 50 years of age, colonoscopy once every 5 years, for people with a hereditary predisposition - from 40 years of age.
Removal of polyps larger than 1 cm, for smaller sizes - annual observation.
Treatment of inflammatory bowel diseases.
Minimizing avoidable risk factors - a diet enriched with fruits and vegetables, giving up bad habits, exercising, losing weight.