Stages and clinical course of bowel cancer
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Bowel cancer is one of the most common oncological diseases in the world. The diagnosis is most common in Western countries. The largest average frequency is noted in the CIS and Eastern Europe. The lowest incidence is in Asia and Africa. Men are diagnosed with colon cancer more often than women. In recent years, with the introduction of new methods of treatment, it has been possible to significantly reduce the mortality rate of people with colon cancer. Сolon cancer treatment in Germany, Turkey and Israel demonstrates the highest success rates. However, the late diagnosis of the disease remains a major problem, as it prevents the timely administration of the necessary therapeutic measures. Let's discuss what bowel cancer is, how quickly it develops and what are the possible treatments, including stage 4 colon cancer treatment options.
Content
- How quickly does bowel cancer develop?
- Classification of colon cancer
- Where bowel cancer metastasizes?
- Where does lymphogenous bowel cancer metastasize?
- Where does hematogenous bowel cancer metastasize?
- Invasive metastasizing
- Stages of colon cancer
- Stage 4 colon cancer treatment options
- Hospitals and cost of treatment for colon cancer stage 4
- Colon cancer treatment in Germany
How quickly does bowel cancer develop?
Cancer can be detected at an early stage, if the examination is carried out in a timely manner. After all, in most cases cancer does not develop "out of nowhere". There are many precancerous diseases that can be detected and treated in a timely manner, preventing malignancy. People can also conduct periodic check-ups, which will allow for the detection and removal of the tumor in a timely manner, before the appearance of metastases.
The main precancerous diseases of the bowel cancer are:
- Crohn's disease
- Chronic inflammation of the large intestine
- Ulcerative colitis
- Diverticula of the intestine
- Polyposis
Polyps can be multiple or single. Single ones are more dangerous. Sooner or later they degenerate into cancer in 40-50% of cases.
In favorable conditions (e.g. weak immunity or genetic predisposition) cancer develops rapidly. The clinical course and rates of progression depend on many factors:
- Histological type of tumor
- Type of growth, which determines when bowel cancer will give metastasize
- Degree of tumor differentiation
The degree of differentiation of the tissues from which the tumor grows, influence how long bowel cancer will develop. Low-differentiated tumors grow faster than moderately differentiated tumors. Highly differentiated tumors have the best prognosis.
Classification of colon cancer
There is a large number of classifications of malignant intestinal tumors. In clinical practice, the most commonly used ones are:
- TNM classification(determines the stage of colon cancer)
- Histological classification
- Types of cancer by localization
- Types of cancer based on the degree of tissue differentiation
The nature of growth is also determined. It can be endophytic, exophytic or mixed. Endophytic growth occurs when the tumor grows inside the organ wall. It is characterized by a more unfavorable course, because it sprouts faster into neighboring organs and gives metastasis earlier. Exophytic growth occurs when the tumor grows toward the intestinal cavity.
According to the histological classification, there are the following types of bowel cancer:
- Adenocarcinoma (95% of all neoplasms)
- Carcinoid tumors
- Stromal tumors
- Lymphomas
The histotype of the tumor influences how long the bowel cancer will last. Adenocarcinoma can be mucous. Then it has a worse prognosis, as the bowel cancer in this case develops quickly and is more difficult to treat. These types of tumors are divided into mucous, mucoid and colloidal. There are also ring-shaped and mucocellular adenocarcinomas. The histological type is determined by biopsy. It influences the treatment of colon cancer.
Depending on the localization, there are such types of cancer:
- Cancer of sigmoid colon – half of all cases
- Cecum – 20% of all cases
- Appendix
- Ascending, descending or transverse colon
- Hepatic or splenic flexure
From a clinical point of view the most important classification is TNM. Before we proceed to discuss it, we need to understand how and where the bowel cancer metastasizes.
Where bowel cancer metastasizes?
Metastases are secondary tumors. They are formed because the tumor cells spread throughout the body in various ways. Bowel cancer with metastases has a much worse prognosis than bowel cancer which did not metastasize. Metastases develop in the late stages of colon cancer. First, regional metastases are formed. Later appear distant metastases.
Bowel cancer metastases have certain characteristics. There are three types of metastasis:
- Lymphogenous – through the lymphatic vessels
- Hematogenous – through the blood
- Implant (contact) – when bowel cancer metastases spread through the abdominal cavity
Where does lymphogenous bowel cancer metastasize?
The lymphogenous metastases are the first to develop. They develop during the third stage of colon cancer. The order of occurrence of metastatic tumors is determined by the anatomy of lymphatic vessels and the location of the lymph nodes to the tumor.
As a rule, the sequence, where the bowel cancer gives metastases, is as follows:
- Epicolic (supracous) and paracolic (intestinal) lymph nodes.
- Mesenteric or intermediate nodes.
- Lymph nodes at the root of the mesentery of the large intestine, as well as para-aortic (located near the abdominal aorta) lymph nodes.
In patients with this type of metastasizing hyperthermic intraperitoneal chemotherapy (HIPEC) is carried out. HIPEC allows destroying metastases and separate malignant cells in the abdominal cavity. As a rule, HIPEC consolidates the result of surgery and prevents relapse of the disease.
Later, metastases spreading through the lymph nodes get into the lymphatic system. It is located at the level of 1-2 lumbar vertebrae. Through the lymphatic drainage system, tumor cells spread into the venous system. They also penetrate the supraclavicular lymph nodes.
Where does hematogenous bowel cancer metastasize?
Hematogenous metastasis are manifested later than lymphogenous ones. They develop after the tumor spreads into the blood vessels. Most often bowel cancer metastasizes in the liver, lungs and bones.
In this case proton therapy for metastatic colon cancer is carried out. This is the type of radiation therapy that allows precisely destroying metastatic foci and sparing healthy tissues around them. Actually, proton therapy for metastatic colon cancer is one of the stage 4 colon cancer treatment options, as detection of distant metastases is indicative of stage 4 of the disease.
Embolization or chemoembolization of the hepatic artery is indicated to patients with liver metastases. During embolization doctors block the blood vessel that feeds malignant foci, so that they shrink or disappear. In chemoembolization, emboli are additionally covered with chemotherapeutic agents that release slowly during few weeks. Thus, chemoembolization is more effective due to combining two mechanisms of action.
Invasive metastasizing
Another way metastases spread is by the growing of the tumor into the abdominal cavity. It gradually increases in size. At the advanced stages of colon cancer the tumor spreads from the intestine into the cavity of the peritoneum. Parts of the tumor come off and spread to other organs which makes treatment of colon cancer more complicated.
In patients with invasive metastasizing hyperthermic intraperitoneal chemotherapy (HIPEC) is the most suitable therapeutic option. Proton therapy for metastatic colon cancer is also possible.
Stages of colon cancer
The stage of colon cancer is determined on the basis of three criteria:
- The size of the tumor
- The presence of regional and distant metastases
- The involvement of lymph nodes in the oncological process
Stage 0. Stage 0 is localized cancer or carcinoma in situ. This is the most favorable stage of colon cancer, since there are no metastases yet. The tumor did not even spread beyond the intestinal mucosa.
Stage 1. Cancer has already spread beyond the mucosa, i.e. on the submucosa or into the muscle layer. There are no metastases yet.
Stage 2A. New growth spread to all layers of the intestine. But it did not spread to neighboring organs. There are no metastases.
Stage 2B. The tumor has already gone beyond the walls of the intestine. But it has still not given metastases and has not spread to neighboring organs.
Stage 2C. The tumor has grown through all the walls of the intestine, has gone beyond its limits, and already infiltration of neighboring tissues is observed. However, at the 2nd stage of colon cancer there are no metastases yet.
Stage 3A. Often patients ask at what stage of colon cancer do metastases occur. It is at the third stage of colon cancer when they appear. There are only the metastases in the lymph nodes, and they are not yet present in the organs. At 3A degree the tumor grows in the submucosa of the intestinal wall and spreads to 4-6 of the nearest lymph nodes. It can also spread through the entire intestine and affect 1 to 3 lymph nodes. Possible infiltration into adipose tissue.
Stage 3B. Stage 3 of category B is diagnosed in one of the following three cases:
- The cancer spreads to all layers of the intestine and to the peritoneum, but does not reach the internal organs, spreads into adipose tissue, affects 4-6 of neighboring lymph nodes
- The tumor grows into the muscle membrane or through all the layers of the intestine and spreads to 4-6 adjacent lymph nodes
- The tumor penetrates into the submucosal layer or into the muscular layer of the intestine, and also spreads to 7 or more adjacent lymph nodes
Stage 3C. It is diagnosed in such cases:
- The cancer spreads to all the walls of the intestine, extends to the visceral part of the peritoneum (the one which covers the internal organs), but does not spread into the organs themselves, also spreads to the 4-6 nearest lymph nodes
- The tumor grows through all layers of the intestine, as well as 7 or more lymph nodes
- The tumor grows through all the walls of the intestine, spreads to adipose tissue and affects minimum 1 lymph node
There are no distant metastases in stage 3 of bowel cancer. They appear only at the last stage of colon cancer.
Stage 4 of bowel is characterized by the appearance of distant metastases. It is also divided into three subtypes. At this stage, hyperthermic intraperitoneal chemotherapy (HIPEC) and proton therapy for metastatic colon cancer are performed.
Stage 4A. Bowel cancer of the 4th degree of subtype A is characterized by the tumor germination of all layers of the intestine. There is at least 1 distant metastasis (liver or lungs, as well as distant lymph nodes). In this case, regional metastases may be absent.
Stage 4B. The tumor completely or partially affects the intestinal wall. Regional metastases may be present or absent. There is a minimum of 1 distant metastasis in the organs or several distant metastases in the lymph nodes.
Stage 4C. Bowel cancer of stage 4 subtype C is characterized by complete germination of the organ wall, by the presence of regional metastases and tumor spreading to far-located areas of the peritoneum. In this case, distant metastases may not be present.
The most common metastases of bowel cancer are found in the liver. They are observed in 50% of patients with colon cancer. They are caused by a late diagnosis of oncopathology, as it is usually detected late, i.e. at the third or fourth stages of colon cancer. In this case, chemoembolization or proton therapy for metastatic colon cancer are indicated.
Stage 4 colon cancer treatment options
Stage 4 colon cancer is the most advanced stage of the disease that requires careful assessment of the benefits and risks of all therapeutic measures. Stage 4 colon cancer treatment options are somewhat limited, as curative surgeries are no longer possible and patients may not be able to tolerate systemic chemotherapy due to the impairment of kidneys or liver function.
Thus, stage 4 colon cancer treatment options include:
- Palliative surgeries (e.g. removing blocked with a tumor part of the intestine)
- Chemotherapy
- Hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal cancer spreading
- Targeted therapies
- Immunotherapy
- Radiation therapy and proton therapy for metastatic colon cancer
Stage 4 colon cancer treatment options for patients with liver metastases include hepatic artery infusion or chemoembolization, and ablation of metastatic foci.
The choice between few stage 4 colon cancer treatment options may be complicated, as each of them has benefits and risks. For instance, palliative surgery can restore physiological food passage but it is hard to tolerate it for the debilitated patients. Chemoembolization is tolerated better, but requires excellent visualization of blood vessels, which is not possible in all healthcare facilities.
Financial issues can also influence the choice of therapeutic scheme. Unfortunately, insurance companies do not always cover cancer treatment options. Thus, the cost of treatment for cancer stage 4 may become essential for self-payers.
Hospitals and cost of treatment for colon cancer stage 4
When choosing a hospital for the treatment of colon cancer, a patient should pay attention to its technical capabilities and the experience of doctors. The hospital should use modern diagnostic equipment for accurate staging of cancer. All types of surgeries and modern medicines should be available here.
Among the hospitals that specialize in the treatment of bowel cancer are:
- University Hospital Duesseldorf, Department of Gastroenterology, Hepatology and Infectology
- University Hospital of Ludwig-Maximilian University of Munich, Department of Gastroenterology and Hepatology
- University Hospital Ulm, Department of Gastroenterology and Hepatology
- University Hospital Frankfurt-am-Main, Department of Gastroenterology, Hepatology, Pulmonology, Allergology, Endocrinology and Diabetology
- University Hospital Wuerzburg, Department of Gastroenterology, Hematology, Oncology, Hepatology, Infectology, Rheumatology and Clinical Immunology
The cost of treatment for cancer stage 4 depends on the country, healthcare facility and chosen treatment of colon cancer. The average prices for main interventions in the leading European hospitals are as follows:
- Cost of treatment for colon cancer stage 4 with minimally invasive surgery – €27,430
- Cost of treatment for colon cancer stage 4 with da Vinci surgery – €39,530
- Cost of treatment for colon cancer stage 4 with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) – €72,710
- Cost of treatment for cancer stage 4 with chemotherapy – €9,470
- Colon cancer treatment with embolization or chemoembolization – €42,340
- Cost or rehabilitation after the main course of treatment – €1,570 per day
The medical program may be adjusted after receiving the results of the initial laboratory and instrumental examination. In this case, costs will change.
Colon cancer treatment in Germany
Bowel cancer is most common in Western countries. Therefore, doctors from countries such as Germany have the greatest experience in the treatment of colon cancer and have achieved the highest success rate doing that. The field of medicine is well developed in Germany. Therefore, you can undergo colon cancer treatment in Germany.
To organize diagnosis making and colon cancer treatment in Germany, contact Booking Health for assistance. We will help:
- Find a suitable hospital and physician, including a hospital for stage 4 colon cancer treatment
- Solve all organizational issues, including receiving visa
- Provide you with insurance that covers additional expenses in case of complications
- Save up to 50% of the treatment cost due to the absence of additional fees for foreigners, including the cost of treatment for cancer stage 4
We will also reduce the waiting time for treatment of colon cancer and arrange urgent treatment, which is very important in case of bowel cancer. After all, this disease is developing rapidly, and the longer you do not receive medical care, the greater the risk that the tumor will give metastasis.
You will also receive a full service package. We will help with the preparation of the documentation, provide you with an interpreter and meet you at the airport to transport you to the clinic by car. With Booking Health you can rest and fully concentrate on your health, avoiding the need to solve organizational issues during colon cancer treatment in Germany.
Choose treatment abroad and you will for sure get the best results!
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Authors:
The article was edited by medical experts, board certified doctors Dr. Vadim Zhiliuk, Dr. Nadezhda Ivanisova. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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