Bowel cancer (colon cancer) is a malignant malformation that is most common in the Western countries. Occurrence of this disease is 15-20 cases per 100 thousands of population per year. Thanks to the development of the new methods of treatment it is possible to.
Main risk factors of colon cancer are:
The main precancerous polyps are the cause for tumours. Another significant risk factor is chronic inflammatory bowel disease.
Clinical picture varies of the colon cancer depending on the tumour location. If it is located in the ascending colon, symptoms, connected with the impaired absorption function predominate. If the tumouris located in the descending colon, the symptoms of the intestinal obstruction take place first.
Clinical picture of the colon cancer is established by the several symptoms complexes:
Symptoms of the cancer are the same as for other intestinal diseases of the tumour origin. Therefore, it is only possible to establish a diagnosis after the instrumental examinations.
Barium enema or ergographyareX-ray methods of investigation with contrast. With barium enema procedure the doctor assesses the state of the intestine in real time, and while ergography procedure - a picture is taken. Before this, the patient undergoes an enema with contrast medium (barium sulphate). Using these methods the doctor can estimate the shape, the size of the tumour, its location and possible complications (germination of the bladder, small intestine, and vagina).
Colonoscopy is held after the barium enema. This endoscopic diagnostic method involves insertion of an instrument into the colon. In addition to the visual evaluation of the malformation the doctor is able to take a biopsy for cytological and histological examination.
Ultrasound, CT, MRI is non-invasive diagnostic methods that help to detect metastatic tumour in the lung, liver and other organs.
Laparoscopy is an invasive technique with the penetration into the abdominal cavity. The procedure is carried out to assess the prevalence of tumour and metastases detection.
The main treatment method is surgery. It is a chance to considerably lengthen the patient’s life.
Bowel resection. Intestinal tumour area is removed. It has to be added that distal and proximal edges of the cut-off should be far enough away from the formation, so that when their histological study is held, the healthy tissue must not consist atypical cells. In this case, the risk of local recurrence is significantly reduced. Together with the large intestine fragment all regional lymph nodes are also removed.
Extended bowel resection. It is used in the case of germination of the tumour into other organs and tissues. In course of the operation intestinal, stomach, liver, bladder fragments can be removed, depending on the location and extent of cancer process.
HIPEC-hyperthermic intraperitoneal chemotherapy is performed intraoperatively. The indication is peritoneal carcinomatosis. The procedure involves rinsing the abdomen with heated chemotherapy drugs solution. HIPEC-hyperthermic chemotherapy destroys microscopic metastases and remnants of the tumour, thus reducing the risk of relapse.
Chemotherapy and radiation therapy are both used before and after surgery as an adjuvant treatment.
In addition to the techniques used in the past decade new technologies and products that help to treat bowel cancer more effectively are actively introduced.
Laparoscopic bowel resection. Earlier operations on malignant tumours of the colon were performed only with the use of laparotomy, now many types of cancer can be operated on with laparoscopic techniques. The intervention is carried out through several sections of the minimum size. This greatly facilitates the postoperative period with the same operation effectiveness.
Robot-associated operations are conducted using robotic technology. Laparoscopic bowel resection is performed in such a way more accurately with less traumatization, lethality, with easier and more rapid postoperative recovery of the patient.
Inhibitors of immune checkpoints are a new group of drugs for immunotherapy of colon cancer. Control points called molecules, which are located on the surface of cancer cells. They make it clear to the immune system that these cells must not be subjected to its influence. Checkpoint inhibitors inhibit the signalling molecules, whereupon immunity begins to fight the tumour.
A vaccine against cancer is another method of immunotherapy, which lowers the risk of colon cancer recurrence after the surgery. The vaccine enhances human immune system activity against tumour cells.
Bowel cancer is not that aggressive and is characterized by a relatively slow growth. Therefore, the prognosis for this disease is more favourable than for many other malignant tumours of internal organs.
The five-year survival rate of patients, depending on the stage of colon cancer is:
For the stage 4 cancer radical surgery is not performed. Palliative surgery methods are used instead. After them, the average life expectancy of the patients is about 6-12 months.
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