Tumours of the large intestine

Colon cancer is one of the most frequent tumors. Among cancerous lesions of the digestive tract colon cancer ranks third after cancer of the stomach and esophagus. Among patients with surgical departments such patients are from 0.2 to 0.9%. Men develop cancer of the colon slightly more often than women. Colon cancer is more common in patients aged 40 to 60 years. More than 50% of cases of colon cancer occurs in the soil single polyps and polyps of the colon. This process selectively affects a number of areas of the intestine: most often suffer from hepatic and splenic curves colon, then cecum, the downward Department and Sigma, and much less commonly, the upward Department and the transverse part of the colon.
It is customary to distinguish between two forms of colon cancer: exophytic, when a tumor grows in the intestine lumen and leads to partial or complete closing it, and endophytic when cancer spreads to the side of the peritoneum. To exophytic tumors that have often bumpy form, are polypoid and villous forms of cancer. Endophytic tumors have the character of ulcers, circle covering the wall of the intestine. Exophytic cancer occur more often in the right half of the colon, and endophytic is on the left. If the tumor is near bauhinias valves, quite early develops stenosis. Progressive growth of a cancerous tumor on the side of the peritoneum a counter-reaction to nearby organs (loops of small bowel, gland), which are soldered with a tumor to form a conglomerate of large size. Further development of tumors may lead to perforation in her free abdominal cavity, which entails the development of peritonitis. Pitting of the tumor from the mucosa of the colon can result in massive bleeding.
Multiple colon cancer is rare (from 0.6%to 7%) and occurs mainly when polyposis, less often on the grounds of ulcerative colitis. For more malignant than single cancer.
As for the microscopic structure of colon cancer, mostly there are adenocarcinomas (80%), then slimy colloidal (12-15%) and mozgoviy cancers.
Symptoms of colon cancer differs depending on the form and shape of the tumor and its location. Sometimes colon cancer a long time asymptomatic or manifest nonspecific symptoms, characteristic of other diseases of the gastrointestinal tract. At different locations and forms of the disease appear belching, sometimes smelly, aversion to food, alternating constipation and diarrhea with mucus, especially the stinking smell of the chair with a large number of gases. This "discomfort of bowels" should bring to the suspicion about cancer of the colon. According to B. L. Bronstein (1950), the phenomenon of discomfort observed in 14% of cases. Pain are regular and relatively early signs of disease: patients complain first to the heaviness in the stomach, then the pain intensifies, and if intestinal obstruction become persistent, recurrent and cramping. When viewed only in malnourished patients can detect a tumor of the big sizes, swelling of the proximal intestine tumor. Percussion is of little help in determining tumor. Palpation allows you to determine the size of the tumor, its location, mobility. Sometimes patients themselves grope their tumor in the abdomen. 20% in colon cancer in Calais blood, and in the early stages of the disease it is only 7 % (B. L. Bronstein). Excessive bleeding in colon cancer are rare, but sometimes they are the first signs of disease. "No cause anemia" hypochromic type and accelerated ROHE give reason to suspect a malignant tumor. Anemia is more common in the location of tumors in the proximal colon. In 37 % of cases of colon cancer have fever - and not only with extensive cancerous lesions with decay, but with moderate development of tumors in combination with inflammatory reaction. Using rectoromanoscopy can detect a tumor of the sigmoid colon and perform the biopsy and cytological smears taken from suspicious for cancer sites.
An important role in the diagnosis of cancer of the colon plays a contrast x-ray examination of the colon.
Currently, surgery is the only radical method of treatment of colon cancer at an early stage, i.e. when resection of part of the intestine is removed not only the tumor and regional lymph nodes.
When the impracticability of radical operations because of the severity of the patient or in the presence of metastases to eliminate the symptoms of intestinal obstruction are palliative operations that are in the off tumour part of the intestine and in applying bypass anastomosis.
Sarcoma of colon cancer is rare and is from 1 to 3% of cases of colon tumors. Sarcoma of the colon is observed in all ages - from 7 months to 63 years, but most often between the ages of 20 to 40 years. History often marked abdominal trauma. The most frequently affected cecum. The size of the tumor vary from the size of a small Apple head to an adult. Sarcoma of the colon is often in the form of dense, hilly site, sannogo with neighbouring authorities and the anterior abdominal wall. Often sarcoma of the colon is in the form of clutches, with the intestinal wall for a considerable length evenly thickened. The narrowing of the lumen of the intestine in sarcoma it is less common than cancer. Sarcoma develops from submucosal layer grows late peritoneum. In the colon prevail round-cell, then lymphosarcoma and veretenoobraznaya sarcoma. Sarcoma of the colon are growing rapidly. The duration of the disease for up to a year.
At first, the disease is usually asymptomatic, and only when advanced development process occurs anorexia and diarrhea alternating with constipation. Often sarcoma colon simulates chronic appendicitis. When tumors temperature is increased to 39.7 degrees.
Anemia and cachexia are less than cancer. Frequent complications should include the tumor spreads to the adjacent organs, perforation and less - bowel obstruction, and intussusception. Intestinal bleeding are rare. Sarcoma can compress the lower hollow or portal vein and cause ascites and peripheral oedema, and in case of compression of the ureter - hydronephrosis (I. Ya. Deineka, 1960).
Diagnosis sarcoma colon difficult. The thought of sarcoma should occur when there is a rapidly growing, are little painful, rough tumor, not causing stenosis cancer, especially among young people.
Treatment of sarcoma of the colon surgery and is in the early resection of the affected segment of the intestine with the removal of regional lymph nodes, and fiber. The prognosis is poor.
Benign tumors of the colon are very diverse: it polyps, fibroids, lipoma, hemangioma, myoma, leiomyoma etc. These tumors long retain its small size and do not manifest themselves. With the growth of the tumor may have symptoms of narrowing or intussusception.
Particular attention should be given polyps and polipos the colon. Polyps are: hyperplastic with excessive development of the mucous membrane, inflammatory chronic inflammation (dysentery, tuberculosis) and adenomatous, true or polyps, which has in the basis of tumor expansion glands mucous membrane. Cecum most frequently affected polyps. Polyps are found mainly in young people. The size of polyps ranges from the size of millet grain to an adult's fist. Polyps can be placed on a broad basis, or to have a narrow foot.
Symptoms polyps and Pelipasov varies and depends on the number of polyps, their location and structure. Single polyps long does not manifest itself. At the same time adenomatous forms are accompanied liquid stools mixed with mucus and blood, often along the colon there are a pain in combination with constipation, and with the defeat of the sigmoid colon come tenesmus. Patients lose the weight, become anemic. In some cases it is possible to note a small dark spots mucous membranes of the lips, cheeks, palate, nose wings (syndrome Paehtz - Agera). If rectoromanoscopy visible various sizes, shapes and colors of the sigmoid colon polyps. Diagnosis of polyps of the colon is not so difficult with careful x-ray study.
Treatment of surgical and consists of the excision of solitary polyps and resection of the affected part or all of the colon. The Outlook is serious in view of the fact that on the grounds of polyps polyps and cancer.
From benign tumors of the colon in the first place by frequency are lipoma. They are located under the mucous membrane (in this case they are called internal) and over the serous membrane (external). More often they are placed on a broad basis, but sometimes have a leg and then called polypoid lipoma. Lipoma come in various sizes: from a pea to male fist; predominantly occur in individuals after 40 years.
Lipoma long asymptomatic. In General satisfactory condition in patients appear constipation alternating with diarrhea, sometimes with mucus and blood. Reached a considerable size lipoma can prosuvalisya through the abdominal wall and to move freely to palpation. Possible intussusception. Forecast when lipomas colon favorable with timely lipoma removal. The operation consists in resection of part of intestine with lipoma.
Fibroids colon occur very seldom