in section Oncology
Colon cancer refers to common forms of cancer. Incidence rates vary by up to 2 6 100 thousand on the population and have a strong tendency to increase. The main disease is considered nredopuholevym polyposis, which in 50-60% of cases the source of cancer of the colon.
Symptoms of malignant lesions of the colon are diverse, with isolated clinical course of the following forms:
1) toksikoanemicheskaya form is characterized by a predominance of symptoms of weakness, fatigue, body temperature rises, and progressive anemia;
2) in the form of the patients concerned enterokoliticheskoy dull aching and pain in the abdomen, feeling rasiiraniya, alternating constipation and diarrhea, pathological impurities in the feces;
3) in the obstructive form from the beginning of the disease is marked disorder passage through the colon. Patients occur suddenly paroxysmal abdominal pain, accompanied by a delay of gases and feces. At the beginning of the disease pain usually pass on their own, are becoming more frequent in the future in connection with the development of a partial bowel obstruction;
4) dispep ical form appears gastric distress: loss of appetite, nausea, vomiting, belching, feeling of heaviness in the epigastric region, abdominal pain;
5) for psevdovospalitelnoy form characterized by signs of inflammation in the abdomen: abdominal pain, fever, signs of peritoneal irritation.
In most tumors are localized in the cecum, somewhat less - at the left and right bends of the colon and the sigmoid region. In cancer that developed on the background of polyposis, often marked by a plurality of primary tumors.
Basic diagnostic methods - radiological (barium enema) and endoscopic ending obtain material for morphological studies. A must for tumors of the colon is a liver ultrasound, because it is in the liver cancer, colon cancer often metastasizes.
Surgery is the only method of radical treatment of patients with colon cancer. In operation with a radical purpose removes the bowel mesentery, fiber and adjacent regional lymph nodes located along the blood vessels of the mesentery.
RџSЂRё cancer of the right half of the colon right-sided hemicolectomy performed. When the tumor in the cecum and ascending colon removed the right half of the transverse colon resected mesentery, which are all branches of the superior mesenteric artery, which are located along the lymph nodes. In the case of cecal lesions resected and about 20 see the terminal ileum, to ensure adequate removal of the lymph system, located along the ileal-colonic arteries and veins.
If tumor localized in the right flexure of the colon, appropriate intervention is a right-sided hemicolectomy with the mandatory removal of gastrointestinal ligament. In cancer of the middle third of the transverse colon admissible sectoral resection of the bowel.
Left-sided hemicolectomy performed at a cancer of the left colon. When tumors descending part of the colon and the proximal part of the sigmoid colon is also carried out a left hemicolectomy. In the case of lesions of the distal sigmoid colon resection make the crossing on the level of origin of the mesentery of the sigmoid artery from the inferior mesenteric artery.
At the phenomena of obstruction surgery should be divided into two stages: first, impose tsekostomu and through 2-3 weeks perform hemicolectomy. In the presence of metastases be permanently on the testimony form the bypass, handling a colostomy or make palliative resection of the bowel.
Combined and complex treatment of colon cancer is fairly rare. Typically, indications for postoperative chemotherapy is the presence of metastases in regional lymph nodes, deep tumor invasion in the intestinal wall, a large local distribution process. The most widely used for this purpose fluoropyrimidine derivatives - 5-fluorouracil and ftorafur.
Postoperative irradiation is performed for the same indications as chemotherapy. Radiation exposure is advantageously carried out at a cancer of the intestine divisions, which are not covered by peritoneum. This tactic helps to reduce the frequency of local recurrence. Irradiation is carried out with two opposing fields to the total focal dose of about 40-45 Gy.
Some clinics use preoperative radiation, which is carried out under questionable rezektabelygyh malignancy if clearly defined boundaries of destruction. It will also apply protivolezhapshe field, the total dose is 30-40 Gy.
In the presence of liver metastases may be used interventional therapies: regional chemotherapy via the hepatic artery and portal vein.
After radical treatment of the five-year survival of patients with colon cancer is 50-60%. The presence of metastases in regional lymph nodes reduces this figure to 25-30%. Patients with liver metastases usually die within 6-8 months, but with the full intervention treatment of the average duration of their lives up to 24-30 months.
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