Sigmoid colon cancer ICD 10. First symptoms of sigmoid colon cancer and its treatment

Colon cancer must be understood as a malignant neoplasm that grows from the mucous membrane of the large intestine. Very often the tumor is localized in the sigmoid, rectum and cecum.

The sigmoid colon is the segment of the large intestine that lies in front of the rectum. Visually, this intestine resembles the Greek letter “sigma” - Σ, hence its name.

The sigmoid colon occupies an important place in the process of digestion and saturation of the body with nutrients. Based on this, sigmoid colon cancer (ICD 10. Class II (C00-D48), C18, C18.7) is a rather dangerous oncological disease that can be fatal.

According to research data, this type of cancer is diagnosed quite rarely (5-6% of all cases; men over the age of 50 are susceptible to the disease. But still, this process is a relatively favorable form of cancer. With timely diagnosis and adequate treatment, the outcome of the disease improves significantly , compared to stomach cancer.

Occurrence of disease

The medical history of sigmoid colon cancer is influenced by the following factors:

• nature of nutrition - excessive consumption of fatty, meat and flour dishes, lack of products of plant origin;
• diseases of the large intestine (polyps, colitis);
• bowel dysfunction (constipation);
• hereditary factors;
• elderly age.

Clinical picture

Symptoms of colon cancer can vary depending on the location of the tumor process. In the early stages, pronounced symptoms, as a rule, are absent, but when collecting an anamnesis, one can identify a deterioration in general well-being, loss of ability to work, and loss of appetite. Weight loss with sigmoid colon cancer is rare; some patients even gain weight.

<>As the disease progresses, various intestinal symptoms are observed:

• Constipation and diarrhea;
• Rumbling in the intestines;
• Dull and cramping pain in the abdomen that does not depend on food intake;
• Unilateral bloating (with narrowing of the intestinal lumen by a tumor);
• Anemia (the result of chronic blood loss).

Subsequently, the symptoms rapidly increase; in severe cases, intestinal obstruction, inflammatory processes (cellulitis, abscesses, peritonitis), and bleeding occur.

According to research data, this type of cancer is diagnosed quite rarely (5-6% of all cases; men over the age of 50 are susceptible to the disease. But still, this process is a relatively favorable form of cancer.

Diagnosis and treatment

Diagnosis of this form of colon cancer includes anamnesis, external examination, palpation, laboratory tests of stool for obvious or occult blood, X-ray examination, sigmoidoscopy, colonoscopy.

This oncological process can be cured exclusively by surgery. The method of choice is wide resection of the affected area of ​​the intestine with regional lymph nodes.

Rectal cancer is a malignant disease of the terminal portion of colon cancer. It is the last area that is often exposed to cancer, bringing quite a lot of problems to the patient. Like any other disease, colorectal cancer has a code according to the International Classification of Diseases, 10th revision, or ICD 10. So let’s look at this tumor from a classification perspective.

ICD 10 code

C20 – ICD 10 code for colorectal cancer.

Structure

First, let's look at the general structure according to ICD 10 before rectal cancer.

• Neoplasms – C00-D48
• Malignant – C00-C97
• Digestive organs – C15-C26
• Rectum – C20

Neighboring diseases

Next door, in the digestive organs, according to the ICD, diseases of neighboring departments are hidden. We will list them here while we can. So to say, a note.

• C15 – esophagus.
• C16 – .
• C17 – small intestine.
• C18 – colon.
• C19 – rectosigmoid junction.
• C20 – straight.
• C21 – anus and anal canal.
• C22 – and intrahepatic bile ducts.
• C23 – gallbladder.
• C24 – other unspecified parts of the biliary tract.
• C25 – .
• C26 – other and ill-defined digestive organs.

As you can see, any oncological problem has a clear place in the disease classifier.

General information about cancer

We will not dwell on this disease in detail here - we have a separate full article dedicated to it. Here is only brief information and a classifier.

The main causes of the disease are smoking, alcohol, nutrition problems, and a sedentary lifestyle.

Outside of any international classifications, already within the structure according to the location of carcinoma, the following types are distinguished for treatment:

1. Rectosigmoid
2. Superior ampullary
3. Medium ampullary
4. Inferior ampullary
5. Anal hole

Main types:

• Infiltrative
• Endophytic
• Exophytic

According to the aggressiveness of the manifestation:

• Highly differentiated
• Poorly differentiated
• Moderately differentiated

Symptoms

Intestinal cancer in general is a disease that manifests itself only in late stages; patients present at stages 3 or 4.

Highlights in the later stages:

• Blood in the stool
• Fatigue
• Feeling of fullness in the stomach
• Pain during defecation
• Constipation
• Anal itching with discharge
• Incontinence
• Intestinal obstruction
• Diarrhea
• In women, fecal discharge from the vagina through fistulas is possible

Stage 1– small tumor size, up to 2 centimeters, does not extend beyond the organ.

Stage 2– the tumor grows up to 5 cm, the first metastases appear in the lymphatic system.

Stage 3– metastases appear in nearby organs – the bladder, uterus, prostate.

Stage 4– widespread, distant metastases appear. A new classification is possible - into colon cancer.

Forecast

According to the five-year survival rate, the prognosis is divided into stages:

• Stage 1 – 80%.
• Stage 2 -75%.
• Stage 3 – 50%.
• Stage 4 – not registered.

Diagnostics

Basic methods for diagnosing the disease:

• Inspection.
• Palpation.
• Tests: urine, feces for occult blood, blood.
• Endoscopy, Colonoscopy.
• X-ray.
• Tumor markers.
• Magnetic resonance imaging, computed tomography, ultrasound.

Treatment

Let us highlight the main methods of treating this oncology:

Surgical intervention– from targeted removal of the tumor to removal of part of the rectum or its complete resection.

Chemotherapy. Injection of chemicals that destroy malignant cells. Possible side effects. Mainly used as an additional treatment before and after surgery.

Radiation therapy. Another method of additional treatment is to irradiate the tumor with radioactive radiation.

FAQ

Is it necessary to have surgery?

As a rule, yes. Surgery provides the maximum effect of treatment; radiation and chemotherapy only target the affected cells. The operation is not performed only at the last stage, when the treatment itself becomes pointless. So, if they suggest an operation, then all is not lost.

How long do people live with this cancer?

Let's be direct. The disease is not the best. But the survival rate is high. If detected in the first stages, patients live peacefully for more than 5 years. But on the latter it varies, on average up to six months.

Prevention

In order to prevent the occurrence of cancer, we follow these recommendations:

• We do not provide treatment for intestinal diseases - hemorrhoids, fistulas, anal fissures.
• We fight constipation.
• Proper nutrition - emphasis on plant foods.
• We throw out bad habits - smoking and alcohol.
• More physical activity.
• Regular medical examinations.

Sigmoid colon cancer is widespread in developed countries. First of all, scientists associate this phenomenon with the lifestyle and diet of the average resident of an industrialized country. In third world countries, in general, cancer of any part of the intestine is much less common. Sigmoid colon cancer mainly owes its spread to the small amount of plant-based foods consumed and an increase in the overall proportion of meat and other animal products, as well as carbohydrates. No less important and directly related to such nutrition is a factor such as constipation. Slowing the passage of food through the intestines stimulates the growth of microflora that release carcinogens. The longer the intestinal contents are retained, the longer the contact with bacterial secretions, and the more of them become. In addition, constant trauma to the wall with dense feces can also provoke sigmoid colon cancer.
In assessing prevalence, one should not overlook the fact that people live much longer in developed countries. In a poorly developed world with backward medicine, people simply do not live to see cancer.
Every 20 sigmoid colon cancers are hereditary - inherited from parents.
Risk factors also include the presence of other intestinal diseases, such as ulcerative colitis (UC), diverticulosis, chronic colitis, Crohn's disease of the colon, and the presence of polyps. Of course, sigmoid colon cancer can be prevented in this case - it is enough to treat the underlying disease in time.

ICD 10 code

The International Classification of Diseases, 10th revision – ICD 10 implies classification only according to the location of cancer. In this case, ICD 10 assigns code C 18.7 to sigmoid colon cancer. Cancer of the rectosigmoid junction is excluded from this group; in ICD 10 it has its own code - C 19. This is due to the fact that ICD 10 is aimed at clinicians and helping them in the tactics of patient management, and these two types of cancer, different in location, have an approach to surgical treatment varies.
So:
ICD 10 code for sigma cancer – C 18.7
ICD 10 code for cancer of the rectosigmoid junction – C 19

Of course, ICD 10 classifications and codes are not sufficient for a complete diagnosis of sigmoid colon cancer. The TNM classification and various staging classifications are used and mandatory for use in modern conditions.

Symptoms of cancer

Speaking about the first symptoms of colorectal cancer, including sigmoid colon cancer, it should be mentioned that in the very early stages it does not manifest itself at all. We are talking about the most favorable stages in terms of prognosis in situ (in the mucous and submucosal layer of the wall) and the first. Treatment of such early tumors does not take much time; in modern medical centers it is performed endoscopically, giving almost 100% results and a prognosis of five-year survival. But, unfortunately, the vast majority of early-stage sigmoid colon cancer is detected only as an incidental finding during examination for another disease or during a screening study. As mentioned above, the reason for this is the complete absence of symptoms.
Based on this, an extremely important method for detecting early cancer is preventive colonoscopy every 5 years upon reaching 45 years of age. In the presence of a family history (colon cancer in first-degree relatives) - from 35 years of age. Even in the complete absence of any symptoms of intestinal diseases.
As the tumor progresses, the following first symptoms gradually appear and begin to increase:

• Bloody discharge during defecation
• Mucus discharge from the rectum and mucus in the stool
• Worsening constipation

As you can see, the signs described above suggest only one thought - an exacerbation of chronic hemorrhoids is occurring.

Postponing a visit to the doctor for hemorrhoids for a long time, lack of sufficient examination, self-medication is a fatal mistake that claims tens of thousands of lives a year (this is not an exaggeration)! Cancer of the sigmoid and rectum is perfectly masked by its symptoms as chronic hemorrhoids. When the disease acquires its characteristic features, it is often too late to do anything, treatment is crippling or only symptomatic.

I hope you have learned this seriously and forever.
If a doctor diagnosed you with hemorrhoids 10 years ago, prescribed treatment, it helped you, and since then, during exacerbations, you have used various suppositories and ointments on your own (easily and naturally sold in pharmacies in a huge assortment and for every taste), without going back to without being examined - you are a potential suicide.
So, we talked about the first symptoms of sigma cancer.

As sigmoid colon cancer grows, gradually (starting from about the end of stage 2) more characteristic symptoms appear:

• Pain in the left iliac region. It often has a pressing, unstable character. Appears only when the tumor grows outside the intestine.
• Unstable stool, rumbling, flatulence, the appearance of liquid, foul-smelling stool; when defecating, dense stool is in the form of ribbons or sausages. Most often there is a change in diarrhea and constipation. However, when the tumor blocks the entire lumen, intestinal obstruction occurs, requiring emergency surgery.
• Frequently recurrent bleeding after defecation. Remedies for hemorrhoids do not help. There may be an increase in mucus and pus.
• Symptoms characteristic of any other cancer: intoxication, increased fatigue, weight loss, lack of appetite, apathy, etc.

These are, perhaps, all the main symptoms that manifest sigmoid colon cancer.

Treatment and prognosis for sigmoid colon cancer

Treatment at the earliest stages - in situ (stage 0)

Let me remind you that cancer in situ is a cancer with minimal invasion, that is, it is at the earliest stage of its development - in the mucous layer, and does not grow anywhere else. Such a tumor can only be detected by chance or during a preventive study, which has long been introduced into the standards of medical care in developed countries (the absolute leader in this area is Japan). Moreover, the main conditions are the availability of modern video endoscopic equipment, which costs many millions (unfortunately, in the Russian Federation it is present only in large cities and serious medical centers), and the performance of the study by a competent, trained specialist (to the mass availability of which our country will also grow and grow - our medicine is aimed at volume, not quality). Thus, it is better to be examined in a large paid clinic with excellent equipment and staff or in a high-level free hospital.

But let’s return to the topic of the article – treatment of early sigmoid colon cancer. Under ideal conditions, it is performed by submucosal dissection - removal of part of the mucosa with the tumor during endoscopic intraluminal surgery (therapeutic colonoscopy).
The prognosis for this intervention is simply amazing; after 3-7 days in the clinic you will be able to return to normal life. No open surgery. No chemotherapy or radiation therapy.
Naturally, performing this operation for the treatment of sigmoid colon cancer in situ requires first-class endoscopist knowledge of the technique, the availability of the most modern equipment and consumables.

In the early stages (I-II)

The first and second stages include tumors that do not grow into neighboring organs and have a maximum of 1 small metastasis to regional lymph nodes.
Treatment is only radical surgical, depending on the prevalence:

• Segmental resection of the sigmoid colon - removal of a section of the sigmoid colon followed by the creation of an anastomosis - joining the ends. Performed only in stage I.
• Resection of the sigmoid colon - removal of the entire sigmoid colon.
• Left-sided hemicolectomy - resection of the left part of the large intestine with the creation of an anastomosis or removal of an unnatural route for evacuation of feces - colostomy.

If there is a nearby metastasis, regional lymphoidectomy is performed - removal of all lymphatic tissue, nodes, and vessels in this area.
Depending on some conditions, treatment may also require radiation therapy or chemotherapy.
The prognosis is relatively favorable; with an adequate approach, the five-year survival rate is quite high.

In later stages (III–IV)

In advanced cases, more extensive operations are performed - left-sided hemicolectomy with removal of regional lymph nodes and nodes of neighboring zones. Chemotherapy and radiation therapy are used.
In the presence of distant metastases, tumor growth into neighboring organs, only palliative, that is, maximally prolonging life treatment, is recommended. In this case, an unnatural anus is created on the abdominal wall or a bypass anastomosis (a path for feces past the tumor) so that the patient does not die from intestinal obstruction. Adequate pain relief, including narcotic drugs, and detoxification are also indicated.
Modern standards of treatment involve removal of lymph nodes in very distant locations for stage III sigmoid colon cancer, which significantly reduces the chance of disease relapse and increases survival.
The prognosis for advanced sigmoid colon cancer is unfavorable.

Conclusion

As you can see, timely detection, a qualitatively new approach to the treatment of sigmoid colon cancer makes it possible to correct the word “sentence” to the word “temporary inconvenience” for those people who truly value their lives.
Unfortunately, the mentality of our nation, the desire to “endure until the last” does not have a very beneficial effect on the heartless statistics. And this applies not only to sigmoid colon cancer. Every day, hundreds of people suddenly (or not suddenly?) learn a terrible diagnosis, sincerely regretting that they did not see a doctor earlier.

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1.Can cancer be prevented?
The occurrence of a disease such as cancer depends on many factors. No person can ensure complete safety for himself. But everyone can significantly reduce the chances of developing a malignant tumor.

2.How does smoking affect the development of cancer?
Absolutely, categorically forbid yourself from smoking. Everyone is already tired of this truth. But quitting smoking reduces the risk of developing all types of cancer. Smoking is associated with 30% of deaths from cancer. In Russia, lung tumors kill more people than tumors of all other organs.
Eliminating tobacco from your life is the best prevention. Even if you smoke not a pack a day, but only half a day, the risk of lung cancer is already reduced by 27%, as the American Medical Association found.

3.Does excess weight affect the development of cancer?
Look at the scales more often! Extra pounds will affect more than just your waist. The American Institute for Cancer Research has found that obesity promotes the development of tumors of the esophagus, kidneys and gallbladder. The fact is that adipose tissue not only serves to preserve energy reserves, it also has a secretory function: fat produces proteins that affect the development of a chronic inflammatory process in the body. And oncological diseases appear against the background of inflammation. In Russia, WHO associates 26% of all cancer cases with obesity.

4.Do exercise help reduce the risk of cancer?
Spend at least half an hour a week training. Sport is on the same level as proper nutrition when it comes to cancer prevention. In the United States, a third of all deaths are attributed to the fact that patients did not follow any diet or pay attention to physical exercise. The American Cancer Society recommends exercising 150 minutes a week at a moderate pace or half as much but at a vigorous pace. However, a study published in the journal Nutrition and Cancer in 2010 shows that even 30 minutes can reduce the risk of breast cancer (which affects one in eight women worldwide) by 35%.

5.How does alcohol affect cancer cells?
Less alcohol! Alcohol has been blamed for causing tumors of the mouth, larynx, liver, rectum and mammary glands. Ethyl alcohol breaks down in the body to acetaldehyde, which is then converted into acetic acid under the action of enzymes. Acetaldehyde is a strong carcinogen. Alcohol is especially harmful for women, as it stimulates the production of estrogens - hormones that affect the growth of breast tissue. Excess estrogen leads to the formation of breast tumors, which means that every extra sip of alcohol increases the risk of getting sick.

6.Which cabbage helps fight cancer?
Love broccoli. Vegetables not only contribute to a healthy diet, but they also help fight cancer. This is also why recommendations for healthy eating contain the rule: half of the daily diet should be vegetables and fruits. Particularly useful are cruciferous vegetables, which contain glucosinolates - substances that, when processed, acquire anti-cancer properties. These vegetables include cabbage: regular cabbage, Brussels sprouts and broccoli.

7. Red meat affects which organ cancer?
The more vegetables you eat, the less red meat you put on your plate. Research has confirmed that people who eat more than 500g of red meat per week have a higher risk of developing colorectal cancer.

8.Which of the proposed remedies protect against skin cancer?
Stock up on sunscreen! Women aged 18–36 are especially susceptible to melanoma, the most dangerous form of skin cancer. In Russia, in just 10 years, the incidence of melanoma has increased by 26%, world statistics show an even greater increase. Both tanning equipment and sun rays are blamed for this. The danger can be minimized with a simple tube of sunscreen. A 2010 study in the Journal of Clinical Oncology confirmed that people who regularly apply a special cream have half the incidence of melanoma than those who neglect such cosmetics.
You need to choose a cream with a protection factor of SPF 15, apply it even in winter and even in cloudy weather (the procedure should turn into the same habit as brushing your teeth), and also not expose it to the sun's rays from 10 a.m. to 4 p.m.

9. Do you think stress affects the development of cancer?
Stress itself does not cause cancer, but it weakens the entire body and creates conditions for the development of this disease. Research has shown that constant worry alters the activity of immune cells responsible for triggering the fight-and-flight mechanism. As a result, a large amount of cortisol, monocytes and neutrophils, which are responsible for inflammatory processes, constantly circulate in the blood. And as already mentioned, chronic inflammatory processes can lead to the formation of cancer cells.

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Frequency . Colon and rectal cancer in most European countries and in Russia, it ranks sixth overall after cancer of the stomach, lung, breast, and female genital organs and tends to further increase. More than 60% of cases occur in the distal colon. In recent years, there has been a trend toward an increase in the number of patients with proximal colon cancer. Peak incidence- age over 60 years.

Code according to the international classification of diseases ICD-10:

Causes

Risk factors. Diet.. In developed countries, malignancy of the colon mucosa is promoted by an increase in the content of meat in the diet, especially beef and pork, and a decrease in fiber. The high content of meat and animal fat accelerates the growth of intestinal bacteria that produce carcinogens. This process can be stimulated by bile salts. Natural vitamins A, C and E inactivate carcinogens, and turnips and cauliflower induce the expression of benzpyrene hydroxylase, which can inactivate absorbed carcinogens. A sharp decrease in the incidence of the disease has been noted among vegetarians. The incidence of colonorectal cancer is high among workers in asbestos production and sawmills. Genetic factors. The possibility of hereditary transmission proves the presence of familial polyposis syndromes and an increase (3-5 times) in the risk of developing colorectal cancer among first-degree relatives of patients with carcinoma or polyps (nonpolyposis familial, type 1, MSH2, COCA1, FCC1, 120435, 2p22 p21; . 114500, TP53, 17p13.1; . APC, GS, 114500, 5q21 q22; .KRAS2, RASK2, 190070, 12p12.1; 159350, 5q21; 1p13.2; 600079, 7q11.23; . TGFBR2 (transforming growth factor receptor gene), 190182, 3p22; hereditary non-polyposis, type 3, PMS1, PMSL1, 2q31 q33; Other risk factors... Ulcerative colitis, especially pancolitis and disease more than 10 years old (10% risk) Crohn's disease History of colon cancer Polyposis syndrome: diffuse familial polyposis, single and multiple polyps, villous tumors... History of female genital or breast cancer.. Familial cancer syndromes.. Immunodeficiency conditions.

Classifications and staging
. Macroscopic forms of cancer of the colon and rectum.. Exophytic - tumors growing into the intestinal lumen.. Saucer-shaped - oval-shaped tumors with raised edges and a flat bottom.. Endophytic - tumors infiltrating the intestinal wall without clear boundaries. Histological forms .. Adenocarcinoma of varying degrees of maturity predominates (60% of cases) .. Mucous cancer (12-15%) .. Solid cancer (10-12%) .. Squamous cell and glandular squamous cell carcinoma are rarely detected.
. TNM - classification (for colon cancer).. Tis - carcinoma in situ or invasion of the basement membrane without invasion of the submucosal layer.. T1 - tumor invades the submucosal layer.. T2 - tumor invades the muscular layer.. T3 - tumor invades the subserous layer. or adjacent to non-peritoneal tissue sections. T4 - direct tumor invasion into adjacent organs or invasion of the visceral peritoneum. This category also includes cases of germination of non-adjacent parts of the colon (for example, germination of a tumor of the sigmoid colon into the cecum). N0 - metastases to regional lymph nodes are not detected. N1 - there are metastases in 1-3 regional lymph nodes.
. Grouping by stages. Stage 0: TisN0M0. Stage I: T1-2N0M0. Stage II: T3-4N0M0. Stage III: T1-4N1-2M0. Stage IV: T1-4N0-2M1.
. Dukes classification as modified by Estler and Koller(1953) .. Stage A. The tumor does not extend beyond the mucous membrane.. Stage B1. The tumor invades the muscularis, but does not affect the serosa. Regional lymph nodes are not affected. Stage B2. The tumor grows throughout the intestinal wall. Regional lymph nodes are not affected. Stage C1. Regional lymph nodes are affected. Stage C2. The tumor invades the serous membrane. Regional lymph nodes are affected. Stage D. Distant metastases (mainly to the liver).
Clinical picture depends on the location, size of the tumor and the presence of metastases.
. Right colon cancer causes anemia due to slow, chronic blood loss. Often a tumor-like infiltrate is detected in the abdominal cavity and abdominal pain occurs, but due to the large diameter of the proximal colon and liquid intestinal contents, acute intestinal obstruction develops quite rarely and in the later stages of the disease.
. Cancer of the left colon is manifested by disturbances in the functional and motor activity of the intestine. The development of intestinal obstruction is predisposed by the small diameter of the distal parts of the colon, dense feces and frequent circular lesions of the intestine by the tumor. A pathognomonic sign of colon and rectal cancer is pathological impurities in the stool (dark blood, mucus).
. Hematogenous tumor metastasis usually involves the liver; Possible damage to bones, lungs and brain.

Carcinoid tumors are neuroepithelial tumors arising from argentaffinocytes (Kulchitsky cells) and elements of the nerve plexuses of the intestinal wall (see also Carcinoid tumor, Carcinoid syndrome). Colon involvement accounts for about 2% of all gastrointestinal carcinoids. Most often they occur in the appendix, jejunum or rectum. The degree of malignancy of carcinoid tumors depends on their size. Tumor diameter<1 см малигнизируются в 1% случаев, 1-2 см — в 10% случаев, >2 cm - in 80% of cases. Carcinoid tumors grow much slower than cancer. The process begins in the submucosal layer, then spreads to the muscular layer. The serous and mucous membranes are affected much later. Some carcinoids have the ability to metastasize to regional lymph nodes and distant organs (liver, lungs, bones, spleen). However, metastases can grow for years and manifest only as carcinoid syndrome.
Tumors of the vermiform appendix. Carcinoid tumors. Adenocarcinoma. A mucocele (retention or mucous cyst) can behave like a tumor. Perforation of the cyst or contamination of the abdominal cavity during its resection can lead to the development of peritoneal pseudomyxoma, a rare disease characterized by the accumulation of large amounts of mucus in the abdominal cavity.
Other neoplasms (benign and malignant) of the colon are observed quite rarely. From lymphoid tissue - lymphomas. From adipose tissue - lipomas and liposarcoma. From muscle tissue - leiomyoma and leiomyosarcoma.

Squamous cell carcinoma of the anus is usually less malignant than adenocarcinoma; manifested by bleeding, pain, tumor formation and defecation disorders, changes in intestinal motility. Treatment is radiation and surgery, the 5-year survival rate is 60%.
Cloacogenic carcinoma is a tumor of the transitional epithelium in the area of ​​the dentate line of the anal canal; accounts for 2.5% of all cases of anorectal cancer; occurs at the junction of the ectoderm and endodermal cloaca - a blind caudal stretch of the hindgut, more often in women (in a ratio of 3:1), peak age - 55-70 years. Combined treatment: The operation is performed after radiation therapy.
Diagnostics. Rectal digital examination allows you to detect a tumor, determine the nature of its growth, and its connection with adjacent organs. Irrigoscopy (contrast examination of the colon with barium) makes it possible to establish the location, extent of the tumor and its size, but the main thing is to exclude the multiplicity of lesions and polyps. Endoscopy with biopsy - sigmoidoscopy and colonoscopy allow you to clarify the location of the colon tumor; establish the histological structure. Endorectal ultrasound (for rectal cancer) makes it possible to determine tumor growth into adjacent organs (vagina, prostate gland). CT, ultrasound, and liver scintigraphy are performed to exclude distant metastases. If acute intestinal obstruction is suspected, a plain radiography of the abdominal organs is necessary. Laparoscopy is indicated to exclude generalization of the malignant process. Occult blood test. In high-risk patients, guaiac testing for fecal occult blood should be performed frequently and closely monitored for unexplained blood loss. Determination of CEAg is not used for screening, but the method can be used for dynamic monitoring of patients with a history of colon carcinoma; an elevated titer indicates relapse or metastasis.
Treatment. Surgery for colon cancer is the treatment of choice. The extent of the operation depends on the location of the tumor and the general condition of the patient. Radical surgery involves removal of the affected parts of the intestine along with the mesentery and regional lymphatic system.

Types of operations for colon cancer.. For cancer of the right half of the colon - right-sided hemicolectomy with ileotransverse anastomosis.. For cancer of the middle third of the transverse colon - resection of the transverse colon with end-to-end bell anastomosis.. For cancer of the left half of the colon - left-sided hemicolectomy.. For cancer of the sigmoid colon - resection.. Operations can be performed with a one-stage restoration of passage through the intestines, or with a colostomy in case of complications of cancer (intestinal obstruction, tumor perforation, bleeding).. In case of an inoperable tumor or distant metastases - palliative operations with the aim of prevention of complications (intestinal obstruction, bleeding): application of ileotransversoanastomosis, transversosigmoanastomosis, ileo- or colostomy.
. Types of operations for rectal cancer. When the tumor is located in the distal part of the rectum and at a distance<7 см от края заднего прохода — брюшно - промежностная экстирпация прямой кишки (операция Майлса) .. Сфинктеросохраняющие операции можно выполнить при локализации нижнего края опухоли на расстоянии 7 см от края заднего прохода и выше... Брюшно - анальная резекция прямой кишки с низведением дистальных отделов ободочной кишки возможна при опухоли, расположенной на расстоянии 7-12 см от края заднего прохода... Передняя резекция прямой кишки: производят при опухолях верхнеампулярного и ректосигмоидного отделов, нижний полюс которых располагается на расстоянии 10-12 см от края заднего прохода... При малигнизированных полипах и ворсинчатых опухолях прямой кишки выполняют экономные операции: трансанальное иссечение или электрокоагуляцию опухоли через ректоскоп, иссечение стенки кишки с опухолью после колотомии.

Combined treatment. Preoperative radiation therapy for rectal cancer reduces the biological activity of the tumor, reduces its metastatic potential and the number of postoperative relapses in the surgical area. Local postoperative irradiation is indicated if there are doubts about the radicality of the intervention. Chemotherapy is carried out in the adjuvant mode for an advanced process, low-grade tumors ... A combination of fluorouracil with lecovorin or levamisole is used. Treatment carried out for a year, as an independent method it is rarely used, after symptomatic operations.
Forecast. The overall 10-year survival rate is 45% and has not changed significantly in recent years. For cancer limited to the mucosa (often detected by occult blood testing or colonoscopy), survival rates reach 80-90%; with damage to regional lymph nodes - 50-60%. Main Factors factors that influence the prognosis of surgical treatment of colon cancer: the extent of the tumor around the circumference of the intestinal wall, the depth of germination, the anatomical and histological structure of the tumor, regional and distant metastasis. After liver resection for single metastases, the 5-year survival rate is 25%. After pulmonary resection for isolated metastases, the 5-year survival rate is 20%.
Recurrence of colon tumor. Determination of CEAg content is a method for diagnosing recurrent colorectal cancer. The CEAg titer is determined every 3 months during the first 2 years after surgery. A persistent increase in its content indicates the possibility of recurrence or metastasis. Relapses of colon cancer often cause intense pain, lead to exhaustion of the patient and are very difficult to treat. Surgery for recurrent colon tumors is usually palliative in nature and is aimed at eliminating complications (intestinal obstruction).

ICD-10. C18 Malignant neoplasm of the colon. C19 Malignant neoplasm of the rectosigmoid junction. C20 Malignant neoplasm of the rectum. C21 Malignant neoplasm of the anus [anus] and anal canal. D01 Carcinoma in situ of other and unspecified digestive organs