In the international classification of diseases, all neoplasms, both malignant and benign in nature have their own class. Therefore, a pathology such as sigmoid colon cancer according to ICD 10 has code C00-D48 according to the class.
Any oncological process, even if it is localized in a specific organ, has many individual characteristics that distinguish it from other, at first glance, similar pathological conditions.
When coding cancer according to the 10th revision classification, the following indicators are taken into account:
- the primacy of the oncological process (any tumor can initially be localized in a specific organ, for example, the colon, or be the result of metastasis);
- functional activity (implies the production by the tumor of any biological active substances, which is rarely observed in the case of intestinal neoplasms, but is almost always taken into account in oncology thyroid gland and other organs of the endocrine system);
- morphology (the term cancer is a collective concept implying malignancy, but its origin can be anything: epithelial cells, poorly differentiated structures, cells connective tissue and so on);
- spread of the tumor (cancer can affect not one organ, but several at once, which requires clarification in the coding).
Features of sigmoid colon cancer
The sigmoid colon is part of the large intestine, almost its final part, located immediately in front of the rectum. Any oncological processes in it represent dangerous conditions body not only due to intoxication with cancer cells or other common reasons, but also due to significant disruption of the functioning of the digestive tract.
When a sigma tumor develops, the following problems arise:
- bleeding leading to severe degrees anemic syndrome, when blood transfusion is required;
- intestinal obstruction caused by blockage of the intestinal lumen;
- germination in neighboring organs pelvis (lesion genitourinary system in men and women);
- ruptures and melting of the intestinal wall with the development of peritonitis.
However, differentiating the diagnosis for any colon cancer is very difficult due to the similarity of symptoms. Only highly specific examination methods will help confirm the localization of the tumor. In addition, the clinical picture of the disease may long time absent, occurring only when the tumor reaches a significant size. Because of this, according to ICD 10, intestinal cancer is quite difficult to code and, accordingly, prescribe treatment.
Disease coding
Malignant pathologies of the colon are coded C18, divided into subsections. The tumor process in sigma is coded as follows: C18.7. However, there are additional codes for functional and morphological features neoplasms.
Additional clarification is required due to the fact that an oncological diagnosis is established only on the basis of biopsy data, that is, cytological examination.
In addition, the prognosis for the patient will largely depend on the histological type of the tumor. The less differentiated cells specialists find in the sample, the more dangerous the disease is considered and the greater the chance of rapid spread of metastatic foci. In the section of colon neoplasms there are different tumor locations, but the problem is that the pathology spreads quickly. For example, cancer of the cecum according to ICD 10 is designated C18.0, but only until it extends beyond the intestinal tract. When the tumor invades several parts, code C18.8 is set.
Rectal cancer - malignant disease terminal section of colon cancer. It is the last area that is often exposed to a cancerous tumor, 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 speak, 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 classification of diseases.
General information about cancer
We will not dwell on this disease in detail here - we have a separate full article dedicated to it. Here 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:
- Rectosigmoid
- Superior ampullary
- Medium ampullary
- Inferior ampullary
- Anal hole
Main types:
- Infiltrative
- Endophytic
- Exophytic
According to the aggressiveness of the manifestation:
- Highly differentiated
- Poorly differentiated
- Moderately differentiated
Symptoms
Colon cancer in general is a disease that manifests itself only in late stages, patients turn to 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 – bladder, uterus, prostate.
Stage 4– widespread, distant metastases appear. Possible new classification– in 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 occult blood, blood.
- Endoscopy, Colonoscopy.
- X-ray.
- Tumor markers.
- Magnetic resonance imaging, CT scan, 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. Enter chemicals, which destroy malignant cells. Possible side effects. Mainly used as an additional treatment before and after surgery.
Radiation therapy. Another method additional treatment, consists of irradiating the tumor with radioactive radiation.
FAQ
Is it necessary to have surgery?
As a rule, yes. Surgery gives maximum effect from treatment, radiation and chemotherapy only target the affected cells. The operation is not performed only on last stage when treatment itself becomes meaningless. 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 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 is mainly due to its spread due to the small amount of food consumed plant origin and increase total share 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 miss the fact that much more long life people 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 UC (nonspecific ulcerative colitis), diverticulosis, chronic colitis, Crohn's disease of the colon, 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 by 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. Used and required for use in modern conditions TNM classification And various classifications staging.
Symptoms of cancer
Speaking about the first symptoms of colorectal cancer, including sigmoid colon cancer, it should be mentioned that at the most early stages he doesn't show himself in any way. 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 performed endoscopically, gives almost 100% results and a five-year survival prognosis. 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 complete absence symptoms. 
Based on this, an extremely important method for identifying early cancer is a 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 tumors progress, they gradually appear and begin to grow next first symptoms:
- Bloody discharge during the act of 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 takes its toll character traits– 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 you have been using it yourself for exacerbations. various candles and ointments (easily and naturally sold in pharmacies in a huge assortment and for every taste), without going back, 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 stools, rumbling, flatulence, the appearance of liquid foul-smelling feces, when defecating with dense feces - it 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 examination, which has long been introduced into standards 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 available only in major cities and serious medical centers), and the implementation 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. Without chemistry and 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 be necessary. 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 abdominal wall or bypass (path for stool past the tumor), so that the patient does not die from intestinal obstruction. 
Adequate pain relief is also indicated, including narcotic drugs, detoxification.
Modern standards Treatment involves 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?) find out terrible diagnosis, sincerely regretting that I 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 oncological diseases. 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 it affect excess weight on the development of cancer?
Look at the scales more often! Overweight will affect not only the 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. Ethanol decomposes in the body to acetaldehyde, which then, under the action of enzymes, turns into acetic acid. 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 are not only included in healthy diet, they also help fight cancer. This is 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, the blood constantly circulates a large number of cortisol, monocytes and neutrophils, which are responsible for inflammatory processes. And as already mentioned, chronic inflammatory processes can lead to the formation of cancer cells.
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The term “colon cancer” refers to malignant epithelial tumors of the cecum, colon and rectum, as well as the anal canal, that vary in shape, location and histological structure.
ICD-10 CODES
C18. Malignant neoplasm of the colon.C19. Malignant neoplasm of the rectosigmoid junction.
C20. Malignant neoplasm of the rectum.
Epidemiology
In many industrialized countries, colon cancer occupies one of the leading places in frequency among all malignant neoplasms. Thus, in England (particularly in Wales) about 16,000 patients die from colon cancer every year. In the USA in the 90s of the XX century. the number of new cases of colon cancer ranged from 140,000-150,000, and the number of deaths from this disease exceeded 50,000 annually.In Russia, over the past 20 years, colon cancer has moved from sixth to fourth place in frequency of occurrence in women and third in men, second only to lung, stomach and breast cancer.
Prevention
Has a certain preventive value balanced diet with a balanced consumption of animal and plant products; prevention and treatment of chronic constipation, ulcerative colitis and Crohn's disease. Timely detection and removal of colorectal polyps plays an important role, therefore, in people over 50 years of age with an unfavorable family history, regular colonoscopy with endoscopic removal polyps.Etiology and pathogenesis
There is no single cause known to cause colon cancer. Most likely, we are talking about a combination of several unfavorable factors, the leading of which are unbalanced nutrition, harmful environmental factors, chronic diseases colon and heredity.Colorectal cancer is more common in areas where the diet is dominated by meat and consumption is limited vegetable fiber. Meat food causes an increase in concentration fatty acids, which during the digestion process turn into carcinogenic agents. The lower incidence of colon cancer in rural areas and countries with a traditional plant-based diet (India, Central African countries) indicates the important role of plant fiber in the prevention of colon cancer. Theoretically, a large amount of fiber increases the volume of fecal matter, dilutes and binds possible carcinogenic agents, reduces the transit time of contents through the intestine, thereby limiting the time of contact of the intestinal wall with carcinogens.
Close to these judgments is the chemical theory, which reduces the cause of the tumor to the mutagenic effect on the cells of the intestinal epithelium of exo- and endogenous chemical substances(carcinogens), among which the most active are polycyclic aromatic hydrocarbons, aromatic amines and amides, nitro compounds, oflatoxins, as well as metabolites of tryptophan and tyrosine. Carcinogenic substances (for example, benzopyrene) can also be formed due to irrational heat treatment food products, smoking meat, fish. As a result of the impact of such substances on the cell genome, point mutations (for example, translocations) occur, which leads to the transformation of cellular proto-oncogenes into active oncogenes. The latter, triggering the synthesis of oncoproteins, transform a normal cell into a tumor cell.
In patients with chronic inflammatory diseases colon, especially with ulcerative colitis, the incidence of colon cancer is significantly higher than in the population. The risk of developing cancer is influenced by the duration and clinical course diseases. The risk of colon cancer with a disease duration of up to 5 years is 0-5%, up to 15 years - 1.4-12%, up to 20 years - 5.2-30%, the risk is especially high in patients suffering from ulcerative colitis in for 30 years or more - 8.7-50%. With Crohn's disease (in the case of damage to the colon), the risk of developing a malignant tumor also increases, but the incidence of the disease is lower than with ulcerative colitis, and amounts to 0.4-26.6%.
Colorectal polyps significantly increase the risk of developing a malignant tumor. The malignancy index of single polyps is 2-4%, multiple (more than two) - 20%, villous formations - up to 40%. Colon polyps are relatively rare in young people, but are quite common in older people. The most accurate estimate of the incidence of colon polyps can be judged from the results of pathological autopsies. The frequency of detection of polyps during autopsies is on average about 30% (in economically developed countries). According to the State Scientific Center of Coloproctology, the frequency of detection of colon polyps averaged 30-32% during autopsies of patients who died from causes unrelated to diseases of the colon.
Heredity plays a certain role in the pathogenesis of colon cancer. Persons who have a first degree relationship with patients with colorectal cancer have high degree risk of developing a malignant tumor. Risk factors include both malignant tumors of the colon and malignant tumors of other organs. Some hereditary diseases, such as familial diffuse polyposis, Gardner's syndrome, Turco's syndrome, are accompanied high risk development of colon cancer. If colon polyps or the intestine itself are not removed from such patients, then almost all of them develop cancer, sometimes several malignant tumors appear at once.
Familial cancer syndrome, inherited in an autosomal dominant manner, is manifested by multiple adenocarcinomas of the colon. Almost a third of such patients over the age of 50 develop colorectal cancer.
Colon cancer develops in accordance with the basic laws of growth and spread of malignant tumors, i.e. characterized by relative autonomy and unregulated tumor growth, loss of organotypic and histotypical structure, and a decrease in the degree of tissue differentiation.
At the same time, it also has its own characteristics. Thus, the growth and spread of colon cancer is relatively slower than, for example, stomach cancer. For a longer period, the tumor remains within the organ, without spreading deep into the intestinal wall more than 2-3 cm from the visible border. Slow tumor growth is often accompanied by a local inflammatory process that spreads to neighboring organs and tissues. Within the inflammatory infiltrate, cancer complexes constantly grow into neighboring organs, which contributes to the appearance of so-called locally advanced tumors without distant metastasis.
In turn, distant metastasis also has its own characteristics. The lymph nodes and (hematogenous) liver are most often affected, although other organs, in particular the lungs, are also affected.
A feature of colon cancer is the quite common multicentric growth and the occurrence of several tumors simultaneously (synchronously) or sequentially (metachronously) both in the colon and in other organs.
Classification
Forms of tumor growth:- exophytic(predominant growth into the intestinal lumen);
- endophytic(distributes mainly in the thickness of the intestinal wall);
- saucer-shaped(a combination of elements of the above forms in the form of a tumor-ulcer).
- adenocarcinoma(highly differentiated, moderately differentiated, poorly differentiated);
- mucinous adenocarcinoma(mucoid, mucous, colloid cancer);
- signet ring cell(mucocellular) cancer;
- undifferentiated cancer;
- unclassified cancer.
- squamous cell carcinoma(keratinizing, non-keratinizing);
- glandular squamous cell carcinoma;
- basal cell carcinoma.
T - primary tumor:
T x - insufficient data to assess the primary tumor;
T 0 - the primary tumor is not determined;
T is - intraepithelial tumor or with invasion of the mucous membrane;
T 1 - tumor infiltrates to the submucosal layer;
T 2 - the tumor infiltrates the muscular layer of the intestine;
T 3 - the tumor grows through all layers of the intestinal wall;
T 4 - the tumor grows into the serous tissue or directly spreads to neighboring organs and structures.
N - regional lymph nodes:
N 0 - no damage to regional lymph nodes;
N 1 - metastases in 1-3 lymph nodes;
N 2 - metastases in 4 lymph nodes or more;
M - distant metastases:
M 0 - no distant metastases;
M 1 - there are distant metastases.
Stages of tumor development (domestic classification):
Stage I- the tumor is localized in the mucous membrane and submucosal layer of the intestine.
IIa stage- the tumor occupies no more than the semicircle of the intestine, does not extend beyond the intestinal wall, without regional metastases to the lymph nodes.
IIb stage- the tumor occupies no more than the semicircle of the intestine, grows throughout its entire wall, but does not extend beyond the intestine, there are no metastases in the regional lymph nodes.
IIIa stage- the tumor occupies more than the semicircle of the intestine, grows through its entire wall, there is no damage to the lymph nodes.
IIIb stage- a tumor of any size in the presence of multiple metastases to regional lymph nodes.
IV stage - extensive tumor, growing into neighboring organs with multiple regional metastases or any tumor with distant metastases.
Among malignant epithelial tumors, the most common is adenocarcinoma. It accounts for more than 80% of all cancerous tumors colon. For prognostic purposes, knowledge of the degree of differentiation (highly, moderately and poorly differentiated adenocarcinoma), the depth of germination, the clarity of tumor boundaries, and the frequency of lymphogenous metastasis is very important.
Patients with well-differentiated tumors have a more favorable prognosis than patients with poorly differentiated cancer.
Low-grade tumors include the following forms of cancer.
- Mucous adenocarcinoma(mucosal cancer, colloid cancer) is characterized by significant secretion of mucus with its accumulation in the form of “lakes” of different sizes.
- Signet ring cell carcinoma(mucocellular cancer) often occurs in individuals young. More often than with other forms of cancer, massive intramural growth without clear boundaries is noted, which makes it difficult to choose the boundaries of intestinal resection. The tumor metastasizes faster and more often spreads not only to the entire intestinal wall, but also to surrounding organs and tissues with relatively little damage to the intestinal mucosa. This feature complicates not only radiological but also endoscopic diagnosis of the tumor.
- Squamous cell carcinoma It is most common in the distal third of the rectum, but is sometimes found in other parts of the colon.
- Glandular squamous cell carcinoma is rare.
- Undifferentiated cancer. It is characterized by intramural tumor growth, which must be taken into account when choosing the extent of surgical intervention.
G. I. Vorobyov
Colon cancer is considered one of the most common cancers affecting the digestive tract organ such as the intestines. Since it consists of several departments, each of them separately or all at once can be involved in pathology.
The main reason for the formation malignant neoplasm lies in poor human nutrition. However, experts in the field of gastroenterology identify several other predisposing factors.
The danger of the disease is that it is quite for a long time proceeds without the manifestation of any symptoms, and those signs that are expressed cannot accurately indicate the presence of cancer. The main symptoms are pain syndrome, flatulence and the appearance of pathological impurities in the stool.
Diagnostics involves comprehensive examination, starting from palpation of the abdomen and ending wide range instrumental procedures. Treatment is carried out only by surgery.
In the international classification of diseases, this pathology has several meanings, depending on which part of the large intestine was affected. Thus, the ICD-10 code will be C17-C19.
Etiology
Colon cancer is a collective term, since this organ consists of the following sections:
- blind;
- colon - which can be ascending, descending and transverse;
- sigmoid;
- straight.
It is worth noting that this type of oncology in females ranks second - only breast cancer is ahead of it. In men, in terms of frequency of diagnosis, this disease is second only to prostate and lung cancer.
The main reasons for the development of this disease are:
- the course of inflammatory pathologies in the large intestine - this should include. Distinctive features such ailments is that the first one affects only upper layer organ, and the second applies to all tissues;
- complicated heredity - if one of your close relatives has been diagnosed with a similar pathology, then the person’s chances of developing cancer increase significantly. Knowing this, you can independently prevent its occurrence - to do this, you just need to refuse bad habits, eat right and regularly visit a gastroenterologist. Clinicians claim that such a predisposing factor acts as the source of the disease in 25% of cases;
- Poor nutrition – increases the risk of developing the disease, such a diet, which is based on fats and carbohydrates, against the background of which human body do not get sufficient quantity fiber. It is for this reason that the basis of therapy is diet for colon cancer;
- lack of physical activity in a person’s life - those who constantly work in a sitting or standing position, as well as those who, due to their own laziness, do not want to bother themselves, are at high risk of developing oncology physical activity;
- long-term addiction to bad habits - long-term studies of the widespread occurrence of such cancer have shown that those who abuse alcohol and smoke cigarettes are 40% more likely to be exposed to this disease than those who healthy image life;
- formation - such neoplasms are benign, but under the influence of unfavorable factors they can transform into cancer;
- long and uncontrolled reception some groups medicines, in particular, anti-inflammatory and antibacterial agents;
- a person has high body weight;
- disruption of the metabolism of proteins and fats.
It is believed that the main risk group is people over forty years of age and males, since they are several times more likely to develop this disease. However, the possibility of its development in young people cannot be ruled out.
Classification
As mentioned above, malignant neoplasms of the colon in women and men can be localized in different zones of this organ, but the frequency of their damage may vary. For example,
- the sigmoid and descending colon act as the focus of cancer most often - in 36% of cases;
- the cecum and ascending colon are affected in approximately 27% of the total diagnosis of the disease;
- rectal cancer accounts for 19%
- colon cancer – 10%.
According to the nature of their growth, malignant tumors are:
- exophytic - this means that the formations grow into the intestinal lumen;
- endophytic - spread into the thickness of the walls of this organ;
- mixed - have characteristics of the two above forms.
Depending on your histological structure, colon cancer tumors can look like:
- adenocarcinoma – detected in 80% of cases;
- mucoid cancer;
- signet ring cell or mucocellular cancer;
- squamous cell oncology;
- basal cell carcinoma;
- glandular squamous cell carcinoma;
- undifferentiated and unclassified cancer.
Depending on the depth of penetration and spread of metastases, the following stages of cancer are distinguished:
- precancerous condition - with insufficient data to evaluate the tumor;
- zero – the structure of the mucous layer of the large intestine is disrupted;
- initial - in addition to the mucous layer, submucosal tissues are affected;
- moderate severity – the muscle layer is susceptible to infiltration;
- severe – growth of the formation is observed throughout all layers of this organ;
- complicated - in addition to the involvement of all structural parts of the intestinal wall in the pathology, there is a spread of metastases to nearby organs.
The disease is also divided according to the presence or absence of metastases in regional or distant lymph nodes.
Symptoms
Although cancer can affect different parts of this organ, colon cancer has the same symptoms.
In the first stages of the disease, symptoms may be completely absent due to minor tissue damage. However, general clinical manifestations, which are characteristic of many gastrointestinal ailments. Given that they are weakly expressed, people often do not pay attention to them, thereby independently aggravating their condition.
The first symptoms of colon cancer are:
- constant discomfort in the abdominal area;
- increased gas formation;
- stool disorder;
- unpleasant sensations during the act of defecation;
- feeling of fullness in the stomach;
- general weakness.
As the pathological process spreads, the above signs of cancer will become more pronounced, and other manifestations will also appear, including:
- alternation of profuse diarrhea with constipation;
- the appearance of impurities in the stool - we are talking about blood and mucus. It is noteworthy that, depending on the damage to a particular area of the large intestine, they will have different type. For example, when localized in the sigmoid or rectum, blood and mucus will envelop the feces. In all other cases, the stool will change its color, which can vary from red to black;
- anemia – occurs against the background of internal intestinal bleeding;
- pallor and dryness skin;
- unreasonable a sharp decline body weight;
- brittle hair and weakness of nail plates;
- signs of vitamin deficiency;
- increased body temperature and fever.
In addition, it is necessary to take into account that when metastases spread to other organs, for example, to the liver, stomach, spleen, lungs or pancreas, the main symptoms will be supplemented by other manifestations from the affected segment.
Diagnostics
It is almost impossible to make a correct diagnosis in the early stages of the formation of the disease - in such cases, colon cancer will be a diagnostic surprise, identified during instrumental examination person.
If nonspecific symptoms occur, a whole range of appropriate measures will be required. First of all, the gastroenterologist needs to:
- get acquainted with the life history and medical history of not only the patient, but also his close relatives - during subsequent diagnosis, this will indicate the most characteristic cause of oncology in a particular patient;
- conduct a thorough physical examination - this is necessary so that in some cases the presence of damage to this organ can be detected by palpation and percussion of the anterior wall of the abdominal cavity. A digital examination of the rectum and a gynecological examination (for women) will also be required;
- interview the patient in detail to find out the first time of appearance and severity of cancer symptoms. This will help not only to get a general picture of the course of the disease, but also to determine the stage of its progression.
Laboratory research is limited to:
- general clinical blood test - to confirm the course of pathological process in organism;
- microscopic examination of feces;
- test to determine CEA.
To visualize a malignant neoplasm, determine its localization and detect distant or local metastases, the following instrumental procedures are performed:
It is necessary to differentiate colon cancer with metastases from the following diseases:
- nonspecific ulcerative colitis;
- Crohn's disease;
- actinomycosis or tuberculosis of the colon;
- benign tumors;
- polyposis and diverticulitis;
- ovarian cysts and tumors.
Treatment
The most effective method of treating such a disease is surgical intervention. The tactics for performing the operation will differ depending on which part of the colon was affected:
- cecum and ascending colon - right hemicolectomy is performed;
- transverse colon – complete excision;
- descending department colon – left-sided hemicolectomy is performed;
- sigmoid colon - sigmoidectomy.
They also resort to step-by-step intervention, which includes:
- bowel resection;
- colostomy;
- closure of intestinal stoma;
- reconstructive surgery.
Chemotherapy for colon cancer is an additional treatment option. It can be performed both before and after surgery, and also acts as the only method of therapy for inoperable tumors.
After surgical treatment, it is necessary to follow proper nutrition for colon cancer. The diet consists of avoiding fatty foods and minimizing the consumption of carbohydrates, as well as enriching the menu with the following products:
- all varieties of cabbage - cauliflower, white cabbage, Peking cabbage, etc.;
- soybeans and tomatoes;
- onion and garlic;
- nuts, seeds and dried fruits;
- kelp;
- fish and eggs;
- tea, jelly and compote.
All food must be prepared by boiling and steaming, and drinking plenty of water is also required. Other nutritional recommendations are provided by a gastroenterologist or nutritionist.
Possible complications
Oncological damage to the large intestine in women and men can lead to the following consequences:
- the affected organ;
- squeezing internal organs tumor;
- disturbance of the urination process;
- potency disorder;
Prevention and prognosis
To reduce the likelihood of developing such a disease, you must follow simple rules:
- completely give up bad habits;
- eat properly and nutritiously;
- study timely treatment gastrointestinal pathologies that can lead to colon cancer;
- lead a moderately active lifestyle;
- take medications only as prescribed by a clinician;
- be regularly examined by a gastroenterologist, especially for those who have a genetic predisposition.
The prognosis of the disease directly depends on at what stage of the cancer the diagnosis was made. In the first, the five-year survival rate reaches 93%, in the second – 75%, in the third – less than 50%, in the fourth – 5%. Without treatment, a person with this disease can live for about one year.
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