Rectal cancer symptoms
Cancer direct or colon - this is the usual form of cancer, which is a growth of malignant cells in direct or colon.Colon tumors grow slowly, but may eventually become large enough to block the digestive tract.Cancer can spread to the liver, lymph nodes or other organs;Symptoms may not appear until the cancer has reached a significant stage of development.However, early detection and timely treatment prospects are quite optimistic.How to treat cancer folk remedies, see here.
clinical picture of obstructive ileus in colon cancer depends on a combination of two serious diseases and is due to stage each of these processes.
Many authors distinguish two forms of obstructive bowel obstruction: acute and chronic.V.I.Matveev (1965), IB Rozanov et al.(1975) distinguish between acute and intermittent intestinal obstruction, Ushakov YM, et al .. (1981), G. Efimov et al.(1984) and partial -ostruyu AI Rich and colleagues.(1976) - complete and partial, RT Panchenkov et al.(1985) -Completion and growing.
We support the view N.M.Ostrovskogo (1929), NN Alexandrov et al.(1980), KI Mishkin et al.(1981) highlight the feasibility of the three forms of obstructive colonic obstruction - acute, subacute and chronic.
Acute colonic obstruction begins abruptly, with severe abdominal pain, which, as well as other symptoms, growing rapidly.Such an attack occurs among full health in individuals previously considered themselves sick.Pain initially moderate to spilled around the abdomen, after a few hours become paroxysmal, intense, localized in a certain place of the abdomen.
According to F. Dombal et al.(1980), of the 5675 patients who applied for acute abdominal pain lasting up to 1 week, cancer was diagnosed in 106 (1.9%), including 57 (1%) had cancer of the colon.The author believes that all patients with abdominal pain of unknown origin should be evaluated to rule out colon cancer.
characteristic feature of acute colonic obstruction is a delay of gases and stool.This symptom can occur in individuals who have previously had a normal chair, but more often it is observed in patients with persistent constipation.For acute obstruction is characterized, in addition to the delay of gases and stool, rapid bloating.Within a few hours the abdomen becomes swollen dramatically, spherical, there is a desire to release the gases, but it does not work.However, in some cases at the start of an acute attack is a chair, but it is usually lean and no relief, as this is only emptied distal colon.
In some cases, the development of acute intestinal obstruction accompanied by vomiting.It is reflexive in nature.Vomit consist of gastric mucus and food debris.Only in the later stages, when joined by small bowel obstruction, vomiting becomes abundant, with the intestinal contents.
rapid growth of these features results in a clinical picture of acute colonic obstruction.According to our data, the disease is observed in 25% of patients with occlusion of the colon, and a bit more often when the tumor in the right half and the least - with left-sided tumors.Thus, of the 50 patients with obstructive cancer obstruction of the right half 20 (40%) had colon acute form, and from 142 patients with lesions of the left half - only 33 (23.23%).This is due to several reasons.The tumor, even of small size, located in the ileocecal valve, can cause obturation that show signs of small bowel obstruction, which is known to be developing rapidly.
intensity of the clinical picture is determined as the state of the ileocecal valve.It can be functionally complete, t. E. Not to pass the contents of the colon to the small and inferior, when a possible reflux.In the first case between the tumor and stenosing ileocecal valve forms a closed chamber in which the pressure increases rapidly, its walls are stretched as shown by the acute development of the clinical picture.When defective contents from the ileocecal valve colon can be returned into the small and thus "hard" loop is not formed, that clinically less pronounced pattern obstruction.
addition to anatomical inferiority ileocecal valve, which occurs in 10% of people, it can develop a functional deficiency.This is observed with considerable tension cecum when the valve lips apart and can not delay the colonic contents.
acute form of intestinal obstruction when the left-side tumors, according to our data, is less common.This is due to the slower growth of cancer in the left half of the colon, as well as a large amount of the colon segment between stenosing tumor and the ileocecal valve.
When rectal cancer acute form of intestinal obstruction is rare.Most of the tumors located in the ampoule of the rectum, and it has a large enough diameter and obturation it is slow.An exception can be rectosigmoid cancer of the rectum, the narrowest point of the colon, which quickly leads to stenosis and, therefore, intestinal obstruction is severe.According to the data of 101 patients with occlusion of the rectum only 16 developed acute obstruction.
Subacute form of obstructive colonic obstruction is growing more slowly, but the main difference from the acute form is that conservative measures are effective.After applying cleansing enemas copious notes chair are a pain, but a period of remission does not last long.After a few hours, sometimes days, again develops an attack of intestinal obstruction requiring treatment of conservative measures.The intensity of seizures in these cases is smaller than in acute forms.In subacute patients sometimes at home cropped attack obstruction.But over time, the severity and duration of the symptoms of bowel obstruction and grow to a height of one of the attacks, patients get to the hospital.Such a course of the disease is observed in 30% of patients with obstructive colonic obstruction.
chronic form is most common tumor obstruction of the colon.In these cases an obstruction develops gradually, without obvious signs of acute, usually on long-existing background of constipation.Up to a certain point reduction in the lumen of the intestine is compensated by enhanced intestinal peristalsis.The passage of intestinal contents through a narrowed space also contributes to pasty nature of the content, especially in the right half of the colon.Later, however, with an increase of narrowing develop subindemnification and decompensation and rapidly progressing symptoms of bowel obstruction.Constipation is becoming more resistant, more forced to take large doses of laxatives, use a cleansing enema.Along with constipation there is a very important sign of bloating.At first he inconstant, but over time the stomach is swollen all over the long term.It appears heaviness in the stomach.Pain initially wear a constant aching in nature, and later becoming cramping.In this period, patients tend to seek treatment.It is characteristic that the conservative treatment measures have a positive effect.Pain and sometimes bloating after cleansing enema disappears or much reduced.Inexperienced doctors release of patients from a reception home, that is a mistake.After 5-7 days, they again developed an attack of pain with bloating, which is the reason for the hospitalization.However, this slow development of the disease with low intensity of symptoms recognize the diagnosis is delayed for 2-3 months.
According to our data, a chronic form of intestinal obstruction occurs in 36% of patients with tumor obturation, and with the defeat of the right half of the colon in 17.3%, cancer of the left - at 40.2%, with obstruction of the rectum - in 48, 3% of patients.
clinical course of obstructive bowel obstruction may be complicated by peritonitis.The source of peritoneal inflammation in these cases are the perforating tumor diastatic perforation of colon tumors above, and infiltration of germs through the stretched wall of the colon.According to IA Eryukhina et al.(1981), in the occurrence of peritonitis in patients with colon cancer disorders play a significant role in the intestinal wall haemocirculation, ulceration and inflammation in the tumor zone and above it.The development of peritonitis significantly worsens the condition of patients, and the picture is complemented by intestinal obstruction symptoms of peritonitis, there are signs of peritoneal irritation, subsides intestinal peristalsis, picking inflammatory changes in the peripheral blood.
clinical course of obstructive bowel obstruction can mimic acute appendicitis.The mechanism is different in cancers of the left and right of the colon.Pain in the right iliac region is a characteristic sign of cancer of the cecum and the proximal part of the ascending colon.This is due to the peculiarities of the growth of tumors of the right half of the colon.They grow rapidly, increasing in volume, quickly become infected, the inflammation goes on visceral, and then on the parietal peritoneum, which is manifested typical symptoms of acute appendicitis.Another mechanism
pain in the right iliac region is observed at a distal location of tumors in the colon.Bowel obstruction in these cases leads to stretching of the overlying parts of the colon and the first blind.In itself, stretching the walls, and even more joined inflammatory and degenerative changes in the wall of the cecum simulate acute appendicitis.According to our data, sent to the diagnosis of acute appendicitis is 2.4% of patients with uncomplicated colon cancer, and 10.9% of patients with obstructive ileus, and more often in the defeat of the right half of the colon.
Despite the severity of clinical picture and a great opportunity to identify ileus in colon cancer, these patients arrive at hospitals in the later periods.Later, 24 hours after the onset of the disease are hospitalized 75 to 90% of these patients, whereas in other forms of acute obstruction kyshechnoy days later sent to a hospital 8,8-29% of patients.This is explained primarily by a slower development of obstructive bowel obstruction, as well as more advanced age of patients in this group.According to Nesterenko, Yu et al.(1977), patients older than 60 years make up 65%, and according to RT Panchenkova et al.(1985), 68% of colon cancer patients with obstructive obstruction were older than 70 years.Among the observed by us in patients over 60 years was 56.5%.As you know, the person elderly are more reluctant to seek medical attention.However, in some cases, the main reason for the delay providing adequate assistance is differential diagnostic difficulties experienced by physicians in the clinic and in the hospital.
obturation of the lumen of the colon develops as tumor growth.By itself, the value of the tumor has a self-contained significance.In some cases, bowel obstruction observed in small entities.For example, an obstruction in the ileocecal valve can cause the small size of the tumor.Nevertheless, the greater the tumor, the greater the opportunity for the development of ileus;the faster growing tumors, the earlier the obturation.
Recently, researchers are actively studying the growth rate of various malignant tumors.M. Nis-senblatt (1981) believes that the doubling time of most malignant tumors is 50-80 days, and in order to achieve a clinically defined tumor volume of 1 cm in diameter, must be at least 30 doublings, ie. E. About 5 years.S. Bolin et al.(1983) found that colon cancers grow more slowly, and the doubling time for these averages 13Q days.AV Chaklin (1983) writes that from the appearance of the first cancer cell to the development of clinically tumor goes from 2 to 7 years.
However, complete closure of the intestinal lumen to the tumor level, even if the clinical picture of obstruction is rare.Symptoms of obstruction of the colon can occur while maintaining the lumen to 0.6-1.0 cm. In these cases, the obstruction can contribute development of the intestinal wall rigidity due to cancer or inflammatory above and below the constriction.
Quite often, the development of complete obstruction promote foreign bodies stuck in a narrow place at the level of the tumor.This may be the bones of fruit, meat or fish bones, pieces of undigested food.The sealing material may be barium, passed through the mouth for the study of colon.This research method should not be used even in cases of suspected obstruction of the colon.Of the 18 patients with early signs of bowel obstruction, which gave a suspension of barium into, 7 developed a complete obstruction of the colon tumor level that required emergency surgery.
important for the development of colon obstruction is anatomical tumor growth.Exophytic tumors rarely lead to the development of colonic obstruction.Such tumors occupy, usually part of the intestinal wall, are seldom circular, they are often located in the right half of the colon, where the clearance is wide enough and semi-liquid contents.On the contrary, endophytic tumors are usually circular, grow as if pulling the bowel lumen, narrows it.They are located in the left half of the colon lumen where the already narrow and, besides, the content is already solid.All this contributes to the development of more frequent bowel obstruction with endophytic, especially infiltragivnom tumor growth.According N.N.Aleksandrova et al.(1980), of 224 patients with exophytic cancer intestinal obstruction occurred in 14 (6.25%), 86 with peptic form y 3 (3.52%) and 551 patients with infiltrative tumor growth - in 116 (21,05%).
Circular tumor growth, which is more common in the left half of the colon, also contributes to the development of bowel obstruction.Among the 390 patients with a circular tumor obstruction occurred in 111 (28.46%), and from 436 patients with netsirkulyarnym growth - only 14 (3.21%).
incidence of intestinal obstruction also depends on the location of the tumor.Cancer of the left half of the colon often causes obturation lumen.This is due to many reasons, among which important anatomical tumor growth, the diameter of the lumen of the intestine and the nature of the content.All these figures are in the left half of the colon contribute to the emergence of intestinal obstruction.
NN Alexandrov et al.(1980) in cancer of the left colon was observed obstructive ileus almost half of the patients, and cancer of the right half - 2 times less (see Table.).
Table.The incidence of obstructive ileus in colon cancer
According to our data from 513 patients with obstructive ileus was diagnosed in 49 (9.55%), most frequently when the tumor in the left and right bends of the colon (Table.).
Table.The incidence of obstructive ileus in colon cancer development
obstruction colon cancer depends on the stage of the disease.Stage of colon cancer is determined by the totality of characteristics such as the size of the tumor, its extension to depth of the intestinal wall, the surrounding organs and tissues affected by regional and distant lymph nodes and other organs.The development of intestinal obstruction in patients with colon cancer shows tend to neglect the underlying disease.
According G.A.Efimova and Yu.M.Ushakova (1984), F. X. Kutusheva et al.(1984), in 90-100% of patients with complicated colon cancer reveal III and stage IV disease, and stage IV noted in 65-76% of cases [Espers BN et al., 1979;Puncheon Cove R. T. et al., 1985;Klempert A. J. et al., 1986].Of the 306 operated patients in our clinic with symptoms of tumor obstruction of the colon radical surgery failed only 138 (45.09%), among the uncomplicated forms of colon cancer resectability was 71%.