Disease of the colon, ICD code 10. Benign tumors of the large intestine

Colon cancer is considered to be one of the most common cancers affecting such an organ of the digestive tract as the intestines. Since it consists of several departments, each of them individually or all at once can be involved in the pathology.

The main reason for the formation of a malignant neoplasm is the irrational nutrition of a person. However, experts from the field of gastroenterology identify several other predisposing factors.

The danger of the disease lies in the fact that it proceeds for quite a long time without the manifestation of any symptoms, and those signs that are expressed cannot accurately indicate the presence of cancer. The main symptoms are pain, flatulence and the appearance of pathological impurities in stool Oh.

Diagnosis involves a comprehensive examination, ranging from palpation of the abdomen and ending with a wide range of instrumental procedures. Treatment is carried out only by surgery.

AT international classification diseases, such a pathology has several meanings, depending on which section 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 is ascending, descending and transverse;
• sigmoid;
• straight.

It is worth noting that this type of oncology in females takes second place - only breast cancer is ahead of it. In men, in terms of the frequency of diagnosis, this disease is second only to prostate and lung cancer.

The main reasons for the development of such an ailment are:

• the course of pathologies of an inflammatory nature in the large intestine - this should also be attributed. Distinctive features of such ailments is that the first affects only the upper layer of the organ, and the second - extends to all tissues;
• burdened heredity - if any of the close relatives was diagnosed with a similar pathology, then the person's chances of developing cancer are significantly increased. Knowing this, you can prevent its occurrence on your own - for this you just need to give up bad habits, eat right and visit a gastroenterologist regularly. Clinicians claim that such a predisposing factor acts as a source of the disease in 25% of cases;
• irrational nutrition - increases the risk of developing the disease such a diet, in which fats and carbohydrates are the basis, against which human body not getting enough fiber. It is for this reason that the basis of therapy is the 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, out of their own laziness, do not want to bother with physical activity, are at high risk of developing oncology;
• 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 develop this disease than those who healthy lifestyle life;
• formation - such neoplasms are benign, but under the influence of adverse factors they are able to transform into cancer;
• long and uncontrolled reception some groups medicines, in particular, anti-inflammatory and antibacterial agents;
• the presence of a high body weight in a person;
• violation of the process of metabolism of proteins and fats.

It is believed that the main risk group is made up of people over forty years of age and males, since they are several times more likely to manifest such an ailment. However, the possibility of its development in young people is not excluded.

Classification

As mentioned above, a malignant neoplasm of the colon in women and men can be localized in different areas of this organ, but the frequency of their lesions may differ. For example,

• the sigmoid and descending colon acts as a focus of cancer most often - in 36% of cases;
• the blind and ascending colon is affected in about 27% of the total number of diagnosing the disease;
• oncology of the rectum is 19%
• cancerous lesion of the colon - 10%.

According to the nature of 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 signs of the two above forms.

Depending on its histological structure, colon cancer tumors may look like:

• adenocarcinoma - detected in 80% of cases;
• mucoid cancer;
• 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 the course of cancer are distinguished:

• precancerous condition - while there is not enough data to evaluate the tumor;
• zero - the structure of the mucous layer of the large intestine is disturbed;
• initial - in addition to the mucous layer, submucosal tissues are affected;
• moderate- muscle layer lends itself to infiltration;
• severe - germination of the formation is observed in 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 the nearest organs.

The disease is also divided by the presence or absence of metastases in regional or distant lymph nodes.

Symptoms

Despite the fact that different parts of this organ can be affected by cancer, the symptoms of colon cancer are the same.

In the early stages of the development of the disease, symptoms may be completely absent, due to minor tissue damage. However, general clinical manifestations, which are characteristic of many ailments of the gastrointestinal tract. Against the background of the fact that they are weakly expressed, people often do not pay attention to them, which aggravates their condition on their own.

The first symptoms of colon cancer are:

• constant discomfort in the abdomen;
• increased gas formation;
• stool disorder;
• unpleasant sensations during the act of defecation;
• a 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 join, including:

• alternating profuse diarrhea with constipation;
• the appearance of impurities in the feces - we are talking about blood and mucus. It is noteworthy that, depending on the lesion of a particular area of ​​the large intestine, they will have different kind. For example, if 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 sharp decrease in body weight;
• brittle hair and weakness of the nail plates;
• signs of vitamin deficiency;
• increased body temperature and fever.

In addition, it must be taken 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

Make the correct diagnosis for early stages the formation of the disease is almost impossible - 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:

• get acquainted with the life history and medical history of not only the patient, but also his close relatives - in the subsequent diagnosis, this will indicate the most characteristic cause the occurrence of oncology in a particular patient;
• conduct a thorough physical examination - this is necessary so that in some cases it is possible to identify the presence of a lesion of this organ by palpation and percussion of the anterior wall abdominal cavity. You will also need a digital examination of the rectum and a gynecological examination (for women);
• interview the patient in detail - to determine the first time of onset and the severity of cancer symptoms. This will help not only to draw up a general picture of the course of the disease, but also to determine the stage of its progression.

Laboratory studies are limited to the implementation of:

• general clinical blood test - to confirm the course of the pathological process in the body;
• microscopic examination of feces;
• CEA test.

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 ailments:

• nonspecific ulcerative colitis;
• Crohn's disease;
• actinomycosis or tuberculosis of the colon;
• benign tumors;
• polyposis and diverticulitis;
• cysts and tumors of the ovaries.

Treatment

Most effective method The treatment for this disease is surgery. The tactics of performing the operation will differ depending on which part of the colon was affected:

• caecum and ascending colon - right-sided hemicolectomy is performed;
• transverse colon - complete excision;
• descending colon - left-sided hemicolectomy is performed;
• sigmoid colon - sigmoidectomy.

They also resort to a phased intervention, which includes:

• bowel resection;
• colostomy;
• closure of the 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 observe proper nutrition in colon cancer. The diet consists of avoiding fatty foods and minimizing carbohydrate intake, as well as enriching the menu with such products:

• all varieties of cabbage - cauliflower, white cabbage, Beijing, etc .;
• soy and tomatoes;
• onion and garlic;
• nuts, seeds and dried fruits;
• kelp;
• fish and eggs;
• tea, jelly and compote.

All food should be prepared by boiling and steaming, and a plentiful drinking regimen is also required. Other dietary advice is provided by a gastroenterologist or nutritionist.

Possible Complications

Oncological lesions of the large intestine in women and men can lead to the following consequences:

• the affected organ;
• squeezing internal organs a tumor;
• violation of the process of urination;
• potency disorder;

Prevention and prognosis

To reduce the likelihood of developing such a disease, you must follow simple rules:

• completely abandon bad habits;
• eat properly and nutritiously;
• engage in timely treatment of gastrointestinal pathologies that can lead to colon cancer;
• lead a moderately active lifestyle;
• take medications only as prescribed by the clinician;
• regularly examined by a gastroenterologist, especially for those who have a genetic predisposition.

The prognosis of the disease directly depends on the stage at which the cancer was diagnosed. On the first five-year survival rate reaches 93%, on the second - 75%, on the third - less than 50%, on the fourth - 5%. Without treatment, a person with such an ailment can live for about one year.

Valery Zolotov

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Blastoma of the caecum - ICD code 10 C18.0. Blastoma refers to any tumor: benign and malignant. It is about them that will be discussed in this article. But first, some information about the caecum.

The caecum is the first section of the large intestine. It accounts for about 20% of all cases of bowel cancer. Such a high incidence rate is due to the fact that the caecum takes on a significant part of the load. Processed food passes through it and the process of formation of feces begins. The international classification of the disease gives her the code C18.0.

Causes

Unfortunately, with all the achievements modern medicine The causes of this type of cancer are not fully understood. However, information is available to us that unites a group of patients with this disease.

It all starts with the fact that atypical cells appear in the human body that are not destroyed by the immune system. It is at this initial stage that doctors have the most questions. It is clear why cells become atypical, they simply mutate. But for what reason do they miss the immune system, is not yet clear.

After that, the atypical cell begins to multiply. Over time, it comes to the formation of a benign tumor. By itself, it is not dangerous. Symptoms of a person will not disturb, there are no external manifestations. Benign blastoma can bring problems only in two cases:

1. transformation of a benign tumor into a malignant one. The latter will be extremely unpleasant, it can bring a lot of trouble to a person. It gives frightening symptoms that can lead to death. If measures are not taken in time and the tumor is not removed, it will capture most of the body;
2. the growth of a benign tumor to such an extent that it begins to interfere with neighboring organs from working normally due to compression.

In any case, doctors recommend removing even a benign tumor. The risk of its rebirth is quite large, besides, it begins to interfere with the work of the intestines almost immediately. Fortunately, today there are several methods to quickly and painlessly remove it without harming the patient.

Risk factors should also be included in the causes. If you observe such things in yourself, this is a reason to be wary and pass full examination in the hospital. In this case, you can be sure that nothing threatens you. Let's move on to the risk factors:

• hereditary predisposition. Statistics show that about 5% of patients got a tumor for this very reason. Only next of kin are taken into account. The more parents, grandparents with tumors, the more likely it is that a child will develop it over time.
• Having bad habits. Excessive alcohol consumption, smoking. All this means a significant effect of carcinogens on the body. Because of this, the likelihood of cancer in almost any organ increases. These substances significantly weaken the immune system.
• Drug addiction. Drugs are hard on the body. These are the most powerful carcinogens that can cause cancer in any organ.
• Work in a hazardous industry. Exposure to hazardous chemicals, radiation greatly affects the body, causing cells to mutate in greater numbers than usual. Immunity can not cope with the load and sooner or later a tumor appears.
• Age. The older the person, the higher the chance of developing such cancer.
• Availability chronic diseases intestines.
• Transferred and already removed benign tumors. This is an indicator that a person is prone to the formation of such tumors.

Among others, worth Special attention give to the human diet. If he eats too much fatty and fried food, especially pork, then he puts himself in danger. Such a diet without vegetable fiber is considered especially dangerous. The fact is that in the intestines, due to the consumption of meat, flora develops, which itself produces harmful carcinogens. Fiber is able to neutralize them. The combination of excessive consumption of meat and insufficient intake of plant foods increases the chance of developing cancer of the caecum.

Stages of development of cancer of the caecum

As mentioned above, everything starts in a benign tumor in the classic scenario. It is she who then degenerates into a malignant one. Sometimes there are cases when a malignant blastoma immediately appears on the surface of the wall of the caecum. In this case, the tumor develops rapidly and very soon leads to death if treatment is not started in a timely manner.

1. Zero stage. At this stage, a small spot is observed on the surface of the caecum. Small in size, the blastoma has not yet had time to hit the important tissues of the organ, and it can be removed. Nearby The lymph nodes not damaged, metastases are completely absent. Atypical cells that spread through the blood are not yet separated from a malignant tumor.
2. First stage. Blastoma affects two or three layers of the colon. No germination was observed outside intestines. There are still no metastases, the lymph nodes are not yet affected. A simple excision of the tumor is available, the organ can be saved, and the prognosis remains quite favorable.
3. In the second stage of the disease, the tumor begins to grow on the outer wall of the colon. Its removal along with a significant part of the organ is recommended. Lymph nodes remain intact, metastases are still absent.
4. The third stage is much more dangerous. Not only the intestines are affected, but also nearby tissues, in some cases even organs. Removal of the tumor along with the organ is shown. Metastases are absent, but can occur at any time.
5. The fourth stage of the disease is the most dangerous. Significant germination of the tumor in adjacent organs is observed. There are metastases that penetrate into distant parts of the body. Even in the brain, small tumors can appear, which in the future will lead to serious consequences even with proper treatment.

Thus, if you consult a doctor in time, then caecum cancer can be cured and it is not difficult to do so. The problem is that in the zero and first two stages, the symptoms of the disease are simply absent in most cases. A person does not know that he is sick, and therefore sees no reason to seek medical care. If you are at risk, we recommend that you have regular check-ups and remove benign neoplasms in a timely manner.

Symptoms

As mentioned above, the symptoms of cancer in the initial stages are almost completely absent. In fact, it all depends on the individual patient. Remember that each person has a different threshold of sensitivity and a threshold of nervous tension too. Initially, you may feel weakness, loss of efficiency, growing every day. Someone has a loss of appetite and, as a result, a decrease in body weight (up to 10 kg in three months).

It is not uncommon for patients with early stage cancer to experience food rejection. A person simply cannot eat, the stomach immediately rejects any food. Your bowel habits may change. For no apparent reason, the shape of the stool is constantly changing and almost never returns to normal. Over time, more and more frightening symptoms appear:

• bloating, constant belching and flatulence;
• blood appears in the feces (including hidden), mucus;
• may arise depressive states, unwillingness to live. This is typical for patients even in cases where they have not yet learned about the diagnosis;
• with metastases, the condition worsens significantly. Symptoms become almost unpredictable. The fact is that metastases can affect any organ. Based on this, and you need to talk about the symptoms;
• cancer in the third and fourth stages causes severe pain, which only gains strength every day;
• skin color may change.

Over time, the symptoms become more severe. As a result, a person dies from them.

Treatment

At the moment, the main way to cure cancer is surgery. So that the tumor does not bother, it is necessary to remove it. At the initial stages of the development of the disease, only the tumor and a small part of the adjacent tissue can be excised.

In the later stages, the situation becomes more complicated. It is necessary to perform an operation to remove organs affected by a malignant neoplasm. You also need to remove the lymph nodes. Before the operation, the patient undergoes a course radiotherapy and chemotherapy. With the help of these measures, it is possible to stop the development of the tumor and metastases.

If the tumor is inoperable, measures are taken to improve the quality of life of the patient, doctors simply struggle with the symptoms.

Symptoms and treatments for colon cancer (Read in 5 minutes)

Symptoms and treatment of a tumor of the caecum (Read in 4 minutes)

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

Malignant formation in the rectum and its prevention

Posted By: admin May 05, 2016

The digestive organs are often subject to dysfunctional processes in the human body. This is due to a violation of the regimen and quality of the substances supplied to the digestive system, as well as due to the influence of external negative factors on the body. As a result, a person may experience serious illness which has a high mortality rate. We are talking about a malignant process that occurs in any organ.

The rectum (rectum) is the final section of the digestive tract, which originates from the sigmoid colon and is located before the anus. If we take into account the oncology of the large intestine as a whole, then rectal cancer (Cancerrectum) occurs in up to 80% of cases. Cancer rectum, according to statistics, affects the female half of the population, although the difference with this pathology in men is small. In the International Classification of Diseases (ICB) 10 views, colorectal cancer ranks codemcb -10 C 20, colon codemcb -10 C 18 and codemcb -10 C 18.0 - caecum. Kodymkb -10, intestinal oncological pathologies are taken from mkb - O (oncology) in accordance with:

• The primary and localization of the tumor;
• Recognizability (the neoplasm may be of an indefinite and unknown nature D37-D48);
• Near morphological groups;

Rectal cancer (mcb -10 C 20) often develops in adulthood, that is, after 60 years, but often, the oncoprocess affects people in the reproductive period life cycle. In most cases, the pathology is observed in the ampulla of the rectum, but there is a localization of the neoplasm above the ampulla of the intestine, in the anus-perineal part and in the sigmoid rectum.

Causes (Cancerrectum)

Cancer of the rectum (µb -10 C 20) occurs mainly after long-term precancerous pathologies. There is a version of a hereditary predisposition to the oncology of the rectum. The remaining scars after injuries and operations can also be reborn into malignancy. The consequences of congenital anomalies of the large intestine is one of the causes of rectal cancer. People suffering from chronic hemorrhoids, anal fissures, are more likely to be at risk for the occurrence of an oncological process in the rectum. Infectious diseases, such as dysentery, as well as chronic constipation and inflammatory processes in the organ (proctitis, sigmoiditis) with the formation of an ulcer or bedsore, may be factors that cause rectal cancer.

Precancerous conditions of the rectum

Polyposis(adenomatous, villous polyps). Such formations are observed in both children and adults. Polyps, both in a single form and in multiple, develop from epithelial tissue in the form of oval formations, which may have a wide base or a thin stalk. Male patients often suffer from polyposis and this pathology has a hereditary factor. Microscopic examination of the affected area reveals hyperplasia of the intestinal mucosa, which is expressed by a colorful picture. With the act of defecation, polyps can bleed and mucous discharge is noted in the feces. Patients with polyposis feel frequent tenesmus (the urge to empty the rectum) and pulling pains after defecation. The course of such a process often develops into oncology, in about 70% of cases, while the degeneration can affect some of the many existing polyps. Treatment of polyposis is carried out only with the help of surgery.

Chronic proctosigmoiditis. Such an inflammatory process is usually accompanied by the formation of cracks and ulcerations, against which hyperplasia of the intestinal mucosa develops. In the feces of the patient after defecation, mucus and blood are found. Such a pathology is considered an obligate precancer, therefore, patients with proctosigmoiditis are put on a dispensary with an examination every six months.

A variety of oncology of the rectum (microbial -10 C 20)

The form of the malignant process in the rectum can be determined by the diagnosis of rectal cancer, which consists in a digital examination and a rectoscopic examination of the organ. Determine the endophytic and exophytic form. The first, is characterized by the defeat of the cancerous formation of the inner mucous layer of the intestine, and the second, with germination into the lumen of the organ wall.

The exophytic form of a tumor of the rectum looks like a cauliflower or a mushroom, from the surface of which, after touching, bloody serous discharge is released. This form of education appears from the polyp and is called polyposis. Diagnosis of rectal cancer is often made by biopsy and subsequent histological analysis biomaterial.

Saucer-shaped cancer looks like an ulcer with dense bumpy and granular edges. The bottom of such a tumor is dark with necrotic plaque.

The endophytic form is represented by a strong growth of the tumor, which thickens the intestinal wall and makes it immobile. This is how diffuse-infiltrative cancer of the rectum develops.

The appearance of a deep flat ulcer with an infiltrate that bleeds and grows rapidly indicates an ulcerative-infiltrative form of cancer. The tumor is characterized by a rapid course, metastasis and germination in nearby tissues.

Cancer of the rectum spreads through the bloodstream, locally and lymphatically. With local development, the tumor grows in all directions, gradually affecting all layers of the intestinal mucosa in depth. With a complete tumor of the rectum, significant infiltrates are formed outside of it, which pass to the bladder, prostate in men, vagina and uterus in women. Depending on the histological examination, determine cancer of the colloidal type, mucous and solid. Metastases, the tumor directs to the bones, lungs, liver tissue, and rarely to the kidneys and brain.

Clinic of rectal tumor

The initial malignancy of the rectum may not signal specific symptoms other than minor local sensations. Consider how rectal cancer manifests itself during the development of the tumor and its decay:

• Constant and aggravated during emptying, pain in the anus is one of the primary sensations in the presence of a tumor. Appearance severe pain may accompany the process of germination of cancer outside the rectum;
• Tenesmus - frequent urge to empty, in which there is a partial release of mucous and bloody stools;
• Frequent diarrhea - may indicate both a dysbacteriosis of the digestive tract, and the presence of a tumor in the rectum. In this condition, the patient may observe "ribbon-like feces", a small amount of feces with a lot of mucus and bloody discharge. A complication of this symptom is atony of the sphincter of the anus, which is accompanied by incontinence of gases and stools;
• Mucous and spotting is a manifestation of the inflammatory process of the intestinal mucosa. Such symptoms may be a harbinger of the oncological process or its neglect. The appearance of mucus can be before emptying or during it, as well as instead of stool. Blood appears in a small amount in the early stages of cancer, and in a larger volume it is observed with the rapid growth of the tumor. Bloody issues come out before defecation or together with feces, in the form of a scarlet or dark mass with clots.
• In the late stage of the neoplasm, during its decay, purulent, fetid discharges are noted;
• General clinic: sallow complexion, weakness, rapid weight loss, anemia.

Help in the malignant process of the rectum

The most important help in such a pathology is the prevention of the onset of the disease. Prevention of rectal cancer is characterized by a careful attitude to your body, that is, it is necessary to control the diet, exercise and psychological condition, and also consult a doctor in time if you experience inflammatory processes intestines. Eating foods and drinks containing flavor substitutes, emulsifiers, stabilizers, preservatives and harmful dyes, as well as the abuse of smoked meats, fatty foods, alcohol, carbonated water, etc., can provoke cell mutation and the occurrence of a malignant process in the upper and lower sections of the digestive tract.

Nutrition for rectal cancer should completely exclude the above foods and sweets with a sparing diet that should not irritate the intestines and have a laxative effect. The diet for rectal cancer is based on the increased use of selenium (a chemical element), which stops the proliferation of atypical cells and is found in seafood, liver, eggs, nuts, beans, seeds, greens (dill, parsley, cabbage, broccoli), cereals (not peeled wheat and rice).

The postoperative diet for rectal cancer in the first two weeks excludes: milk, broths, fruits and vegetables, honey and cereals from wheat.

Prevention of rectal cancer is timely treatment hemorrhoids, colitis, anal fissures, personal hygiene, control over the act of defecation (systematic bowel movements, the absence of a difficult act of defecation, as well as the presence of blood and mucus in the feces), passing test analyzes to check for the presence of atypical cells.

Rectum cancer treatment

The treatment for this type of cancer is surgical intervention and combined treatment. Carry out radical, palliative operations in combination with chemotherapy and radiation sessions. The most commonly used surgery with a radical approach (the Quenu-Miles operation) and the removal of the rectum according to Kirchner. Depending on the degree of damage and the stage of the tumor, resection of the malignant site is sometimes performed.

Radiation therapy for rectal cancer is used in doubtful cases radical operations and with the imposition of an unnatural anus, as a result, the growth of the tumor is delayed and the viability of the cancer patient is prolonged, since the prognosis for the survival of such patients is often unfavorable.

Rectal cancer

ICD-10 code

Related diseases

Symptoms

Bleeding (the intensity of intestinal bleeding is usually insignificant, and most often they occur in the form of a small admixture of scarlet blood in the feces);

Constipation, incontinence of feces and gases, bloating, frequent false urge to defecate);

Soreness in the rectum;

weight loss, pallor of the skin);

Violation of the well-being of patients (general weakness, fatigue);

Anemia (a decrease in the level of hemoglobin in the blood, which is usually caused by intestinal bleeding in rectal cancer).

In later stages of the disease, patients may experience intestinal obstruction, manifested by cramping pains in the abdomen, gas and stool retention, vomiting.

The reasons

Polyps of the rectum belong to the group of obligate precancerous diseases with a high probability of transformation into cancer.

Treatment

* anterior resection of the rectum with the restoration of its continuity by applying an anastomosis ( partial removal rectum when the tumor is located in its upper section);

* low anterior resection of the rectum with anastomosis (almost complete removal of the rectum with preservation of the anal sphincter when the tumor is located above 6 cm from the anus).

* abdominal-perineal extirpation of the rectum (complete removal of the rectum and obturator apparatus with the imposition of a single-barrel colostomy in the left iliac region);

Low anterior resection (coloproctology) of the rectum is performed with the imposition of an anastomosis (fistula) using a mechanical suture, open or laparoscopically. It is used in case of cancer of the rectum, with localization of the tumor in the lower parts of the rectum, at a distance of 4-8 cm from the anal canal. Advantages this method: no lifelong colostomy. Currently, patients with low-grade rectal cancers rarely undergo anastomoses, operations end without anastomosis formation. Patients get a colostomy they live with. The presence of a colostomy prevents patients from leading a socially active life, limits their daily activities, a colostomy causes great moral harm, patients live in constant stress. Performing low anterior resections with a mechanical suture will allow patients to ordinary life, will save them from all the problems associated with the stoma. It requires modern electrosurgical equipment: an ultrasonic scalpel, a modern bipolar coagulator, as well as the availability of modern staplers in the departments of coloproctology (circular).

ICD 10 - C20 - Cancer of the rectum

Rectal cancer is a malignant disease of the end part of colon cancer. It is the latter area that is often exposed to a cancerous tumor, bringing the patient quite a lot of problems. Like any other disease, rectal cancer has a code according to the International Classification of Diseases 10 revision, or ICD 10. So let's consider this tumor from the standpoint of classification.

ICD code 10

C20 - colorectal cancer code according to ICD 10.

Structure

First, let's analyze overall structure according to ICD 10 to rectal cancer.

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

Neighboring diseases

In the neighborhood in the digestive organs, according to the ICD, diseases of neighboring departments are hidden. We list them here while we can. So to speak, note.

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

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

General information about cancer

We will not dwell here in detail on this disease - we have a separate full article devoted to rectal cancer. Here only short information and classifier.

The main causes of the disease are smoking, alcohol, nutritional 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. Upper ampullar
3. Medium ampoule
4. Lower ampullar
5. anus

According to the aggressiveness of the manifestation:

• highly differentiated
• Poorly differentiated
• Average differentiated

Symptoms

Intestinal cancer in general is a disease that manifests itself only in the later stages, patients turn to 3 or 4.

Highlights in the later stages:

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

stages

Stage 1 - a small size of the tumor, 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 five-year survival, the prognosis is divided into stages:

Diagnostics

The main methods of diagnosing the disease:

• Inspection.
• Palpation.
• Analyzes: urine, feces occult blood, blood.
• Endoscopy, Colonoscopy.
• X-ray.
• Tumor markers.
• Magnetic resonance imaging, CT scan, Ultrasound.

Treatment

We highlight the main methods of treatment of this oncology:

Surgical intervention - from the point removal of the tumor to the removal of part of the rectum or its complete resection.

Chemotherapy. The introduction of chemicals that destroy malignant cells. Possible side effects. It is mainly used as an additional treatment before and after surgery.

Radiation therapy. Another method additional treatment, is to irradiate the tumor with radioactive irradiation.

FAQ

Is it necessary to have an operation?

As a rule, yes. Surgery gives the maximum effect of treatment, radiation and chemotherapy only get the affected cells. The operation is not done only at the last stage, when the treatment itself already becomes meaningless. So - if they offer to do an operation, then everything is not lost yet.

How long do people live with this cancer?

Let's be straight. The disease is not the best. But the survival rate is high. When detected in the first stages, patients live quietly for more than 5 years. But on the latter in different ways, on average up to six months.

Prevention

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

• We do not start the treatment of intestinal diseases - hemorrhoids, fistulas, anal fissures.
• We fight constipation.
• Proper nutrition - emphasis on plant foods.
• throwing out bad habits- smoking and alcohol.
• More physical activity.
• Regular medical checkups.

Rectal cancer

• 1 Rectum
• 2 Incidence
• 3 Risk factors
• 4 Histological picture
• 5 Staged
• 6 Clinical picture
• 7 Diagnostics
• 8 Treatment
• 9 Forecast
• 10 Notes
• 11 See

Rectum

The rectum is the end section of the large intestine from top to bottom. sigmoid colon to the anus (lat. anus), being the end of the digestive tract. The rectum is located in the pelvic cavity, begins at the level of the 3rd sacral vertebra and ends anus in the perineum. Its length is 14-18 cm, the diameter varies from 4 cm at the beginning to 7.5 cm in its widest part, located in the middle of the intestine, then the rectum again narrows to the size of a gap at the level of the anus. Around the anus subcutaneous tissue the muscle is located - the external sphincter of the anus, blocking the anus. At the same level there is an internal anal sphincter. Both sphincters close the intestinal lumen and hold stool in it.

Incidence

Rectal cancer occupies the 3rd place in the structure of the incidence of malignant neoplasms of the gastrointestinal tract, accounting for 45% of intestinal neoplasms and 4-6% in the structure of malignant neoplasms of all localizations.

Risk factors

The factors contributing to the occurrence of rectal cancer, many authors include a long stay of feces in the ampoule of the rectum, chronic constipation, bedsores and ulcers. Obligate precancerous diseases of the rectum include polyps (adenomatous, villous) with a high probability of transformation into cancer. Certain factors increase the risk of developing the disease. These include:

• Age. The risk of developing rectal cancer increases with age. Most cases of the disease are observed in the age group, while the disease in the age<50 лет без семейного анамнеза встречаются гораздо реже.
• Cancer history. Patients who have previously been diagnosed with colon cancer and treated appropriately are at increased risk for developing colon and rectal cancer in the future. Women who have had ovarian, uterine, or breast cancer are also at increased risk of developing colorectal cancer.
• Heredity. The presence of colon and rectal cancer in blood relatives, especially aged<55 лет, или у нескольких родственников, значительно увеличивает риск развития заболевания. . Семейный полипоз толстой кишки в случае отсутствия соответствующего лечения почти в 100 % случаев приводит к возрасту 40 лет к раку толстой кишки.
• Smoking. The risk of dying from rectal or colon cancer is higher in smokers than in non-smokers. Received by the American Cancer Society American Cancer Society) evidence suggests that women who smoke have a 40% greater risk of dying from colorectal cancer than women who have never smoked. Among male smokers, this figure is 30%.
• Diet. Studies show that a diet high in red meat and low consumption of fresh fruits, vegetables, poultry, and fish increases the risk of colorectal cancer. At the same time, people who often eat fish have a lower risk.
• Physical activity. Physically active people have a lower risk of developing colorectal cancer.
• Virus. Carrying some viruses (such as some strains of human papillomavirus) may be associated with colorectal cancer and is an obligate precancerous condition for anal cancer.
• Alcohol. Drinking alcohol, especially in large quantities, may be a risk factor.
• Vitamin B6 intake inversely associated with the risk of colorectal cancer.

Histological picture

In rectal cancer, the following histological forms are observed: glandular cancer (adenocarcinoma, solid cancer, cricoid, mixed, scirr) is more often observed in the ampullar region of the rectum; Rarely, there may be squamous cell carcinoma or melanoma in the rectum (rather than the anal canal), probably due to the presence of ectopic transitional epithelium or melanocytes.

staging

• Stage I - a small, clearly delimited movable tumor or ulcer up to 2 cm in greatest dimension, affects the mucous membrane and submucosal layer of the intestine. There are no regional metastases.
• Stage II - a tumor or ulcer up to 5 cm in size, does not extend beyond the intestine, occupies no more than half the circumference of the intestine. There are no metastases or with the presence of single metastases in regional lymph nodes located in the pararectal tissue.
• Stage III - a tumor or ulcer more than 5 cm in greatest dimension, occupies more than a semicircle of the intestine, germinates all layers of the intestinal wall. Multiple metastases in regional lymph nodes.
• Stage IV - an extensive, decaying, immobile tumor that grows into the surrounding organs and tissues. Numerous metastases to regional lymph nodes. Distant (hematogenous) metastases.

International classification of rectal cancer according to the TNM system :

The symbol T contains the following gradations:

• TX - insufficient data to evaluate the primary tumor;
• Tis - preinvasive carcinoma;
• T1 - the tumor infiltrates the mucous membrane and submucosal layer of the rectum;
• T2 - the tumor infiltrates the muscle layer, without limiting the mobility of the wall of the intestinal wall;
• T3 - a tumor that grows through all layers of the intestinal wall with or without infiltration of adrectal tissue, but does not spread to neighboring organs and tissues.
• T4 - a tumor that grows into the surrounding organs and tissues.

The symbol N indicates the presence or absence of regional metastases.

• NX - insufficient data to evaluate regional lymph nodes
• N0 - no involvement of regional lymph nodes
• N1 - metastases in 1ן regional lymph nodes
• N2 - metastases in 4 or more regional lymph nodes

The symbol M indicates the presence or absence of distant metastases.

• M0 - no distant metastases
• M1 - with the presence of distant metastases.

Clinical picture

The most common and constant symptom of rectal cancer is bleeding. It occurs both in the early and later stages and is observed in 75-90% of patients. The intensity of intestinal bleeding is insignificant, and most often they occur in the form of impurities or blood in the feces, or dark clots, are not constant. Unlike bleeding hemorrhoids, in cancer, the blood precedes the stool or is mixed with the stool. As a rule, profuse bleeding does not occur, and anemia in patients is more often detected in the later stages of the disease.

In rectal cancer, mucus and pus are secreted from the anus along with blood. This symptom usually appears in the later stages of the disease and is due to the presence of concomitant perifocal inflammation.

The second most common symptom of cancer are various types of intestinal disorders: changes in the rhythm of defecation, fecal shape, diarrhea, constipation and incontinence of feces and gases. The most painful for patients are frequent false urges to defecate (tenesmus), accompanied by secretions of a small amount of blood, mucus and pus. After defecation, patients do not feel satisfaction, they still have a feeling of a foreign body in the rectum. False urges can be observed from 3-5 times a day. As the tumor grows, especially with stenosing cancer of the upper rectum, constipation becomes more persistent, bloating is determined, especially in the left abdomen. Initially, these symptoms are intermittent, then they become permanent.

Due to the further growth of the tumor and the addition of inflammatory changes, partial or complete low intestinal obstruction occurs. At the same time, patients experience cramping abdominal pain, accompanied by gas and stool retention, vomiting occurs periodically. Pain sensations in patients with rectal cancer appear when the tumor spreads locally, especially when it moves to surrounding organs and tissues. Only in cancer of anorectal localization, due to the involvement of the rectal sphincter zone in the tumor process, pain is the first symptom of the disease at an early stage. At the same time, patients tend to sit on only one half of the buttocks - a “symptom of a stool”.

Violation of the general condition of patients (general weakness, fatigue, anemia, weight loss, pallor of the integument) is due to daily blood loss, as well as tumor intoxication in the later stages of the disease. Of decisive importance in the diagnosis are a full examination by a specialist doctor and the results of a study of biopsy and cytological material.

Diagnostics

Rectal cancer refers to neoplasms of external localization, but, nevertheless, the percentage of errors and neglect in this form of cancer does not tend to decrease. Diagnosis of rectal cancer should be comprehensive and include:

• digital examination of the rectum,
• endoscopic methods - sigmoidoscopy with biopsy, fibrocolonoscopy (to exclude concomitant polyps or primary multiple lesions of the overlying colon),
• X-ray methods - irrigography, plain radiography of the abdominal cavity, chest,
• Ultrasound and computed tomography - to diagnose the spread of the tumor to neighboring organs, to determine metastases in the abdominal organs (liver) and in the lymph nodes,
• laboratory methods - general and biochemical blood tests, blood tests for tumor markers (to determine the prognosis of treatment and further monitoring).

Treatment

The surgical method is leading in the treatment of rectal cancer. In recent years, complex treatment has been actively used: irradiation in the form of preoperative exposure, after which surgical removal of the intestine with the tumor is performed. If necessary, chemotherapy is prescribed in the postoperative period.

The question of choosing the type of surgery for rectal cancer is very complex and depends on many factors: the level of the location of the tumor, its histological structure, the degree of spread of the tumor process and the general condition of the patient. The final volume and type of surgical intervention are determined in the operating room after laparotomy and a thorough revision of the abdominal organs.

The widespread point of view that the most radical operation for rectal cancer is abdominoperineal extirpation is currently hardly acceptable both from an oncological standpoint and from the point of view of possible subsequent social and labor rehabilitation.

The main types of operations on the rectum:

• anterior resection of the rectum with restoration of its continuity by applying an anastomosis (partial removal of the rectum when the tumor is located in its upper section);
• low anterior resection of the rectum with anastomosis (almost complete removal of the rectum with preservation of the anal sphincter when the tumor is located above 6 cm from the anus).
• abdominal-perineal extirpation of the rectum (complete removal of the rectum and obturator apparatus with the imposition of a single-barrel colostomy in the left iliac region);

Low anterior resection (coloproctology) of the rectum is performed with the imposition of an anastomosis (fistula) using a mechanical suture, open or laparoscopically. It is used in case of cancer of the rectum, with localization of the tumor in the lower parts of the rectum, at a distance of 4-8 cm from the anal canal. Advantages of this method: no lifelong colostomy. Currently, patients with low-grade rectal cancers rarely undergo anastomoses, operations end without anastomosis formation. Patients get a colostomy they live with. The presence of a colostomy prevents patients from leading a socially active life, limits their daily activities, a colostomy causes great moral harm, patients live in constant stress. Performing low anterior resections with a mechanical suture will allow patients to lead a normal life, relieve them of all the problems associated with the stoma. It requires modern electrosurgical equipment: an ultrasonic scalpel, a modern bipolar coagulator, as well as the availability of modern staplers in the departments of coloproctology (circular).

Forecast

The prognosis for rectal cancer depends on the stage of the disease, the form of growth, the histological structure of the tumor, the presence or absence of distant metastases, the radicalism of the intervention performed. According to the generalized data of domestic and foreign authors, the overall 5-year survival after radical surgical treatment of rectal cancer ranges from 34 to 70%. The presence of metastases in regional lymph nodes reduces the 5-year survival to 40% versus 70% without metastases. Five-year survival rate after surgical treatment of rectal cancer, depending on the stage of the tumor process, is: at stage I - up to 80%, at stage II - 75%, at stage IIIa - 50%, and at stage IIIb - 40%.

Notes

1. Levin K.E., Dozois R.R. (1991). "Epidemiology of large bowel cancer". World J Surg 15(5): 562-7. doi:10.1007/BF
2. Penn State University
3. Strate LL, Syngal S (April 2005). "Hereditary colorectal cancer syndromes". Cancer Causes Control 16(3):. doi:10.1007/s8-4
4. American Cancer Society Smoking Linked to Increased Colorectal Cancer Risk - New Study Links Smoking to Increased Colorectal Cancer Risk 6 December 2000
5. ‘Smoking Ups Colon Cancer Risk’ at Medline Plus
6. Chao A, Thun MJ, Connell CJ, et al. (January 2005). "Meat consumption and risk of colorectal cancer". JAMA 293(2):. doi:10.1001/jama.293.2.172
7. "Red meat 'linked to cancer risk'". BBC News: Health. 15 June 2005. http://news.bbc.co.uk/2/hi/health/.stm
8. National Institute on Alcohol Abuse and Alcoholism Alcohol and Cancer - Alcohol Alert No.
9. Larson, S.; Orsini, N.; Wolk, A. (2010). "Vitamin B6 and risk of colorectal cancer: a meta-analysis of prospective studies". JAMA: the journal of the American Medical Association 303(11): 1077-1083. doi:10.1001/jama.2010.263
10. AJCC Cancer Staging Manual (Sixth ed.). Springer-Verlag New York, Inc. 2002.

see also

Links

papilloma adenoma, fibroadenoma, cystadenoma, adenomatous polyp non-invasive carcinoma basal cell carcinoma squamous cell carcinoma adenocarcinoma colloidal carcinoma solid carcinoma small cell carcinoma fibrous carcinoma medullary carcinoma

fibroma (desmoid) histiocytoma lipoma hibernoma leiomyoma rhabdomyoma granular cell tumor hemangioma glomus tumor lymphangioma synovioma mesothelioma osteoblastoma chondroma chondroblastoma giant cell tumor fibrosarcoma liposarcoma leiomyosarcoma rhabdomyosarcoma angiosarcoma osteosarcoma osteogenic lymphangiosarcoma

and membranes of the brain

astrocytoma astroblastoma oligodendroglioma oligodendroglioblastoma pinealoma ependymoma ependymoblastoma choroid papilloma choroidcarcinoma ganglioneuroma ganglioneuroblastoma neuroblastoma medulloblastoma glioblastoma meningioma meningeal sarcoma sympathoblastoma ganglioneuroblastoma chemofibromatomas neurofibrocomatoma neurofibrocomatoma

Tumor suppressor genes Oncogene Staging Grading Carcinogenesis Metastasis Carcinogen Research Paraneoplastic phenomena ICD-O List of oncological terms

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• Cancer of the rectum, V. B. Alexandrov. The monograph formulates the current state of the problems that are of the greatest interest in the study of such severe suffering as rectal cancer. Special attention… Read moreBuy for 631 RUB
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• Rectal cancer, . The monograph provides an analysis of the most common precancerous diseases, the frequency and prevalence of cancer of this localization, provides data on the pathological anatomy and classification of cancer of the rectum ... Read moreBuy for 210 rubles

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In the international classification of diseases, all neoplasms, both malignant and benign have their own class. Therefore, such a pathology as sigmoid colon cancer according to ICD 10 has the code C00-D48 according to the class.

Any oncological process, even if it is localized in a specific organ, has many individual features that distinguish it from other, at first glance, the same 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 of any biologically active substances by the tumor) 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 that implies malignancy, but its origin can be any: epithelial cells, poorly differentiated structures, connective tissue cells, and so on);
• the spread of the tumor (cancer can affect more than 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 the final part of it, located immediately in front of the rectum. Any oncological processes in it are dangerous conditions of the body, not only due to intoxication with cancer cells or other common causes, but also due to a significant disruption of the functioning of the digestive tract.

When sigma is newly formed, the following problems arise:

• bleeding leading to severe degrees of anemic syndrome, when a blood transfusion is required;
• intestinal obstruction caused by blockage of the intestinal lumen;
• germination in neighboring organs of the small pelvis (lesion of the genitourinary system in men and women);
• ruptures and melting of the intestinal wall with the development of peritonitis.

However, differentiating the diagnosis for any oncology of the large intestine is a very difficult task due to the similarity of symptoms. Only highly specific examination methods will help confirm the localization of the neoplasm. Besides, clinical picture diseases can long time be absent, appearing only when the tumor reaches a significant size. Because of this, according to ICD 10, bowel cancer is quite difficult to code and, accordingly, prescribe treatment.

Disease coding

Malignant pathologies of the colon are under the code C18, divided into subparagraphs. The tumor process in sigma is encoded as follows: C18.7. At the same time, there are additional codes for the functional and morphological features of the neoplasm.

Additional clarification is required due to the fact that an oncological diagnosis is established only on the basis of biopsy data, that is, a cytological examination.

In addition, the prognosis for the patient will largely depend on the histological type of neoplasm. The less differentiated cells are found in the sample, the more dangerous the disease is considered and the greater the chances of a rapid spread of metastatic foci. In the section of neoplasms of the large intestine, there are different localizations of the tumor, but the problem is that the pathology spreads rapidly. For example, cancer of the caecum according to ICD 10 is designated C18.0, but only until it goes beyond the intestine. When the tumor captures several departments, code C18.8 is set.

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