Colon disease microbial 10. Sigmoid colon cancer: causes, treatment, prognosis

Sigmoid colon cancer is widespread in developed countries. First of all, scientists associate this phenomenon with the lifestyle and diet of an average resident of an industrialized country. In third world countries in general, cancer of any part of the intestine is much less common. Sigmoid colon cancer mainly owes its spread to a small amount of food eaten plant origin and an increase in the overall share of meat and other animal products, as well as carbohydrates. No less important and directly related to such nutrition is such a factor as constipation. Slowing down the passage of food through the intestines stimulates the growth of microflora that releases carcinogens. The longer the intestinal contents are retained, the longer the contact with the secretions of bacteria, and the more they themselves become. In addition, constant traumatization of the wall with dense fecal masses can also provoke sigmoid colon cancer.
In assessing prevalence, one should not miss the fact that a person lives much longer in developed countries. In a poorly developed world with backward medicine, people simply do not live up to cancer.
Every 20 sigmoid colon cancer is hereditary acquired - inherited from parents.
Risk factors may also include the presence of other bowel diseases, such as UC (non-specific 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 code 10

International Classification of Diseases 10 revision - ICD 10 implies classification only by cancer localization. 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 patient management tactics, and these two types of cancer, different in localization, have an approach to surgical treatment differs.
So:
ICD code 10 sigma cancer - C 18.7
ICD code 10 cancer of the rectosigmoid junction - C 19

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

Cancer Symptoms

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 at all. We are talking about the most favorable in terms of prognosis stages in situ (in the mucous and submucosal layer of the wall) and the first. The treatment of such early tumors does not take much time, in modern medical centers performed endoscopically, gives almost 100% result and prognosis of five-year survival. But, unfortunately, the vast majority of early-stage sigmoid colon cancer is detected only as an incidental finding during examination for another disease or during a screening study. As mentioned above, the reason for this is complete absence symptoms.
Based on this, an extremely important method for identifying early cancer is a preventive colonoscopy every 5 years after reaching the age of 45. In the presence of a burdened family history (colon cancer in first-line relatives) - from the age of 35. Even in the absence of any symptoms of bowel disease.
With the progression of the tumor, the following first symptoms gradually appear and begin to grow:

Blood discharge during the act of defecation
Mucus discharge from the rectum and mucus in the stool
Worsening of constipation

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

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 disguised by its symptoms as chronic hemorrhoids. When the disease takes its toll character traits- to do something is often too late, the treatment is crippling or only symptomatic.

I hope you take this seriously and forever.
If a doctor diagnosed you with “hemorrhoids” 10 years ago, prescribed treatment, it helped you, and since then, with exacerbations, you have been using various suppositories and ointments on your own (easily and naturally sold in pharmacies in a huge assortment and for every taste), no longer contacting without being examined - you are a potential suicide.
So, we talked about the first symptoms of sigma cancer.

With the growth of sigmoid colon cancer, gradually (starting approximately from the end of stage 2) more characteristic symptoms are added:

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

Here, perhaps, are 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 germinate anywhere else. It is possible to detect such a tumor only by chance or during a preventive study, which has long been introduced into the 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 present only in large cities and serious medical centers), and the performance of a study by a competent trained specialist (until the mass availability of which our country will also grow and grow - Our medicine is focused on 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 back to the topic of the article - the treatment of early sigmoid colon cancer. Under ideal conditions, it is performed by the method of submucosal dissection - the removal of part of the mucosa with a tumor during endoscopic intraluminal surgery (therapeutic colonoscopy).
The prognosis for this intervention is simply amazing, after 3-7 days in the clinic you can return to normal life. Without open surgical operation. No chemotherapy or radiation therapy.
Naturally, the performance of this operation for the treatment of sigmoid colon cancer in situ requires first-class knowledge of the endoscopist's technique, the availability of the most modern equipment and consumables.

Early stages (I-II)

The first and second stages include tumors that do not grow into neighboring organs, with 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 followed by the creation of an anastomosis - connecting the ends. It is performed only at stage I.
Resection of the sigmoid colon - removal of the entire sigmoid completely.
Left-sided hemicolectomy - resection of the left side of the large intestine with the creation of an anastomosis or removal of an unnatural fecal evacuation route - a colostomy.

In the presence of a closely located metastasis, regional lymphoidectomy is performed - removal of all lymphatic tissue, nodes, vessels in this area.
Depending on some conditions in the treatment, it 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.

Late 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 germination in neighboring organs - only palliative, that is, life-prolonging treatment as much as possible. In this case, an unnatural anus on the abdominal wall or a bypass (path for feces past the tumor) so that the patient does not die from intestinal obstruction. Adequate pain relief, including narcotic drugs, detoxification is also shown.
Modern standards of treatment suggest removal of lymph nodes in very distant locations for stage III sigmoid colon cancer, which significantly reduces the chance of recurrence of the disease and increases survival.
The prognosis for advanced sigmoid colon cancer is poor.

Conclusion

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

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1. Can cancer be prevented?
The occurrence of a disease such as cancer depends on many factors. No one can be completely safe. But everyone can significantly reduce the chances of a malignant tumor.

2. How does smoking affect the development of cancer?
Absolutely, categorically ban yourself from smoking. This truth is already tired of everyone. But quitting smoking reduces the risk of developing all types of cancer. Smoking is associated with 30% of cancer deaths. 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, the risk of lung cancer is already reduced by 27%, as the American Medical Association found.

3. Does excess weight affect the development of cancer?
Keep your eyes on the scales! Extra pounds will affect not only the waist. The American Institute for Cancer Research has found that obesity contributes to the development of tumors in the esophagus, kidneys, and gallbladder. The fact is that adipose tissue serves not only to store 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 just appear against the background of inflammation. In Russia, 26% of all cancer cases are associated with obesity.

4. Does exercise help reduce the risk of cancer?
Set aside at least half an hour a week for exercise. Sports are on the same level as proper nutrition when it comes to cancer prevention. In the US, one third of all deaths associated with the fact that patients did not follow any diet and did not pay attention to physical education. The American Cancer Society recommends exercising 150 minutes a week at a moderate pace or half as much but more vigorously. However, a study published in the journal Nutrition and Cancer in 2010 proves that even 30 minutes is enough to reduce the risk of breast cancer (which affects one in eight women in the world) by 35%.

5.How does alcohol affect cancer cells?
Less alcohol! Alcohol is blamed for causing tumors in the mouth, larynx, liver, rectum, and mammary glands. Ethyl alcohol breaks down in the body to acetaldehyde, which then, under the action of enzymes, passes into acetic acid. Acetaldehyde is the strongest carcinogen. Alcohol is especially harmful to women, as it stimulates the production of estrogen - 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 part of a healthy diet, they also help fight cancer. This is also why recommendations for healthy eating contain the rule: half of the daily diet should be vegetables and fruits. Especially useful are cruciferous vegetables, which contain glucosinolates - substances that, when processed, acquire anti-cancer properties. These vegetables include cabbage: ordinary white cabbage, Brussels sprouts and broccoli.

7. Which organ cancer is affected by red meat?
The more vegetables you eat, the less red meat you put on your plate. Studies have confirmed that people who eat more than 500 grams of red meat per week have a higher risk of developing colon cancer.

8. Which of the proposed remedies protect against skin cancer?
Stock up on sunscreen! Women aged 18-36 are particularly susceptible to melanoma, the deadliest 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 artificial tanning equipment and the sun's rays are blamed for this. The danger can be minimized with a simple tube of sunscreen. A study published in the Journal of Clinical Oncology in 2010 confirmed that people who regularly apply a special cream get melanoma half as often as those who neglect such cosmetics.
The cream should be chosen with a protection factor of SPF 15, applied even in winter and even in cloudy weather (the procedure should turn into the same habit as brushing your teeth), and also do not expose yourself to sunlight from 10 to 16 hours.

9. Do you think stress affects the development of cancer?
By itself, stress does not cause cancer, but it weakens the entire body and creates conditions for the development of this disease. Studies have shown that constant worry changes activity immune cells responsible for turning on the "hit and run" 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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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 colon are under 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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INTESTINAL POLYPS- honey. A polyp is a tumor on a stalk or a wide base, hanging from the walls of a hollow organ into its lumen, regardless of the microscopic structure. Frequency and localization Preventive checkups using endoscopic equipment show ... Disease Handbook

Active ingredient ›› Pancreatin (Pancreatin) Latin name Micrasim ATX: ›› A09AA02 Polyenzyme preparations (lipase + protease, etc.) Pharmacological group: Enzymes and antienzymes Nosological classification (ICD 10) ›› C25… … Medicine Dictionary

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-.
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 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 it. Here only short information and classifier.

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

Beyond all international classifications already inside the structure, according to the location of the carcinoma, the following types are distinguished for treatment:

rectosigmoid
Upper ampullar
Medium ampoule
Lower ampullar
anus

Main types:

infiltrative
Endophytic
exophytic

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.

1 stage- a small size of the tumor, up to 2 centimeters, does not extend beyond the organ.

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

3 stage- metastases appear in nearby organs - bladder, uterus, prostate.

4 stage- widespread, distant metastases appear. Possible new classification- in colon cancer.

Forecast

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

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

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.

For diagnostics benign tumors large intestine laboratory and instrumental research methods are used. The data of an objective examination in most cases are uninformative. In some cases, pallor of the skin and the presence of spotting from the anus.
From laboratory methods a general blood test is used, in which, in the presence of bleeding, a decrease in the level of erythrocytes and hemoglobin is noted. Signs of anemia are most often observed with multiple bleeding colon polyps. If benign tumors of the large intestine are complicated by inflammation of the mucous membrane, erosion or the addition of a secondary infection, in general analysis blood revealed an increase in the level of leukocytes and acceleration of ESR. When conducting a fecal occult blood test, minor bleeding is diagnosed, which is invisible during examination.
From instrumental methods diagnostics, irrigoscopy (X-ray examination of the large intestine) is used: for better visualization of the intestine, a contrast containing barium is injected. With the help of this study, defects in the filling of the mucosa are detected, which indicates the presence of a tumor. The radiological criterion for benign tumors of the large intestine is the presence of a mobile filling defect with smooth, even and clear edges without changes in the relief of the mucous membrane. The presence of these signs makes it possible to distinguish benign neoplasms from malignant ones.
An important method for diagnosing benign tumors is endoscopy of various parts of the large intestine. With the help of sigmoidoscopy, the rectum and lower sections of the large intestine are examined. Colonoscopy allows you to look at the entire intestine for benign neoplasms. When conducting this diagnostic procedure The proctologist can take tissue samples for morphological examination, which will make it possible to clarify the morphology of the tumor and decide on the tactics of treatment.
In most cases (60-75%), benign tumors of the large intestine are well visualized with a rectoscope or colonoscope. Polyps can be located either on a thin stalk or on a wide base. The mucous membrane of benign tumors of the large intestine has a normal pink color, although in some cases it may be purplish-red, standing out against the background of surrounding tissues. With the development of inflammation, the mucous membrane of benign tumors becomes edematous and hyperemic, which is clearly seen with endoscopy of the large intestine. In the case of erosion, a mucosal defect with edematous edges, covered with fibrinous plaque, is visualized.