Download Colon cancer

Diseases
of the
colon
Epidemiology
Colon cancer is one of the first places in the
structure of cancer. Among the malignant tumors of
the digestive cancer of the colon in the CIS in third
place. Usually affects people between the ages of 50
to 70 years, with the same frequency for both men
and women. Neoplasm of the colon and rectum are
most common in economically developed countries,
which is associated with dietary patterns, diet
deficient in fiber and slag. Also in the occurrence of
cancer of the colon plays a major part precancerous
lesions, which include polyps and polyposis of the
colon, villous adenoma, ulcerative colitis, Crohn's
disease.
Anatomical sections of the
colon
1 - hepatic flexure, 2 - ascending
colon, 3 - cecum, 4 - transverse colon,
5 - splenic flexure, 6 - descending
colon, 7 - the sigmoid colon, 8 rectum.
Blood supply to the colon
1 - average intestinal colic artery;
2 - right colonic intestinal artery;
3 - iliac artery intestinal colic;
4 - inferior mesenteric artery, 5 marginal branch;
6 - superior mesenteric artery
artery, 7 - left colonic intestinal
artery;
8 - sigmoid intestinal branches.
The functions of the colon
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Motor,
Absorptive,
Excretory.
In the colon is absorption of water (up to
95%), electrolytes, some gaseous substances.
Thanks to the activity of intestinal
microflors in the colon it is involved into the
metabolism of B vitamins and vitamin K
Histological structure of the
colon
The wall of the colon consists of mucosa,
submucosa,
muscular
and
serous
membranes. In the mucosal epithelium
differentiate, lamina propria and muscle
plate. The mucosa of the colon lacks villi,
but it has a large number of crypts. In his
own plate mucosal concentrations of K are
associated lymphoid tissue in the form of
single and group of lymph (Peyer's
patches) of the follicles. Muscle membrane
is represented by longitudinal and circular
smooth muscle fibers.
Colonoscopy
Normal terminal ileum
Colonoscopy
Ileocecal valve (Baugins flap).
Colonoscopy
The hepatic flexure of the colon.
Colonoscopy
Transverse colon
Colonoscopy
Rectum
Anomalies and malformations
•Dystopy
•Dolichosigmoid
•Dolichocolon
•Stenosis
•Atresia
Hirschsprung's disease
Hirschsprung disease (megacolon) - a
hereditary disease
colon associated with the violation of its
evacuation activities, and accompanied by
constipation and abdominal distention.
Can occur in one in every 5,000
newborns.
As a rule, occurs in children and adolescents
in adults is extremely rare
The etiology of Hirschsprung’s
disease
The hypoplasia (gipoganglioz) or no
(aganglioz) intramuscular ganglion cells
and submucosal nerve plexus.
Diagnosis of Hirschsprung's
disease
•Complaints
•Anamnesis of disease
•Rectal exam
•Sigmoidoscopy
•Colonoscopy
The clinical picture
•Constipation
• bloating
•abdominal pain.
•Assimetric abdomen
•General signs: weakness,
nausea, vomiting, appetite
deteriorates.
Diagnostics
Rectal examination
Irrigography
Treatment: Surgery is the removal of without ganglionar zone and
decompensated advanced parts of a colon followed by reduction of intestinal
permeability.
Ulcerative colitis
Ulcerative colitis - a chronic
inflammatory disease of the colon,
affecting, as a rule, direct mucous
membrane and other parts of the colon,
which has a continuous or relapsing
chronic course.
Pathogenesis
Sensitization
Etiology
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Infectious theory
Allergic theory
The development of autoimmunity
Subsidence in the intestinal mucosa
antigen-antibody reaction
The development of colitis, ulcers
Joining a secondary infection
Violation of the innervation of gut
Nutritional deficiency
Diagnosis
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Patient complaints
Anamnesis
Sigmoidoscopy
Irrigografy
Colonoscopy
Endoscopic picture at NUC
Clinical picture:
•diarrhea (up to 40 times a day) with the release of blood and mucus,
sometimes - pus,
•severe abdomen pain,
•tenesmus,
•vomiting,
•high body temperature.
•leukocytosis with a shift of leukocyte to the left, decrease in
hemoglobin, hematocrit
Differential diagnosis
•Dysentery
• Proctitis
• Crohn's Disease
Treatment
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Conservative treatment:
A diet rich in protein, carbohydrate restriction, and dairy
products
Desensitization and antihistamines (diphenhydramine, pipolfen,
suprastin, tavegil)
Vitamins (A, E, C, K, B)
Bacteriostatic drugs (etazol, ftalazol, sulgin, enteroseptol)
Salazopiridazin
Steroids (prednisone, dexamethasone)
Surgical Treatment Applied to the development of complications:
Profuse bleeding
Perforated ulcer
Toxic dilatation
Diverticulosis of COLON
Diverticulum - a blind ending saccate protrusion
limited area of ​a hollow organ, particularly the colon.
Diverticulosis means having diverticuls multiple.
Сomplications:
Diverticulitis
Stricture
Bleeding
Perforation
Clinical picture:
Clinical manifestations of diverticular disease are absent.
Diverticulitis:
Pain in the abdomen
Unstable stool
Сonstipation
Diarrhea
Decreased appetite,
nausea, vomiting occasionally
The clinical picture very similar to that in acute
appendicitis, but the symptoms are detected on the left.
Against the background of diverticulitis diverticulum
perforation may occur in the free abdominal cavity (from 2
- 27%) with peritonitis.
Diagnosis
Diagnosis of diverticular disease is based on data from medical
history, results of radiologic and colonoscopic studies. When
diverticulitis performance X-ray and endoscopic studies is dangerous
because of the possibility of perforation diverticulum.
Diagnosis of diverticular sigmoid
gut filled with intestinal
content
Diverticuls and
inflamed stenosis
(Narrowing).
Bleeding diverticulum
Colonoscopy
Endoscopic picture of the
diverticulosis of the colon
Treatment
Conservative
•diet
•antispasmodics
•antibiotics
•sulfa drugs
•warm enema with an antiseptic solution
surgery
•perforation of a diverticulum,
•development of intestinal obstruction
•internal fistulas,
•massive bleeding,
•expressed diverticulitis with frequent exacerbations, with failure of medical treatment.
•When diverticulitis of the colon is removed lesion ulcer (hemicolectomy, resection of the
sigmoid colon), it is appropriate combination of these operations with myotomy of the
colon, which leads to a decrease in intraluminal pressure.
Polyps and polyposis of the colon
and rectum
75% cases polyps are common originated from the epithelium of
sigmoid colon and rectum
There are distinguished:
juvenile,
hyperplastic,
glandular (adenomatous),
glandular-villous polyps,
villous adenoma,
diffuse polyposis of the colon
(the true and secondary).
Diagnosis: along with the clinical symptoms and anemnesis
data are important and recto-colonoscopy, irrigography
Sigmoid colon polyp
on a stalk
Colon polyp on a
broad basis
Large colon polyp (6x6 cm)
base diameter of 3 cm polyp considerably
narrows the lumen of the intestine,
causing partial obstruction
Colon polyps on the stem
Minor bleeding from
the removed polyp
Treatment
Choice of treatment of polyps and diffuse polyposis colon
cancer should be individualized. Solitary polyps removed
by electrocautery or a recto-colonoscopy.
Polipectomy
Annealing polyp with loop The remaining stump of the
polyp
with large central
vessel
Overlay clips on the vessel
In order to avoid bleeding
Conservative treatment of colon polyps is futile.
Any polyp found during colonoscopy, should be
removed through the endoscope or transanal and
examined under a microscope
Example of endoscopic resection of
villous adenomas, tubular
Tubular-villous
adenoma of the colon
The plot of the colon after
endoscopic resection of adenomas
The vast majority of researchers
rightly says that cancer
(adenocarcinoma), colon
(colorectal) cancer in most cases
increases from benign polyps
(adenomas)
Colon cancer
Colon cancer - a
malignant epithelial
tumor that affects the
most distal colon. For a
long time may be
asymptomatic, and only
at a relatively late stage
there are signs of
gastrointestinal
bleeding, constipation
and abdominal pain of
varying intensity.
There are four stages of colon cancer
•Stage I - limited small tumor, localized in the thickness
of mucosal or submucosal layer. Metastases in the
lymph nodes there.
•Stage II: a) large tumor, but it takes no more than a
semicircle intestine, does not go beyond it, without
metastases in regional lymph nodes, and b) a tumor of
the same size or smaller with a single metastasis to the
nearest lymph nodes.
•Stage III: a) the tumor is more than a semicircle gut,
grows all of its adjacent wall or peritoneum, with no
metastases in regional lymph nodes, and b) a tumor of
any size in the presence of multiple metastases to
regional lymph nodes.
•Stage IV: extensive swelling, germinating in the
adjacent organs, with multiple metastases to regional
lymph nodes or any swelling in the presence of distant
metastases.
Clinic
Clinical picture: depends on the location of
the tumor, the type of growth, size,
presence of complications
It involves pain, intestinal discomfort,
intestinal disorders, abnormal
discharge, breach of the general
condition of patients and sometimes
the presence of palpable tumors.
Intestinal discomfort
Manifested loss of appetite, belching, nausea,
feeling of heaviness in the epigastric region.
Intestinal disorder caused by inflammatory
changes in the intestinal wall, disorders of
motility and narrowing of the lumen. They appear
constipation, diarrhea, constipation, alternating
diarrhea and, rumbling in the abdomen, abdominal
distention. With a sharp narrowing of the lumen
of the intestine develops obstructive ileus - a
partial or complete.
Pathological discharge
Pathological discharge: an admixture of blood,
pus, mucus in the stool is seen in 40-50% of
patients. Blood in the stool is a result of the
collapse of the tumor, and mucus and pus due to
inflammation in the area of ​decay and
associated colitis.
In some patients the only clinical expression
of disease is the presence of palpable tumors
(most often in tumors of the right half of the
colon)
Clinical forms of cancer
Toxico-anemic
Manifested loss of appetite, nausea, retching,
vomiting, feeling of heaviness, general fatiqug
Enterocolitic form
Bloating, heavyness in abdomen, constipation.
Stool with blood and pus
Clinical forms of cancer
Dyspeptic form
Manifested loss of appetite, nausea, retching,
vomiting, feeling of heaviness and swelling in the epigastric
area, pain in the upper abdomen.
Obstructive forms
The leading symptom of obstructive cancer ileus. This gives rise
to attacks of abdominal pain, rumbling in the abdomen, swelling,
bloating, no discharge of feces and gas. Initially, these symptoms
are independently, occasionally repeating, which is typical for a
partial bowel obstruction.
Clinical forms of cancer
Pseudo-inflammatory form
It is characterized by abdominal pain and increasing the
temperature
temperature of the body. Intestinal disorders are expressed
weak. In a blood test reveal leukocytosis,
increased sedimentation rate.
cancer forms
When the cancer forms a tumor in the abdomen or the
patient discovers, or a physician in the study of the patient.
At the same time other manifestations of tumors of the
colon in a patient or not they are expressed very poorly.
Complications
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Ileus obstruction
Inflammation of the tissues surrounding the
tumor
Perforation of the tumor,
Intestinal bleeding,
Fistula between the colon and neighboring
organs.
Diagnostics
•Complaints
•History of disease
•MSCT
•Colonoscopy
Diagnostics
(Various options for colorectal cancer)
Diagnostics
Treatment
•Treatment: Surgical method
•X-ray and chemotherapy for cancer
of the colon are ineffective
Case fatality: at radical operations performed for cancer
Colon is 6-8%. Five-year survival depends
the stage of disease and degree of differentiation of tumor cells and
among radically operated an average of 50%
The tactics of general physician:
1. Collecting the patient^s complains and
history
2. To refer for the MSCT
3. Referring and preparing for colonoscopy
and irrigography
4.To refer in time for proctologyst’s
examination