Sigmoid colon cancer: causes, signs, stages, removal. Sigmoid colon cancer: causes, treatment, prognosis Sigmoid colon cancer stage 2

The sigmoid colon, whose shape resembles the Latin letter S laid on its side, is an extremely important part of the large intestine in which the final formation of feces occurs.

It is here that they part with nutrients and water, which are absorbed into the blood, and feces enter the rectum (which is a continuation of the sigmoid) and are excreted from the body.

Concept of illness

Sigmoid colon cancer is a malignant tumor that develops from the epithelial tissues of the mucous membrane of this organ.

The leading importance is attached to surgical intervention: without it it is impossible to cure this disease. In the presence of small cancerous tumors with clear boundaries, they are removed (resection) along with part of the affected intestine and adjacent lymph nodes. After this, the integrity of the intestinal tube is restored.

Small tumors with a low level of malignancy can be removed using a gentle (endoscopic) method - without making a skin incision.

During a laparotomy operation, a specialist makes several small punctures through which fiber-optic tubes equipped with a miniature video camera and endoscopic instruments are inserted into the patient's abdominal cavity.

When treating an advanced tumor that has reached stage IV, an operation can be performed to completely remove the sigmoid colon with a procedure designed to remove gases and feces.

Sometimes a colostomy is removed temporarily, only to improve the results of the operation. A few months later, the colostomy is removed, restoring the natural passage of feces through the anus.

In some cases, the colostomy is made permanent. With this type of operation, the patient is forced to walk with a colostomy bag for life.

Chemotherapy– treatment of cancer using drugs that destroy cancer cells and inhibit their ability to rapidly divide – comes to the aid of even patients with advanced disease and can be used both before and after surgery. When using one drug we talk about monochemotherapy, when using several – about polychemotherapy. Unfortunately, it cannot replace surgical treatment. With its help, doctors only reduce the size of cancer tumors and slow down their growth. As an independent therapeutic method, it is used only in relation to inoperable patients.
Radiotherapy sigmoid colon cancer is performed very carefully, since there is a high risk of perforation of the walls of this organ. In addition, most types of colorectal cancer have low sensitivity to this therapeutic method. However, the use of radiation therapy can have good results in shrinking the tumor before surgery and in destroying cancer cells that may have remained at the border of healthy and diseased tissue.

Prognosis after surgery

The prognosis (most often moderately favorable) for sigmoid colon cancer primarily depends on the level of differentiation of tumor cells: highly differentiated malignant tumors are treated better.

Equally important is early detection of cancer and its immediate treatment.

Complex treatment of patients (combining surgery with chemoradiotherapy) with single metastases in regional lymph nodes gives a five-year survival rate of 40% of patients. In the absence of such therapy, less than a quarter of patients survive.
If sigmoid colon cancer is limited only to its mucous membrane, after resection of tumor tissue, the five-year survival rate is at least 98%.

Since sigmoid colon cancer is one of the least aggressive and most benign forms of malignant neoplasms, if patients seek medical help in a timely manner, they still have a very high chance of a complete cure.

Dietary nutrition for sigmoid colon cancer

Postoperative diet is of great importance in the treatment of sigmoid colon cancer. During the first day, the patient is advised to fast (his nutrition is carried out by intravenous administration of nutrient solutions containing amino acids and glucose).

For six days after surgery, the patient is contraindicated in eating any solid food. His diet should consist of juices, broths, thin cereals, vegetable purees and herbal decoctions, and after mandatory consultation with a doctor.

Ten days after the operation, the patient’s diet is varied with lean meats, fish and dairy products. The ideal ratio of nutritional components in a therapeutic diet: 50% should be carbohydrates, 40% proteins, and only 10% fats.

The patient must completely stop using:

fatty meats and fish;
fried foods;
pickles, marinades and canned food;
sausages and smoked meats;
baked goods, chocolate and sweets;
coffee, strong tea, alcoholic and carbonated drinks;
eggs, cheese and whole milk;
freshly baked bread;
vegetables containing coarse fiber;
legumes.

Methods of culinary processing of products intended to feed a person who has undergone colon surgery should be boiling and steaming. Portions should be small. You should eat food at least five times a day.

Vegetables, cereals, dairy products, lean fish and meats, fruits, biscuits, dried bread, crackers are very healthy.

The video shows sigmoid colon cancer using colonoscopy:

There is an increasing trend in the incidence of colorectal cancer worldwide. In Russia, according to statistical data for 2015, tumors of this location occupy fourth place in the structure of all malignant neoplasms and account for 12%. The reasons most likely lie in the deteriorating environmental situation, the accumulation of genetic mutations and changes in dietary patterns towards foods low in fiber.

Of all malignant neoplasms of the colon, localization of carcinoma in the sigmoid colon occurs in approximately 50% of cases.

In the International Classification of Diseases (ICD 10), sigmoid colon cancer is coded C18.7.

Brief anatomical excursion

The sigmoid colon is the final section of the colon, has an S-shaped curved shape, and is located in the left iliac fossa. Its length ranges from 45 to 55 cm.

In this section of the intestine, feces are formed, which subsequently move into the rectum. Based on anatomical landmarks and blood supply characteristics, surgeons distinguish three sections - proximal (upper), middle and distal (lower). Depending on the segment in which the tumor is localized, the volume of surgical intervention is selected.

Reasons for development

Predisposing factors for the development of the disease include:

consumption of refined, high-calorie, low-fiber foods;
obesity;
sedentary lifestyle;
smoking, alcohol;
age over 60 years.

Despite the fact that a common understanding of the causes of malignant tumors of this localization has not yet been formed, a connection has been identified between the development of sigmoid colon cancer in people at risk.

Presence of confirmed colon cancer in first-degree relatives. The chance of developing cancer in such individuals increases by 2-3 times.
Hereditary intestinal diseases. First of all, this is familial adenomatous polyposis, against which, without appropriate treatment, a malignant tumor develops in 100% of cases.
Polyps of the sigmoid colon. These are benign formations (adenomas) emanating from the mucous membrane. Polyps degenerate into cancer in 20-50% of cases. Almost always, carcinoma develops from a polyp, extremely rarely - from unchanged mucosa.
Other precancerous intestinal lesions are ulcerative colitis, Crohn's disease, and sigmoiditis.
Previously undergone operations for malignant intestinal tumors of other locations.
Condition after treatment of malignant neoplasms of the breast and ovaries in women.

Symptoms of sigmoid colon cancer

Sigmoid colon cancer develops quite slowly, and for a long time there is no clinical manifestation. It may take several years from the onset of malignant cell degeneration to the appearance of the first symptoms. This fact has both positive and negative aspects.

First, slow-growing cancer can be detected and treated in its early stages using minimally invasive technologies.

On the other hand, if nothing bothers a person, it is very difficult to motivate him to perform the examination. Especially something as unpleasant as a colonoscopy.

In 80% of cases, the first symptoms of sigmoid colon cancer are:

Defecation disorder. There may be retention of stool for up to several days, alternation of constipation with diarrhea, tensema (false urges) or a multi-stage bowel movement (several trips to the toilet are required to empty the intestines).
Various pathological discharges from the anus. These may be impurities of blood and mucus.
The presence of general weakness, increased fatigue, pallor of the skin, the appearance of shortness of breath and palpitations (signs of anemia and intoxication).
Discomfort in the abdomen (bloating, pain in the left half and lower parts of the abdominal cavity).

As the tumor grows, all symptoms progress to serious complications - acute intestinal obstruction, perforation of the organ wall, or bleeding from the tumor. Almost half of the patients admitted urgently with obstruction are patients with advanced sigmoid colon cancer, the classic clinical picture of which is severe cramping pain, bloating, lack of stool and gas, and vomiting.

Symptoms of sigmoid colon cancer in women and men are almost the same, the only peculiarity is that anemia in women for a long time can be interpreted based on other reasons, and, in the absence of characteristic clinical manifestations, the woman is sent for an intestinal examination quite late.

Diagnostics

A malignant neoplasm of the sigmoid colon can be suspected based on one or more of the listed symptoms. The following are carried out to confirm the diagnosis:

stool occult blood test;
general blood analysis;
sigmoidoscopy (examination of the rectosigmoid region using a rigid apparatus), an old method, but still used in some medical institutions;
sigmoidoscopy - examination of the lower (distal) parts of the intestine with a flexible endoscope;
colonoscopy – examination of the entire colon;
irrigoscopy - x-ray examination of the colon using a barium enema (now rarely performed, only if colonoscopy is not possible);
biopsy of a changed area of the mucous membrane or a whole polyp;
Ultrasound or CT scan of the abdominal cavity and pelvis;
X-ray of the lungs to exclude metastases;
determination of tumor markers CEA, CA 19.9.

Additional examination methods are prescribed according to indications: endoscopic ultrasound, MRI of the abdominal cavity with contrast, PET-CT, scintigraphy of skeletal bones, diagnostic laparoscopy.

Classification

Based on the nature of the invasion, exophytic (growing inward) and endophytic (growing into the intestinal wall) forms are distinguished.

Based on the histological structure, they are distinguished:

Adenocarcinoma (in 75-80% of cases) is a tumor of glandular tissue; it can be highly, moderately and poorly differentiated.
Mucous adenocarcinoma.
Signet ring cell carcinoma.
Undifferentiated cancer.

Classification according to the TNM system

The international TNM classification allows tumor staging, which affects the treatment plan and prognosis.

T (tumor) is the spread of the primary focus.

Tis - cancer in situ, the tumor is limited to the mucous layer.
T1, T2, T3 – the neoplasm, respectively, grows into the submucosa, muscular layer, and spreads into the subserosal base.
T4 – invasion (spread) beyond the intestinal wall is determined; Possible ingrowth into surrounding organs and tissues.

N (nodus) - metastasis to regional lymph nodes.

N0 – there is no damage to the lymph nodes.
N1 - metastases in 1-3 lymph nodes.
N2 – damage to more than 3 lymph nodes.

M – presence of distant metastases.

M0 - no foci.
M1 – metastases in other organs are determined. Cancer of this section most often metastasizes to the liver, less often to the lungs, brain, bones and other organs.

Based on TNM, the following stages of cancer are distinguished:

II. T3-T4; N0M0.

III. T1-T4; N1-N2; M0.

IV. T any; N any; M1.

Treatment

The “gold standard” for treatment of sigmoid colon cancer is surgery.

Surgery

If the tumor has not spread beyond the mucous membrane, its endoscopic removal is quite acceptable. Usually in practice it happens like this: an endoscopist excises a suspicious polyp and sends it for histological examination. If the pathologist detects carcinoma in situ, the patient is carefully examined again, and if there are no signs of spread of the process, he is considered cured and is observed according to a specific plan.

For stages 1, 2 and 3 of cancer, bowel resection is necessary. Operations for malignant tumors are performed according to the principle of surgical radicalism in compliance with ablastics. This means:

Sufficient extent of resection (at least 10 cm from the tumor above and below its borders).
Early ligation of vessels coming from the neoplasm.
Removal of a section of intestine in one package from regional lymph nodes.
Minimal trauma to the affected area.

Types of operations for sigmoid colon cancer:

Distal resection. It is performed when the tumor is located in the lower third of the intestine. 2/3 of the organ and the upper ampullary part of the rectum are removed.
Segmental resection. Only the area affected by the tumor is removed. Typically used for stage 1-2 cancer located in the middle third.
Left-sided hemicolectomy. For stage 3 cancer and its location in the upper third of the intestine, the left half of the colon is removed to form a colorectal anastomosis (the transverse colon is mobilized, lowered into the pelvis and sutured to the rectum).
Obstructive resection (Hartmann type). The essence of the intervention is that the area with the tumor is resected, the efferent end of the intestine is sutured, and the adductor end is brought out onto the abdominal wall in the form of a single-barrel colostomy. This intervention is performed in weakened, elderly patients, during emergency operations for intestinal obstruction, and when it is impossible to form an anastomosis in one operation. Often it is the first stage of surgical treatment. Second, after preparing the patient, it is possible to perform reconstructive surgery. Less commonly, a colostomy remains forever.
Palliative surgical benefits. If the tumor has spread so much that it cannot be removed, or there are multiple metastases in other organs, only measures to eliminate intestinal obstruction are applied. Usually this is the formation of an unnatural anus - colostomy.
Laparoscopic resection. Allowed for small sizes of the primary focus.

Chemotherapy

The goal of chemotherapy is to destroy as many cancer cells as possible in the body. For this purpose, cytostatic and cytotoxic drugs are used, they are prescribed by a chemotherapist.

For stage 1 cancer, treatment is usually limited to surgery.

Types of chemotherapy treatment:

Postoperative - indicated for stage 2-3 patients with regional metastases, with a poorly differentiated tumor, and doubts about the radicality of the operation. An increase in the level of the tumor marker CEA 4 weeks after surgery can also serve as an indicator for prescribing chemotherapy.
Perioperative - prescribed to patients with single distant metastases in preparation for their removal
Palliative chemotherapy treatment is carried out for patients with stage 4 cancer to alleviate the condition, improve the quality of life and increase its duration.

Stage IV sigmoid colon cancer

Treatment of malignant tumors of this localization with single metastases to the liver and lungs is carried out according to the following protocols:

The primary tumor is removed, if possible, the metastases are simultaneously excised, and chemotherapy is prescribed after the operation. After a pathomorphological examination of the removed tumor, a genetic analysis is performed: the study of mutations in the KRAS gene. And, based on the diagnostic results, indications for prescribing targeted drugs (bevacizumab) are determined.
After removal of the primary tumor, several courses of chemotherapy are carried out, then the metastases are removed, and after surgery, treatment with cytotoxic drugs is also carried out.
If sigmoid colon cancer is associated with metastatic lesions of one lobe of the liver, then after removal of the primary lesion and subsequent chemotherapy treatment, anatomical liver resection (hemihepatectomy) can be performed.

In case of multiple metastases or tumor invasion of neighboring organs, palliative surgery and chemotherapy are performed.

Forecast

The prognosis after surgery depends on many factors: stage, age of the patient, concomitant diseases, degree of malignancy of the tumor, and the presence of complications.

Mortality after planned oncological interventions on the sigmoid colon is 3-5%, with emergency ones – up to 40%.

The five-year survival rate for radical cancer treatment is about 60%.

If radical treatment is carried out while maintaining natural bowel movements, the patient fully returns to a full life.

Observations with an oncologist to prevent relapses are carried out every 3 months for the first year, then every six months for five years, and then once a year.

Prevention

Early detection of precancerous conditions and initial forms of cancer. An annual stool test for occult blood for persons over 50 years of age, colonoscopy once every 5 years, for people with a hereditary predisposition - from 40 years of age.
Removal of polyps larger than 1 cm, for smaller sizes - annual observation.
Treatment of inflammatory bowel diseases.
Minimizing avoidable risk factors - a diet enriched with fruits and vegetables, giving up bad habits, exercising, losing weight.

Main conclusions

Malignant neoplasms of the described localization occupy a leading place in cancer morbidity and mortality.
The number of patients with this diagnosis is growing every year, especially in highly developed countries.
It remains asymptomatic for a long time.
At an early stage it is completely curable.

Cancerous lesions of the digestive system are quite common, and this is due to the aggressive environment in which these organs function. Sigmoid colon cancer is one of the most dangerous, as it does not give any symptomatic manifestations for a very long time, making early diagnosis of the problem difficult. It is very important to carefully monitor your condition and the functioning of the digestive tract - only in this way, based on general knowledge regarding the disease, can you suspect the presence of cancer in time.

What is sigmoid colon cancer

The sigmoid colon is the last element before the rectum and has a very specific shape (in the form of an inclined English letter S). The high probability of cancer formation in this area is determined by the physiological characteristics of the organ. The intestine is bounded on all sides by the peritoneum, which tightly fixes it to the rest of the tract. If not enough components are supplied with processed food that stimulate peristalsis, the feces formed in the sigmoid colon are retained there. As a result, pressure is created on the walls, circulatory disorders occur, and a large number of harmful components are released from the stagnant masses. Under such conditions, proliferations of epithelial cells are formed, which gradually turn into a cancerous form.

Malignant tumors in this part of the intestine can be represented by such types of formations as:

adenocarcinoma (formed from glandular tissue);
adenocarcinoma of the mucous type with an unfavorable course;
signet ring cell carcinoma.

Physician's note: adenocarcinoma is the most common type, occurring in approximately 75% of cases. The cellular form is the rarest, accounting for only about 3% of diagnoses.

Stages of disease development

Depending on how strongly the disease has developed and what damage it has caused to the body, it seems possible to distinguish several stages of sigmoid colon cancer:

at the first stage, the formation is localized in the mucous membrane of the intestine and does not extend beyond it;
At the second stage, two courses of events are possible:
- stage 2a – the extent of the tumor does not exceed half the circumference of the intestine, there are no metastases, as well as spread beyond the walls;
- stage 2b - the size of the tumor is similar to the a-type stage, but there is a deep spread, that is, all layers of the wall are affected;
the third stage can also occur in two forms:
- a-type - in the absence of metastases, the spread has reached a size exceeding half the circumference of the organ;
- b-type – there is metastasis to nearby (regional) lymph nodes;
at the fourth stage, the presence of extensive metastasis to neighboring or distant organs is noted, and changes in the omentum are possible.

Reasons for the development of the disease

As is the case with other types of cancer, the exact causes of the disease have not been established. Doctors identify a number of factors, the presence of which is associated with the formation of a malignant tumor in the intestine:

genetic predisposition;
the presence of chronic diseases of the colon (diverticulosis, Crohn's disease, etc.);
atony (decreased tone of the intestinal walls), most often of an age-related nature;
intestinal polyposis;
poor nutrition;
a sedentary lifestyle, which disrupts the peristalsis of the digestive system;
consequences of surgical interventions in the abdominal cavity;
smoking, alcoholism and consumption of foods that contain large amounts of carcinogens.

Symptoms

It is possible to distinguish both the main symptoms of sigmoid colon cancer and specific ones, typical only for certain stages of the disease. Common manifestations include:

bowel dysfunction (constipation, diarrhea);
increased fatigue;
decreased appetite, changes in taste preferences;
weight loss;
weakness and pallor of the skin.

Specific manifestations - table

It is worth noting that the characteristics of symptoms are not distinguished depending on the gender of the patient - men and women are equally susceptible to the disease.

Diagnostics

When a patient consults a doctor with complaints that coincide with the symptoms of sigmoid colon cancer, the specialist will first conduct a digital examination of the intestine, which will make it possible to feel the presence of a tumor if it is of sufficient size. To confirm the nature of the diagnosis, the following diagnostic measures can be carried out:

colonoscopy - examination of the intestine using a flexible tube with optical fiber (endoscope). During the procedure, it is possible to take material for a biopsy of the tumor;
sigmoidoscopy - the method has a similar principle to colonoscopy, but a special short endoscope is used;
X-ray examination with barium contrast (irrigoscopy);
Magnetic resonance imaging allows you to clearly determine the location of the tumor, its size and extent, as well as the presence of metastases. This information is extremely important for prescribing treatment and drawing up a surgical plan.

Treatment

In the vast majority of cases, the main treatment method for cancer localized in the sigmoid colon is surgery. This type of therapy is implemented regardless of the stage or severity of the disease, as it acts as the most effective approach in medical practice. In this case, other types of treatment measures can be used, including radiation and chemotherapy. Folk remedies are powerless in the fight against this type of cancer.

Operation

Surgical intervention in this case can be performed as part of a classic resection or as a minimally invasive operation (laparoscopy). During the surgical process, the part of the intestine in which the tumor is located is removed. Since a particular cancer is characterized by a low rate of development dynamics, it is quite easy to cure it in the early stages using surgery. In advanced forms, surgery can significantly reduce the risks of disease progression and complications during the rehabilitation period.

Radiation and chemotherapy

Chemotherapy may include several active substances, but this type of treatment remains applied, carried out before or after a surgical procedure. This condition is based on studies that have shown that chemotherapy is not very effective for treating sigmoid colon cancer.

Radiation therapy may also be given, but is not used to treat adenocarcinoma, which is the most common type of sigmoid colon cancer. This is due to the fact that this type of exposure can lead to damage to the intestine, namely its perforation. Moreover, tumors localized in the area under consideration have low sensitivity to radiation exposure.

Diet

Diet plays an important role in sigmoid colon cancer, namely during the period of postoperative rehabilitation. A balanced and specialized diet can improve bowel function and reduce postoperative symptoms, as well as reduce the risk of complications.

The most difficult period is the first seven days after the intervention. This is explained by the fact that the functioning of the gastrointestinal tract has been disrupted and the digestive system now strives to recover, which is why patients often have diarrhea for a week.

In connection with the described conditions, the power system may have the following form:

breakfast - fruit puree and freshly squeezed juice in a small amount;
second breakfast - oatmeal;
lunch - vegetable puree soup with a small piece of bran bread;
dinner - baked or steamed vegetables with tea;
2 hours before bedtime, you should drink a glass of kefir every day or eat yogurt with natural fruits.

Prognosis and possible complications

The prognosis for treatment of the disease largely depends on how timely the disease was identified and therapy carried out. It is also important to understand that the peculiarities of its course and development play an important role during the patient’s postoperative recovery.

If the disease was diagnosed in the early stages, after which adequate treatment was carried out, then the prognosis is very good. The specific type of cancer has been sufficiently studied, and therapeutic methods for tumors in the sigmoid colon are effective.

However, the process can be complicated in some situations, one of which is the young age of the patient. The fact is that in a young body the processes of cell division and transformation occur quite quickly. Thus, the disease progresses rapidly and can lead to metastasis. Metastases can also spread to tissues of other organs, for example, the liver, which increases risks and complicates treatment.

Prevention

When it comes to prevention, the main task is to prevent conditions that contribute to the occurrence of the disease. In this case, the main reason is irritation of the intestinal mucosa; therefore, prevention lies in maintaining the normal state of the intestinal lining.

Since the main condition for disruption of the sigmoid colon is stagnation of feces, which is associated with the anatomy of a particular section of the intestine, measures should be taken to normalize intestinal motility. In order for the reduction and movement of masses through the intestine to be carried out adequately, it is necessary to lead an active lifestyle, which includes exercise and proper nutrition, walks in the fresh air and swimming.

Since the disease may be a consequence of an advanced disease of the gastrointestinal tract, it is necessary to promptly diagnose and treat all disorders of this system.

Sigmoid colon cancer is a fairly common problem due to the peculiarities of the functioning of this part of the intestine. The main symptoms are associated with disturbances in the process of fecal formation and defecation. With timely and adequate treatment, the prognosis for recovery is favorable.

Sigmoid colon cancer, even after the appearance of a polyp, the disease may not manifest itself, this is due to the subtleties of the structure of the sigmoid colon

Oncological disease in any form poses a danger to human health and life. If we talk about the intestines, among malignant neoplasms the most common tumor is the sigmoid colon. At the end of the article, we will offer you a statistical prognosis for stages 2, 3 and 4 of sigmoid colon cancer, but first we suggest you familiarize yourself with what its symptoms are, how to diagnose cancer and what treatment methods exist.

Sigmoid colon cancer is not called the silent killer for nothing. Even after the polyp appears, the disease may not manifest itself. This is due to the subtleties of the structure of the sigmoid colon.

What is this gut?

Sigmoid colon is a separate section of the human intestine that resembles an English S in an inclined form. Feces are formed here, and substances beneficial to the body are absorbed. If there are few components in food to stimulate peristalsis, it can linger in the intestine, stretch the walls, and impair blood circulation. In the future, this leads to stagnation and the formation of polyps.

Symptoms of sigmoid colon cancer

The peculiarities of blood circulation are such that neoplasms of the sigmoid region grow quite slowly and do not manifest themselves at first. Any alarming disturbances are drowned out by the peritoneum. This is the main insidiousness of tumors in this part of the intestine. If the disease manifests itself somehow in the early stages, then these symptoms are quite subtle. They are not specific and are characteristic of most other, less dangerous diseases. Most patients rarely pay attention to them and come to the doctor when it is too late to do anything.

What symptoms should make you suspicious?

Minor disturbances of peristalsis, which can manifest themselves as flatulence, belching, rumbling, and painful urge to go to the toilet. Diarrhea can be replaced by constipation - subsequently they make themselves felt more and more often.
The appearance of blood clots in the stool. Some patients may mistake them for hemorrhoids and are not in a hurry to go to the hospital. Meanwhile, when a dangerous polyp is injured in masses, blood appears.
Cramping pain. They are observed on the left side of the gastrointestinal tract and do not depend on how long ago you ate food. Due to the fact that the tumor begins to grow directly into the intestinal walls, and the passage of feces is difficult, painful sensations arise. Usually this symptom is characteristic of the second or 3rd stage.
Increased fatigue, pale skin. The patient's appetite may disappear, body weight drops, and taste preferences become perverted. This condition occurs due to further growth of the tumor. It blocks the lumen of the sigmoid colon. Elimination of feces is difficult, and intoxication of the body is possible.
When the tumor blocks the lumen, bloating occurs.
The last stages of the disease are characterized by an increase in the size of the liver and serious intoxication of the body. The skin takes on an earthy tint and signs of jaundice appear. Bleeding becomes more massive, peritonitis and intestinal abscesses are observed.

Due to the vagueness of the symptoms, the diagnosis of sigmoid cancer is made in the last stages. That's why it's so important to get the diagnosis right. The earlier a correct diagnosis is made, the higher the patient’s chances of overcoming the disease.

How is it determined: cancer diagnosis

To make a truly correct diagnosis, a variety of methods can be used. This includes taking an anamnesis, stool examination, examination along with palpation.

The simplest method is considered to be finger diagnostics. The sigmoid colon is very easy to feel through the rectum. An experienced specialist will immediately determine the presence of a foreign growth. It is unfortunate that people rarely go to the doctor for minor complaints. Also, methods such as sigmoidoscopy or traditional ultrasound of the abdominal cavity can be used to confirm the diagnosis. Let's consider these types of diagnostics in more detail.

Colonoscopy and sigmoidoscopy. Methods that allow visual examination of the surface of the intestine to detect polyps and other neoplasms. They allow you to do a biopsy, that is, take a piece of tissue. The methods themselves are very painful, so they are not prescribed to older people, as well as to patients with weakened immune systems.
Irrigoscopy. X-ray using barium. A more gentle procedure that does not cause any discomfort to the person. He drinks a barium solution, sometimes given through an enema into the rectum. X-rays make it possible to identify the tumor itself due to the fact that barium reliably envelops all the walls of the intestine.
MRI or magnetic resonance therapy. Perhaps the most revealing of all. Determines the presence of a tumor and its size, as well as location, presence of metastases, etc. This allows you to correctly determine the stage of the disease and make the necessary predictions regarding the effective treatment of cancer.

Stages of development, survival prognosis

Like any other cancer, sigmoid colon cancer has several stages. The survival prognosis depends on when the tumor was diagnosed.

Sigmoid colon cancer, stage 1

A small tumor, maximum 1.5 cm in size, begins to grow in the intestinal mucosa. There are no metastases as such. If therapy was started almost immediately, the probability of curing patients within several years is quite high - 95%.

Stage 2: prognosis

If the size of the tumor is more than 15 mm, but less than half the diameter of the sigmoid region, the person is diagnosed with the second stage of cancer. It can be divided into subspecies. In the first case, the tumor did not have time to go beyond the intestinal wall, and there were no metastases. In the second, the tumor has already grown into the intestinal wall, and single metastases have appeared. Survival rate is also quite high, although it decreases with the appearance of metastases.

Sigmoid colon cancer stage 3 prognosis: how long do they live?

This stage can be divided into two subtypes. In the first case, the tumor occupied more than half the diameter of the intestine, but there were no metastases. The second subtype is associated with the appearance of numerous metastases.

When treatment begins at stage 3, and even with the presence of metastases, the survival rate is much lower and equal to 40%.

Stage 4 sigmoid colon cancer: how long do they live?

Unfortunately, the development of stage 4 cancer is unfavorable. The tumor can completely close the lumen, metastasize to internal organs, or grow into the intestine or bladder. The survival rate is very low - 30% for several years.

Treatment

Removal of the formation through surgery has long been considered the main and most effective method of treatment. Along with it, other methods can be used:

Chemotherapy. It is a drug treatment option that prevents cell growth and effectively destroys them. Thanks to chemotherapy, it is possible to significantly prolong the life of a sick person - even if metastases have already affected internal organs. However, chemotherapy cannot replace surgical intervention - it only shrinks the tumor and slows its growth. In rare cases, if the cancer is inoperable, chemotherapy is used as an alternative treatment. The method must be used with extreme caution, as it has serious consequences.
Radiotherapy (Radiation therapy). It is a combined method that affects a malignant tumor. It not only destroys cancer cells, but also prevents their division. Sometimes the tumor shrinks so much in size during radiation therapy that it becomes practically invisible even with the use of diagnostic equipment. After this therapy, the outcome of the operation is much better.

As for surgery, it involves removing part of the intestine with the tumor and lymph nodes that are located nearby. When the affected area of the intestine is removed, a comprehensive restoration of intestinal integrity is performed.

Sometimes in the later stages, a comprehensive removal of the sigmoid intestine is performed and a colostomy is performed. It ensures normal waste of feces and gases. This measure in itself is temporary and is used to improve the results of the operation. Then, depending on the patient’s condition, the colostomy can be removed and feces can be removed through the anus.

During examination, neoplasms with a low degree of malignancy are often diagnosed. The tumor can be removed endoscopically, without any incisions. Then the tumor tissue is simply excised using endoscopic instruments. But it is better to carry out such operations at stages 1-2.

If the patient is diagnosed with stage 3, surgery is always performed only after chemoradiotherapy. It significantly slows down cell growth and improves prognosis. After surgery, additional treatment is sometimes prescribed in the form of drugs and radiation. This reduces the risk of relapse of this dangerous disease.

If detected early, a form of cancer such as a tumor of the sigmoid region can be treated, and the outcome is quite favorable. A proper diet and balanced nutrition play a big role in the process. For example, alcohol and carbonated drinks, spices, fried foods, black tea and coffee are contraindicated for patients. But you can eat vegetables and fruits.

is a malignant neoplasm of epithelial origin located in the sigmoid part of the large intestine. In the initial stages it is asymptomatic. Then there is pain and discomfort in the abdomen, flatulence, and a feeling of incomplete bowel movement. There is an alternation of constipation and diarrhea. Often, a tumor-like formation can be felt in the left half of the abdomen. The diagnosis is made on the basis of complaints, anamnesis, external examination data, ultrasound, rectosigmoidoscopy, irrigoscopy, MRI, biopsy and other studies. Treatment – surgery, chemotherapy, radiotherapy.

General information

Sigmoid colon cancer is a fairly common malignant tumor that affects the area of the large intestine located above the rectum. Originates from glandular epithelial cells. Accounts for 34% of the total number of colorectal cancer cases. In 60% of cases it affects patients aged 40-60 years. Men suffer 1.5 times more often than women. At first, sigmoid colon cancer is often asymptomatic or mildly symptomatic, which complicates timely diagnosis. As the tumor progresses, it spreads to nearby organs, giving regional and hematogenous metastases (to the liver, lungs, spine, and less often to other organs). Treatment is carried out by specialists in the field of abdominal oncology surgery and surgical proctology.

Causes

The high probability of developing sigmoid colon cancer is due to the characteristics of this organ. The sigmoid colon is located on the left side of the abdomen, just above the rectum, and is S-shaped. When the movement of contents through the intestines slows down, chyme remains in the sigmoid colon for a long time, which increases the time of contact of toxic food processing products with the mucous membrane of the organ. Factors that increase the risk of developing sigmoid colon cancer include a sedentary lifestyle and poor diet: consumption of foods with low amounts of plant fiber, large amounts of fatty, fried and spicy foods, the predominance of animal fats and light carbohydrates. Both of these factors cause a slowdown in intestinal motility. Poor nutrition contributes to an increase in the amount of carcinogenic substances in the intestinal contents.

Among other circumstances that increase the likelihood of sigmoid colon cancer, experts name constipation, in which the mucous membrane not only comes into contact with carcinogens for a long time, but is also injured by solid contents. Alcohol abuse plays a negative role. In addition, sigmoid colon cancer often develops against the background of precancerous processes and inflammatory bowel diseases. More than 50% of neoplasms occur against the background of intestinal polyps, diverticulitis and other conditions accompanied by damage to the mucous membrane. Unfavorable heredity matters.

Classification

Taking into account the growth characteristics, two types of sigmoid colon cancer are distinguished: exophytic and endophytic. Exophytic tumors grow predominantly in the intestinal lumen and are protruding nodes on a thick stalk. As the process progresses, the tumor often ulcerates, bleeding and infection are possible. Endophytic tumors grow predominantly deep into the intestine. They spread along the intestinal wall and can surround the intestine in a circular manner. In the center of the neoplasm, areas of ulceration appear. The circular growth of sigmoid colon cancer causes a narrowing of the intestinal lumen and impedes the movement of feces. Endophytic tumors are more typical for the sigmoid colon.

Taking into account the histological structure, three types of sigmoid colon cancer are distinguished:

Adenocarcinoma. Originates from glandular epithelial cells. It is detected in 75-80% of cases of this disease. It can be highly differentiated, moderately differentiated and poorly differentiated. The lower the level of differentiation of sigmoid colon cancer, the worse the prognosis.
Mucosal adenocarcinoma. It is a type of poorly differentiated adenocarcinoma. It is represented by mucinous cells that secrete large amounts of mucus. Characterized by rapid growth and early metastasis.
Signet ring cell carcinoma of the sigmoid colon. It is represented by atypical ring-shaped cells, formed as a result of intracellular accumulation of mucin, which pushes the cell nuclei to the periphery. Diagnosed in 3-4% of patients with oncological lesions of the sigmoid colon. It is proceeding unfavorably.

Taking into account the prevalence of the process, the following stages of sigmoid colon cancer are distinguished:

Stage 1– the size of the tumor does not exceed 2 cm, the node is located within the mucous or submucosal layer. Regional and hematogenous metastases are not detected.
2A stage– the size of the tumor is less than half the circumference of the intestine. Sigmoid colon cancer does not invade the intestinal wall. Regional and hematogenous metastases are not detected.
2B stage– the tumor affects the intestinal wall, but does not extend beyond it. Metastases are detected in the lymph nodes. There is no distant metastasis.
Stage 3A– the diameter of the tumor exceeds half the circumference of the intestine. Metastases are not detected.
Stage 3B– lymphogenous metastases are detected.
Stage 4A– cancer of the sigmoid colon blocks the intestinal lumen. Hematogenous metastases are detected.
4B stage– the neoplasm affects nearby organs with the formation of conglomerates, enterovesical fistulas, etc.

Symptoms of cancer

In the early stages, sigmoid colon cancer is asymptomatic or has scanty clinical manifestations. Patients may complain of bloating and rumbling in the abdomen, alternating constipation and diarrhea. As it progresses, constipation predominates. Impurities of mucus, pus and blood appear in the stool. When the intestinal wall grows and there is a mechanical obstacle to the movement of chyme, cramping or dull pain occurs in the left half of the abdomen. Sometimes the first manifestation of the disease is the development of intestinal obstruction.

Patients with sigmoid colon cancer exhibit weakness, fatigue, pallor or grayish skin tone, hyperthermia, loss of weight and appetite due to cancer intoxication. With the development of intestinal obstruction, paroxysmal cramping pain occurs, repeating every 10-15 minutes, bloating, stool and gas retention are noted. Possible vomiting. When the intestinal wall is destroyed, peritonitis develops. In advanced cases of sigmoid colon cancer, cachexia, anemia, jaundice and liver enlargement are observed. When hematogenous metastases appear, symptoms appear that indicate dysfunction of the affected organs.

Diagnostics

The diagnosis of sigmoid colon cancer is made taking into account the medical history, complaints, objective examination data and the results of additional studies. The most informative are endoscopic methods (sigmoidoscopy and colonoscopy), which allow visual assessment of the volume and location of the tumor, as well as taking material for subsequent histological examination. In the process of examining patients with suspected sigmoid colon cancer, irrigoscopy and stool occult blood testing are also used.

To detect metastases, ultrasound of the abdominal organs, chest x-ray, x-ray of the spine and other diagnostic techniques are used. The final diagnosis is made based on the results of histological examination. Sigmoid colon cancer is differentiated from inflammatory and precancerous diseases of the intestine, with mobile tumors of the mesentery and fixed neoplasms of the retroperitoneal space.

Treatment of sigmoid colon cancer

When treating this pathology, oncological surgeons usually use combination therapy, including surgery, radiotherapy and chemotherapy. In this case, the leading role is given to surgical treatment aimed at radical tumor removal. The extent of the operation depends on the extent of sigmoid colon cancer. In the early stages, in some cases, the use of endoscopic techniques is permissible.

In case of common processes, resection of the sigmoid colon with a section of the mesentery and nearby lymph nodes is performed. The affected area is removed with 5 centimeters of intact distal and proximal intestine. Surgical intervention for sigmoid colon cancer can be one- or two-stage. In one-stage operations, after tumor removal, the surgeon performs an anastomosis, restoring intestinal continuity. In advanced cases, the intestine is resected to form a colostomy, and the integrity of the intestine is restored several months after the first operation.

In the pre- and postoperative period, patients with sigmoid colon cancer are prescribed chemotherapy and radiotherapy. In advanced cases, palliative therapy is carried out to ensure intestinal patency and reduce pain. Sometimes sigmoid colon cancer requires emergency surgical interventions aimed at eliminating intestinal obstruction, sanitizing the abdominal cavity in case of peritonitis, etc.

Prognosis and prevention

The prognosis for sigmoid colon cancer is determined by the type of tumor, the prevalence of the malignant process, the level of cell differentiation, the patient's age, the presence of concomitant diseases and other factors. The average five-year survival rate is 65.2%. With stage 1 neoplasms, 93.2% of patients overcome the five-year mark. With stage 2 sigmoid colon cancer, 82.5% of patients survive up to five years from diagnosis. For stage 3 tumors, this figure decreases to 59.5%, for stage 4 lesions – to 8.1%.