Cancer of the colon is one of the cancers most common in Portugal, being the third cause of death in the world.
The colon cancer is one of the types of malignant cancer and invasive, and more common both in men as in women.
The pathology starts in the colon (part of large intestine), being different from the cancer-rectal, once the latter begins in the rectum. If reach want to the colon, as the rectum, we are faced with the cancer, colo-rectal.
The difference between the colon and the rectum is based on the anatomic location in the gut and in need of a different treatment, specific to the anatomical region affected, however, the tumor biology is the same.
Colon cancer, originates in the cells that form the layer of epithelium wall of the large intestine. These cells when they suffer changes in its genome (DNA), they become cancer cells and produce new cells in an uncontrolled way, totally unnecessary.
Can occur the process of metastização, that is, the cancer cells invade the surrounding tissues and spreading to other parts of the body.
Generally, this type of cancer starts with the formation of a polyp (abnormal growth of the tissue of the intestinal wall), however not all polyps turn into cancer.
THE EPIDEMIOLOGY OF THE DISEASE
Colon cancer is the 3rd most common cancer after cancer of the breast and of the prostate, affecting more men than women.
RISK FACTORS OF COLON CANCER
Among the main risk factors of developing colon cancer can count on:
- Age: the likelihood of developing this type of cancer increases with age.
- Polyps in the colon: all the polyps grow from the mucous membrane, but differ in size, shape and appearance.
The likelihood of having cancer in a polyp depends on the type of polyp, and there are the hiperplásicos, adenomatous, or adenomas and polyps inflammatory. The adenomatous polyps benign, especially those with more than 1cm, can undergo malignant degeneration.
- Inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease increase the risk. The risk associated with Crohn’s disease is less than that associated with ulcerative colitis.
- Personal history and/or family of cancer, that is, if a family member of a first or second grade had this type of cancer, the risk of developing it is higher.
- Lynch syndrome , or cancer non-polypoid hereditary.
- Unhealthy diet, some studies suggest that a diet low in fruits and vegetables, calcium and fiber, and on the other hand rich in fat, contribute negatively in the development of cancer.
- Smoking and alcohol abuse, increases the likelihood of developing polyps in the intestine.
- The disease is more common in societies industrializeds than in underdeveloped countries.
- Sedentary lifestyle, a time that regular physical activity can reduce the risk by more than 50%.
SYMPTOMS OF COLON CANCER
Cancer of the colon, manifests itself mainly by changes of the intestinal transit, in this way, you should be alert and consult your doctor if you exhibit the following symptoms:
- Diarrhea or constipation;
- Feeling that the bowel was not completely empty after a bowel movement;
- Retorragias (blood in stool);
- The feces of different consistency;
- Pain or discomfort cramping;
- Sudden weight loss for no apparent reason;
- Asthenia, or is, a huge tiredness with no apparent cause;
- Nausea or vomiting.
- Patients present with anemia, abdominal mass palpable, hepatomegaly, adenopathies palpable, jaundice.
PREVENTION AND EARLY DIAGNOSIS
Prevention essentially means the adoption of healthy habits and the conduct of examinations for the early detection of polyps or lesions in the colon and rectum.
Several studies recommend the beginning of the early diagnosis from the age of 50, however, you should be your doctor to assess your case and determine when it should start this routine.
To facilitate the diagnosis can be performed 3 types of tests, such as:
1. TOTAL COLONOSCOPY
Is the exam is more complete since it allows you to view the entire rectum and the colon. It is the introduction of a tube through the anus, which allows the doctor to view the inside and look for polyps and possible injury. In the case of polyps, can be performed a polypectomy, or the removal of polyps found for later analysis.
2. FLEXIBLE SIGMOIDOSCOPY
This exam is only displayed the rectum and the lower part of the colon. The exam is very similar to colonoscopy.
3. OCCULT BLOOD IN THE STOOL
This is an examination of indirect which allows you to check for the presence of blood in the stool and is an indicator to value. If positive, should be done on a colonoscopy. It can be an indicator of the presence of polyps, however, can also be indicator of other pathologies benign as is the case of the hemorrhoids.
There are other examinations for the early diagnosis of colorectal cancer, such as the barium enema and the touch rectal.
In addition to the colonoscopy or sigmoidoscopy, may be requested still additional tests such as a ct scan computerized axial (cat scan) or an mri.
However, the effective diagnosis of cancer of the colon is possible only by microscopic examination by the Pathological Anatomy of the crops held in the examinations referred to previously.
TREATMENT OF COLON CANCER
The treatment should be defined by a clinical team, multidisciplinary, depending on the stage of the disease. We can verify the following:
- Stadium 0 and I – the treatment option is usually surgery.
- Stage II – treatment option is surgery, which can be applied to therapeutic systemic (chemotherapy) complementary to surgery.
- Stage III – the therapeutic options include surgery and chemotherapy.
- Stage IV – at this stage, the treatment is individualized but based on chemotherapy.
Sometimes it is necessary surgery for the removal of part of the colon, called a colectomy, and that can be total or segmental. Whenever possible, the surgeon connects the parts to the normal of the intestine so as to ensure the normal intestinal transit.
When this situation is not possible, the surgeon makes a colostomy, or is, causes surgically in an opening in the abdominal wall – a stoma – connecting the upper part of the intestine to the outside, placing an outer bag for collection of feces.
Usually the colostomy is needed until healing surgery completed, after which the surgeon reconeta the intestine and closes the stoma.
However, in some cases, the colostomy may be needed on a permanent basis.
Patients who have been treated for cancer of the colon, must be followed by an oncologist, gastroenterologist, and/or by the surgeon who operated.
The follow-up must include regular assessment examinations and journals, such as colonoscopy control, occult blood in stools, a marker antigen, carcino-embryonic (CEA), the TAC among others, to identify any new cancers or cancers waste.
The screening, as a preventive measure, assumes in this particular case evidence and relevance, because if done effectively, greatly reduces the rate of incidence and mortality.
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