The fourth stage of intestinal cancer is a very advanced, last stage of oncology. The malignant process with such an anomaly spreads to the entire intestine, actively metastasizes, and affects the lymphatic system and nearby organs. The fourth stage of the disease does not respond to traditional methods of treatment, therefore a palliative method is used. But, because by this time the metastases have already penetrated all organs, mainly the liver, patients die suddenly.
Growing aggressively, affecting neighboring organs, stage 4 intestinal cancer is located in any part of the large intestine: rectum, cecum, sigmoid colon, sometimes in the area of the transition of the sigmoid to the rectum.
Tumors of the intestinal tract of grade 1-2 can be treated quite successfully, and a favorable prognosis is possible. As soon as alarming symptoms appear, you should immediately consult a doctor. At stage 4, the disease is incurable, the patient is prescribed palliative therapy, a strong pain reliever. Surgical intervention will not win, but will only alleviate the suffering of the unfortunate person. It is impossible to predict how long they live at this stage; the period depends on the age, immunity of the patient, and the adequacy of treatment.
Symptoms of the anomaly
Signs of type 4 cancer are complete destruction of the walls of the intestinal tract by the tumor, as a result of which the contents enter the blood, causing fatal poisoning of the body. Characteristic symptoms:
- deterioration of health;
- loss of appetite, body weight;
- frequent vomiting, nausea;
- dizziness;
- heat;
- difficulty defecating;
- the presence of blood, mucus or pus in the stool;
- abdominal pain;
- flatulence, bloating;
- diarrhea, constipation;
- belching;
- grayish coating on the tongue.
Internal hemorrhages provoke the development of anemia, the patient’s skin becomes painfully pale and cyanotic.
The spread of metastases occurs in similar ways:
- through the vessels of the lymphatic system;
- through the circulatory system;
- implantation method.
Cancer cell metastases
Treatment
Stage 3 colon cancer is often widespread or affects the walls quite deeply within some limits. In this regard, the only treatment option remains surgical removal of the tumor with its draining lymphatic system (regional nodes).
The third stage of intestinal cancer involves complex treatment, which includes the following measures:
- Surgical intervention (the main type of treatment);
- Chemoradiation therapy;
- Treatment of concomitant pathology by other specialists.
Operational
The scope of surgical intervention is determined by the surgeon individually. This is influenced by the stage of the disease, the degree of malignancy of the tumor, and its location.
The following types of surgical treatment are performed:
- Complete colectomy. The entire colon is removed;
- Hemicolectomy. Half of the colon is removed;
- Colectomy of the sigmoid colon;
- Total mesorectal excision. The rectum with its surrounding tissue and lymph nodes is removed
- Low anterior rectal resection;
- Abdominoperineal extirpation of the rectum.
Radical operations are often accompanied by colostomy of patients, which significantly worsens the quality of life. In this regard, many clinics are developing variants of sphincter-preserving techniques that allow this to be avoided.
Chemoradiation therapy
In this case, combined treatment with cytotoxic drugs and radiation therapy is used. This is necessary to prevent tumor relapse and influence possible sites of elimination (metastases), which significantly increases the patient’s life expectancy.
Chemoradiation therapy for patients at stage 3 of intestinal cancer is carried out before surgery (neoadjuvant) and/or after it. In some cases, this can reduce the size of the tumor, which affects the extent of surgery, which will avoid the formation of a permanent colostomy.
Targeted (biological) therapy
This technique is aimed at stopping the growth and division of tumor cells. For this purpose, the following pharmaceuticals have been developed:
"Cetuximab" ("Erbitux");
- Bevacizumab (Avastin);
- “Panitumumam” (“Vectibix”);
- "Aflibercept" ("Zaltrap").
They have been successfully used to treat colorectal cancer that has spread beyond the digestive tract. The only problem is their cost, which cancer patients rarely can afford.
https://youtu.be/uiCffSzUFe4
Possible therapy for late stage colon cancer
The fight against an advanced cancer process will take a lot of time and effort, and is done in several approaches. A full course of therapy does not guarantee healing; the prognosis is disappointing: during treatment, toxins enter the liver through the bloodstream, causing complications.
Traditional treatment methods include:
- Surgical resolution is complete resection of the tumor along with removal of metastases. In some cases, the tumor grows so large that the doctor is forced to remove most of the intestine, making it impossible to stitch it together. As a result, the surgeon forms a colostomy - he brings the intestine to the wall of the peritoneum with the attachment of a colostomy bag to empty the intestines. Sometimes the same method is used for inoperable tumors to eliminate obstruction and alleviate the patient’s suffering.
- Radiation therapy is used to prepare for surgery, slowing down the spread of cancer cells. This method is based on radioactive rays.
- Chemotherapy - along with radiation treatment, is used to reduce the size of the tumor, slows down the oncological process, without prolonging the patient’s life, but facilitating resection.
- Traditional methods - despite the skepticism, such remedies have an effective positive effect on the patient’s condition, but only in conjunction with professional treatment.
Traditional medicine is in demand, despite the development of traditional medicine. In a complex of measures in the fight against metastases, decoctions and tinctures of herbs are used, sometimes containing poisons in small dosages.
Treatment of a malignant process in the intestine at stage 4 is directly dependent on the capabilities of the human body, on the type of tumor that has penetrated the organs.
When a diagnosis of stage 4 intestinal cancer is made, the prognosis for healing is disappointing, because by this point metastases have affected almost all organs, the person is rotting from the inside, doctors are unable to help, they can only alleviate the agony.
Clinical picture
Often cancer in the first stages is asymptomatic or under the “mask” of other diseases (prostatitis, hemorrhoids, colpitis). It can only be accompanied by non-periodic bleeding due to ulceration or trauma to the surface of the tumor with intestinal contents.
Stage 3 of rectal cancer is already extremely dangerous. In this case, not always the oncology can be completely eliminated by surgeons; there is metastatic damage to the regional lymph nodes, but the survival rate is still quite high.
At this stage, the following symptoms already appear, which should alert a person and prompt them to go to a medical institution:
| Colon lesion | Rectal lesion |
|
|
The clinical picture can also be supplemented by signs of damage to other organs when a malignant tumor grows or is close to them.
Postoperative complications, consequences
Surgery at stage 4 of intestinal cancer is associated with a great risk to the patient’s life. But even a successful operation does not guarantee the absence of complications. The first alarming symptom is blood entering the abdominal cavity, sutures and wounds that do not heal for a long time, and infections. Other complications are also possible:
- Incomplete anastomosis - suturing the edges of the intestines after removing the affected segment. If the surgeon does not apply enough stitches, the edges may separate or soften, which threatens the entry of feces into the peritoneum and peritonitis.
- Indigestion – after surgery, the patient experiences flatulence and difficulty defecating. A person is forced to sit on strict, monotonous diets.
- Adhesions can cause impaired motility of the intestinal muscles, cause acute pain and, in general, pose a health hazard.
Rehabilitation
After the intervention, the patient is transferred to the intensive care unit, where he wakes up from anesthesia and gradually returns to normal. Analgesics or epidural pain relief are prescribed to relieve postoperative pain. A special drainage is attached to the seam area to remove excess fluid. Over the next few days it is removed.
The patient is allowed to eat without the help of a nurse only a few days after resection. The initial menu should include liquid puree soups, liquid porridges, and low-fat broths. After a week, the patient can independently move around the hospital department. To speed up the healing of the intestines and reduce the risk of complications, it is recommended to wear a special bandage to reduce the load on the abdominal muscles.
It is mandatory to prepare a special diet, which the patient must strictly adhere to. The stoma (artificial anal opening), if one has been removed, initially looks swollen, but shortens and shrinks after a couple of weeks.
If the patient's condition has stabilized and there are no complications, he is discharged from the department after a week. Postoperative sutures are removed after ten days.
Post-operative diet
A healthy diet and a special diet are the most important part of the treatment of intestinal cancer, since the disease affects the intestinal tract. Patients with abdominal cancer often have no appetite, so be prepared to eat through force. It is necessary to eat, it is important to defeat the disease; refusing food will end badly. It is recommended to eat five to six times a day in small portions of non-hot, crushed food. It is necessary to wipe for better absorption. Quick snacks are prohibited; food must be chewed thoroughly.
At-risk groups
Malignant lesions develop equally often in men and women. In the structure of oncological diseases of the digestive tract, the leading role belongs to colorectal cancer (colon), which is often quite difficult to determine at stages 1-2 due to unexpressed clinical manifestations.
Most often, stage 3 colon cancer is found in people in the following risk groups:
- Predisposing factors:
- Age. Women and men after 40-50 years of age are prone to more frequent development of cancer (the risk increases several times);
- Presence of cancer in relatives;
- Rare hereditary diseases (for example, familial diffuse polyposis), leading to the formation of adenomas - benign neoplasms that can degenerate into cancer;
- Chronic inflammatory diseases of the gastrointestinal tract - nonspecific ulcerative or granulomatous colitis.
- Provoking factors:
- Poor nutrition, which mainly consists of meat products, semi-finished products, animal fats, fried and smoked foods, as well as various confectionery products against the background of insufficient consumption of vegetables and fruits;
- Smoking;
- Obesity;
- Frequent consumption of alcoholic beverages.
Under normal conditions, the intestines contain a certain number of microorganisms that participate in digestion. However, many enzymatic substances released by them during poor nutrition/fecal stagnation have carcinogenic and mutagenic effects. These include phenols, nitrosamines, ammonia and many others.
It must be remembered that bowel cancer is not a contagious disease, that is, it cannot be transmitted to other people.
Features of the tumor
Growth and spread occurs at a slower rate than with stomach cancer. For quite a long time, the cancer is located only within the organ, not spreading deeper than 2–3 cm from the visible borders. Tumor growth is accompanied by an inflammatory process, which often spreads to neighboring tissues and organs. Atypical cells gradually grow within the boundaries of the inflammatory infiltrate into the surrounding tissues. This gives rise to the formation of locally advanced tumors, when there is no distant metastasis yet.
Distant metastasis has its own characteristics, since most often metastases are found in liver cells, sometimes reaching the lungs (distribution routes: through the blood, lymph). Another feature is the multicentric nature of growth. Additional tumor foci may appear simultaneously or sequentially both in the intestine and in other organs.
Forecast for life
- Stage 1 – about 95% of patients live more than 5 years.
- Stage two – about 75% of patients live more than 5 years.
- Stage three – about 50% of patients live more than 5 years.
- Stage four (with the presence of metastases) – about 5% of patients live more than 5 years.
You need to understand that all of these are very average indicators, which additionally depend on many related factors:
- patient's age,
- the state of his immune system,
- the presence of concomitant pathologies.
And the main thing to remember is that the likelihood of completely overcoming bowel cancer exists regardless of the stage at which it was diagnosed. At the same time, time is both a partner and an enemy of the patient. If you use it rationally, the result of therapy is quite likely to be positive.
Symptoms of bone metastases
Depending on the location of bone metastases, persistent pain in the arms, legs, neck, back, and lower back is bothersome. Weakening of bones threatens pathological fractures: they occur when exposed to small mechanical loads, from which healthy bones do not break.
The tumor destroys bone tissue, which causes calcium to be washed out into the blood. Hypercalcemia develops, which manifests itself in the form of decreased appetite, nausea, and constipation.
Early diagnosis of the disease
Today, one of the priority areas in the diagnosis of tumor diseases is analysis of tumor markers. Blood is examined for the presence of markers in combination with other methods, which makes it possible to determine the degree of effectiveness of treatment in the early stages and provide quite accurate prognostic information. The main markers for colon tumors are CA-19-19 and CA-242. To detect metastasis of colorectal cancer to the liver parenchyma as early as possible, an embryonal cancer antigen test is used. Analysis for tumor markers is the determination of specific proteins that are produced by the tumor itself and enter the blood.
ZERO DEGREE - stage 0 or Carcinoma in SItu
With this degree of intestinal cancer, malignant tumor cells are located only in the intestinal mucosa. There is no spread of the tumor. There are also no symptoms at this stage. In this form, a malignant neoplasm is detected only sometimes during a screening examination or during a colonoscopy performed for another disease. But even in these cases, the incidence of tumor detection is insignificant. As a rule, at stage 0 intestinal cancer is diagnosed when intestinal polyps are removed in a timely manner.
Surgery in this case is the only necessary treatment.
In most cases, a minimally invasive procedure is required, which can be done in which the polyp or area of cancer is removed through a colonoscope (local excision).
The survival prognosis with diagnosis and timely correct treatment is almost 100%. Modern spectral imaging and fluorescent marking systems used in oncology clinics in Belgium make it possible to accurately determine the boundaries of a tumor. This allows surgeons to always achieve the so-called “negative margin” during surgery, that is, complete removal of the tumor while preserving as much healthy tissue as possible.
Classification
Colon cancer is classified according to the location where the primary tumor occurs.
Stages of bowel cancer
Cancer is distinguished:
- Vermiform appendix.
- Cecum.
- Ascending, transverse and descending colon.
- Sometimes tumors of the hepatic and splenic angles are isolated separately.
- Sigmoid colon.
- Exophytic (polypoid) - into the lumen of a hollow organ. In this case, symptoms appear most quickly, and obstructive intestinal obstruction becomes dominant. It is most often observed in the cecum and ascending colon. Annular is a special case of exophytic growth. The tumor tissue forms a ring, narrowing the intestinal lumen and causing obstruction.
- Endophytic (endophytic-ulcerative) - grows into the wall of the organ and beyond. It is characterized by late onset of symptoms and a high risk of contact metastasis and germination into adjacent organs. More typical for the descending department.
- Diffuse (infiltrating) – the tumor grows to the sides of the primary focus, without narrowing the lumen. Difficult to diagnose.
- Mixed – tumor growth without a clear direction.
The types of cells from which a tumor is built determine its growth rate, tendency to metastasize, and sensitivity to a particular type of treatment.
- Intraepithelial neoplasia – atypia and polymorphism of epithelial cells, violation of their mutual position. Often found in removed polyps.
- Invasive colorectal cancer is a tumor that has grown through the basal lamina of the intestinal epithelium. This group includes all diagnosable types of cancer.
Cancerous tumor in the intestine
In 40% of cases, the disease affects parts of the colon (ascending, descending transverse), 20% of colon cancer - inflammation in the cecum or rectum. Most often this is a squamous cell type of cancer, and 10% occur in the sigmoid part of the colon.
Cancer is treated in many countries, but the leading clinics in the world are medical centers in Germany, the USA and Israel.
