Colon carcinoma is a slow-growing tumor. Metastases in colon cancer occur in late stages, so if a malignant neoplasm in the colon is detected early, the cancer patient has a great chance of recovery.
Laparoscopy can detect metastases in the abdominal cavity
What are metastases?
In intestinal cancer, metastases act as malignant degeneration of organ cells. The lesion extends only to the mucous membrane. Often the disease progresses in the rectum and colon. Therefore, the disease is called colorectal cancer. People over 40 years of age are at risk. Patients do not live with the disease for a long time if metastases develop in the final stages.
The process of damage begins with a tumor, when the growth exceeds 5 cm in diameter, metastasis occurs to neighboring organs and epithelium. Oncological disease is dangerous for patients due to the early manifestation of lesions. In most cases, patients die, but the disease has a favorable prognosis, unlike other types of cancer. This occurs due to the manifestation of the first and early symptoms of metastases in colorectal cancer.
Symptoms
The main symptoms are caused by hypercalcemia, pathological fractures and spinal compression. There is also an increased temperature due to an active metabolic process and accelerated cell division.
Hypercalcemia
In one third of patients, bone metastases cause hypercalcemia. Calcium, which is part of the bones, is released during bone erosion and enters the blood. Hypercalcemia causes a number of symptoms:
Nervous system:
- Mental instability;
- Lethargy;
- Depression;
- Mental activity disorder.
The cardiovascular system:
- Decreased pressure;
- Arrhythmia.
Gastrointestinal tract:
- Lack of appetite;
- Nausea;
- Vomit;
- Ulcerative formations.
Urinary system:
- Increased urine production;
- Kidney failure;
- Intoxication.
Classification of diseases in the digestive tract
Metastases in the intestine are divided into stages. Doctors count 5 stages in the course of a malignant tumor. Therefore, everything starts from stage 0. There is no cancer, but a formation in the form of a tumor or polyp is observed.
Then the following stages of intestinal metastasis are officially distinguished:
- at stage 1, a node of altered epithelium develops, but there are no metastases;
- Stage 2 branches into subtypes, which is characterized by a tumor without metastases (2A) or the presence of lesions on the lymph nodes (2B);
- at stage 3, branching occurs again, when the disease completely grows into the intestinal wall (3A) or cancer cells spread in large numbers to the lymph nodes (3B);
- Stage 4 is characterized by the appearance of growths and their spread to other organs with mucous epithelium.
Treatment of pathology
Colon cancer with metastases is treated using the following procedures.
Chemotherapy. There are situations when surgical treatment cannot bring the desired results. In this case, treatment is carried out with chemotherapy and biological drugs. This treatment is aimed at relieving pain, reducing symptoms, improving the patient’s quality of life and prolonging it.
Treatment should be carried out individually based on the stage of the disease, the metastatic nature of the tumor and other factors. The treatment is long-term and continues until it gives a positive result. Since the drugs are highly toxic, the patient may experience side effects, in which case these drugs are excluded for a certain period of time, but are subsequently prescribed again.
Surgery
The operation is prescribed based on the following factors:
- Presence of metastases in the liver.
- Tumor processes in other organs.
- If metastases have approached large vessels, such as the portal vein, hepatic vein. These vessels are responsible for the functioning of the liver; if they are affected, the entire functioning of the liver will be disrupted.
- Cirrhosis of the liver.
Heart disease may be a contraindication to surgery.
The operation is performed under general anesthesia for 3 to 6 hours. An incision is made in the right hypochondrium, the liver is divided into 8 segments, the tumor is identified and, together with the segment, is removed. After the operation, the patient is in the hospital from 4 days to 1 week. The risk of death with a single liver metastasis is minimal.
Radiofrequency ablation (RFA)
This treatment method involves “local heating” of the tumor in order to destroy cancer cells. Under ultrasound guidance, a thin electrode is inserted into the tumor. There is a special current at the end of the electrode, which uses radio waves to heat the tumor to 100 degrees Celsius. At this temperature, cancer cells die. The electrode is inserted under the skin either during laparoscopy or during surgery. Often during surgery, after removing the main tumor and large metastases, the remaining lesions are destroyed using the RFA method. RFA, which is injected through the skin, cauterizes a tumor measuring 3-4 cm. The procedure takes 15-20 minutes. The procedure is performed on an outpatient basis and does not require anesthesia.
Postoperative treatment
Treatment after surgery is prescribed by the attending physician based on an individual approach to the disease. If the patient is over 60 years of age, but the operation was satisfactory, then age will not be an obstacle to subsequent chemotherapy and radiation therapy. If the operation was performed at the first and second stages of the disease, then subsequent treatment may not be required. Just regular monitoring by an oncologist will be enough.
But at the second stage of the disease, sometimes there may be single metastases, and subsequent surgical treatment may require chemotherapy. It can be prescribed in tablets.
At the third stage of cancer after surgery, chemotherapy is indicated, which is prescribed in 8 courses and lasts on average 6 months. At all stages of the disease, constant monitoring by an oncologist is recommended, as the disease may recur. And the sooner relapses are detected, the more successful subsequent treatment will be.
Observation by an oncologist includes the following activities:
- constant surveillance;
- regular blood donation for CEA and carcinoembryonic antigen;
- regular colonoscopy to detect relapses;
- periodic CT scans.
What causes metastases to appear?
The causes of cancer include diseases and conditions of the body. Therefore, the development of metastases is associated with genetic predisposition.
Intestinal diseases with inflammation of the walls of the mucous epithelium include the following pathologies:
- polyposis in the rectum;
- ulcerative colitis;
- difficulty in bowel movements;
- colon adenoma;
- Crohn's disease.
In addition to diseases of the digestive system, bad habits influence the development of malignant tumor cells. Sometimes the cause of intestinal cancer is Lynch syndrome or a chronic form of proctitis.
Features of the clinical picture
Signs of the development of metastases do not have any features and appear like other diseases. Therefore, when diagnosing, doctors rely on the presence of the following symptoms:
- sharp pain in the abdomen when turning and bending;
- constant pain syndrome;
- constipation;
- bloating.
The main symptoms are similar to intoxication of the body. This manifests itself in attacks of nausea and vomiting. Sometimes unpleasant belching occurs. Symptoms of metastases in the intestines are manifested by bleeding from the anus.
When metastases grow, the patient begins to develop cachexia. This sign of bowel cancer is observed as weakness. Along with this comes weight loss. Then the patient develops symptoms of a psychological disorder.
Therapy methods
To effectively treat MTS in the abdominal cavity, a large number of drugs and methods are used. However, getting rid of cancer is very difficult. Radiation and chemotherapy are intended to prevent oncological processes after tumor removal and do not give the best results in the fight against metastases.
The main disadvantage of these procedures is the complete destruction of immune cells. As a result, a person becomes ill and becomes infected with viruses and infections. It happens that death occurs not from cancer, but from pneumonia - the body simply cannot fight it (or other viral infectious pathologies).
However, radiation and chemical therapy are still prescribed first, since there are no more effective ways to destroy pathological cells. In this case, there are additional ways of influence:
- Targeted therapy. Using potent drugs, they destroy the receptors responsible for tumor growth. Healthy cells are practically not affected.
- Immunotherapy. An experimental treatment method that involves exposing the body to monoclonal antibodies that activate the immune system.
- Surgical removal. Prescribed for single metastases. Radiosurgery is often used.
- Arterial embolization. The feeding pathways of malignant foci are blocked.
Additionally, a large number of potent drugs are prescribed.
Prognosis for metastases
Over the past decades, doctors have managed to reduce the mortality threshold after removal of malignant tumors to 5% (at the beginning of the 2000s, this figure reached 20%). However, metastases are a more serious problem, since it is impossible to predict their appearance in a particular organ, as well as the timing of primary development.
Only timely detection during routine diagnosis in the initial stages can contribute to positive treatment. But it should be understood that metastasis is the most dangerous and serious oncological process.
Rehabilitation measures after chemotherapy and effective restoration of liver and immune system functions can improve the prognosis. In advanced cases, patient survival rarely reaches 1-2 years.
Distribution routes
Malignant cells can spread throughout the body. There are only 3 main places where cancer spreads from the colon or colon. The formations develop into direct invasion of the walls of nearby organs. In addition, metastases spread through the blood or lymph.
Because of this, cancerous lesions appear in the spine. This is frequent metastasis and the appearance of secondary malignant tumors. In this case, the symptoms are confused with the manifestation of an intervertebral hernia. When the rectum is damaged, malignant cells move to the liver tissue. Symptoms include pain in the right side in the area under the ribs. Symptoms spread to the skin as jaundice. Sometimes metastases settle in the lung tissues, which impairs respiratory function.
Causes
The appearance of mts (metastases) in the bones is caused by the spread of cancer cells through the blood vessels from the primary affected organ into the bone tissue, developing into malignant tumors. Most often, cancer cells migrate from the primary affected thyroid, prostate and mammary glands, lungs, kidneys, as well as in sarcomas, lymphomas and Hodgkin's lymphoma. Less common are metastases from the cervix, ovaries, gastrointestinal tract and soft tissues and very rarely from other organs. The most common location of metastases is in bones with abundant blood supply: the bones of the pelvis, arms, legs, chest, spine, skull, bone marrow and ribs. Metastases are often found in the hip, shoulder and knee joints. With breast cancer in women, with cancer of the thyroid gland, kidneys and lungs, metastases can go to the xiphoid process, the body and manubrium of the sternum, as well as to the ilium, ribs, pelvic, hip and shoulder bones.
Tumors disrupt the work of osteoblasts and osteoclasts - large multinucleated cells responsible for regulating the structure and destruction of bone tissue during the process of cellular renewal.
Surgery, pathological fractures and other complications of metastasis can cause chylostasis (stagnation of lymph), which leads to edema. Bone metastases can cause severe pain, such as with melanoma of the spine or a tumor of the ischium that can put pressure on a nerve.
What will happen if left untreated?
A complication of the disease is the transition to secondary growths. If proper treatment is not carried out on time, when the growth is a benign polyp, then the patient begins to struggle for life. When cancer progresses, the patient's body is poisoned by cell decay products. Therefore, signs of the disease appear. When metastasis occurs to other tissues, metabolic processes are disrupted.
Therefore, additional diseases begin to develop:
- malignant melanoma of the skin;
- skin carcinoma.
Secondary growths appear only in the presence of a primary tumor.
Establishing a diagnosis
Diagnosis of metastases in the intestine is done in several stages. It is necessary to go to the hospital after the first sign appears in the form of abdominal pain when moving or bending. First, the doctor examines and palpates the peritoneal area. This is necessary to determine the presence of malignant neoplasms, which are manifested by bloating and changes in intestinal contractility.
Then the patient is required to undergo instrumental examinations:
- rectoscopy;
- sigmoidoscopy;
- colonoscopy;
- biopsy of malignant cells;
- ultrasonography;
- magnetic resonance therapy.
In addition to regular colonoscopy, a virtual examination is performed. In addition, the patient is referred for an X-ray of the intestine. In addition to instrumental research methods, blood and urine tests are required from the patient for intestinal cancer. The results will immediately show a changed blood cell count. In addition, with the development of metastases, elements of the breakdown of cancer cells are observed in the blood.
Diagnostics
Since any cancer has a tendency to metastasize, the patient always undergoes additional examination of the entire body to identify secondary foci. A number of studies are prescribed:
- General and biochemical blood test.
- Analysis for tumor markers.
- Chest X-ray.
- Computer or magnetic resonance imaging.
- X-ray of the pelvic bones.
- Ultrasound examination of the abdominal and pelvic organs.
Metastases are confirmed after histological or cytological examination of tissue taken from the lesion by biopsy.
