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There are no people in the world who have never had ARVI (acute respiratory viral diseases)...

A healthy human body is able to absorb so many salts obtained from water and food...

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Bowel cancer icd 10

Colon cancer

Colorectal cancer is more often observed in areas where the diet is dominated by meat and the consumption of plant fiber is limited. Meat food causes an increase in the concentration of fatty acids, which during digestion turn into carcinogenic agents. The lower incidence of colon cancer in rural areas and countries with a traditional plant-based diet (India, Central African countries) indicates the important role of plant fiber in the prevention of colon cancer. Theoretically, a large amount of fiber increases the volume of fecal matter, dilutes and binds possible carcinogenic agents, reduces the transit time of contents through the intestine, thereby limiting the time of contact of the intestinal wall with carcinogens.

These judgments are close to the chemical theory, which reduces the cause of the tumor to the mutagenic effect on the cells of the intestinal epithelium of exo- and endogenous chemical substances (carcinogens), among which polycyclic aromatic hydrocarbons, aromatic amines and amides, nitro compounds, oflatoxins, as well as tryptophan metabolites are considered the most active and tyrosine. Carcinogenic substances (for example, benzopyrene) can also be formed during irrational heat treatment of food products, smoking of meat and fish. As a result of the impact of such substances on the cell genome, point mutations (for example, translocations) occur, which leads to the transformation of cellular proto-oncogenes into active oncogenes. The latter, triggering the synthesis of oncoproteins, transform a normal cell into a tumor cell.

In patients with chronic inflammatory diseases of the colon, especially ulcerative colitis, the incidence of colon cancer is significantly higher than in the general population. The risk of developing cancer is influenced by the duration and clinical course of the disease. The risk of colon cancer with a disease duration of up to 5 years is 0-5%, up to 15 years - 1.4-12%, up to 20 years - 5.2-30%, the risk is especially high in patients suffering from ulcerative colitis in for 30 years or more - 8.7-50%. With Crohn's disease (in the case of damage to the colon), the risk of developing a malignant tumor also increases, but the incidence of the disease is lower than with ulcerative colitis, and amounts to 0.4-26.6%.

Colorectal polyps significantly increase the risk of developing a malignant tumor. The malignancy index of single polyps is 2-4%, multiple (more than two) - 20%, villous formations - up to 40%. Colon polyps are relatively rare in young people, but are quite common in older people. The most accurate estimate of the incidence of colon polyps can be judged from the results of pathological autopsies. The frequency of detection of polyps during autopsies is on average about 30% (in economically developed countries). According to the State Scientific Center of Coloproctology, the frequency of detection of colon polyps averaged 30-32% during autopsies of patients who died from causes unrelated to diseases of the colon.

Heredity plays a certain role in the pathogenesis of colon cancer. Persons who have a first-degree relationship with patients with colorectal cancer have a high risk of developing a malignant tumor. Risk factors include both malignant tumors of the colon and malignant tumors of other organs. Some hereditary diseases, such as familial diffuse polyposis, Gardner's syndrome, Turco's syndrome, are accompanied by a high risk of developing colon cancer. If colon polyps or the intestine itself are not removed from such patients, then almost all of them develop cancer, sometimes several malignant tumors appear at once. Familial cancer syndrome, inherited in an autosomal dominant manner, is manifested by multiple adenocarcinomas of the colon. Almost a third of such patients over the age of 50 develop colorectal cancer. Colon cancer develops in accordance with the basic laws of growth and spread of malignant tumors, i.e. characterized by relative autonomy and unregulated tumor growth, loss of organotypic and histotypical structure, and a decrease in the degree of tissue differentiation.

At the same time, it also has its own characteristics. Thus, the growth and spread of colon cancer is relatively slower than, for example, stomach cancer. For a longer period, the tumor remains within the organ, without spreading deep into the intestinal wall more than 2-3 cm from the visible border. Slow tumor growth is often accompanied by a local inflammatory process that spreads to neighboring organs and tissues. Within the inflammatory infiltrate, cancer complexes constantly grow into neighboring organs, which contributes to the appearance of so-called locally advanced tumors without distant metastasis.

In turn, distant metastasis also has its own characteristics. The lymph nodes and (hematogenous) liver are most often affected, although other organs, in particular the lungs, are also affected. A feature of colon cancer is the quite common multicentric growth and the occurrence of several tumors simultaneously (synchronously) or sequentially (metachronously) both in the colon and in other organs. Forms of tumor growth:

• exophytic (predominant growth into the intestinal lumen);
• endophytic (distributes mainly in the thickness of the intestinal wall);
• saucer-shaped (a combination of elements of the above forms in the form of a tumor-ulcer).

• adenocarcinoma (well-differentiated, moderately differentiated, poorly differentiated);
• mucous adenocarcinoma (mucoid, mucous, colloid cancer);
• signet ring cell (mucocellular) cancer;
• undifferentiated cancer;
• unclassified cancer.

• squamous cell carcinoma (keratinizing, non-keratinizing);
• glandular squamous cell carcinoma;
• basal cell (basaloid) cancer.

N - regional lymph nodes:

N0 - no damage to regional lymph nodes; N1 - metastases in 1-3 lymph nodes; N2 - metastases in 4 lymph nodes or more;

M - distant metastases:

M0 - no distant metastases; M1 - there are distant metastases.

Stages of tumor development (domestic classification):

Stage I - the tumor is localized in the mucous membrane and submucosal layer of the intestine. Stage IIa - the tumor occupies no more than the semicircle of the intestine, does not extend beyond the intestinal wall, without regional metastases to the lymph nodes. Stage IIb - the tumor occupies no more than the semicircle of the intestine, grows throughout its entire wall, but does not extend beyond the intestine, there are no metastases in the regional lymph nodes. Stage IIIa - the tumor occupies more than the semicircle of the intestine, grows through its entire wall, there is no damage to the lymph nodes. Stage IIIb - a tumor of any size with multiple metastases to regional lymph nodes. Stage IV - an extensive tumor growing into neighboring organs with multiple regional metastases or any tumor with distant metastases. Among malignant epithelial tumors, the most common is adenocarcinoma. It accounts for more than 80% of all colon cancers. For prognostic purposes, knowledge of the degree of differentiation (highly, moderately and poorly differentiated adenocarcinoma), the depth of germination, the clarity of tumor boundaries, and the frequency of lymphogenous metastasis is very important. Patients with well-differentiated tumors have a more favorable prognosis than patients with poorly differentiated cancer.

Low-grade tumors include the following forms of cancer.

• Mucous adenocarcinoma (mucosal cancer, colloid cancer) is characterized by significant secretion of mucus with its accumulation in the form of “lakes” of different sizes.
• Signet ring cell carcinoma (mucocellular carcinoma) often occurs in young people. More often than with other forms of cancer, massive intramural growth without clear boundaries is noted, which makes it difficult to choose the boundaries of intestinal resection. The tumor metastasizes faster and more often spreads not only to the entire intestinal wall, but also to surrounding organs and tissues with relatively little damage to the intestinal mucosa. This feature complicates not only radiological but also endoscopic diagnosis of the tumor.
• Squamous cell carcinoma is most common in the distal third of the rectum, but is sometimes found in other parts of the colon.
• Glandular squamous cell carcinoma is rare.
• Undifferentiated cancer. It is characterized by intramural tumor growth, which must be taken into account when choosing the extent of surgical intervention.

G. I. Vorobyov

medbe.ru

The first symptoms of sigmoid colon cancer and its treatment

Home Intestinal Diseases

Sigmoid colon cancer is widespread in developed countries. First of all, scientists associate this phenomenon with the lifestyle and diet of the average resident of an industrialized country. In third world countries, in general, cancer of any part of the intestine is much less common. Sigmoid colon cancer mainly owes its spread to the small amount of plant-based foods consumed and an increase in the overall proportion of meat and other animal products, as well as carbohydrates. No less important and directly related to such nutrition is a factor such as constipation. Slowing the passage of food through the intestines stimulates the growth of microflora that release carcinogens. The longer the intestinal contents are retained, the longer the contact with bacterial secretions, and the more of them become. In addition, constant trauma to the wall with dense feces can also provoke sigmoid colon cancer. In assessing prevalence, one should not miss the fact that people live much longer in developed countries. In a poorly developed world with backward medicine, people simply do not live to see cancer. Every 20 sigmoid colon cancers are hereditary - inherited from parents.

Risk factors also include the presence of other intestinal diseases, such as ulcerative colitis (UC), diverticulosis, chronic colitis, Crohn's disease of the colon, and the presence of polyps. Of course, sigmoid colon cancer can be prevented in this case - it is enough to treat the underlying disease in time.

ICD 10 code

The International Classification of Diseases, 10th revision – ICD 10 implies classification only by the location of cancer. In this case, ICD 10 assigns code C 18.7 to sigmoid colon cancer. Cancer of the rectosigmoid junction is excluded from this group; in ICD 10 it has its own code - C 19. This is due to the fact that ICD 10 is aimed at clinicians and helping them in the tactics of patient management, and these two types of cancer, different in location, have an approach to surgical treatment varies. So: ICD 10 code for sigma cancer – C 18.7

ICD 10 code for cancer of the rectosigmoid junction – C 19

Of course, ICD 10 classifications and codes are not sufficient for a complete diagnosis of sigmoid colon cancer. The TNM classification and various staging classifications are used and mandatory for use in modern conditions.

Symptoms of cancer

Speaking about the first symptoms of colorectal cancer, including sigmoid colon cancer, it should be mentioned that in the very early stages it does not manifest itself at all. We are talking about the most favorable stages in terms of prognosis in situ (in the mucous and submucosal layer of the wall) and the first. Treatment of such early tumors does not take much time; in modern medical centers it is performed endoscopically, giving almost 100% results and a prognosis of five-year survival. But, unfortunately, the vast majority of early-stage sigmoid colon cancer is detected only as an incidental finding during examination for another disease or during a screening study. As mentioned above, the reason for this is the complete absence of symptoms. Based on this, an extremely important method for detecting early cancer is a preventive colonoscopy every 5 years upon reaching 45 years of age. In the presence of a family history (colon cancer in first-degree relatives) - from 35 years of age. Even in the complete absence of any symptoms of intestinal diseases. As the tumor progresses, the following first symptoms gradually appear and begin to increase:

• Bloody discharge during defecation
• Mucus discharge from the rectum and mucus in the stool
• Worsening constipation

As you can see, the signs described above suggest only one thought - an exacerbation of chronic hemorrhoids is occurring.

Postponing a visit to the doctor for hemorrhoids for a long time, lack of sufficient examination, self-medication is a fatal mistake that claims tens of thousands of lives a year (this is not an exaggeration)! Cancer of the sigmoid and rectum is perfectly masked by its symptoms as chronic hemorrhoids. When the disease acquires its characteristic features, it is often too late to do anything, treatment is crippling or only symptomatic.

I hope you have learned this seriously and forever. If a doctor diagnosed you with hemorrhoids 10 years ago, prescribed treatment, it helped you, and since then, during exacerbations, you have used various suppositories and ointments on your own (easily and naturally sold in pharmacies in a huge assortment and for every taste), without going back to without being examined - you are a potential suicide.

So, we talked about the first symptoms of sigma cancer.

As sigmoid colon cancer grows, gradually (starting from about the end of stage 2) more characteristic symptoms appear:

• Pain in the left iliac region. It often has a pressing, unstable character. Appears only when the tumor grows outside the intestine.
• Unstable stool, rumbling, flatulence, the appearance of liquid, foul-smelling stool; when defecating, dense stool is in the form of ribbons or sausages. Most often there is a change in diarrhea and constipation. However, when the tumor blocks the entire lumen, intestinal obstruction occurs, requiring emergency surgery.
• Frequently recurrent bleeding after defecation. Remedies for hemorrhoids do not help. There may be an increase in mucus and pus.
• Symptoms characteristic of any other cancer: intoxication, increased fatigue, weight loss, lack of appetite, apathy, etc.

These are, perhaps, all the main symptoms that manifest sigmoid colon cancer.

Treatment and prognosis for sigmoid colon cancer

Treatment at the earliest stages - in situ (stage 0)

Let me remind you that cancer in situ is a cancer with minimal invasion, that is, it is at the earliest stage of its development - in the mucous layer, and does not grow anywhere else. Such a tumor can only be detected by chance or during a preventive study, which has long been introduced into the standards of medical care in developed countries (the absolute leader in this area is Japan). Moreover, the main conditions are the availability of modern video endoscopic equipment, which costs many millions (unfortunately, in the Russian Federation it is present only in large cities and serious medical centers), and the performance of the study by a competent, trained specialist (to the mass availability of which our country will also grow and grow - our medicine is aimed at volume, not quality). Thus, it is better to be examined in a large paid clinic with excellent equipment and staff or in a high-level free hospital. But let’s return to the topic of the article - treatment of early sigmoid colon cancer. Under ideal conditions, it is performed by submucosal dissection - removal of part of the mucosa with the tumor during endoscopic intraluminal surgery (therapeutic colonoscopy). The prognosis for this intervention is simply amazing; after 3-7 days in the clinic you will be able to return to normal life. No open surgery. Without chemistry and radiation therapy.

Naturally, performing this operation for the treatment of sigmoid colon cancer in situ requires first-class endoscopist knowledge of the technique, the availability of the most modern equipment and consumables.

In the early stages (I-II)

The first and second stages include tumors that do not grow into neighboring organs and have a maximum of 1 small metastasis to regional lymph nodes. Treatment is only radical surgical, depending on the prevalence:

• Segmental resection of the sigmoid colon - removal of a section of the sigmoid colon followed by the creation of an anastomosis - joining the ends. Performed only in stage I.
• Resection of the sigmoid colon - removal of the entire sigmoid colon.
• Left-sided hemicolectomy - resection of the left part of the large intestine with the creation of an anastomosis or removal of an unnatural route for evacuation of feces - colostomy.

If there is a nearby metastasis, regional lymphoidectomy is performed - removal of all lymphatic tissue, nodes, and vessels in this area. Depending on some conditions, treatment may also require radiation therapy or chemotherapy.

The prognosis is relatively favorable; with an adequate approach, the five-year survival rate is quite high.

In later stages (III–IV)

In advanced cases, more extensive operations are performed - left-sided hemicolectomy with removal of regional lymph nodes and nodes of neighboring zones. Chemotherapy and radiation therapy are used. In the presence of distant metastases, tumor growth into neighboring organs, only palliative, that is, maximally prolonging life treatment, is recommended. In this case, an unnatural anus is created on the abdominal wall or a bypass anastomosis (a path for feces past the tumor) so that the patient does not die from intestinal obstruction. Adequate pain relief, including narcotic drugs, and detoxification are also indicated. Modern standards of treatment involve removal of lymph nodes in very distant locations for stage III sigmoid colon cancer, which significantly reduces the chance of disease recurrence and increases survival.

The prognosis for advanced sigmoid colon cancer is unfavorable.

Conclusion

As you can see, timely detection, a qualitatively new approach to the treatment of sigmoid colon cancer makes it possible to correct the word “sentence” to the word “temporary inconvenience” for those people who truly value their lives. Unfortunately, the mentality of our nation, the desire to “endure until the last” does not have a very beneficial effect on the heartless statistics. And this applies not only to sigmoid colon cancer. Every day, hundreds of people suddenly (or not suddenly?) learn a terrible diagnosis, sincerely regretting that they did not see a doctor earlier.

Important!

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1.Can cancer be prevented? The occurrence of a disease such as cancer depends on many factors. No person can ensure complete safety for himself. But everyone can significantly reduce the chances of developing a malignant tumor.

2.How does smoking affect the development of cancer? Absolutely, categorically forbid yourself from smoking. Everyone is already tired of this truth. But quitting smoking reduces the risk of developing all types of cancer. Smoking is associated with 30% of deaths from cancer. In Russia, lung tumors kill more people than tumors of all other organs.

Eliminating tobacco from your life is the best prevention. Even if you smoke not a pack a day, but only half a day, the risk of lung cancer is already reduced by 27%, as the American Medical Association found.

3.Does excess weight affect the development of cancer? Look at the scales more often! Extra pounds will affect more than just your waist. The American Institute for Cancer Research has found that obesity promotes the development of tumors of the esophagus, kidneys and gallbladder. The fact is that adipose tissue not only serves to preserve energy reserves, it also has a secretory function: fat produces proteins that affect the development of a chronic inflammatory process in the body. And oncological diseases appear against the background of inflammation. In Russia, WHO associates 26% of all cancer cases with obesity.

4.Do exercise help reduce the risk of cancer? Spend at least half an hour a week training. Sport is on the same level as proper nutrition when it comes to cancer prevention. In the United States, a third of all deaths are attributed to the fact that patients did not follow any diet or pay attention to physical exercise. The American Cancer Society recommends exercising 150 minutes a week at a moderate pace or half as much but at a vigorous pace. However, a study published in the journal Nutrition and Cancer in 2010 shows that even 30 minutes can reduce the risk of breast cancer (which affects one in eight women worldwide) by 35%.

5.How does alcohol affect cancer cells? Less alcohol! Alcohol has been blamed for causing tumors of the mouth, larynx, liver, rectum and mammary glands. Ethyl alcohol breaks down in the body to acetaldehyde, which is then converted into acetic acid under the action of enzymes. Acetaldehyde is a strong carcinogen. Alcohol is especially harmful for women, as it stimulates the production of estrogens - hormones that affect the growth of breast tissue. Excess estrogen leads to the formation of breast tumors, which means that every extra sip of alcohol increases the risk of getting sick.

6.Which cabbage helps fight cancer? Love broccoli. Vegetables not only contribute to a healthy diet, but they also help fight cancer. This is also why recommendations for healthy eating contain the rule: half of the daily diet should be vegetables and fruits. Particularly useful are cruciferous vegetables, which contain glucosinolates - substances that, when processed, acquire anti-cancer properties. These vegetables include cabbage: regular cabbage, Brussels sprouts and broccoli.

7. Red meat affects which organ cancer? The more vegetables you eat, the less red meat you put on your plate. Research has confirmed that people who eat more than 500g of red meat per week have a higher risk of developing colorectal cancer.

8.Which of the proposed remedies protect against skin cancer? Stock up on sunscreen! Women aged 18–36 are especially susceptible to melanoma, the most dangerous form of skin cancer. In Russia, in just 10 years, the incidence of melanoma has increased by 26%, world statistics show an even greater increase. Both tanning equipment and sun rays are blamed for this. The danger can be minimized with a simple tube of sunscreen. A 2010 study in the Journal of Clinical Oncology confirmed that people who regularly apply a special cream have half the incidence of melanoma than those who neglect such cosmetics.

You need to choose a cream with a protection factor of SPF 15, apply it even in winter and even in cloudy weather (the procedure should turn into the same habit as brushing your teeth), and also not expose it to the sun's rays from 10 a.m. to 4 p.m.

9. Do you think stress affects the development of cancer? Stress itself does not cause cancer, but it weakens the entire body and creates conditions for the development of this disease. Research has shown that constant worry alters the activity of immune cells responsible for triggering the fight-and-flight mechanism. As a result, a large amount of cortisol, monocytes and neutrophils, which are responsible for inflammatory processes, constantly circulate in the blood. And as already mentioned, chronic inflammatory processes can lead to the formation of cancer cells.

THANK YOU FOR YOUR TIME! IF THE INFORMATION WAS NECESSARY, YOU CAN LEAVE A FEEDBACK IN THE COMMENTS AT THE END OF THE ARTICLE! WE WILL BE GRATEFUL TO YOU!

Coding of sigmoid colon cancer in the ICD

In the international classification of diseases, all neoplasms, both malignant and benign, have their own class. Therefore, a pathology such as sigmoid colon cancer according to ICD 10 has code C00-D48 according to the class.

• Disease coding

Any oncological process, even if it is localized in a specific organ, has many individual characteristics that distinguish it from other, at first glance, similar pathological conditions.

When coding cancer according to the 10th revision classification, the following indicators are taken into account:

• the primacy of the oncological process (any tumor can initially be localized in a specific organ, for example, the colon, or be the result of metastasis);
• functional activity (implies the production of any biologically active substances by the tumor, which is rarely observed in the case of intestinal tumors, but is almost always taken into account in oncology of the thyroid gland and other organs of the endocrine system);
• morphology (the term cancer is a collective concept implying malignancy, but its origin can be anything: epithelial cells, poorly differentiated structures, connective tissue cells, and so on);
• spread of the tumor (cancer can affect not one organ, but several at once, which requires clarification in the coding).

Features of sigmoid colon cancer

The sigmoid colon is part of the large intestine, almost its final part, located immediately in front of the rectum. Any oncological processes in it represent dangerous conditions of the body, not only due to intoxication with cancer cells or other general causes, but also due to significant disruption of the functioning of the digestive tract.

When a sigma tumor develops, the following problems arise:

• bleeding leading to severe degrees of anemic syndrome, when blood transfusion is required;
• intestinal obstruction caused by blockage of the intestinal lumen;
• germination into neighboring pelvic organs (damage to the genitourinary system in men and women);
• ruptures and melting of the intestinal wall with the development of peritonitis.

However, differentiating the diagnosis for any colon cancer is very difficult due to the similarity of symptoms. Only highly specific examination methods will help confirm the localization of the tumor. In addition, the clinical picture of the disease may be absent for a long time, appearing only when the tumor reaches a significant size. Because of this, according to ICD 10, intestinal cancer is quite difficult to code and, accordingly, prescribe treatment.

Disease coding

Malignant pathologies of the colon are coded C18, divided into subsections. The tumor process in sigma is coded as follows: C18.7. At the same time, there are additional codes for the functional and morphological features of the neoplasm.

Additional clarification is required due to the fact that an oncological diagnosis is established only on the basis of biopsy data, that is, cytological examination.

In addition, the prognosis for the patient will largely depend on the histological type of the tumor. The less differentiated cells specialists find in the sample, the more dangerous the disease is considered and the greater the chance of rapid spread of metastatic foci. In the section of colon neoplasms there are different tumor locations, but the problem is that the pathology spreads quickly. For example, cancer of the cecum according to ICD 10 is designated C18.0, but only until it extends beyond the intestinal tract. When the tumor invades several parts, code C18.8 is set.

mkbkody.ru

Malignant formation in the rectum and its prevention

The digestive organs are often susceptible to dysfunctional processes in the human body. This occurs due to a violation of the regime and quality of substances entering the digestive system, as well as due to the influence of external negative factors on the body. As a result, a person may face a serious illness that has a high mortality rate. We are talking about a malignant process that occurs in any organ.

The rectum (rectum) is the final section of the digestive tract, which originates from the sigmoid colon and is located to the anus. If we take into account the oncology of the large intestine as a whole, then rectal cancer (Cancerrectum) occurs in up to 80% of cases. Cancer rectum, according to statistics, affects the female half of the population, although the difference with this pathology in men is small. In the International Classification of Diseases (ICD) 10 views, rectal cancer ranks codemcb -10 C 20, colon cancer ranks codemcb -10 C 18 and codemcb -10 C 18.0 - cecum. Codemkb -10, intestinal oncological pathologies taken from icd - O (oncology) in accordance with:

• Primaryity and localization of the tumor;
• Recognizability (the neoplasm may be of an uncertain and unknown nature D37-D48);
• A number of morphological groups;
• Functional activity;
• A malignant lesion that is noted outside the tumor localization;
• Classifications;
• Benign neoplasmsD10-D

Rectal cancer (μd -10 C 20) often develops in adulthood, that is, after 60 years, but often the oncological process affects people during the reproductive period of the life cycle. In most cases, the pathology is observed in the ampulla of the rectum, but there is localization of the neoplasm above the ampulla of the intestine, in the anal-perineal part and in the sigmoid section of the rectum.

Causes (Cancerrectum)

Rectal cancer (μd -10 C 20) occurs mainly after long-term precancerous pathologies. There is a version about a hereditary predisposition to colorectal cancer. Remaining scars after injuries and operations can also degenerate into a malignant formation. The consequences of congenital anomalies of the large intestine are one of the causes of colorectal cancer. People suffering from chronic hemorrhoids and anal fissures are more likely to be at risk for developing an oncological process in the rectum. Infectious diseases, such as dysentery, as well as chronic constipation and inflammatory processes in the organ (proctitis, sigmoiditis) with the formation of ulcers or bedsores, may be factors that cause rectal cancer.

Precancerous conditions of the rectum

Polyposis (adenomatous, villous polyps). Such formations are observed in both children and adults. Polyps, both single and multiple, develop from epithelial tissue in the form of oval formations, which can have a wide base or a thin stalk. Male patients often suffer from polyposis, and this pathology has a hereditary factor. On microscopic examination of the affected area, hyperplasia of the intestinal mucosa is observed, which is expressed by a motley picture. During the act of defecation, polyps may bleed and mucous discharge may be observed in the stool. Patients with polyposis experience frequent tenesmus (the urge to empty the rectum) and nagging pain after defecation. The course of such a process often develops into oncology, in approximately 70% of cases, while the degeneration may affect some of the many existing polyps. Polyposis is treated only with surgery.

Chronic proctosigmoiditis. Such an inflammatory process is usually accompanied by the formation of cracks and ulcerations, against the background of which hyperplasia of the intestinal mucosa develops. In the patient's stool after defecation, mucus and blood are found. This pathology is considered an obligate precancer, so patients with proctosigmoiditis are registered with a dispensary and examined every six months.

Type of rectal oncology (micd -10 C 20)

The form of a malignant process in the rectum can be determined by diagnosing rectal cancer, which consists of a digital examination and rectoscopic examination of the organ. Endophytic and exophytic forms are determined. The first is characterized by a cancerous lesion of the inner mucous layer of the intestine, and the second, with germination into the lumen of the organ wall.

The exophytic form of a rectal tumor looks like a cauliflower or mushroom, from the surface of which, after touching, a bloody-serous discharge is released. This form of formation appears from a polyp and is called polyposis. Diagnosis of rectal cancer is often carried out using a biopsy method and subsequent histological analysis of the biomaterial.

Saucer-shaped cancer looks like an ulcer with dense, bumpy and granular edges. The bottom of such a tumor is dark with necrotic plaque.

The endophytic form is represented by a strong growth of the tumor, which compacts the intestinal wall and makes it immobile. This is how diffuse-infiltrative rectum cancer develops.

The appearance of a deep flat ulcer with infiltration, which bleeds and grows rapidly, indicates an ulcerative-infiltrative form of cancer. The tumor is characterized by a rapid course, metastasis and germination into nearby tissues.

Rectal cancer spreads through the bloodstream, locally and by lymphatic routes. With local development, the tumor grows in all directions, gradually affecting all layers of the intestinal mucosa up to 10-12 cm in depth. When the rectum is completely affected by the tumor, significant infiltrates form outside of it, which spread to the bladder, prostate in men, vagina and uterus in women. Depending on the histological examination, colloid type, mucous and solid cancer is determined. Metastases, the tumor spreads to the bones, lungs, liver tissue, and rarely to the kidneys and brain.

Rectal tumor clinic

The initial malignant formation of the rectum may not be signaled by any special symptoms, except for minor local sensations. Let's consider how rectal cancer manifests itself during the development of the tumor and its disintegration:

• Constant and intensifying with emptying, pain in the anus is one of the primary sensations in the presence of a tumor. The appearance of severe pain may accompany the process of cancer growing beyond the rectum;
• Tenesmus – frequent urge to defecate, during which there is partial release of mucous and bloody feces;
• Frequent diarrhea may indicate both dysbiosis of the digestive tract and the presence of a tumor in the rectum. With this condition, the patient may experience “band-like stool,” a small amount of feces with a large amount of mucus and bloody discharge. A complication of this symptom is atony of the anal sphincter, which is accompanied by incontinence of gases and bowel movements;
• Mucous and bloody discharge is a manifestation of the inflammatory process of the intestinal mucosa. Such symptoms may be a harbinger of an oncological process or its neglect. The appearance of mucus can occur before or during bowel movements, as well as instead of feces. Blood appears in small quantities in the early stages of cancer, and in larger quantities it is observed during rapid tumor growth. Bloody discharge comes out before defecation or along with feces, in the form of a scarlet or dark mass with clots.
• In the late stage of the neoplasm, when it disintegrates, purulent, foul-smelling discharge is noted;
• General clinic: sallow complexion, weakness, rapid weight loss, anemia.

Help with rectum malignancy

The most basic help for such pathology is to prevent the occurrence of the disease. Prevention of rectal cancer is characterized by a careful attitude towards your body, that is, it is necessary to control your diet, exercise and psychological state, and also consult a doctor in a timely manner if inflammatory processes in the intestines occur. Eating foods and drinks containing taste substitutes, emulsifiers, stabilizers, preservatives and harmful dyes, as well as abuse of smoked foods, fatty foods, alcohol, carbonated water, etc., can provoke cell mutation and the occurrence of a malignant process in the upper and lower parts of the digestive tract.

Nutrition for colorectal cancer should completely exclude the above foods and sweets with a focus on a gentle diet that should not irritate the intestines and have a laxative effect. The diet for colorectal cancer is based on increased consumption of selenium (a chemical element), which stops the proliferation of atypical cells and is found in seafood, liver, eggs, nuts, beans, seeds, herbs (dill, parsley, cabbage, broccoli), cereals (unpeeled wheat and rice).

The postoperative diet for rectal cancer excludes in the first two weeks: milk, broths, fruits and vegetables, honey and wheat cereals.

Prevention of rectal cancer is the timely treatment of hemorrhoids, colitis, anal fissures, personal hygiene, control over the act of defecation (systematic bowel movements, absence of difficult bowel movements, as well as the presence of blood and mucus in the stool), passing test tests for verification presence of atypical cells.

Rectum cancer treatment

Therapy for this form of oncology consists of surgery and a combined treatment method. Radical, palliative operations are performed in combination with chemotherapy and radiation sessions. The most commonly used surgery is a radical approach (Quenu-Miles operation) and Kirchner rectal removal. According to the extent of the lesion and the stage of the tumor, resection of the malignant area is sometimes performed.

Radiation therapy for rectal cancer is used in doubtful cases of radical surgery and when an unnatural anus is applied, as a result of which tumor growth is delayed and the viability of the cancer patient is prolonged, since the prognosis for survival of such patients is often unfavorable.

To diagnose benign tumors of the large intestine, laboratory and instrumental research methods are used. Objective examination data in most cases are uninformative. In some cases, pale skin and bloody discharge from the anus may be noted.
Among the laboratory methods, a general blood test is used, in which, in the presence of bleeding, a decrease in the level of red blood cells and hemoglobin is noted. Signs of anemia are most often observed with multiple bleeding colon polyps. If benign tumors of the large intestine are complicated by inflammation of the mucous membrane, erosion or the addition of a secondary infection, a general blood test reveals an increase in the level of leukocytes and an acceleration of ESR. When performing a stool occult blood test, minor bleeding that is not noticeable upon examination is diagnosed.
Among the instrumental diagnostic methods, irrigoscopy (x-ray examination of the large intestine) is used: for better visualization of the intestine, contrast containing barium is injected. Using this study, defects in the filling of the mucosa are detected, which indicates the presence of a tumor. The radiological criterion for benign tumors of the large intestine is the presence of a mobile filling defect with smooth, even and clear edges without changes in the relief of the mucous membrane. The presence of these signs makes it possible to distinguish benign neoplasms from malignant ones.
An important method for diagnosing benign tumors is endoscopy of various parts of the large intestine. Using sigmoidoscopy, the rectum and lower parts of the large intestine are examined. Colonoscopy makes it possible to examine the entire intestine for benign tumors. When carrying out this diagnostic procedure, the proctologist can take tissue samples for morphological examination, which will make it possible to clarify the morphology of the tumor and determine treatment tactics.
In most cases (60-75%), benign tumors of the large intestine are well visualized using a rectoscope or colonoscope. Polyps can be located either on a thin stalk or on a wide base. The mucosa of benign tumors of the large intestine is a normal pink color, although in some cases it can be purplish-red, standing out from the surrounding tissue. With the development of inflammation, the mucous membrane of benign tumors becomes swollen and hyperemic, which is clearly visible during endoscopy of the large intestine. If erosions occur, a mucosal defect with edematous edges, covered with fibrinous plaque, is visualized.

Colon cancer must be understood as a malignant neoplasm that grows from the mucous membrane of the large intestine. Very often the tumor is localized in the sigmoid, rectum and cecum.

The sigmoid colon is the segment of the large intestine that lies in front of the rectum. Visually, this intestine resembles the Greek letter “sigma” - Σ, hence its name.

The sigmoid colon occupies an important place in the process of digestion and saturation of the body with nutrients. Based on this, sigmoid colon cancer (ICD 10. Class II (C00-D48), C18, C18.7) is a rather dangerous oncological disease that can be fatal.

According to research data, this type of cancer is diagnosed quite rarely (5-6% of all cases; men over the age of 50 are susceptible to the disease. But still, this process is a relatively favorable form of cancer. With timely diagnosis and adequate treatment, the outcome of the disease improves significantly , compared to stomach cancer.

Occurrence of disease

The medical history of sigmoid colon cancer is influenced by the following factors:

• nature of nutrition - excessive consumption of fatty, meat and flour dishes, lack of products of plant origin;
• diseases of the large intestine (polyps, colitis);
• bowel dysfunction (constipation);
• hereditary factors;
• elderly age.

Clinical picture

Symptoms of colon cancer can vary depending on the location of the tumor process. In the early stages, pronounced symptoms, as a rule, are absent, but when collecting an anamnesis, one can identify a deterioration in general well-being, loss of ability to work, and loss of appetite. Weight loss with sigmoid colon cancer is rare; some patients even gain weight.

<>As the disease progresses, various intestinal symptoms are observed:

• Constipation and diarrhea;
• Rumbling in the intestines;
• Dull and cramping pain in the abdomen that does not depend on food intake;
• Unilateral bloating (with narrowing of the intestinal lumen by a tumor);
• Anemia (the result of chronic blood loss).

Subsequently, the symptoms rapidly increase; in severe cases, intestinal obstruction, inflammatory processes (cellulitis, abscesses, peritonitis), and bleeding occur.

According to research data, this type of cancer is diagnosed quite rarely (5-6% of all cases; men over the age of 50 are susceptible to the disease. But still, this process is a relatively favorable form of cancer.

Diagnosis and treatment

Diagnosis of this form of colon cancer includes anamnesis, external examination, palpation, laboratory tests of stool for obvious or occult blood, X-ray examination, sigmoidoscopy, colonoscopy.

This oncological process can be cured exclusively by surgery. The method of choice is wide resection of the affected area of ​​the intestine with regional lymph nodes.

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:

1. Defecation disorder. There may be retention of stool for up to several days, alternation of constipation with diarrhea, tensema (false urge) or a multi-stage bowel movement (several trips to the toilet are required to empty the intestines).
2. Various pathological discharges from the anus. These may be impurities of blood and mucus.
3. The presence of general weakness, increased fatigue, pallor of the skin, the appearance of shortness of breath and palpitations (signs of anemia and intoxication).
4. 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 passage 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:

1. 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.
2. 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.
3. 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.

In the international classification of diseases, all neoplasms, both malignant and benign, have their own class. Therefore, a pathology such as sigmoid colon cancer according to ICD 10 has code C00-D48 according to the class.

Any oncological process, even if it is localized in a specific organ, has many individual characteristics that distinguish it from other, at first glance, similar pathological conditions.

When coding cancer according to the 10th revision classification, the following indicators are taken into account:

• the primacy of the oncological process (any tumor can initially be localized in a specific organ, for example, the colon, or be the result of metastasis);
• functional activity (implies the production of any biologically active substances by the tumor, which is rarely observed in the case of intestinal tumors, but is almost always taken into account in oncology of the thyroid gland and other organs of the endocrine system);
• morphology (the term cancer is a collective concept implying malignancy, but its origin can be anything: epithelial cells, poorly differentiated structures, connective tissue cells, and so on);
• spread of the tumor (cancer can affect not one organ, but several at once, which requires clarification in the coding).

Features of sigmoid colon cancer

The sigmoid colon is part of the large intestine, almost its final part, located immediately in front of the rectum. Any oncological processes in it represent dangerous conditions of the body, not only due to intoxication with cancer cells or other general causes, but also due to significant disruption of the functioning of the digestive tract.

When a sigma tumor develops, the following problems arise:

• bleeding leading to severe degrees of anemic syndrome, when blood transfusion is required;
• intestinal obstruction caused by blockage of the intestinal lumen;
• germination into neighboring pelvic organs (damage to the genitourinary system in men and women);
• ruptures and melting of the intestinal wall with the development of peritonitis.

However, differentiating the diagnosis for any colon cancer is very difficult due to the similarity of symptoms. Only highly specific examination methods will help confirm the localization of the tumor. In addition, the clinical picture of the disease may be absent for a long time, appearing only when the tumor reaches a significant size. Because of this, according to ICD 10, intestinal cancer is quite difficult to code and, accordingly, prescribe treatment.

Disease coding

Malignant pathologies of the colon are coded C18, divided into subsections. The tumor process in sigma is coded as follows: C18.7. At the same time, there are additional codes for the functional and morphological features of the neoplasm.

Additional clarification is required due to the fact that an oncological diagnosis is established only on the basis of biopsy data, that is, cytological examination.

In addition, the prognosis for the patient will largely depend on the histological type of the tumor. The less differentiated cells specialists find in the sample, the more dangerous the disease is considered and the greater the chance of rapid spread of metastatic foci. In the section of colon neoplasms there are different tumor locations, but the problem is that the pathology spreads quickly. For example, cancer of the cecum according to ICD 10 is designated C18.0, but only until it extends beyond the intestinal tract. When the tumor invades several parts, code C18.8 is set.