Thursday, November 12, 2009

Diagnosis of colorectal cancer

As a first simple analysis measures the faecal occult (hidden) blood in the stool, and a sampling of the rectum are carried out, as they are performed as screening measures or as part of preparedness.

Occult blood in the stool.

To test for faecal occult blood test, the patient receives 3 cards, which he takes home. For 3 consecutive days, will now chair a small amount applied to these test cards, which are then released back to the doctor. With the help of a test fluid that is instilled into the doctor's office on the cards can also be seen blood in the stool, if it is not visible to the naked eye. If the test is positive, further examinations should be performed to rule out any disease or colon cancer as early as possible to determine.

By scanning only a limited area of the intestine is reached.

The scanning of the rectum is the search for tumors located in this area, but even this limited part of the intestine is recordable. If the test positive for occult blood, which means it can be shown blood, this indicates a source of bleeding in the gut. This may be a tumor, but also another, eg inflammatory disease.

Endoscopic examinations are necessary for bowel cancer suspicion.

In concrete suspicion of cancer, but further measures are necessary. Here are a primary rectal and call colonoscopy (Rectosigmoidoscopy and colonoscopy) to. In preparation for these investigations, a cleansing of the bowel is necessary to achieve a "good view" for the physician and thus the best possible study conditions. For cleaning, it is necessary to take a few days before the examination only liquid food, and take immediately before the date is a laxative.

With a small forceps, tissue samples can be taken.

During the investigation itself is first introduced some air into the bowel to distend it. Subsequently, a flexible tube is advanced with the endoscope into the intestine, the rectum mirror up to the beginning of this section of the intestine, where colonoscopy up to the beginning of the entire large intestine. The actual reflection, that is the consideration of the intestinal mucosa through the lens, is only given the slow withdrawal of the instrument. If abnormal areas are found in the intestinal mucosa can be removed via a small built-in clamp directly to the small tissue histological examination. Even benign colon tumors (adenomas, see "tumors") may be directly removed through a small loop. Because the mirror examination Dilate is perceived by the necessities of the intestine affected by many to be unpleasant, may advance and / or be given during the investigation of pain and mild sedative.

Here is a brief overview of possible endoscopic examinations of the colon:
  • Proctoscopy: Is the study of the bowel disease. A proctoscope is a device with which you can view the rectum. It is a simple, tubular instrument. It may be with handle 8 to 15 inches long. The opening in front is beveled. Sometimes in the middle of the side a little window. Through the cavity in the middle of a lighting or other devices can be pushed. Thus it is possible to sample tissue or even obliterated hemorrhoids. By proctoscope the doctor can only reach the front areas of the anus.
  • Rectoscopy: The rectoscope proctoscope which is very similar, but it is much longer with up to 30 centimeters. The rectoscope can be rigid or flexible. Thus, the entire rectum may be considered. Often, so the view is better, pumped some air into the rectum, which later without any problems re-entering the outside world.
  • Sigmoidoscopy: The name of this investigation is derived from the sigmoid colon, which means nothing other than S-shaped colon. In the lower region of the colon is examined using a flexible endoscope. This study is one of the colonoscopy and is performed only if it has been found with proctoscopy and rectoscopy no cause for complaints. About miniature instruments, it is possible to sample tissue or remove, for example, to diverticula.
  • Colonoscopy: With the help of this study mirrored the entire large intestine to the transition into the small intestine.

X-ray with contrast may be necessary as a supplement.

In addition to the reflection of the large intestine x-ray examination can be performed with contrast material. Again, a preliminary bowel cleansing is necessary. For the investigation of liquid contrast agent itself opens into the intestine. To ensure that this is good from the inside walls of the intestine port, then after the contrast agent has not opened a little air, then the contrast slightly pressed against the intestinal walls. On the x-rays then prepared striking shape changes of the intestinal wall are visible, which may indicate a tumor.

Further investigation should determine the extent of the disease.

If the diagnosis of colorectal cancer found, further investigations are recommended to determine the extent of the disease:
  • Blood test to determine one (by the tumor-related anemia, anemia) (see "clinical picture and course").
  • Ultrasound examination of the liver to find any seed off "daughter tumors (metastases) to.
  • Renal ultrasound examination to rule out a urinary. A hydronephrosis can occur when a growing tumor on the intestine pushes the ureter and the urine from the kidney can not drain properly.
  • For tumors of the rectum with an ultrasound scan ultrasound probe introduced into the intestine to assess the thickness of the tumor.
  • Chest X-ray to exclude lung metastases.
  • Computed display to the size of the tumor and its spatial relationship to adjacent organs.

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