Causes of colon cancer

The main cause of malnutrition is adopted.

As causes of colon cancer is considered part of the diet. It is assumed that high-fat meat and rich, and thereby increasing the risk of diet low in fiber. Although this hypothesis has not been definitively proved, the indication of their accuracy but quite clear. Other risk factors are also counted and alcohol addiction, asbestos, and the frequent consumption of nitrosamines, for example in the form of cured one assumes that about 80 to 90 percent of colorectal diseases on nutritional and environmental factors are due. The risk of cancer increases from the 45th Year of life.

Adenomas or colon polyps can become malignant.

People who have benign tumors of the colon (called adenomas), one also speaks of intestinal polyps, there have a certain risk that convert it into a malignant tumor and thus into a cancer. If such a benign tumor, for example during a colonoscopy, found, we recommend the removal of the adenoma or during the investigation, e.g using a small loop.

Ulcerative colitis increases the risk of bowel cancer.

Patients who have chronic inflammatory bowel disease, the so-called ulcerative colitis suffer, also are at increased risk for colon cancer. Ulcerative colitis is known as a precancerous condition. This term describes diseases that are considered as potential "preliminary stage" for the development of cancer. For this reason, needed regular check-ups in ulcerative colitis by colonoscopy.

The risk increases with family pressures already at a young age.
For certain family obligations, or inherited diseases, there is an increased risk of getting colon cancer:

• People who have a particular gene, as evidenced so-called HNPCC gene, cancer to 80 - 90 percent of colon cancer. Conversely, at 10 to 15 percent of all cancer patients found that gene.

• In some families, this often leads to benign tumors of the colon (adenomas), one speaks of "familial adenomatous polyposis coli. At the risk of colorectal cancer is affected by the transformation of benign tumors to malignant tumors in 70 percent. However, less than 1 percent of patients with colon cancer, such polyposis coli.

• There are also some hereditary diseases in which occur particularly in the large intestine to the formation of benign adenomas. These can turn into cancer. These genetic diseases include Gardner's syndrome, in which the risk of malignancy is 85 percent, Turcot syndrome (about 70 per cent risk of malignancy), and the Peutz-Jeghers syndrome with only a low risk of malignancy.

Regular inspections are necessary.

Must be based on these family-related risks from the fact that the disease affected much earlier to cancer. Therefore, risk groups should have from 25 years of age once a year to an ultrasound examination every two years and perform an endoscopy.

Treatment for colorectal cancer

More on the gastro-intestinal disorders can be found here.

For the treatment of colon cancer are essentially 3 eligible therapies:

• Operation
• Radiotherapy
• Chemotherapy
  

Some of these therapeutic possibilities are also applied in combination.

The operation is paramount.

If the tumor is confined to the intestinal wall, it can be removed surgically good. However, it is necessary to remove the affected bowel, including associated lymph nodes and the connective tissue that attaches the intestines to the rear wall of the abdomen (mesentery), too. The resulting "gap" in the intestine can be bridged by the two resulting tails are linked. In colon cancers, is directly operated by an abdominal incision, in tumors of the rectum is also possible to access the tumor through the anus. Sometimes it is necessary to create the defecation a colostomy (artificial anus) to the newly operated to relieve bowel. To the end of a loop of intestine is sewn into the abdominal wall, where the stool is discharged into a glued-on bag. Depending on the individual situation, such artificial anus can be created as a bridging or a permanent solution.

Metastases can also be operated on.

Surgery is also useful if they have formed individual metastases in the liver and / or in the lungs. These can be removed with a surrounding rim of healthy tissue surgery as well.

Radiation therapy can be applied before and after surgery.

Radiotherapy is mainly performed for tumors in the rectum and that for larger tumors (stage T3 and T4, see "Staging". In general, the irradiation is performed before surgery to shrink the tumor already. Will the radiation therapy applied after surgery, the goal is to kill, and possibly some residual tumor cells. The duration of radiation therapy is highly individual. It depends on the tumor size and the nature and extent of planned or carried out the operation.

Conditions of chemotherapy:

Chemotherapy may be complementary especially if:

• Metastases
• A rapidly growing tumor or
• There are strong tumor-related symptoms.
  

The duration of treatment varies depending on the individual used drugs (cytostatics, cf "General Treatment") and the overall treatment approach.

A regular follow-up is necessary.

After completion of treatment of a regular follow-up examinations must be performed to detect any recurrence (recurrence of the disease) or metastatic disease early enough and effectively treated. In the event that an artificial anus was constructed, whose condition is monitored in the follow-up as well. Possibly, according to a major intestinal surgery, or after installation of an artificial anus a change in diet necessary. Such counseling is also often included in the follow-up. Follow-up examinations are usually during the first 2 years after completion of therapy in 3-month intervals is required. After that for another 3 years every 6 months. The investigations include a colonoscopy to exclude a relapse and an ultrasound examination of the liver and a chest X-ray to rule out metastases


For early detection of the tumor, the chances of recovery are good.

The chances of a cure for colon cancer depends mainly on the extent of tumor growth within the intestinal wall and the presence of metastases in the lymph nodes. It was found that after surgery, patients without metastases in the lymph nodes, and limited to the inner bowel wall tumor growth 5 years after the operation to 70 - 80 percent (stage I, 95 percent living, 80 percent stage II, stage III 30 - 60 percent). In patients with involvement of lymph nodes, this share is 30 - 50 percent.

Colon cancer staging

The TNM system is crucial in the choice of individual therapy.

After the TNM system of cancer according to the size of the tumor (T), the appearance of" daughter tumors (metastases) in lymph nodes (N, Latin for "nodus = knot and the occurrence of metastases in other organs (M) divided. This has consequences for the individual therapy in individual patients. For colorectal cancer, there is the following TNM classification:

T = size of the tumor
T stage

• Tx: No tumor assessment possible.
• T0: No evidence of a tumor.
• Tis: Non-invasive (not) in the surrounding tissue ingrown tumor.
• T1: tumor grows within the intestinal wall into the layer beneath the mucosal tissue.
• T2: tumor to grow into the muscle of the intestinal wall.
• T3: tumor grows beyond the bowel wall.
• T4: Tumor extends to adjacent organs or the peritoneum.
  

N = involvement of lymph nodes
N stage

• Nx: lymph nodes can not be assessed.
• N0: Lymph nodes are not affected.
• N1: Metastasis in 1 to 3 nearby lymph nodes.
• N2: Metastasis in 4 or more nearby lymph nodes.
  

M = Metastases
M stage

• M0: no organ metastases detected.
• M1: metastases in other organs present (eg, liver).
  

Stages:

Specifically for the colon cancer is the classification according to the TNM system also classified into 5 stages, which, however, is based on the TNM system:

• Stage 0: TisN0M0
• Stage I: T1N0M0 or T2N0M0
• Stage II: T3N0M0 or T4N0M0
• Stage III: Any T stage, as well N1M0 and N2M0
• Stage IV: Any T stage, and each N stage, as well as M1

Risk factor of colorectal cancer

The main cause of malnutrition is adopted.

As causes of colon cancer is considered part of the diet. It is assumed that high-fat meat thereby increasing the risk of diet low in fiber. Although this hypothesis has not been definitively proved, the indication of their accuracy but quite clear. Other risk factors are also counted and alcohol addiction, asbestos, and the frequent consumption of nitrosamines, for example in the form of cured one assumes that about 80 to 90 percent of colorectal diseases are due to nutritional and environmental factors. The risk of cancer increases from the 45th year of life.

Adenomas or colon polyps can become malignant.

People who have benign tumors of the colon (called adenomas), one also speaks of intestinal polyps, there have a certain risk that cast them as a malignant tumor and thus into a cancer. If such a benign tumor, for example during a colonoscopy, found, we recommend the removal of the adenoma or during the investigation, e.g using a small loop.

Ulcerative colitis increases the risk of bowel cancer.

Patients who have chronic inflammatory bowel disease, the so-called ulcerative colitis suffer, also are at increased risk for colon cancer. Ulcerative colitis is known as a precancerous condition. This term describes diseases that are considered as potential "preliminary stage" for the development of cancer. For this reason, needed regular check-ups in ulcerative colitis by colonoscopy.

The risk increases with family pressures already at a young age.

For certain family obligations, or inherited diseases, there is an increased risk of getting colon cancer:

• People who have a particular gene, as evidenced so-called Hereditary Non-polyposes Colorectal Cancer (HNPCC gene), cancer to 80 - 90 percent of colon cancer. Conversely, at 10 to 15 percent of all cancer patients found that gene.

• In some families, this often leads to benign tumors of the colon (adenomas), one speaks of "familial adenomatous polyposis coli. At the risk of colorectal cancer is affected by the transformation of benign tumors to malignant tumors in 70 percent. However, less than 1 percent of patients with colon cancer, such polyposis coli.

• There are also some hereditary diseases in which occur particularly in the large intestine to the formation of benign adenomas. These can turn into cancer. These genetic diseases include Gardner's syndrome, in which the risk of malignancy is 85 percent, Turcot syndrome (about 70 per cent risk of malignancy), and the Peutz-Jeghers syndrome with only a low risk of malignancy.

Regular inspections are necessary.

Must be based on these family-related risks from the fact that the disease affected much earlier to cancer. Therefore, risk groups should have from 25 years of age once a year to an ultrasound examination every two years and perform an endoscopy.

Disease and progression in colon cancer

More on the gastro-intestinal disorders can be found here.

At the start of colon cancer symptoms do not occur. Only late show general symptoms such as bloating or general, occasional indigestion. Because these complaints, however, are very commonplace, they hardly disturb anyone. That is why cancer is often discovered late, when the tumor growth leads to more serious complaints.

Frequent diarrhea and constipation occur in alternation.

With the increasing size of the tumor reduces the intestine, thus reducing its permeability. Then, the bolus can not freely pass through the gut, constipation is the result. If the bowel is narrowed by the tumor growth over a longer distance, it can be a very thin form result of the deposed stool. Conversely, the tumor growth can affect the large intestine but also in its function of avoiding the pre-digested chyme fluid. In this case, diarrhea symptoms are the result. Often these symptoms appear constipation and diarrhea but on the exchange.

You may experience severe abdominal pain.

If the tumor during its growth, which restricts the intestine and thereby threatened the regular onward movement of chyme. By strong contraction of the underlying muscles in the intestinal wall of the intestine tries to squeeze the stool against the obstacle or to get past. These strong muscle contractions are perceived by those affected can be very painful in the form of cramping abdominal pain.

The chair can be mixed with blood or mucus.

Some symptoms are noticeable to the chair. Changes in appearance can be caused by both the tumor itself, but they can also reactions of the intestinal mucosa at the tumor to be. Occasionally, blood or mucus can be observed on the chair. In particular, blood occurs occasionally from the tumor itself. The mucus produced is amplified by the irritated bowel wall. The blood outlet may be so small that it can not be detected by the naked eye, but only through a special test (occult blood test, cf "preventive measures"). Due to increased blood loss in turn can lead to a general anemia occur (anemia), which manifests itself in the form of pallor, fatigue, weakness, and diminished performance. For many sufferers, it also comes to weight loss.

Weight loss and weakness are often very stressful.

In particular, this "constitutional symptoms" such as weakness and declining performance, are often a great burden, since they participate in the hitherto exercised severely limit daily activities. In addition to the targeted cancer therapy for example can Blood transfusions are administered to compensate for the anemia and thus increase the well-being. Physiotherapy exercises are another helpful measure.

An artificial anus may be necessary.

Some stakeholders must be created as part of the operative tumor removal, an artificial anus. Many patients, this is unpleasant, and they limit their social contacts. Specialist inform individuals about proper care and detailed advice on how to deal with a colostomy. As a rule, then normal social contact problem. In partnership, family and friends open discussions are helpful to familiarize yourself with the new situation.

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.

Complaints and Therapy of Pancreatic cancer

Complaints not become effective until late on

As with many other types of cancer even when symptoms of pancreatic cancer at a later stage. Therefore, it is usually detected very late. Pancreatic cancers are on the rise. Today every third to fourth with cancer which is affected.

In most cases, in 75 percent of all cases, the head of the pancreas is affected.

Carcinomas in the pancreatic head cause the following symptoms:

• Nausea
• Loss of appetite
• Weight Loss
• Painless jaundice
  

Carcinoma of the pancreas body - Carcinoma of the pancreas in the body cause the following symptoms:

• Severe abdominal pain in the upper abdomen, radiating to the back. You become stronger after eating and lying down.

Aetiologies

Smokers are at greater risk
The causes are unclear. Favoring contribute off:

• Chronic pancreatitis
• Alcohol
• Nicotine
• Carcinogenic food components, peroxides, for example, during the heating of polyunsaturated fatty acids are formed, or nitrosamines, nitrates and nitrites, which are contained in cured and smoked.
  

Therapy

Operation only in the early stages

Only in the early stages of pancreatic cancer, with about 20 percent of all cases, removal of the pancreas possible. Thus, life expectancy is increased. Those affected will be the removal of the pancreas and diabetes need to inject insulin. In all other cases, only the recurrent tumor symptoms are treated. Affected and / or relatives should be informed early on about the possibilities of home care.


Intra-arterial chemotherapy and chemoembolization

One form of non-drug therapy, which is also used in liver cancer, is the Intra-arterial chemotherapy and chemoembolization.

These types of chemotherapy have the advantage of fewer side effects compared to intravenous or oral. If a cytostatic drug on the vein (intravenously) or in the form of tablets orally introduced into the body, it acts more systemic, it will affect the whole organism, because the drug enters the bloodstream. The risk of side effects, here is higher. If the chemotherapy drug injected directly into the tumor, however, reached only a small fraction of drug in the bloodstream. Therefore, the concentration in the cancerous tissue itself is high.

Systemic side effects are less

For this type of therapy, the cytotoxic Fluorodeoxyuridine (FUDR, Floxuridine) is preferably used. About 90 percent of this substance be chemically altered in the liver and thus inactivated. This process is called "first-pass effect or presystemic elimination", i.e a medicinal product may lose some of its effectiveness if it is metabolized to a large extent by the liver before it reaches the bloodstream. In the case of FUDR, which is directly administered in liver cancer, does this high "first pass effect" that the possible occurrence of systemic side effects is very low.

The flow rate of blood is reduced in the tumor

The intensity of the effect of locally administered cytostatic drugs can be further increased if the flow velocity of arterial blood in the tumor vessels is lowered. This provides for a longer residence time of the drug in diseased tissue, because it is not by the slowing of blood flow can be taken away so quickly. Combined to reduce the flow to be the cytostatic drug with fat droplets are injected into the tumor vessel. This process is called chemoembolization. ) A embolus (grch Embolos = wedge is a stopper, which is located in the bloodstream. This can for example a blood clot, or foreign objects like his in this case a fat droplets.

A cure is obtained with this process. It is used to relieve the symptoms and thus preserving the quality of life of those affected. In addition, the tumor can be reduced with this method so that the possibility of an operation and it can be safely removed.

Pain

In addition to a change in diet, the implementation of a pain therapy is recommended. Because of the severe pain are often used early on opiates.