CANCER OF THE LARGE INTESTINE
DEFINITION: For cancer refers to an uncontrolled proliferation of cells , this may be benign if it remains confined to the site of development , malignant if it invades surrounding tissues or spread through remote metastases. Tumors of the large intestine can be benign or malignant. In the first category we find all polyps ( sessile or pedunculated neoplasm that juts out into the intestinal lumen) benign ; amartomatosi , inflammatory and hyperplastic. In the second category are neoplastic polyps ; tubular adenomas and hairy that may evolve into carcinomas , that constitute the group of highest importance of malignant intestinal. In the following descriptions we will consider mainly the colon cancer.
ETIOLOGY : The colon cancer is a disease characteristic of the intermediate or advanced , affects both sexes with an incidence slightly higher for men , There is a genetic predisposition. There is a transformation from neoplastic polyps to carcinomas.
SYMPTOMS: The initial stages of the disease are asymptomatic. Even after the disease is characterized by symptoms of ill-defined and associated with other abdominal conditions. The main ones are : Diffuse abdominal pain , modifications of the hive , or ribbon-like stools with blood and anemia.
DIAGNOSIS : In this disease is of great importance prevention. Colonoscopy performed at 35 years and thereafter at annual intervals over longer or shorter depending on various factors is the best prevention against colon cancer . The diagnosis is made initially with specialist and may be supplemented by further investigations such as blood tests , Colonoscopy , abdominal ultrasound , chest X-ray and tac thoracic / abdominal.
TREATMENT: In the course of colonoscopy can be removed so atraumatic polyps at an early stage. When the tumor has reached a degeneration such that the dimensions do not allow a removal of endoscopic or necessary the removal of the lymph nodes then surgery remains the only way to fight the disease. Interventions executables vary according to the location and extent of the tumor and do always behold the removal of the intestinal tract in question and the subsequent anastomosis of the stumps residues. In some cases you can only palliative interventions in order to restore the intestinal recanalization. Then an oncologist will decide the most appropriate therapeutic strategy to combat the disease. To date there are genetic tests to identify the best post-operative therapy and the possible risk of recurrence.
COMPLICATIONS: The main complications of colon cancer are: occlusions , perforation of the intestinal wall and fistulas (formation of tramiti) with adjacent organs.
INTERVENTION FOR CANCER OF THE LARGE INTESTINE
Carcinoma of the colon recognizes hereditary causes ( so it is important to undergo a colonoscopy in the presence of a positive family history) , for the rest there are only suppositions corroborated by studies more or less reliable so eat lots of fiber and regularly take aspirin protects from disease. The consumption of red meat linked to an increased incidence of the disease is conflicting opinions.
Indications for surgery
The indication for intervention is always in the presence of intestinal carcinoma also only in order to restore an intestinal transit to avoid the complications described above.
Results
The results will be better than earlier will be treated the disease. If the va una polipectomia endoscopic ( removal of the polyp in the course of endoscopic examination) to intestinal resection ( removal of the portion of intestine affected by tumor) , all'emicolectomia the ds sn ( removal of half or sn ds colon and part of the transverse) , the total colectomy ( removal of the entire colon) , to the packaging of a terminal colostomy in the iliac fossa ( procedure which consists in the upstream section of the intestine of the tumor and its suturing to the abdominal level). It is clear that the higher the speed the better the conditions in the diagnosis of the patient in post-operative. Today it is possible to use in post-operative genetic testing that address the care and prognosis of the disease.
The intervention
The operation is performed under general anesthesia , is , with appropriate variations , in the intestinal section upstream and downstream of the tumor and subsequent anastomosis of the stumps. Our experience has taught us that traditional ( possibility of manual abdominal exploration in the initial phase of the intervention associated with a better visualization of the operative field and better radical surgery when necessary) manuale suture ( avoiding the trauma of the staples of staplers) offers the best results in the short and long term.
Conclusions relating to the intervention
-
Duration intervention: 60 /120 my ( in relation to the indication)
-
Type of anesthesia: General
-
Dressings: 3
-
Length of stay: 5 gg.
-
Resumption of normal activities: 15 gg.
