Šta su kolorektalni karcinomi?

U gornjem dijelu debelog crijeva, koji je jedan od organa probavnog sistema, otprilike 150-180 cm je debelo crijevo, 15-17 cm u donjem dijelu je područje zvano rektum, a ispod je analni kanal. Rak koji se vidi u debelom crijevu i rektumu naziva se kolorektalni rak. Polipi u debelom crijevu i rektumu čine 90% kolorektalnog karcinoma.
Prepoznavanje u ranoj fazi i uklanjanje ovih polipa, koji će se vjerovatno pretvoriti u rak za oko 5-10 godina, značajno smanjuje rizik od raka debelog crijeva.

Prevalencija kolorektalnih karcinoma

Rak debelog crijeva svrstava se kao treći najrašireniji rak u svim vrstama. Dok su kolorektalni karcinomi, koji su češći kod muškaraca širom svijeta, na trećem mjestu nakon raka pluća i prostate kod muškaraca, to dolazi nakon raka dojke u smislu prevalencije kod žena.
Rana dijagnoza kolorektalnog karcinoma, koji je smrtonosna vrsta raka, i upotreba novih metoda liječenja s razvojem tehnologije su među faktorima koji smanjuju stopu smrtnosti.

Uzroci i faktori rizika kolorektalnih karcinoma

Među uzrocima kolorektalnog karcinoma su promjenjivi faktori kao što su nezdrava ishrana, kao i nepromjenjivi rodni, starenje i genetski faktori. Općenito, uzroci i faktori rizika kolorektalnog karcinoma mogu se navesti na sljedeći način:

Doba

Rak debelog crijeva je vrsta raka koja se može pojaviti u bilo kojoj dobi. Međutim, studije pokazuju da je 90% pacijenata s dijagnozom kolorektalnog karcinoma u grupi starijoj od 40 godina..

Polipi

Polipi, čija je prevalencija veća kod osoba starijih od 50 godina, mogu biti benigni, ali se u nekim slučajevima mogu vremenom pretvoriti u rak. Iz tog razloga, formiranje polipa treba rano otkriti redovnim pregledima, a ove polipe treba ukloniti iz tijela prije nego što postanu kancerogene.

Porodična istorija kolorektalnog raka

Može se reći da ako postoji istorija kolorektalnog karcinoma kod srodnika prvog stepena kao što su majka, otac i brat i sestra, vjerovatnoća razvoja kolorektalnog karcinoma kod te osobe će se povećati. Osobe s porodičnom istorijom kolorektalnog karcinoma trebale bi početi skrining testove deset godina prije dobi u kojoj je članu porodice dijagnosticirana bolest..

Genetski poremećaji

Sindromi nasljednog raka kao što su porodični adenomatozni polipi su među faktorima koji povećavaju rizik od kolorektalnog karcinoma. Osobe s ovim i sličnim poremećajima trebale bi imati genetsko testiranje i od malih nogu ih prati kolonoskopija.

Prethodni kolorektalni karcinomi

Također treba imati na umu da pacijenti koji su ranije imali kolorektalni rak imaju veću vjerovatnoću da ponovo razviju ovu bolest. Istovremeno, karcinomi dojke, materice i jajnika povećavaju učestalost kolorektalnog karcinoma otprilike dva puta.

Ulcerozni kolitis ili Crohnova bolest

Upalne crijevne bolesti (ulcerativni kolitis i Crohnova bolest) su okidači za kolorektalni rak. Ljudi sa ovim bolestima imaju deset puta veću vjerovatnoću da razviju kolorektalni rak od drugih ljudi.

Nezdrav životni stil

Prekomjerna konzumacija crvenog mesa i prerađenog mesa, životinjskih masti i hrane bogate ugljikohidratima, ne uključujući dovoljno vlakana u ishrani, te niska konzumacija voća i povrća su među faktorima koji povećavaju rizik od kolorektalnog karcinoma. Neaktivni (sedentarni) život, pušenje i upotreba alkohola, te gojaznost su također faktori koji povećavaju rizik od raka. Vitamini A, C i E mogu pomoći u smanjenju razvoja raka. U isto vrijeme, pacijenti s dijabetesom tipa 2 također imaju veću vjerovatnoću da razviju rak debelog crijeva od drugih ljudi.

Simptomi kolorektalnih karcinoma

Kod kolorektalnih karcinoma, kao i kod svih vrsta raka, neki uobičajeni simptomi pomažu u dijagnosticiranju. Ovi simptomi mogu biti manje bolesti kao što su hemoroidi. Međutim, treba imati na umu da u većini slučajeva rak debelog crijeva ne pokazuje nikakve simptome, ili se jaki simptomi slični boli javljaju u uznapredovalim fazama.
U slučaju da tumor raste u debelom crijevu, mogu se vidjeti i teški poremećaji kao što su crijevna opstrukcija i povezana crijevna zapetljanost. Najčešći simptomi kolorektalnog karcinoma su sljedeći:
• Blood in the stool
• Diarrhea or constipation, sudden and unexpected changes in intestinal movements
• unexplained weight loss
• Stomachache
• feeling tired
• Weakness
• Anemia due to iron deficiency
• thinning in the stool
• Vomiting
• Frequent gas pains, cramps
• Feeling of fullness in the abdomen
These symptoms alone are not sufficient for a diagnosis of colorectal cancer. However, it is essential for early diagnosis for people who still have one or more symptoms to consult a doctor without delay.

Stages of Colorectal Cancers

Colorectal cancer, like other cancers, progresses gradually. After the diagnosis of cancer is made, it is determined to what stage the cancer has gone, and a treatment plan is drawn up accordingly.
•Stage 1: The cancer has spread to the intestinal wall. However, cancerous cells have not yet reached the outside of the colon.
•Stage 2: Cancer has spread to all intestinal folds. There is no spread to lymph nodes.
•Stage 3: Cancer has spread only to nearby lymph nodes and has not metastasized to other organs or lymph nodes.
•Stage 4: Cancer has spread to distant organs and tissues such as the lung and liver.

Diagnosis of Colorectal Cancers

Colorectal cancers, like many cancers, progress without showing many symptoms until the tumor grows. For this reason, polyps should be diagnosed by making regular checks, which should be removed with early intervention.In addition to routine check-ups, some tests should be done to diagnose cancer in people who show symptoms. The tests can diagnose cancer and determine its stage.

Physical Examination

First, family history, changes in intestinal movements and defecation, weight loss, and bleeding of people who apply to the doctor with specific complaints are questioned. Other patient diseases are also examined, and a rectal touch examination is performed. Rectal touch, on the other hand, can be defined as an anus examination conducted by the doctor through the finger.

Complete Blood Count

Complete blood count is an essential diagnostic test. It can also determine whether red blood cell levels have changed in people with bleeding, a sign of anemia.

Examination of occult blood in stool

This test, which determines whether occult blood is present in the stool sample that the patient will give, is also among the tests that help diagnose.

Rectosigmoidoscopy

The last 60-70 cm of the large intestine, including the anus, rectum, and sigmoid colon, is examined by an instrument with a camera at the end. During this procedure, called recto sigmoidoscopy, polyps and abnormal areas are concerned.

Colonoscopy

In the colonoscopy method, the inner surface of the large intestine is examined through a device from the anus. This procedure differs from rectosigmoidoscopy because the entire large intestine can be read in colonoscopy. Tissue samples can be taken for biopsy during colonoscopy, or polyps can be taken from the body. In addition, cancer cases that are diagnosed early and have not progressed can be treated with colonoscopy.

Other Imaging Methods

With imaging tests such as MR (magnetic resonance), US (ultrasound), CT (computed tomography), and PET (positron emission tomography), it is possible to detect how far the cancer has spread, other suspicious areas where the cancer may metastasize, and whether the treatment is effective.

Treatment of Colorectal (Large Intestine) Cancers

The primary treatment for colorectal cancer is surgery. Chemotherapy and radiotherapy are other options depending on the stage of the tumor. Before starting treatment, the cancer stage should be determined, and the patient should be informed about the treatment options, the side effects of these treatment options, and the changes that can be seen after the surgery.

It should not be forgotten that the treatment of colon and rectal cancer is done differently. Therefore, whether surgery or chemotherapy/radiotherapy is preferred in these two types of cancer may vary from patient to patient.

In the surgical method used in the treatment of colon cancer, the cancerous area and part of the intestine on both sides of the tumor are removed. After the tumorous area is removed, both ends of the intestine are tied together. However, in some cases, the remaining part may need to be attached to the anterior abdominal wall after removing the diseased part of the colon. As a result of this intervention, called a colostomy, stool comes out of the bags placed on the abdominal wall, not from the anus. This may be temporary or, in some cases, permanent. Chemotherapy applied to colon cancer patients can be carried out together with surgical methods in cases of second-stage cancer. In the third stage, chemotherapy is applied after the surgery. In contrast, in the fourth stage, it is impossible to resort to surgical methods; in this case, only chemotherapy is used. In some patients, it may not be possible to apply surgical methods after chemotherapy.
In rectal cancer, on the other hand, surgical methods can be applied in cases where cancerous cells are seen only in the last part of the large intestine. In this case, part of the rectum can be removed, or the whole can be removed. Temporary colostomy is also a method applied after rectal cancer surgery. However, suppose the tumor is close to the anus. In that case, the muscle controlling defecation is also removed with the cancer, and it should not be forgotten that the colostomy procedure is permanent in this case. Chemotherapy and radiotherapy are applied together with surgical intervention in second and third-stage cancer cases. Therapies can be administered before, during, and after surgery. In the fourth stage of rectal cancer, chemotherapy is applied primarily. In some patients, radiotherapy and surgery may be used in addition to chemotherapy.

Thanks to the experience accumulated for many years in the treatment of colon and rectal cancers, laparoscopic surgeries performed with the help of camera systems and elongated hand tools through small holes drilled in the abdominal wall, and Davinci robotic surgery, which is a more advanced method, has reached today's point.At this point, we perform less painful surgeries and offer our patients better cosmetic results. With the help of advanced high-definition HD camera systems, less bleeding, urination, and better protection of the nerves for performing sexual sensory functions are provided thanks to the surgical anatomy, which is seen in much more detail compared to open surgery.

In addition, in the last ten years, the early stages of rectal cancer can be successfully treated, and the anus can be protected with long non-surgical chemotherapy and radiotherapy applications called NOM. In addition to this progress, especially in rectal cancer, with individualized treatments and targeted therapies, treatment tailoring can be done, and specific treatments can be planned for the person and the disease. If colorectal cancers are treated using an integrative approach in centers where tumor boards work well, radiation oncology, surgery, gastroenterology, medical oncology, nuclear medicine, pathology, radiology/interventional radiology, and tomotherapy units are gathered, and the use of contemporary guidelines is mandatory, the most successful stage-specific reasonable survival rates will be achieved.