ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Malignant formation in the rectum and its prevention

Posted By: admin 05/05/2016

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;

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 (ICB -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. The 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 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 is a frequent urge to defecate, during which partial release of mucous and bloody feces is noted;
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 intestine 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.

Rectal cancer

ICD-10 code

Associated diseases

Symptoms

Bleeding (the intensity of intestinal bleeding is usually insignificant, and most often it occurs in the form of a small admixture of scarlet blood in the stool);

Constipation, incontinence of feces and gases, bloating, frequent false urge to defecate);

Pain in the rectal area;

Weight loss, pale skin).

Impaired well-being of patients (general weakness, fatigue);

Anemia (a decrease in the level of hemoglobin in the blood, which is usually caused by intestinal bleeding in colorectal cancer).

In later stages of the disease, patients may experience intestinal obstruction, manifested by cramping abdominal pain, retention of gases and stool, and vomiting.

Causes

Rectal polyps belong to the group of obligate precancerous diseases with a high probability of transformation into cancer.

Treatment

* anterior resection of the rectum with restoration of its continuity by anastomosis (partial removal of the rectum when the tumor is located in its upper part);

* low anterior resection of the rectum with anastomosis (almost complete removal of the rectum with preservation of the anal sphincter when the tumor is located above 6 cm from the anus).

* abdominal-perineal extirpation of the rectum (complete removal of the rectum and obturator apparatus with the application of a single-barreled colostomy in the left iliac region);

Low anterior resection (coloproctology) of the rectum is performed with anastomosis (anastomosis) using a mechanical suture, open or laparoscopic. It is used in the case of rectal cancer, with the tumor localized in the lower parts of the rectum, at a distance of 4-8 cm from the anal canal. The advantages of this method: no lifelong colostomy. Currently, patients with low rectal cancers rarely undergo anastomoses; operations are completed without the formation of an anastomosis. Patients are given a colostomy, which they live with. The presence of a colostomy prevents patients from leading a socially active life, limits their daily activities, the colostomy causes enormous moral harm, and patients live in constant stress. Performing low anterior resections using a mechanical suture will allow patients to lead a normal life and relieve them of all the problems associated with an ostomy. This requires modern electrosurgical equipment: an ultrasonic scalpel, a modern bipolar coagulator, as well as the presence of modern staplers in coloproctology departments (circular).

ICD 10 – C20 – Rectal cancer

Rectal cancer is a malignant disease of the terminal portion of colon cancer. It is the last area that is often exposed to cancer, bringing quite a lot of problems to the patient. Like any other disease, colorectal cancer has a code according to the International Classification of Diseases, 10th revision, or ICD 10. So let’s look at this tumor from a classification perspective.

ICD 10 code

C20 – ICD 10 code for colorectal cancer.

Structure

First, let's look at the general structure according to ICD 10 before colorectal cancer.

Neoplasms – C00-D48
Malignant – C00-C97
Digestive organs – C15-C26
Rectum – C20

Neighboring diseases

Next door, in the digestive organs, according to the ICD, diseases of neighboring departments are hidden. We will list them here while we can. So to speak, a note.

C15 – esophagus.
C16 – stomach.
C17 – small intestine.
C18 – colon.
C19 – rectosigmoid junction.
C20 – straight.
C21 – anus and anal canal.
C22 – liver and intrahepatic bile ducts.
C23 – gallbladder.
C24 – other unspecified parts of the biliary tract.
C25 – pancreas.
C26 – other and ill-defined digestive organs.

As you can see, any oncological problem has a clear place in the disease classifier.

General information about cancer

We will not dwell on this disease in detail here - we have a separate full article devoted to rectal cancer. Here is only brief information and a classifier.

The main causes of the disease are smoking, alcohol, nutrition problems, and a sedentary lifestyle.

Outside of any international classifications, already within the structure according to the location of carcinoma, the following types are distinguished for treatment:

Rectosigmoid
Superior ampullary
Medium ampullary
Inferior ampullary
Anal hole

According to the aggressiveness of the manifestation:

Highly differentiated
Poorly differentiated
Moderately differentiated

Symptoms

Intestinal cancer in general is a disease that manifests itself only in late stages; patients present at stages 3 or 4.

Highlights in the later stages:

Blood in the stool
Fatigue
Feeling of fullness in the stomach
Pain during defecation
Constipation
Anal itching with discharge
Incontinence
Intestinal obstruction
Diarrhea
In women, fecal discharge from the vagina through fistulas is possible

Stages

Stage 1 – small tumor size, up to 2 centimeters, does not extend beyond the organ.

Stage 2 – the tumor grows up to 5 cm, the first metastases appear in the lymphatic system.

Stage 3 - metastases appear in nearby organs - bladder, uterus, prostate.

Stage 4 – widespread, distant metastases appear. A new classification is possible - into colon cancer.

Forecast

According to the five-year survival rate, the prognosis is divided into stages:

Diagnostics

Basic methods for diagnosing the disease:

Inspection.
Palpation.
Tests: urine, feces for occult blood, blood.
Endoscopy, Colonoscopy.
X-ray.
Tumor markers.
Magnetic resonance imaging, computed tomography, ultrasound.

Treatment

Let us highlight the main methods of treating this oncology:

Surgical intervention - from targeted removal of the tumor to removal of part of the rectum or its complete resection.

Chemotherapy. Injection of chemicals that destroy malignant cells. Possible side effects. Mainly used as an additional treatment before and after surgery.

Radiation therapy. Another method of additional treatment is to irradiate the tumor with radioactive radiation.

FAQ

Is it necessary to have surgery?

As a rule, yes. Surgery provides the maximum effect of treatment; radiation and chemotherapy only target the affected cells. The operation is not performed only at the last stage, when the treatment itself becomes pointless. So, if they suggest an operation, then all is not lost.

How long do people live with this cancer?

Let's be direct. The disease is not the best. But the survival rate is high. If detected in the first stages, patients live peacefully for more than 5 years. But on the latter it varies, on average up to six months.

Prevention

In order to prevent the occurrence of cancer, we follow these recommendations:

We do not provide treatment for intestinal diseases - hemorrhoids, fistulas, anal fissures.
We fight constipation.
Proper nutrition - emphasis on plant foods.
We throw out bad habits - smoking and alcohol.
More physical activity.
Regular medical examinations.

Rectal cancer

1 Rectum
2 Morbidity
3 Risk factors
4 Histological picture
5 Staging
6 Clinical picture
7 Diagnostics
8 Treatment
9 Forecast
10 Notes
11 See

Rectum

The rectum is the end section of the large intestine downward from the sigmoid colon to the anus (lat. anus), being the end of the digestive tract. The rectum is located in the pelvic cavity, begins at the level of the 3rd sacral vertebra and ends with the anus in the perineum. Its length is 14-18 cm, its diameter varies from 4 cm at the beginning to 7.5 cm in its widest part, located in the middle of the intestine, then the rectum narrows again to the size of the slit at the level of the anus. Around the anus in the subcutaneous tissue there is a muscle - the external anal sphincter, which covers the anus. At the same level there is an internal sphincter of the anus. Both sphincters close the intestinal lumen and hold feces in it.

Morbidity

Rectal cancer ranks 3rd in the structure of the incidence of malignant neoplasms of the gastrointestinal tract, accounting for 45% among intestinal neoplasms and 4-6% in the structure of malignant neoplasms of all localizations.

Risk factors

Many authors include long-term presence of feces in the rectal ampulla, chronic constipation, bedsores and ulcers as factors contributing to the occurrence of rectal cancer. Obligate precancerous diseases of the rectum include polyps (adenomatous, villous) with a high probability of transformation into cancer. Certain factors increase the risk of developing the disease. These include:

Age. The risk of developing colorectal cancer increases with age. Most cases of the disease are observed in the age group, while the disease occurs in<50 лет без семейного анамнеза встречаются гораздо реже.
Oncological history. Patients who have previously been diagnosed with colon cancer and treated appropriately are at increased risk for developing colon and rectal cancer in the future. Women who have had ovarian, uterine, or breast cancer are also at increased risk for developing colorectal cancer.
Heredity. Presence of colorectal cancer in blood relatives, especially in old age<55 лет, или у нескольких родственников, значительно увеличивает риск развития заболевания. . Семейный полипоз толстой кишки в случае отсутствия соответствующего лечения почти в 100 % случаев приводит к возрасту 40 лет к раку толстой кишки.
Smoking. The risk of death from colorectal cancer is higher in patients who smoke than in nonsmokers. Received by the American Cancer Society American Cancer Society) Evidence suggests that women who smoke have a 40% greater risk of dying from colorectal cancer than women who have never smoked. Among male smokers, this figure is 30%.
Diet. Research shows that a diet high in red meat and low in fresh fruits, vegetables, poultry and fish increases the risk of colorectal cancer. However, people who frequently eat fish have a lower risk.
Physical activity. Physically active people have a lower risk of developing colorectal cancer.
Virus. Carriage of certain viruses (such as some strains of human papillomavirus) may be associated with colorectal cancer and is an obligate precancerous condition for anal cancer.
Alcohol. Drinking alcohol, especially in large quantities, may be a risk factor.
Vitamin B6 intake is inversely associated with the risk of colorectal cancer.

Histological picture

In rectal cancer, the following histological forms are observed: glandular cancer (adenocarcinoma, solid cancer, signet ring cell, mixed, scirrhus) is more often observed in the ampullary part of the rectum; Rarely, the rectum (rather than the anal canal) may have squamous cell carcinoma or melanoma, probably due to the presence of ectopic transitional epithelium or melanocytes.

Staging

Stage I - a small, clearly demarcated, mobile tumor or ulcer up to 2 cm in greatest dimension, affecting the mucous membrane and submucosal layer of the intestine. There are no regional metastases.
Stage II - a tumor or ulcer measuring up to 5 cm, does not extend beyond the intestine, and occupies no more than half the circumference of the intestine. There are no metastases or with the presence of single metastases in regional lymph nodes located in the perirectal tissue.
Stage III - a tumor or ulcer more than 5 cm in greatest dimension, occupies more than the semicircle of the intestine, grows through all layers of the intestinal wall. Multiple metastases in regional lymph nodes.
Stage IV - an extensive disintegrating, immobile tumor that grows into surrounding organs and tissues. Many metastases to regional lymph nodes. Distant (hematogenous) metastases.

International classification of rectal cancer according to the TNM system :

The T symbol contains the following gradations:

TX - insufficient data to assess the primary tumor;
Tis - preinvasive carcinoma;
T1 - the tumor infiltrates the mucous membrane and submucosal layer of the rectum;
T2 - the tumor infiltrates the muscle layer, without limiting the mobility of the intestinal wall;
T3 - a tumor that grows through all layers of the intestinal wall with or without infiltration of perirectal tissue, but does not spread to adjacent organs and tissues.
T4 is a tumor that grows into surrounding organs and tissues.

The symbol N indicates the presence or absence of regional metastases.

NХ - insufficient data to evaluate regional lymph nodes
N0 - no damage to regional lymph nodes
N1 - metastases in 1 regional lymph nodes
N2 - metastases in 4 or more regional lymph nodes

The M symbol indicates the presence or absence of distant metastases.

M0 - without distant metastases
M1 - with the presence of distant metastases.

Clinical picture

The most common and consistent symptom of colorectal cancer is bleeding. It occurs in both early and later stages and is observed in 75-90% of patients. The intensity of intestinal bleeding is insignificant, and most often they occur in the form of impurities or blood in the stool, or dark clots, and are not constant. Unlike bleeding from hemorrhoids, with cancer the blood precedes the stool or is mixed with the stool. As a rule, profuse bleeding does not occur, and anemia in patients is more often detected in the later stages of the disease.

With rectal cancer, mucus and pus are released from the anus along with blood. This symptom usually appears in later stages of the disease and is due to the presence of concomitant perifocal inflammation.

The second most common symptom of cancer is various types of intestinal dysfunction: changes in the rhythm of bowel movements, the shape of feces, diarrhea, constipation and incontinence of feces and gases. The most painful for patients is the frequent false urge to defecate (tenesmus), accompanied by the discharge of small amounts of blood, mucus and pus. After defecation, patients do not experience satisfaction; they are left with the sensation of a foreign body in the rectum. False urges can be observed from 3-5 times a day. As the tumor grows, especially with stenotic cancer of the upper rectum, constipation becomes more persistent, and bloating is detected, especially in the left abdomen. At first these symptoms are intermittent, then they become constant.

Due to further growth of the tumor and the addition of inflammatory changes, partial or complete low intestinal obstruction occurs. In this case, patients experience cramping pain in the abdomen, accompanied by retention of gases and stool, and periodic vomiting occurs. Pain in patients with rectal cancer appears when the tumor spreads locally, especially when it spreads to surrounding organs and tissues. Only in anorectal cancer, due to the involvement of the rectal sphincter zone in the tumor process, pain is the first symptom of the disease at an early stage. In this case, patients tend to sit on only one half of the buttock - the “stool symptom”.

Violation of the general condition of patients (general weakness, fatigue, anemia, weight loss, pallor) is caused by daily blood loss, as well as tumor intoxication in the later stages of the disease. A full examination by a medical specialist and the results of a study of biopsy and cytological material are of decisive importance in diagnosis.

Diagnostics

Rectal cancer is a tumor of external localization, but, nevertheless, the percentage of errors and neglect in this form of cancer does not tend to decrease. Diagnosis of rectal cancer should be comprehensive and include:

digital examination of the rectum,
endoscopic methods - sigmoidoscopy with biopsy, fibrocolonoscopy (to exclude concomitant polyps or primary multiple lesions of the overlying parts of the colon),
X-ray methods - irrigography, survey radiography of the abdominal cavity, chest,
Ultrasound and computed tomography - to diagnose the spread of the tumor to neighboring organs, determine metastases in the abdominal organs (liver) and lymph nodes,
laboratory methods - general and biochemical blood tests, blood tests for tumor markers (to determine the prognosis of treatment and further monitoring).

Treatment

The surgical method is the leading one in the treatment of rectal cancer. In recent years, complex treatment has been actively used: irradiation in the form of preoperative exposure, after which surgical removal of the intestine with the tumor is performed. If necessary, chemotherapy is prescribed in the postoperative period.

The question of choosing the type of surgery for rectal cancer is very complex and depends on many factors: the level of location of the tumor, its histological structure, the degree of spread of the tumor process and the general condition of the patient. The final volume and type of surgical intervention are determined in the operating room after laparotomy and a thorough examination of the abdominal organs.

The widespread point of view that the most radical operation for rectal cancer is abdominoperineal extirpation is currently hardly acceptable both from an oncological point of view and from the point of view of possible subsequent social and labor rehabilitation.

Main types of rectal operations:

anterior resection of the rectum with restoration of its continuity by anastomosis (partial removal of the rectum when the tumor is located in its upper part);
low anterior resection of the rectum with anastomosis (almost complete removal of the rectum with preservation of the anal sphincter when the tumor is located above 6 cm from the anus).
abdominal-perineal extirpation of the rectum (complete removal of the rectum and obturator apparatus with the application of a single-barreled colostomy in the left iliac region);

Forecast

The prognosis for rectal cancer depends on the stage of the disease, the form of growth, the histological structure of the tumor, the presence or absence of distant metastases, and the radicalism of the intervention performed. According to generalized data from domestic and foreign authors, the overall 5-year survival rate after radical surgical treatment of rectal cancer ranges from 34 to 70%. The presence of metastases in regional lymph nodes reduces 5-year survival to 40% versus 70% without metastases. The five-year survival rate after surgical treatment of rectal cancer, depending on the stage of the tumor process, is: at stage I - up to 80%, at stage II - 75%, at stage III a - 50%, and at stage III b - 40%.

Notes

Levin KE, Dozois RR (1991). "Epidemiology of large bowel cancer". World J Surg 15(5):562-7. doi:10.1007/BF
Penn State University health and disease information
Strate LL, Syngal S (April 2005). "Hereditary colorectal cancer syndromes". Cancer Causes Control 16(3):. doi:10.1007/s8-4
American Cancer Society Smoking Linked to Increased Colorectal Cancer Risk - New Study Links Smoking to Increased Colorectal Cancer Risk 6 December 2000
‘Smoking Ups Colon Cancer Risk’ at Medline Plus
Chao A, Thun MJ, Connell CJ, et al. (January 2005). “Meat consumption and risk of colorectal cancer.” JAMA 293(2):. doi:10.1001/jama.293.2.172
“Red meat ‘linked to cancer risk’.” BBC News: Health. 15 June 2005. http://news.bbc.co.uk/2/hi/health/.stm
National Institute on Alcohol Abuse and Alcoholism Alcohol and Cancer - Alcohol Alert No.
Larson, S.; Orsini, N.; Wolk, A. (2010). "Vitamin B6 and risk of colorectal cancer: a meta-analysis of prospective studies." JAMA: the journal of the American Medical Association 303 (11): 1077-1083. doi:10.1001/jama.2010.263
AJCC Cancer Staging Manual (Sixth ed.). Springer-Verlag New York, Inc. 2002.

Links

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fibroma (desmoid) histiocytoma lipoma hibernoma leiomyoma rhabdomyoma granular cell tumor hemangioma glomus tumor lymphangioma synovioma mesothelioma osteoblastoma chondroma chondroblastoma giant cell tumor fibrosarcoma liposarcoma leiomyosarcoma rhabdomyosarcoma angiosarcoma lymph angiosarcoma osteogenic sarcoma chondrosarcoma

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Tumor suppression genes Oncogene Staging Gradations Carcinogenesis Metastasis Carcinogen Research Paraneoplastic phenomena ICD-O List of oncological terms

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Rectal cancer, V. B. Alexandrov. The monograph formulates the current state of problems that are of greatest interest in the study of such a serious suffering as rectal cancer. Special attention... Read moreBuy for 631 RUR
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The term “rectal cancer” refers to a pathological process, the course of which is accompanied by the formation of a malignant tumor. According to statistics, 45% of cases of neoplasms of the gastrointestinal tract are due to this disease. The disease is included in the International Classification of Diseases (ICD 10). Rectal cancer belongs to the group of malignant neoplasms of the digestive organs.

Currently, there are several ways to treat the pathology. If you consult a doctor in a timely manner, the prognosis is usually favorable.

Pathogenesis

The rectum is the final section of the intestine, ending at the anus. It is through the latter that feces leave the body into the environment. In an adult, it can vary between 15-20 cm. Its widest part is the ampulla, located in the pelvis and surrounded by a fat layer.

The mucous membrane of the organ contains a huge number of cells responsible for the production of mucus. It, in turn, facilitates the passage of feces through the intestines, that is, it plays the role of a kind of lubricant.

Under the influence of various unfavorable factors, the development of a pathological process that affects the mucous membrane is triggered. A malignant tumor gradually begins to form in it. As a result, the patient’s condition worsens and it becomes difficult to empty the organ. Ignoring pathology poses a threat not only to the health, but also to the life of the patient.

ICD-10 code C20 was assigned to colorectal cancer.

Etiology

The development of the disease can occur under the influence of a large number of triggering factors. The main causes of rectal cancer (in ICD-10, some of them are also assigned codes):

Polyps. Their sizes are of clinical significance. These neoplasms are benign, but if their height is 1 cm or more, the risk of cancer degeneration increases significantly.
Diffuse polyposis. This is a pathology, the development of which is most often due to hereditary predisposition. This is not yet rectal cancer (in ICD-10 the pathology has a different code), but already a condition that precedes it. The disease is characterized by the formation of a large number of polyps on the mucous membrane.
Human papillomavirus. Active activity of the pathogen in the area of the anus also does not always lead to rectal cancer. In ICD-10, papillomavirus is assigned code B07, that is, in fact, the pathology is characterized by the formation of warts and condylomas. However, these neoplasms sometimes have a tendency to become malignant.
Unbalanced diet. Most often found in people who consume large amounts of meat products. Such food, entering the intestines, is a favorable environment for the proliferation of pathogenic microorganisms. Reducing the consumption of plant-based fiber makes it difficult for stool to pass out, which is why their contact with tissues becomes longer.
Hypovitaminosis. With regular consumption of foods rich in vitamins A, E and C, the process of inactivation of carcinogens starts. With their deficiency, the degree of negative impact on the mucous membrane increases.
Obesity. According to statistics, people with excess body weight are most often diagnosed with colorectal cancer (ICD-10 also lists a large number of diseases that develop due to excess weight).
Physical inactivity. Contrary to popular belief, it is a disease. It also has its own code in ICD-10. Rectal cancer often develops in people whose lifestyle is extremely sedentary.
Frequent consumption of alcoholic beverages. Ethyl alcohol not only has an irritating effect on the mucous membrane, but also promotes the formation of cancer cells.
Regular contact with harmful substances. In this case, we are talking about persons whose professional activities involve working with toxic compounds.
Genetic predisposition.

Regardless of the severity of the symptoms and causes of rectal cancer (ICD-10, as mentioned above, indicates a large number of provoking pathologies), treatment of the disease cannot be delayed. This is due to the fact that the disease poses a threat to the patient’s life.

According to ICD-10, rectal cancer is a malignant neoplasm that forms on the mucous membrane. This process is accompanied by the appearance of specific symptoms. Its intensity directly depends on the size and location of the tumor, the nature of its growth and the duration of the disease.

The main symptoms of rectal cancer (some of them are also listed in ICD-10):

Discharge of blood from the anus.
Diarrhea or, on the contrary, constipation.
Discharge of pus or mucus from the anus.
Fecal incontinence.
Flatulence.
Frequent urge to defecate (up to 16 times a day). As a rule, they cause suffering to the patient.
Bloating.
Signs of intestinal obstruction (vomiting, severe pain in the abdominal area).
A sharp decrease in body weight.
"Stool sign." A patient with a tumor tries not to sit on hard surfaces with both buttocks, but only one.
Increased degree of fatigue.
General weakness.

If any of the above symptoms occur, you should consult a doctor. It is advisable to come to a therapist for your initial appointment. The doctor will prescribe a series of tests and, if there is a suspicion of a tumor, refer you to an oncologist and proctologist.

Diagnostics

The first step is collecting an anamnesis. The doctor carefully listens to the patient's complaints and asks him questions about his lifestyle. Already at this stage, a specialist may suspect that the patient has a neoplasm - rectal cancer. ICD-10 (code), existing complaints, examination results - this is a list of what the doctor enters into the medical record. To confirm the diagnosis, consultation with specialists is required. They are the ones who treat the patient.

Currently, the following studies are prescribed to confirm the diagnosis of rectal cancer:

Examination using rectal speculum.
Irrigoscopy.
Digital rectal examination.
Sigmoidoscopy.
CT scan.
Blood test for tumor markers.
Biopsy.
Histological examination.
Cytological analysis.

If necessary, the doctor prescribes additional tests: radiography of the abdominal organs, fibrocolonoscopy, laparoscopy, intravenous urography.

Based on the results, the doctor writes down a diagnosis with an ICD-10 code and signs of rectal cancer in the chart. Treatment is also described in detail.

Types of tumors

Each neoplasm has a specific histological structure. In this regard, rectal tumors are classified as follows:

Adenocarcinomas. Formed from glandular tissue.
Signet ring cell cancer. It is extremely rare and has a high mortality rate.
Solid cancer. Rarely seen. Tumor cells are arranged in sheets.
Scyrous cancer. The neoplasm is characterized by a large volume of intercellular substance.
Squamous cell carcinoma. Characterized by early metastasis.
Melanoma. The tumor is located in the area of the anus.

According to ICD-10, rectal cancer is a malignant process. In the classification of diseases, the above types of tumors are not assigned separate codes. They are all marked with the designation C20.

Tumor growth pattern

The neoplasm may rise above the surface of the mucosa. In this case, it is customary to talk about exophytic cancer. Sometimes the tumor grows into the intestinal wall. This is an endophytic cancer. A mixed form is often diagnosed. In this case, tumors grow both inside and into the lumen of the rectum.

Degree of aggressiveness

The course of the disease is also classified according to the rate of progression of the pathological process. In this case, the cancer can be low-, medium- and highly differentiated. Accordingly, in the first case, the pathology develops slowly and is not accompanied by painful symptoms, in the latter, the tumor grows quickly, and the process of metastasis starts in a short time.

In ICD-10, rectal cancer, as mentioned above, belongs to the group of malignant diseases. That is, in some cases it is possible to get rid of this pathology only through surgical intervention.

Any surgery on the rectum is traumatic. Currently, there are several intervention methods that make it possible to maintain normal bowel movements in the future and avoid negative consequences.

The main types of operations used in practice:

Resection of the anal sphincter and part of the rectum. It is advisable to carry out this type of intervention if there is a tumor in the area of the anus.
Removal of part of the rectum. After resection, the above tissues are sutured to the anus.
Abdominal-anal surgery. In this case, the rectum is completely removed and a new canal is formed by suturing tissue.
Abdominal-anal resection with excision of the muscle sphincter. The operation is identical to the previous one. The difference is that the anal sphincter is removed along with the rectum.
Abdominoperineal extirpation. Involves removal of the rectum and anal canal. The formation of the reservoir is carried out by lowering the sigmoid colon.

Pelvic evisceration is considered the most difficult operation. It involves the removal of all organs from this area. It is advisable to carry out this type of intervention if the tumor has significantly grown into neighboring tissues.

Radiation and chemotherapy

These treatment methods are auxiliary. Radiation therapy is carried out mainly in the preoperative period. The course of treatment is 5 days.

The following complications may occur during therapy:

Skin ulcers in the irradiation area.
Diarrhea.
Anemia.
Cystitis.
Atrophy of internal organs.
Leukemia.
Necrosis.

Chemotherapy is indicated after surgery. The goal of treatment is to consolidate the effect of the intervention and prevent the spread of cancer cells. The drugs are administered to the patient intravenously.

If you have colorectal cancer, your diet should be balanced. It is important to limit the consumption of foods rich in animal fats. The menu must contain vegetables and fruits. It is necessary to exclude fried, spicy and sour foods from the diet.

Forecast

The outcome of the disease directly depends on the timeliness of visiting a doctor. According to statistics, with early diagnosis and proper treatment, the survival rate in the next 5 years is 80%. If the first measures were carried out already at the stage of metastasis, this figure is half as much.

Prevention

To prevent the development of the disease, you do not need to follow specific recommendations. The general rules of prevention look like this:

In the diet, it is advisable to reduce the amount of food rich in animal fats.
Regularly expose the body to physical activity.
Control body weight.
Promptly treat identified diseases of the gastrointestinal tract.
Stop smoking and drinking alcoholic beverages.

Persons whose close relatives have suffered from colorectal cancer are recommended to undergo examination once a year. It includes both laboratory and instrumental diagnostic methods.

Finally

Rectal cancer is a disease characterized by the formation of a malignant tumor on the mucous membrane. Pathology poses a threat not only to health, but also to life. In this regard, you should consult a doctor when the first alarming signs occur. The main method of treating the disease is surgery. The choice of methodology is based on the results of diagnostic measures. Additionally, radiation and chemotherapy are performed. ICD-10 code C20 was assigned to colorectal cancer.

It begins at the level of the 3rd sacral vertebra and ends with the anus in the perineal area. Its length is 14-18 cm, its diameter varies from 4 cm at the beginning to 7.5 cm in its widest part, located in the middle of the intestine, then the rectum narrows again to the size of the slit at the level of the anus. Around the anus in the subcutaneous tissue there is a muscle - the external anal sphincter, which covers the anus. At the same level there is an internal anal sphincter. Both sphincters close the intestinal lumen and hold feces in it.

Morbidity

Risk factors

Factors contributing to the occurrence of rectal cancer, many authors include prolonged stay of feces in the ampulla of the rectum, chronic constipation, bedsores and ulcers. Obligate precancerous diseases of the rectum include polyps (adenomatous, villous) with a high probability of transformation into cancer. Certain factors increase the risk of developing the disease. These include:

Histological picture

In rectal cancer, the following histological forms are observed: glandular cancer (adenocarcinoma, solid cancer, signet ring cell, mixed, scirrhus) is more often observed in the ampullary part of the rectum; Rarely, the rectum (rather than the anal canal) may have squamous cell carcinoma or melanoma, likely due to the presence of ectopic transitional epithelium or melanocytes.

Staging

Russian classification:

Stage I - a small, clearly demarcated, mobile tumor or ulcer up to 2 cm in greatest dimension, affecting the mucous membrane and submucosal layer of the intestine. There are no regional metastases.
Stage II - a tumor or ulcer measuring up to 5 cm, does not extend beyond the intestine, and occupies no more than half the circumference of the intestine. There are no metastases or with the presence of single metastases in regional lymph nodes located in the perirectal tissue.
Stage III - a tumor or ulcer more than 5 cm in greatest dimension, occupies more than the semicircle of the intestine, grows through all layers of the intestinal wall. Multiple metastases in regional lymph nodes.
Stage IV - an extensive disintegrating, immobile tumor that grows into surrounding organs and tissues. Many metastases to regional lymph nodes. Distant (hematogenous) metastases.

International classification of rectal cancer according to the TNM system :

The T symbol contains the following gradations:

TX - insufficient data to assess the primary tumor;
Tis - preinvasive carcinoma;
T1 - the tumor infiltrates the mucous membrane and submucosal layer of the rectum;
T2 - the tumor infiltrates the muscle layer, without limiting the mobility of the intestinal wall;
T3 - a tumor that grows through all layers of the intestinal wall with or without infiltration of perirectal tissue, but does not spread to adjacent organs and tissues.
T4 is a tumor that grows into surrounding organs and tissues.

The symbol N indicates the presence or absence of regional metastases.

NХ - insufficient data to evaluate regional lymph nodes
N0 - no damage to regional lymph nodes
N1 - metastases in 1 regional lymph nodes
N2 - metastases in 4 or more regional lymph nodes

The M symbol indicates the presence or absence of distant metastases.

M0 - without distant metastases
M1 - with the presence of distant metastases.

Clinical picture

The second most common symptom of cancer is various types of intestinal dysfunction: changes in the rhythm of bowel movements, the shape of feces, diarrhea, constipation and incontinence of feces and gases. The most painful for patients is the frequent false urge to defecate (tenesmus), accompanied by the discharge of small amounts of blood, mucus and pus. After defecation, patients do not experience satisfaction; they are left with the sensation of a foreign body in the rectum. False urges can be observed from 3-5 to 10-15 times a day. As the tumor grows, especially with stenotic cancer of the upper rectum, constipation becomes more persistent, and bloating is detected, especially in the left abdomen. At first these symptoms are intermittent, then they become constant.

Diagnostics

digital examination of the rectum,
endoscopic methods - sigmoidoscopy with biopsy, fibrocolonoscopy (to exclude concomitant polyps or primary multiple lesions of the overlying parts of the colon),
X-ray methods - irrigography, survey radiography of the abdominal cavity, chest,
Ultrasound and computed tomography - to diagnose the spread of the tumor to neighboring organs, determine metastases in the abdominal organs (liver) and lymph nodes,
laboratory methods - general and biochemical blood tests, blood tests for tumor markers (to determine the prognosis of treatment and further monitoring).

Treatment

Main types of rectal operations:

anterior resection of the rectum with restoration of its continuity by anastomosis (partial removal of the rectum when the tumor is located in its upper part);
low anterior resection of the rectum with anastomosis (almost complete removal of the rectum with preservation of the anal sphincter when the tumor is located above 6 cm from the anus).
abdominal-perineal extirpation of the rectum (complete removal of the rectum and obturator apparatus with the application of a single-barreled colostomy in the left iliac region);

Forecast

Notes

Links

Tumors and oncology
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Bowel cancer icd 10

Colon cancer

The term “colon cancer” refers to malignant epithelial tumors of the cecum, colon and rectum, as well as the anal canal, that vary in shape, location and histological structure. C18. Malignant neoplasm of the colon. C19. Malignant neoplasm of the rectosigmoid junction. C20. Malignant neoplasm of the rectum. In many industrialized countries, colon cancer occupies one of the leading places in frequency among all malignant neoplasms. Thus, in England (particularly in Wales) about 16,000 patients die from colon cancer every year. In the USA in the 90s of the XX century. the number of new cases of colon cancer ranged from 140,000-150,000, and the number of deaths from this disease exceeded 50,000 annually. In Russia, over the past 20 years, colon cancer has moved from sixth to fourth place in frequency of occurrence in women and third in men, second only to lung, stomach and breast cancer. A balanced diet with balanced consumption of animal and plant products has a certain preventive value; prevention and treatment of chronic constipation, ulcerative colitis and Crohn's disease. Timely detection and removal of colorectal polyps plays an important role, therefore, in people over 50 years of age with an unfavorable family history, regular colonoscopy with endoscopic removal of polyps is necessary. There is no single cause known to cause colon cancer. Most likely, we are talking about a combination of several unfavorable factors, the leading of which are unbalanced nutrition, harmful environmental factors, chronic diseases of the colon and heredity.

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.

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).

Histological structure of tumors of the colon and rectum:

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

Special histological forms of rectal cancer:

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

Stages of tumor development (International classification according to the TNM system, 1997): T - primary tumor: Tx - insufficient data to assess the primary tumor; T0 - the primary tumor is not determined; Tis - intraepithelial tumor or with mucosal invasion; T1 - tumor infiltrates to the submucosal layer; T2 - tumor infiltrates the muscular layer of the intestine; T3 - the tumor grows through all layers of the intestinal wall; T4 - the tumor invades the serous tissue or directly spreads to neighboring organs and structures.

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.

Determination of the stage of the disease should be based on the results of the preoperative examination, data from the intraoperative revision and postoperative examination of the removed segment of the colon, including a special technique for studying the lymph nodes.

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 down 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. No chemotherapy or radiation therapy.

Naturally, performing this operation to treat 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 relapse 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.

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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.

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Malignant formation in the rectum and its prevention

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

Causes (Cancerrectum)

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.

Type of rectal oncology (ICB -10 C 20)

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.

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

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 is a frequent urge to defecate, during which partial release of mucous and bloody feces is noted;
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 postoperative diet for rectal cancer excludes in the first two weeks: milk, broths, fruits and vegetables, honey and wheat cereals.

Rectum cancer treatment

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The term “colon cancer” refers to malignant epithelial tumors of the cecum, colon and rectum, as well as the anal canal, that vary in shape, location and histological structure.

ICD-10 CODES

C18. Malignant neoplasm of the colon.
C19. Malignant neoplasm of the rectosigmoid junction.
C20. Malignant neoplasm of the rectum.

Epidemiology

In many industrialized countries, colon cancer occupies one of the leading places in frequency among all malignant neoplasms. Thus, in England (particularly in Wales) about 16,000 patients die from colon cancer every year. In the USA in the 90s of the XX century. the number of new cases of colon cancer ranged from 140,000-150,000, and the number of deaths from this disease exceeded 50,000 annually.

In Russia, over the past 20 years, colon cancer has moved from sixth to fourth place in frequency of occurrence in women and third in men, second only to lung, stomach and breast cancer.

Prevention

A balanced diet with balanced consumption of animal and plant products has a certain preventive value; prevention and treatment of chronic constipation, ulcerative colitis and Crohn's disease. Timely detection and removal of colorectal polyps plays an important role, therefore, in people over 50 years of age with an unfavorable family history, regular colonoscopy with endoscopic removal of polyps is necessary.

Etiology and pathogenesis

There is no single cause known to cause colon cancer. Most likely, we are talking about a combination of several unfavorable factors, the leading of which are unbalanced nutrition, harmful environmental factors, chronic diseases of the colon and heredity.

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.

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%. 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.

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.

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.

Classification

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).

Histological structure of tumors of the colon and rectum:

adenocarcinoma(highly differentiated, moderately differentiated, poorly differentiated);
mucinous adenocarcinoma(mucoid, mucous, colloid cancer);
signet ring cell(mucocellular) cancer;
undifferentiated cancer;
unclassified cancer.

Special histological forms of rectal cancer:

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

Stages of tumor development (International classification according to the TNM system, 1997):
T - primary tumor:
T x - insufficient data to assess the primary tumor;
T 0 - the primary tumor is not determined;
T is - intraepithelial tumor or with invasion of the mucous membrane;
T 1 - tumor infiltrates to the submucosal layer;
T 2 - the tumor infiltrates the muscular layer of the intestine;
T 3 - the tumor grows through all layers of the intestinal wall;
T 4 - the tumor grows into the serous tissue or directly spreads to neighboring organs and structures.

N - regional lymph nodes:
N 0 - no damage to regional lymph nodes;
N 1 - metastases in 1-3 lymph nodes;
N 2 - metastases in 4 lymph nodes or more;

M - distant metastases:
M 0 - no distant metastases;
M 1 - 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.
IIa stage- 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.
IIb stage- 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.
IIIa stage- the tumor occupies more than the semicircle of the intestine, grows through its entire wall, there is no damage to the lymph nodes.
IIIb stage- a tumor of any size in the presence of multiple metastases to regional lymph nodes.
IV stage- 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 cancer) 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 It is most common in the distal third of the rectum, but is sometimes found in other parts of the colon.
Glandular squamous cell carcinoma rarely occurs.
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