Bowel cancer: how to live after surgery?

After removal intestinal tumors patients are faced with a situation where they cannot yet consider themselves healthy. Even if there are no further signs of disease, cancer survivors remain under long-term supervision by an oncologist. This is due to the fact that radical surgical treatment does not guarantee complete removal of all tumor foci. The malignant process is characterized by invasion or infiltrative growth into adjacent layers and tissues, and cancer cells may be present quite far beyond the visible tumor. Within 15 days after the operation, a histological examination of the removed section of the intestine is required to make sure that the tumor has been completely removed; its type and boundaries are clarified under a microscope. The type of tumor is determined because the biopsy taken before surgery does not always accurately convey the number and type of cells included in the tissue sample.

The risk remains even after properly performed surgery to remove a tumor in the intestine. Even before treatment, some cancer cells can spread through the blood and lymph flow, that is, metastasize from the tumor to other organs and not manifest themselves for some time. Colon cancer most often metastasizes to the lymph nodes of the abdominal cavity and the liver. That is why, simultaneously with a section of the intestine, as many lymph nodes as possible are removed (lymphadenectomy). If the tumor grows throughout the intestinal wall, cancer cells will disperse throughout the peritoneum (carcinomatosis).

Thus, recurrence of oncology in the intestine after surgery is highly likely. While the risk of relapse remains, the patient after surgery to remove intestinal cancer is not considered recovered and is under clinical observation, the purpose of which is to identify a new malignant process as early as possible in order to begin re-treatment as early as possible. The higher the stage of the primary tumor, the higher the likelihood of relapse after radical treatment. Colon cancer, according to statistics, is more often detected in later stages, so there is a high risk that the tumor will recur.

The return of the tumor is possible both a month after intestinal surgery and several years later, therefore in oncology the minimum observation period is 5 years. In case of local relapse, the patient may experience a recurrence of the symptoms present before treatment, for example, manifestations of intestinal obstruction or intestinal bleeding, pain in the area of intestinal resection. To monitor changes in the surgical site, endoscopic examination (colonoscopy) is performed regularly. In case of spread to other organs, radiation diagnostics (X-ray, computed tomography, ultrasound) helps detect metastases. The clinical recommendations of the Ministry of Health of the Russian Federation clearly define examination methods and the timing when the examination should be repeated (the higher the risk, the more often).

There are currently no guaranteed methods for preventing the recurrence of cancer. Preoperative and postoperative chemotherapy have been shown to reduce the likelihood of relapse, but its use is severely limited due to toxic side effects and severe adverse events in response to chemotherapy. After the operation, the oncologist gives the necessary recommendations, which should be strictly adhered to. Recommendations relate to nutrition, physical activity, taking medications and the already mentioned dispensary observation.

If a repeat malignant process is detected, just like the first time, the question of complete removal of the tumor foci is raised. If after surgery there are no metastases, and the recurrence of colon cancer is local, they again try to remove the new tumor completely. With multiple distant metastases in different organs, the tumor is considered inoperable. In such cases, palliative surgery is possible in order to make the patient’s life easier and eliminate the most dangerous symptoms (for example, placing an intestinal stoma on the abdominal wall for tumor intestinal obstruction). To slow down oncological progress, antitumor therapy can be carried out, which is currently represented by many new methods and completely new classes of drugs. If metastases are single, it is possible to try to radically remove them along with the tumor. Today, radiofrequency ablation of secondary tumors in the liver has shown excellent results, allowing complete removal of malignant foci.