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Oncology treatment

Colon cancer with liver metastases

The blood supply to the intestines is designed in such a way that all venous blood flowing from it is filtered by the liver. This organ processes nutrients obtained from food and neutralizes toxic compounds. That is why the liver becomes the first “stop” for metastases in case of intestinal cancer. It reveals metastases in more than half of the patients.

What are metastases?

Metastasis is the main difference between a malignant process and a benign one. Cancer cells are able to migrate with lymph or blood far beyond the boundaries of the primary tumor. It is enough for one cell to be carried by the bloodstream to any organ with a developed capillary network for it to settle there and begin to multiply uncontrollably to give rise to a secondary tumor. As the metastatic tumor grows, it begins to destroy liver tissue and grow into ducts and vessels.

Malignant secondary lesions in the liver may not manifest themselves at all, but can cause pain, symptoms of liver failure and general exhaustion. Metastases can interfere with the normal outflow of bile, causing the patient to develop obstructive jaundice. In such cases, doctors first find the “branches” of the tumor, and then begin searching for the malignant source.

Why is a biopsy performed?

To understand where tumor cells came from in the liver, a sample is taken directly from the tumor site. The biopsy is performed with a needle under ultrasound guidance. This procedure does not require general anesthesia or incisions, but is performed directly through the skin, which is why it is called percutaneous biopsy. The resulting sample is examined under a microscope and the type of cells that make up the metastasis, and therefore the primary tumor, is determined. Oncology of the liver and intestines are very often combined, and the pathologist can detect cells of intestinal origin in the biopsy. Bowel cancer can develop from a variety of tissues. Depending on the type of cells, sarcomas, adenocarcinomas, neuroendocrine, lymphoid and stromal tumors are distinguished. A malignant process in the intestines may not manifest itself for the time being.

How does cancer manifest itself?

But, if the tumor grows into the intestinal lumen (exophytic growth), it begins to impede the passage of food, and as its size increases, it completely blocks it. In this case, partial intestinal obstruction becomes complete and requires emergency surgical intervention, since it threatens the patient’s life. In such cases, intestinal cancer becomes a surgical finding.

If the tumor grows into the thickness of the intestinal wall (endophytic growth), then intestinal patency can be maintained, and the tumor itself can grow into the wall and neighboring organs. The most severe stage is considered to be the spread of tumor cells throughout the peritoneum - carcinomatosis. In this case, the prognosis is already extremely unfavorable.

Can cancer be removed?

Malignant bowel disease can be completely removed by surgical excision of the section of intestine with the tumor. But resection will bring recovery only in the complete absence of secondary tumor foci: in the lymph nodes, in neighboring or distant organs. The probability of cure in this case is the highest, but an intestinal tumor at this stage is rarely detected, sometimes by chance - during a routine examination or examination for another disease. A single resection allows you to remove all malignant tissue, and the prognosis for such a patient is the most favorable.

But usually intestinal oncology is discovered when there are already complications and metastases in the liver. In this case, they speak of the last, fourth stage of the disease. With multiple metastases, the tumor is considered inoperable. Palliative surgery is prescribed to remove as many tumor cells as possible, and antitumor therapy is carried out.

Colon cancer with liver metastases has a poor prognosis. Not so long ago, the presence of secondary tumors in this organ was a sign of an incurable disease. Currently, new types of chemotherapy and targeted therapy have emerged that make it possible to fight these “branches” of the malignant process.

How are metastases treated?

If an intestinal tumor is inoperable due to liver metastases, chemotherapy is first prescribed to reduce the size of the tumor itself and the number of secondary lesions in the liver. Sometimes chemotherapy allows you to destroy most of the distant metastases and perform intestinal resection.

If single lesions remain in the liver, they are combated with various methods that have already proven their effectiveness. The oldest and most traumatic of them is surgical. The tumor was simply excised (liver resection), which was very traumatic, risky and not always feasible. That is why modern surgery has armed itself with other innovative technologies that do not require extensive intervention.

One of them is radiofrequency ablation. This method uses high-frequency electrical current to literally vaporize limited areas of liver tissue. Ablation is good because it allows you to destroy metastases without harming surrounding normal cells. The method has proven itself in the fight against liver metastases after intestinal cancer, but it also has its limitations: the secondary tumor should not be near large vessels, it should not exceed a certain size, and there should not be many malignant foci.

Another method is called embolization and refers to intravascular interventions. In this case, the artery supplying the tumor is blocked. The method is very precise and allows selective action on the smallest vessels to lead to tumor destruction. To speed up the death of cancer cells, a chemotherapy drug is also injected directly into the feeding vessel. The method is called chemoembolization, and it does not have a toxic effect on healthy cells.

What is remission?

Modernoncology annually introduces more and more effective and minimally invasive technologies into practice, making it possible to treat intestinal cancer even with metastases, which are no longer a death sentence for the patient. If, after surgery to remove the primary tumor, secondary lesions are discovered after some time, treatment continues. That is why, over a 5-year period, the absence of a malignant process after removal of intestinal cancer is not called recovery, but remission.

The likelihood of relapse increases depending on the stage of the disease. In order to detect possible relapses in a timely manner, the patient is followed up with an oncologist after the operation. According to the standards of the Ministry of Health of the Russian Federation, even after complete removal of an intestinal tumor, you must undergo regular examinations. Endoscopy is used to monitor the condition of the area of the intestine where the primary tumor was removed. For the upper intestines, fibrogastroduodenoscopy (FGDS) is used, for colorectal cancer (large intestine) - sigmoidoscopy and colonoscopy. Ultrasound and computed tomography make it possible to detect metastases in the liver while they are still large and can be eliminated with modern methods.

Author of the article:

Aleksanyan Aleksan Zavenovich

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