Factors of Bleeding Severity Dependence in Acute Bleeding Colorectal Cancer
Colorectal cancer remains a major issue, despite the rapid development of modern medicine. According to the WHO, in 2012 in the world there were registered more than 1.36 million cases of colorectal cancer. According to our clinic data, intestinal bleedings comprise 9.5 % of the total number of gastrointestinal bleedings, and patients with acute bleeding colorectal cancer constitute 21.6 % in the structure of intestinal bleeding and 29.7 % in the structure of complicated colorectal cancer.
Objective of the Work. To identify factors of intestinal bleeding severity dependence in acute bleeding colorectal cancer.
Material and Methods. The object of research were 241 patients with acute bleeding colorectal cancer hospitalized in Kyiv city center to provide care for patients with gastrointestinal bleedings in 2002–2013. Moderate severity of hemorrhage was detected in 99 (41.1 %) patients, the average one — in 49 (20.3 %), severe — in 93 (38.6 %).
Results and Discussion. The dependence of the severity of intestinal bleeding localization, depth of tumor invasion, morphological and histological types of acute bleeding colorectal cancer were analyzed. In hospitalized patients, the following stage of the cancer process was: I — in 13 (5.4 %) patients, II — in 142 (58.9 %), III — in 41 (17.0 %), IV — in 45 (18.7 %). Tumors with a high degree of differentiation were detected in 141 (66.8 %) patients: highly differentiated adenocarcinoma (G-1) — in 35 (24.8 %), moderately differentiated adenocarcinoma (G-2) — in 105 (74.5 %), dimorphic tumor — highly differentiated adenocarcinoma + carcinoid (G-1) — in 1 (0.5 %). Tumors with a low degree of differentiation were detected in 70 (33.2 %) patients: low-grade adenocarcinoma (G-3) — in 58 (82.9 %), mucus (mucoid) adenocarcinoma (G-3) — in 10 (14.3 %), low-grade neuroendocrine carcinoma (NET) (G-3) — in 1 (1.4 %), glandular-squamous cell carcinoma (G-3) — in 1 (1.4 %). Exophytic type of growth was detected in 129 (53.5 %) patients, endophytic — in 112 (46.5 %). In 74 (30.7 %) of hospitalized patients was anemia. Among them, 63 (85.1 %) patients previously operated on for colorectal cancer, or with special treatment, and 11 (14.9 %) who were examined and treated for other diseases to diagnosis acute bleeding colorectal cancer in our clinic. Analyzed the presence of hemodynamic disturbances during hospitalization in this group of patients in the clinic and compared to the main group.
Conclusion. Acute bleeding cancer of the right half of the colon is less common compared to its localization in the left half of the colon — 58 (40.6 %) cases versus 85 (59.4 %), but in absolute terms the incidence of severe bleeding in tumor lesions of the right half colon is 2 times higher in relation to malignant neoplastic lesions of the left half of the colon and 2.1 times in relation to cancer of the rectum. With increasing depth of invasion of cancerous tumor grows and the number of intestinal bleeding moderate and severe stages, reaching 68.0 % at the depth of tumor invasion T3-T4. Structure in the severity of intestinal bleeding severe degree 1.7 times more likely to be determined by endophytic forms compared with exophytic, with moderate and severe bleeding levels identified in 67.3 % of 55 patients with diffuse infiltrative form and 80.7 % of 57 patients with ulcerative-infiltrative form, which is higher 2.1 and 4.2 times higher than moderate bleeding according to these groups endophytic forms acute bleeding colorectal cancer. Decline with differentiation of cancerous tissue, the number of bleeding severe, reaching 65.7 % in tumors with a low degree of differentiation. In absolute terms more severe bleeding in the localization acute bleeding colorectal cancer in the right half of the colon, but their intensity is less, which results in a smaller amount of bleeding with hemodynamically significant component in this location. When localizing acute bleeding colorectal cancer in the right half of the colon, severe bleeding occurs more, but their intensity is less than the localization in the left half of the colon and rectum, where heavy bleeding are less common, but the intensity of their more and more often they are accompanied by hemodynamically significant violations .
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