Diagnosis

The diagnosis of intestinal cancer can be made with certainty in the following instances: 1. If by abdominal or rectal palpation a tumor can be detected which is situated in the small or large bowel, and accompanied by symptoms of cachexia and disturbances of defecation. 2. The presence of a tumor as just described, and the discovery of small particles of the neoplasm in the evacuation giving microscopically the appearance of a cancerous growth. 3. Gradually increasing disturbances of the bowel for a few months in a heretofore healthy person, accompanied by cachexia and symptoms of a beginning or already developed stricture of the bowels and the presence of a small particle of growth in the stools, giving as above microscopically the picture of cancer.

If there is no tumor and if nothing cancerous is found in the stools, the diagnosis can never be made with certainty. A probable diagnosis of intestinal cancer will have to be made if cachexia is present, together with symptoms of gradually developing intestinal disturbances, indicating the beginning of an obstruction of the bowel, in a middle-aged or elderly person who has been well up to a few months before.

Prognosis

The prognosis of intestinal cancer is always unfavorable. Unless an early operation and total excision of the growth is resorted to, a fatal issue is sure to follow, although the exact duration of life can hardly be predicted, the latter depending upon subsequent complications.

Treatment

A cure is possible only by a total and thorough removal of the growth. We must therefore always endeavor to make the diagnosis as early as possible and advise an immediate operation whenever feasible. Cancer of the rectum can be recognized quite early and resection of the neoplasm is here followed by brilliant results. If the tumor is located farther up in the large bowel or in the small intestine, then the results of an operation are not so promising, for here the recognition of the growth is possible only at an advanced period, and by that time often adhesions with other organs and cancerous infection of the glands have already taken place. Excision of the tumor and resection of the intestine in the neighborhood of the neoplasm with an end-to-end anastomosis should be practised whenever feasible. In case, however, total resection is impossible, an entero-enterostomy or entero-colostomy, or if the cancer is situated in the rectum, a colostomy (artificial anus) will be of benefit. These operations are palliative in nature and prolong life, at the same time making it more comfortable. They are intended to allay the symptoms of obstruction and to carry the fecal matter over a new route, not passing through and thus not irritating the cancerous area.

In some instances of inoperable cancer of the rectum curettage followed by the application of the thermo-cautery is of benefit for a short period.

Aside from these surgical means the treatment should be symptomatic. The diet should consist of foods containing plenty of nourishment but very little indigestible residue, thus forming only a small quantity of fecal matter. If there is stagnation of the intestinal contents, cathartics will have to be given in order to liquefy the fecal matter. This can be done by means of castor oil, rhubarb, magnesium sulphate, and so on. If the neoplasm is located in the large bowel, irrigations with warm oil or water are preferable. The pains should be allayed by means of warm baths and cataplasms, but if these fail, by narcotic remedies, such as morphine, opium, codeine, or belladonna; suppositories being here most suitable. Eventual complications should be treated as such.