Darmkrebs Symptome – Proktologe Freiburg Screening

Darmkrebs Symptome

Die Vorsorge

Immer wieder lesen wir über Dickdarmkrebs und um die dazugehörige Vorsorge. Umso öfter wir davon lesen oder hören, desto mehr beschleicht uns das Gefühl, dass wir irgendetwas verpassen. Sind wir mit der Vorbeugung nicht schon zu spät? Oder gerade umgekehrt „Das geht uns alles gar nichts an, das betrifft uns in keiner Weise“, „Die übertreiben alle“, nach dem Motto „wieder eine Sorge, um die wir uns kümmern müssen“.

Die Wahrheit liegt irgendwo dazwischen. Man muss es relativieren, denn jeder Mensch hat eine andere gesundheitliche Ausgangslage und nur eine verantwortungsvolle Beratung bei einem Spezialisten, der das Für und Wider mit dem Betroffenen erörtert, kann uns letzten Endes Klarheit bringen.

Der wesentliche Hintergrund, den Darm nicht außer Acht zu lassen, liegt darin, dass er bei anfänglichen Veränderungen keine Schmerzsignale aussendet. Der Darm als solches ist nämlich nicht wirklich schmerzempfindlich. Beschwerden werden über den Bandapparat und andere Strukturen, mit denen der Darm verbunden ist, vermittelt.

Was sind also die ersten Symptome bei beginnenden Veränderungen, die für einen Darmtumor sprechen könnten:

  1. Wiederholte schmerzfreie anale Blutungen
  2. Bauchschmerzen, die sich durch andere Gegebenheiten nicht erklären lassen (Unverträglichkeit auf Nahrungsmittel, Entzündungen, starke Gasentwicklung, Magen-Darm-Grippe, Infektionen, Durchfall, Stuhlverhärtung etc.)
  3. Plötzliche Leistungsminderung und Gewichtsabnahme
  4. Allgemeine nicht erklärbare Müdigkeit, Abgeschlagenheit
  5. Bei Blutbildkontrolle ungewöhnliche Ergebnisse

Um hier nur einige Möglichkeiten zu nennen.

Die Aussage, die wir am häufigsten zu hören bekommen: „Das sind ja nur die Hämorrhoiden“.

Doch gerade darin liegt die Gefahr. Der Stuhltest auf verstecktes Blut, der Blutspuren anzeigt, sollte immer weiter abgeklärt werden. Eine wiederholte Testung, bis der Test kein Blut mehr anzeigt, kann behandlungs-bedürftige Befunde verschleppen – mit zum Teil verheerenden Folgen.

Was also tun?

Mit zunehmendem Lebensalter tritt Darmkrebs sehr viel häufiger auf, weshalb ab dem 50. Lebensjahr zur Darmspiegelung (Koloskopie) geraten wird. Die neusten Studien zeigen jedoch, dass auch wesentlich jüngere Menschen an Darmkrebs erkranken können. Bei ca. 30% der Darmkrebsfälle bestand bereits ein familiäres Risiko. Eine frühzeitige Maßnahme sollte daher bereits in jüngeren Jahren regelmäßig erfolgen, um dem Risiko einer möglichen Darmkrebserkrankung vorzubeugen und um die Vorstufen von Darmkrebs rechtzeitig erkennen und behandeln zu können.

Der Hintergrund

Hier ist es interessant, dass gerade einmal bis zu 7% aller Menschen, die diese Maßnahme in Anspruch nehmen könnten, auch wirklich nutzen. Der häufigste Grund für die Zurückhaltung ist das unangenehme intensive Abführen vor der Untersuchung. Als nächstes werden genannt, mögliche Schmerzen und Verletzungen des Darmes und die Frage nach dem eigentlichen Nutzen bei doch auch oft in den Medien unterschiedlich dargestellten Meinungen.

Doch wie bereits oben erläutert, sollte dies in einem Gespräch mit dem Facharzt besprochen werden.

Der Darmkrebs ist einer der am besten erforschten Krebsarten überhaupt. Darmkrebs entsteht aus entarteten Darmpolypen, die im Allgemeinen sehr langsam wachsen.

Die meisten Polypen sind gutartige Polypen (Schleimhautpolypen) ohne jede Bedeutung. Zum Glück gibt es nur wenige Unterarten, die allerdings mit den Jahren durchaus entarten und damit bösartig werden können. Diese Entwicklung dauert aller Erfahrung und je nach Voraussetzung etwa 3-10 Jahre. Frühzeitig erkannt, kann man Darmpolypen heute während der Dickdarmspiegelung oder der Mastdarmspiegelung entfernen.

 

Darmkrebs tritt in den verschiedenen Abschnitten des Dickdarms unterschiedlich häufig auf. Die meisten aller Darmtumore findet man im letzten Darmabschnitt, also im Mastdarm und dem angrenzenden S-Darm (sog. Sigma).

Meist wird aus Angst und falscher Scham eine Untersuchung hinausgezögert. Treten dann die ersten Beschwerden auf, ist der Tumor teilweise schon fortgeschritten. Über den Darm spricht man nicht gerne. Beschwerden und Veränderungen bei der Verdauung und der Stuhlentleerung…dies ist auch heute immer noch ein Tabuthema – trotz der intensiven öffentlichen Aufklärungsarbeit und der Informations-möglichkeiten mithilfe aller modernen Medien.

Fast jedes andere gesundheitliche Problem wird zuhause, am Arbeitsplatz oder in der Freizeit mit der Familie, Freunden oder Bekannten besprochen. Ob es der letzte Check-Up mit Belastungs-EKG, die Knieoperation oder die Implantate beim Zahnarzt waren. Nur über den Darm wird geschwiegen. Dabei haben viele Menschen aus dem Kreis der Verwandtschaft, der Arbeitskollegen oder dem Freundeskreis dieselben oder ähnliche Beschwerden.

Die Anamnese (Vorgeschichte)

Zunächst wird gründlich die Vorgeschichte des Patienten erörtert. Dabei spielen Beschwerden wie z.B. Stuhlveränderungen, Afterblutungen, Inkontinenz-erscheinungen oder Erkrankungen wie Darmentzündungen (wie Morbus Crohn, Colitis ulcerosa o.ä.) sowie auch die Gesundheitsgeschichte der engen Familie und deren Erkrankungen eine wichtige Rolle. Die vielen einzelnen Informationen helfen dem Arzt im Wesentlichen bei der Findung der richtigen Vorbeugemaßnahme, um bereits im Vorfeld nach Möglichkeit die Entstehung eines Darmtumors einzuschränken. Auch wenn die Fragen oft als peinlich empfunden werden, sollten Sie sich Ihrem Arzt anvertrauen.

Die Untersuchung

Test auf verstecktes Blut im Stuhl

Bei etwa 5% der untersuchten Patienten wird durch den Test Blut im Stuhl nachgewiesen. Doch das heißt nicht, dass Sie tatsächlich an Darmkrebs erkrankt sind. Häufig sind Hämorrhoiden oder andere Blutungsquellen die Ursache. Doch reicht allein die jährliche Stuhltestung nicht aus, sondern sollte durch eine jährliche Untersuchung beim Proktologen und der ergänzenden Koloskopie je nach Absprache bzw. Erfordernis ergänzt werden, so dass Sie die optimale Vorsorge wahrnehmen und dadurch das Risiko an Darmkrebs zu erkranken um ein vielfaches verringern können.

Austasten mit dem Finger

Eine vorsichtige Tastuntersuchung des Enddarms (Rektaluntersuchung, Austasten des Afters, digitale anale Austastung) kann dem erfahrenen Arzt bereits einen entscheidenden Hinweis auf eine entsprechende Veränderung geben.

Rektoskopie (Mastdarmspiegelung)

Für diese Untersuchung wird in der Regel ein starres Instrument von ca. 20 bis 30cm Länge und einem Durchmesser von etwa zwei Zentimeter verwendet. Die Untersuchung dauert nur wenige Minuten. Dabei können zum Beispiel Entzündungen, Engstellen, Divertikel (Darmausstülpungen), Hämorrhoiden und Polypen sowie andere krankhafte Veränderungen entdeckt werden.

Polypen können sich unter bestimmten Umständen im Laufe der Zeit zu Dickdarmkrebs entwickeln und sollten deshalb zeitnah entfernt werden. Auch können Blutungen entdeckt und direkt behandelt werden. Die Mastdarmspiegelung kann ohne spezielle Vorbereitung durchgeführt werden. Gelegentlich wird der Darm kurz vor der Untersuchung durch einen kleinen Einlauf gereinigt.

Die Proktoskopie (Analkanal- und Enddarmspiegelung)

Für die Untersuchung wird ein sog. starres Instrument von ca. 10 bis 15cm Länge und variablem Durchmesser verwendet. In diesem Bereich werden die Größe des Hämorrhoidengewebes und andere Veränderungen genauestens untersucht. Gerade dieser sensible Abschnitt mit dem hochkomplizierten Apparat des Afterschließmuskels sorgt für unsere Kontinenz (Haltekraft). Jede krankhafte Veränderung kann damit erhebliche Auswirkung auf dieses System haben.

Die Koloskopie (Dickdarmspiegelung)

Vor der Untersuchung muss der Dickdarm komplett entleert werden, damit die Untersuchung nicht durch Stuhlreste behindert wird. Dafür wird am Vortag, zum Teil noch Stunden vor der eigentlichen Untersuchung ein starkes Abführmittel verabreicht. Das Abführen mit Abführlösungen empfinden viele Menschen als belastend. Vor ein paar Jahren mussten drei bis vier Liter wenig schmackhafter Flüssigkeit innerhalb weniger Stunden getrunken werden.

Der auch heute noch teils unangenehm empfundene Geschmack kann durch Kühlung der Lösung oder Zusatz von Apfelsaft oder anderer Fruchtsäften etwas gemindert werden. Es sind in der Zwischenzeit auch andere Präparate auf dem Markt, die den Vorgang deutlich erleichtern. Zwar muss der Patient dabei auch viel trinken (Tee, Wasser usw.), aber das Trinken fällt meistens leichter. Die für Sie in Frage kommenden Abführmöglichkeiten werden mit Ihnen von Ihrem Arzt vor der Untersuchung eingehend besprochen.

Während der Koloskopie können die verschiedenen Abschnitte des Darmes untersucht werden, gleichzeitig können Polypen entfernt und Biopsien (Gewebeproben) entnommen werden. Auf Wunsch kann während der Untersuchung ein Bewusstsein dämpfendes Medikament verabreicht werden, um den zuweilen schmerzhaften Druck durch die eingebrachte Luft und durch das flexible Untersuchungsinstrument selbst im Bauchraum zu reduzieren.

Eine Koloskopie erfolgt bei unauffälligem Befund erneut nach etwa 8-10 Jahren, bei gefundenen Polypen oder positiver Familienanamnese (bereits an Dickdarmtumore erkrankte Verwandte) allerdings auch in deutlich geringeren Abständen.

Die virtuelle Koloskopie

Dabei handelt es sich um eine computergestützte Untersuchungsmethode ähnlich der Durchführung einem CT (Computertomographie). Trotz hervorragender Ergebnisse bleibt diese Methode ausgesuchten Fällen unter bestimmten Umständen vorenthalten. Das Abführen des Darms bleibt einem dabei nicht erspart. Zudem können keine direkten Eingriffe wie das Entfernen von Polypen, das Gewinnen von Gewebsmaterial oder das Stillen von Blutungen vorgenommen werden, sodass letzten Endes bei Bedarf trotz alledem eine direkte Dickdarmspiegelung mit dem Instrument durchgeführt werden muss.

Fazit

Bitte denken Sie daran, dass jedes Jahr in Deutschland ungefähr 70.000 Menschen an Darmkrebs erkranken. Bei den ersten Symptomen, einem positiven Stuhltest, veränderter ungewöhnlicher Stuhlentleerung (ungeklärtem Wechsel von Durchfall und Verstopfung, länger anhaltenden Bauchschmerzen, tastbaren Veränderungen im Bauchraum usw.), kann es bereits Darmkrebs in fortgeschrittenem Stadium sein und ist daher wesentlich schwerer zu behandeln.

Allerdings kann es Jahre dauern, bis sich aus einem Polypen ein bösartiger Tumor entwickeln kann. Nutzen Sie daher Ihre Möglichkeiten zur Vorsorge, genauso wie Sie es zum Beispiel für Ihre Zähne tun.

Sowohl Ihr Arzt als auch die medizinischen Fachangestellten sind auf Ihre Bedürfnisse, Ängste und Fragen vorbereitet; und denken Sie daran, auch wir selbst und unsere Angehörigen können davon betroffen sein.

Sprechen Sie mit uns.

Ihr

Dr. Stephan Potzler

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