Oncology of the rectum is often detected only in the later stages. This situation is due to untimely access to doctors, but the symptoms force the person to go to the hospital. However, cancer is a disease that is often fatal. In 2012, there was a record number of deaths from the development of malignant tumors - about 8 million people, according to WHO statistics, and 450 thousand of these people died from colon cancer. 70-80% of deaths are preventable if diagnosed early.
Oncology of the rectum is the occurrence of a malignant tumor in the distal large intestine, which is of epithelial origin. Clinically, this pathology is manifested by the presence of specific impurities in the feces (blood, mucus), bleeding from the rectum, pain in the sacrum and perineum, weight loss, weakness, anemia. As diagnostic methods, fecal occult blood tests, identification of laboratory markers, biopsy with subsequent morphological examination,sigmoidoscopy. Treatment - surgical (extirpation or resection of the rectum), with the possible use of chemotherapy for metastases to regional lymph nodes.
Suffer from this disease in most cases, older people, and among the patients there are significantly more men than women.
Predisposing factors
Several categories of factors contribute to the occurrence of rectal cancer. These include:
- Presence in the medical history of information about relatives who suffered from bowel cancer. For example, adenomatous familial polyposis is a rather rare genetic pathology in which there is a violation in cell division of the intestinal epithelial layer. There is such a disease with a frequency of 1:11000. From the appearance of the first symptom, it always turns into cancer. Lynch syndrome is also a fairly common gene mutation that causes a tendency to oncology of the rectum. Causes approximately 5% of all cases.
- Chronic bowel disease, such as Crohn's disease, non-specific ulcerative colitis (abbreviated as NUC), Whipple's disease, adenomas and polyps in the intestine (benign tumors), chronic proctitis, as well as diseases that provoke a violation of peristalsis (irritable bowel syndrome, motor dyskinesia, complications of stem vagotomy, etc.). What else can provoke rectal cancer?
- Wrong lifestyle often leads to cancer, nutritional factors: lack or insufficient amount of food consumedfiber (pearl and corn grits, fruits, vegetables, black bread, etc.), the predominance of irritating and indigestible foods (flour, spicy, fatty and s alty foods), plentiful and rare meals. Smoking is also a factor that affects the digestive organs to a certain extent. Alcohol has little effect on the rectum, but its role in the development of cancer is not excluded.
It should be noted that hemorrhoids do not cause oncological processes. There is an opinion among people that this disease is a risk factor for this disease, but this is a delusion. Since hemorrhoidal formations are not part of the mucous membrane, they cannot affect the rectal epithelium. However, if left untreated for a long time, this disease leads to chronic proctitis, which is a risk factor.
Oncology of the rectum does not always develop in the presence of one of the above factors (the exception is familial adenomatous polyposis and colon polyps). In order to timely diagnose the pathology, one should pay attention to the specific symptoms that accompany the development of a malignant neoplasm.
Classification
Therapeutic tactics, symptoms and signs of the disease in rectal oncology are determined by the location and size of the tumor, the degree of its differentiation, spread to the lymph nodes and other organs.
Malignant neoplasm may be located:
- Anorectally - above the anus there is a hole (in the sphincter zone). There is suchtumor localization in 6% of cases. The disease is characterized by early symptoms in the form of constant stabbing pain, which is not relieved by NSAIDs. Because of this, the patient has the so-called "stool symptom"), when a person is forced to sit on one buttock.
- Ampulyarno - in the middle section of the rectum. This is the most common localization (84%). The initial symptom is bleeding.
- Nadampullary - the tumor is localized in the upper area of the rectum (10% of cases) and does not cause any symptoms for a long time. Often people seek help because of bowel obstruction.
In addition to the above criteria, an important role is played by the level of differentiation of the oncological process - how tumor cells are similar to normal cells of the rectum. To date, there are 4 main categories of rectal oncology (cancer can be different):
- Adenocarcinoma (well-differentiated tumors) - more than 90% of cells have a normal structure.
- Medium differentiated - half of all cells are "atypical" (not similar to he althy body cells).
- Poorly differentiated (small, large and squamous cell carcinoma) - 90% malignant cells.
- Undifferentiated, in which tumors contain more than 95% of "atypical" cells.
The less differentiated oncology is diagnosed, the faster the neoplasm grows, spreads throughout the body and responds worse to therapy.
Stages
Symptoms of rectal cancer depend on the stage. To assess the development of the tumor and the spread of pathological cells throughout the body, the stages were determined by clinicians:
- I stage of oncological pathologies of the intestine is characterized by the absence of obvious clinical symptoms and patient complaints. If the manifestations are still present, then they are rather non-specific - a person may complain of general weakness, a slight increase in temperature, malaise, and during defecation, he may experience unpleasant symptoms. The tumor at the same time has a very small size and penetrates the epithelium of the intestinal wall, without penetrating deep into. Along with this, there are no lesions of regional lymph nodes and metastases to other organs.
- II stage. At this stage, rectal cancer differs in the size of the tumor, which can reach 5 cm. At the same time, malignant cells do not penetrate into other parts of the intestine. There are no metastases at this stage yet, but sometimes there is a single lesion of the lymph nodes. At this stage, damage to nearby he althy tissues develops, due to which the symptoms may worsen. Digestive disorders, increased intestinal bleeding are possible. The patient may complain of tenesmus (painful urging) or persistent constipation. General he alth deteriorates significantly. Tumor growth causes a narrowing of the intestinal lumen, intestinal obstruction develops, manifested by constipation and pain. At the second stage, the lumen is blocked by 50%.
- III stage, the features of which are the size of the malignant neoplasm - more than 5 cm, the presence of metastases inlymph nodes, damage to neighboring organs and tissues, germination of cells in the thickness of the intestinal wall. The symptoms of this stage are significantly pronounced. Patients complain of frequent bleeding, intestinal obstruction, pain syndrome, which is associated with the germination of the tumor in the intestinal wall, chronic disorders of the digestive process. With oncology of the rectum, the symptoms and signs of the disease are aggravated at the last stage. The patient's stool contains pus, blood and mucus.
- IV stage. Oncology of the rectum at stage 4 is characterized by multiple metastatic lesions of the internal organs, both adjacent (reproductive, bladder, liver), and located remotely - the lungs and bones. A malignant neoplasm is large, its cells penetrate through the entire thickness of the intestinal wall. The clinical picture of the 4th stage of oncology of the rectum is quite severe. The patient complains of pronounced digestive disorders, he is constantly worried about pain and discomfort in the abdomen. Harmful substances formed during metabolism are not utilized from the patient's body, but penetrate into the bloodstream. This contributes to the emergence of an intoxication syndrome, which is manifested by a deterioration in the general condition, a decrease in body weight.
Symptoms and signs of colon cancer
This disease may not manifest itself as specific symptoms for a long time. The situation of the patient is aggravated by the fact that when symptoms appear, people often do not pay attention to it.
Main groupssymptoms of rectal cancer are:
- Isolation and their nature. It can be blood or mucous discharge, which is represented by pure blood, as in rectal bleeding (low location of the tumor). The neoplasm, localized in the upper and middle ampullae, is manifested by the presence of undigested blood.
- Intestinal irritation. These can be periodic pains in the abdomen by the type of spasms, sensation of a foreign body in the rectal area, false urge to defecate, diarrhea. These symptoms often occur in the early stages of cancer and precede intestinal obstruction, which is characteristic of large tumors.
- As a sign of oncology of the rectum, it is possible to single out a violation of the intestinal patency. The occurrence in the patient of a tendency to constipation or aggravation of an existing problem in the presence of a similar history. In addition, there is often bloating, rumbling, which is accompanied by soreness. Complete obstruction is characterized by gas and stool retention, severe bloating, severe pain, and vomiting.
- General symptoms. General weakness, fatigue, lethargy, pallor of the skin, slight fever, weight loss, change in taste preferences and loss of appetite.
What should alert?
The difficulty of early diagnosis of rectal cancer is that its first manifestations are rather non-specific. Usually these are conditions that are periodically observed in each person.
Therefore, regarding thisdiseases should alert such signs:
- Primary occurrence of any symptoms characteristic of this pathology and their long-term persistence (subfebrile temperature, weakness, loss of appetite and weight, constipation, discomfort in the rectal area).
- Gradual progression of symptoms characteristic of any pathologies of the rectum, if they were present in the past.
- The appearance of any pathological discharge, especially with an admixture of blood. Patients with hemorrhoidal bleeding of a chronic nature should definitely pay attention to their intensity and quality of the secreted blood, which change with oncology of the rectum.
- The first symptoms of cancer in the form of intestinal obstruction or severe bleeding always indicate the late stages of the development of a malignant process.
Prognosis for oncology of the rectum
Five-year survival rate for oncological diseases of the rectum of the fourth stage is no higher than 10%. As a result of the extensive growth of the tumor and the spread of metastases to various organs, the prognosis for patients becomes quite unfavorable - the chances of recovery in such patients are almost zero.
The tactics of specialists is very important, which is palliative care aimed at improving the general condition of a person. This is achieved through symptomatic therapy measures.
Features of the course in men and women
Despite the fact that the bulksymptoms of rectal oncology (especially in the initial stages) is in no way related to the sex of patients, yet there are some differences in its clinical course in men and women. Signs of oncology of the rectum is important to identify in a timely manner.
Cancer of the intestine in women can germinate in the tissues of the vagina or uterus. A cancerous lesion of the uterus, as a rule, does not affect the clinical picture of the pathological process, but the germination of a malignant tumor in the vaginal tissue can lead to the occurrence of a rectovaginal fistula. As a result, fecal matter and gases may be released from the vagina.
What are the signs of rectal cancer in men? A malignant tumor in men can grow into the walls of the bladder, provoking the development of a rectovesical fistula, which leads to the release of feces and gases from the urethra. In this case, the bladder often becomes infected. An infection that has entered his cavity through the ureters penetrates the kidneys and causes pyelonephritis.
Diagnosis
In addition to collecting complaints and searching for predisposing factors in the case of rectal cancer and oncology, the diagnosis requires an examination of the perianal region and rectum. For this purpose, the patient must take the knee-elbow position. A tumor can be detected using this procedure only when it is located low.
In addition, a digital examination is performed, thanks to which it is possible to reliably diagnose the presence of a neoplasm in the intestinal cavity and determine its approximate size. Any preparation for the patientimplementation of this diagnostic measure is not required. The study takes no more than 10 minutes.
Colonoscopy
To the fore in diagnostic measures in the presence of signs of oncology of the intestine and rectum, instrumental techniques come to the fore, thanks to which it is possible to detect a neoplasm and establish its malignant nature of origin. At the moment, the following standards for diagnostic measures are in force, which are approved by the Russian Association of Oncologists.
Colonoscopy followed by biopsy is an endoscopic examination of the colon, which is performed using special instruments shaped like an elastic tube. At the end of such a device, a light source and a video camera are placed, which allow you to examine the intestinal wall in detail and detect pathological formations on it. In the process of colonoscopy, a specialist using endoscopic forceps takes biological material - a piece of the mucous membrane of the rectum - for further examination under a microscope and the detection of malignant cells. A false negative result is observed with a deep location of the formation (in the submucosal layer). In this case, a deep biopsy is performed - the material for study is taken from two layers at once - submucosal and mucous. To minimize the possibility of error, the latest modifications of colonoscopy have been developed:
- Magnifying, in which the endoscopic instrument has powerful lenses to magnify the image up to 100-115 times, which allows you to examine not only the intern althe surface of the rectum, but also its small structures (as under a microscope). Thanks to this technique, "atypical" cells are detected already during the procedure.
- Fluorescence colonoscopy. For this method, the instrument is equipped with a source of ultraviolet radiation in a special spectrum, which causes malignant cells to fluoresce.
- Chromoendoscopy, in which a special dye (for example, iodine solution) is injected into the intestinal cavity. This allows you to determine the area where malignant cells are localized. In this case, they are completely discolored, while he althy structures become dark in color.
- Narrow-spectrum endoscopy, which is characterized by the use of two additional sources of narrow-band light (green and blue) during colonoscopy. With the help of this method, the vessels of the rectum become available for routine examination. Oncology can be detected by an increased number of irregularly shaped arterioles and capillaries in a specific area.
If it is not possible to conduct a complete diagnostic examination of the rectum, then sigmoidoscopy can be performed - this is an identical procedure that allows you to examine only the lower intestine (30-35 cm long). In this case, the information will be incomplete, since the condition of such intestines as the colon and sigmoid remains unknown.
Pelvis MRI
This is the most informative study to study the tumor. With its help, the size of the neoplasm, the level of its germination into the wall are determinedintestines and neighboring tissues, the presence of metastases in the lymph nodes. Without this study, no treatment is recommended.
Ultrasound of the abdomen
This procedure is necessary in order to evaluate the presence of metastases in the abdominal cavity. However, the information content of ultrasound is much less, since this method does not provide reliable confirmation of the malignant nature of the formation and the degree of its growth. With the help of ultrasound, doctors receive general information about the structure of organs, their location and existing pathologies of a structural nature.
Other research methods
Additionally, for symptoms and signs of rectal cancer, an X-ray of the entire chest is performed to detect lung metastases. Often, the patient is prescribed computed tomography, which helps to detect metastasis to the lymph nodes of the mediastinum and heart.
Among laboratory research methods, a blood test is performed for oncomarkers (diagnosis of a malignant process in the body) - a cancer-embryonic antigen. This is a kind of test for rectal oncology, which is used for early diagnosis.
In a complex evaluating all the information received, oncologists make a diagnosis, determine the stage of rectal oncology and determine the tactics of therapy.
Treatment
The main method of treatment of oncology of the rectum is the surgical removal of the tumor itself, the affected lymph nodes and adjacent tissues. The choice of technique is made by the surgeon-oncologist and depends on the stage of the pathological process, the size of the neoplasm, the degree of damage.metastases of other tissues and organs.
Removal of a polyp in the rectum is often carried out during a colonoscopy by means of electrocoagulation. If further histology of the polyp reveals malignant cells that do not grow to the base of this tumor, therapy at this stage can be considered complete. However, this approach is considered justified only at the initial stage of the disease. In most cases of oncology of the rectum, extirpation (removal) or radical resection of the rectum with the introduction of a permanent colostomy is necessary, in some cases, reconstructive surgery.
When late-stage cancer with deep germination in the tissue and the development of multiple metastases is detected, a palliative operation is performed: removal of a malignant tumor to increase the intestinal lumen and normalize the patient's condition. Complete cure of cancerous tumors in advanced stages is impossible. In medical practice, in most cases, surgical removal of the tumor is combined with chemo- and radio-radiation therapy to prevent the suppression of the spread of "atypical" cells and prevent the recurrence of the pathological process.
Chemotherapy involves the use of drugs that inhibit the growth of malignant cells. Cytotoxic drugs that are used in such treatment are not sufficiently specific to cancer cells and provoke a wide range of side effects. However, the complex use of chemotherapy and surgical treatment with timely diagnosedrectal cancer helps to get a positive effect and significantly reduce the likelihood of recurrence of the disease, increasing the survival of patients.
Radiation therapy for rectal cancer is sometimes used as an adjunct to prevent recurrence after surgical removal of the cancer, and may also be used to reduce the size of the lesion and relieve existing symptoms.
Consequences of the operation
Surgical intervention may entail certain risks, especially if it is surgery on the rectum for oncology. Among the unpleasant consequences, it should be noted:
- abdominal bleeding;
- development of infections;
- long recovery period;
- serious digestive disorders;
- rupture of the sewn edges of the intestine and the occurrence of an inflammatory process, in some difficult cases - up to peritonitis;
- urinary and fecal incontinence;
- sexual dysfunction;
- adhesion process.
After surgery to remove the rectum, oncology can recur within two years. In order to detect metastases in a timely manner, it is necessary to constantly be observed by an oncologist, conduct colonoscopy and other examinations, and take tests.
Another dangerous complication after surgery on the rectum in oncology is radiation sickness - a complex of local and general reactive changes that are caused by exposure to high doses of ionizing radiation on tissues, cells andbody environment. This condition occurs with symptoms of hemorrhagic diathesis, neurological signs, hemodynamic disturbances, increased susceptibility to infectious consequences, skin and gastrointestinal lesions.
Disability
Is disability coming? In oncology of the rectum, the group can be determined as the first, as well as the second or third. In 95% of patients, the first or second group is assigned, since oncology of the rectum ranks first among oncological tumors of other localizations in terms of severity of consequences.
Food
Features of nutrition in oncology of the rectum after surgery may be the same as before the development of the disease. Good stool regulation will help prevent digestive upset and bloating.
In the field of a complete cure, it is advisable to follow a diet: completely abandon spicy, fatty and fried foods - it is better to boil, stew or steam foods. It is recommended to consume plenty of fluids, in particular between meals, at least 2 liters per day. Meals should be fractional (5-6 times a day), the patient is advised to chew food thoroughly, do not eat very cold or hot.
Dietary nutrition for oncology of the rectum allows eating only baked, boiled or raw vegetables. Steam cooking is considered the best option, which allows you to save useful substances, vitamins and trace elements during heat treatment.
There is a belief: bread with oncology of the rectum must be completelyexclude from the diet. This opinion is erroneous, since this product is necessary for the restoration of the body. You will have to refuse baking from pastry, but you can eat wheat bread made from coarse flour. Basically, patients are advised to use dryers and crackers.
A special issue in the diet are liquid meals. The best option after the operation would be soups based on low-fat meat broth. Boiled vegetables are added to them, but it is recommended to forget about frying vegetables for the first course for a long time.
Doctors also do not prohibit the use of cold soups - beetroot and cabbage soup. In limited quantities, you can eat lean meat, which should be baked or boiled. Boiled sea fish is especially useful after operations on the rectum. This product promotes rapid tissue repair.
Cabbage and beets are recommended as side dishes or vegetable dishes. You can use greens as an indispensable component of any diet. Doctors also recommend including buckwheat in the diet.
A sparing balanced diet is needed for symptoms and signs of rectal cancer. Legumes during the rehabilitation period are strictly prohibited, because they cause increased gas formation in the intestines. The number of eggs in the diet is limited: no more than one per day, and at the same time the product is recommended to be added to salads or other dishes. The use of fats is also limited, but a small amount of butter and vegetable oil should be added to dishes.
