Cancer of the rectum - Causes, symptoms and treatment. MF.

  • Cancer of the rectum - Causes, symptoms and treatment. MF.

    Symptoms of rectal cancer
    Treatment of rectal cancer
    Rehabilitation after surgery
    Complications and prognosis
    Doctor's consultation
    Case histories

    Rectal cancer is a malignant tumor that develops from the epithelium of the rectum( its inner lining).

    Causes of colon cancer

    The causes of colorectal cancer are not fully understood, it is assumed that this can be chronic inflammatory diseases - proctitis, ulcerative colitis and chronic anal fissures. An important role in the development of cancer is played by genetic factors: a family history of cancer of the colon and rectum, family diffuse polyposis and others. The latter is characterized by the development of a multitude of polyps( tens and hundreds) - benign formations from the mucosa of the colon and rectum, many of which quickly degenerate into cancer, in these cases the cause of the disease is a genetic mutation( changes in the structure of the nucleus of the cell - chromosomes), inherited. On the development of rectal cancer can affect the characteristics of nutrition: excess in the diet of fatty and meat foods, lack of cereals and vegetables and, as a consequence, violation of stool in the form of constipation. The latter, in turn, lead to irritation of the mucosa of the rectum and colon by toxic products digesting proteins and fats and sucking them into the bloodstream. Excessive nutrition and lack of physical activity, excess weight, can be a trigger factor in the development of tumor pathology of the intestine.

    The relationship of excessive smoking and the increased risk of cancer of the digestive system has been established. In addition, there has been a sharp decline in the number of cancer cases among vegetarians. Also, a professional factor is important: workers in asbestos and sawmills have a risk of getting sick.

    Symptoms of rectal cancer

    Symptoms of rectal cancer are divided into the following groups:

    1. Nonspecific: weakness, weight loss, loss of appetite and aversion to food, perversion of taste and smells, body temperature rises to low figures( within 37 degrees C).

    2. Characteristic:

    - the first symptom is the allocation of pathological impurities in the act of defecation is characteristic of all tumors of the rectum: mucus in moderate or large numbers( since many tumors develop from the mucous glands and are mucus), alone or mixed with pus orblood, sometimes in the form of a bleeding( the blood can be bright red if the tumor is located in the lower parts of the rectum and dark - curled in the form of a liquid black stool or even clots, when the tumor is in the upper partOh);in some cases, pieces of the tumor may be allocated.

    Often, with bleeding from the rectum, patients who suffer prolonged hemorrhoidal enlargement do not consult a doctor, considering blood allocation as a symptom of hemorrhoids. To distinguish the source of bleeding can be as follows: with hemorrhoids, blood appears at the end of the defecation act on fecal masses, with tumors of the rectum the blood is mixed with feces, since bleeding occurs as a result of traumatizing the tumor with the feces;

    - pain gives in the lower back, sacrum, coccyx, perineum: it develops as a result of the tumor germination of the external( serous) shell of the rectum, rich in nerve endings or direct involvement of the nerves and nerve trunks of the pelvis into the tumor mass;In addition, pain can occur as a result of inflammation of surrounding tissues and organs;

    - change in the shape of the stool - "ribbon-like";

    - frequent, painful, frequent desires for defecation;

    - sensations of the presence of a "foreign body" in the rectum, caused by the tumor itself;

    - constipation( with tumors of the upper parts of the rectum): from periodic, with a frequency of 1-2 days to prolonged more than 1 week, accompanied by heaviness in the abdomen, swelling, aching pain in the lower abdomen. Elderly people often do not pay attention to this symptom, because with age, intestinal atony progresses and decreases in the activity of the digestive glands( bile, pancreatic enzymes), disturbing the majority of patients and leading to constipation;

    - for tumors of the anus and the rectum outlet: the presence of a visually detectable tumor in the anus or in the primary parts of the rectum, sometimes determined by the patient himself. Violation of the act of defecation( incontinence of stool and gases) - with the germination of muscles, narrowing the anus. Urinary incontinence - with the germination of the pelvic floor muscles and the urethra( the muscular base of the small pelvis).

    3. Symptoms of far-gone process:

    - strong almost constant pain in the lower abdomen;
    - fecal excretion when urinating or from the vagina in women at rest( with the growth of the tumor of the bladder and the fistula between the lumen of the gut and the bladder or vagina), a consequence of this is chronic inflammation of the bladder mucosa( cystitis) and female genital organs, inflammationcan go up the ureters to the kidneys;
    - excretion of urine from the rectum at rest or in the act of defecation( with tumor growth of the wall of the bladder).

    The figures show the anatomy( sections) of the rectum from the outside and from the inside.

    The following forms of rectal tumor growth are distinguished:

    - in the lumen of the intestine( there is a tumor component in the lumen of the gut - endophytic, from the Latin "endo" -inward);

    - towards fatty tissue and pelvic organs( as such there is no external component of the tumor, it forms a single mass with the surrounding tissues - exophytic, from the Latin "exo" - outwards).

    The following stages of rectal cancer are distinguished:

    1. The tumor does not go beyond the mucous membrane, takes no more than 1/3 of the intestine, there are no metastases;
    2. Tumor up to 5 cm( more than 1/3 of the intestine);b - tumor with metastases in the surrounding lymph nodes;
    3. More than half the circumference or length of the bowel;b- with metastases to the lymph nodes;
    4. A tumor sprouts adjacent organs: the uterus, the vagina, the urethra, the bladder, or pelvic bones.

    Primum swelling, like any malignant tumor, metastasizes to other organs.

    Metastases are cuttings from the primary tumor, having its structure and capable of growing, disrupting the function of those organs where they develop. The appearance of metastases is associated with the regular growth of the tumor: the tissue grows quickly, the nutrition does not suffice for all its elements, some cells lose contact with the rest, it breaks away from the tumor and enters the blood vessels, spreads through the body and enters the organs with a shallow and developed vascular network, lungs, brain, bones), settle in them from the bloodstream and begin to grow, forming colonies - metastases. In some cases, metastases can reach huge sizes( more than 10 cm) and lead to death of patients from poisoning with the products of the tumor's vital activity and disruption of the organ's functioning.

    Cancer of the rectum first of all metastasizes to the nearby lymph nodes - located in the surrounding fatty tissue of the pelvis and along the vessels feeding it, with tumors of the anus metastases can be in the groin. Out of the distant organs, the liver is the first in terms of the lesion frequency, this is due to the peculiarities of the rectal blood supply: from the upper sections, the blood flows directly to the liver and metastases settle in it, as in a natural filter. In second place in the frequency of metastasis are the lungs, the blood from the lower parts of the rectum flows into the system of the inferior vena cava( central vein of the abdominal cavity), and from there straight into the heart and lungs. In addition, metastases can affect the bones, serous lining of the abdominal cavity and other organs. If metastases are unique, they can be removed - this gives a better chance of recovery. If they are multiple, only supportive chemotherapy.

    In addition to cancer, other cancers can develop in the rectum:

    • melanomas - high-grade tumors from pigment cells;
    • sarcomas - tumors of the muscular, circulatory or lymphatic tissues.

    Examination for suspected colorectal cancer

    If a tumor of the rectum is suspected, the following tests are performed first:

    - a digital rectal examination is a very important method;an experienced doctor with this simple technique can detect a tumor located at a distance of up to 15 cm from the anus. Through this research, the location of the tumor is determined( on which wall - the anterior, posterior, lateral), the size of the tumor and the degree of overlapping of the lumen of the gut, the involvement of other organs( soft tissue of the pelvis, vagina).This study should be performed by any doctor with a patient complaining of a violation of defecation, stool or pain in the rectum. The technique is as follows: the patient takes the knee-elbow position( resting on knees and elbows respectively) or lies on the left side with legs bent to the abdomen, the doctor enters the index finger into the anal opening and examines the internal relief of the rectum.

    - sigmoidoscopy( from the Latin "rectum" - rectum): it is carried out with the help of a special device that is inserted into the rectum at a distance of up to 50 cm, with the help of the doctor visually examines the mucosa and takes pieces from suspicious areas for examination. Pretty painful and unpleasant procedure, but absolutely necessary in case of suspected cancer of the rectum.

    - Irrigoscopy - an old but proven method, the introduction of a contrast fluid into the large intestine through an enema followed by X-rays immediately and after bowel movement, if necessary, can fill the gut with air - the so-called double contrast. The method is used to detect cancer of other parts of the intestine, with the suspected combination of several tumors, in weakened and elderly patients who can not perform endoscopic examinations. The method lost its role in the appearance of fibrocolonoscopy.

    - fibrocolonoscopy is an endoscopic method of examination( examination of the entire intestinal mucosa from the inside), the most effective and reliable method of investigation. Allows to locate the exact location of the tumor, take pieces for examination under a microscope, remove small tumors without incisions( benign - polyps);

    Tumor from the intestinal wall
    Tumor overflows the lumen of the intestine

    The photos show colon tumors - view through the fibro colonoscope

    - intravenous urography - with suspected tumor germination in the ureters, bladder;

    - ultrasound examination of the abdominal cavity and small pelvis: it is used to detect distant metastases in other organs and nearby lymph nodes, in the presence of free fluid in the abdominal cavity( ascites), allows to estimate its amount.

    - computed tomography of the abdominal cavity and small pelvis - the method is effective for detecting the germination of the tumor in other organs, messages between the organs( fistula) through which urine and feces enter, metastases in the nearby lymph nodes and other organs of the abdominal cavity, the extent of the tumor;

    - laparoscopy - surgical intervention, through the punctures in the abdominal wall, a camera is inserted and various departments and organs of the abdominal cavity are examined with suspicion of a common process - metastases along the peritoneum and in the liver.

    - recently there was a new blood test for onkomercary - proteins produced only by the tumor and absent in a healthy body. For cancer of the intestine cancer markers are called Ca 19.9 and cancer-embryonic antigen, but they have extremely low diagnostic value, and therefore rarely used.

    Treatment of rectal cancer

    The most important in the treatment of rectal cancer is certainly the surgical method - removal of a tumor-affected organ. Any other treatment gives a supportive, temporary effect.

    Various surgical options are possible:

    1. organ-preserving - that is, removal of the affected bowel as low as possible and forming a hermetic intestinal tube at a lower level in the pelvis, this operation is possible only if the tumor is located in the upper and middle parts of the rectum. The name of the resection of the rectum is called.

    2. Removal of the entire rectum with the movement in its bed of part of the overlying healthy parts and the formation of an "artificial" rectum with the preservation of the sphincter. This operation is possible in the presence of a long descending colon under certain conditions of its blood supply. The resection with the reduction of the colon to the anal canal is called the name.

    Other possible operations have one thing in common: their result is the removal of the artificial anus on the abdomen( colostomy).

    3. Removal of the entire rectum with the tumor and surrounding fiber and lymph nodes in it, without preserving the anal sphincter and with the removal of colostomy.

    4. Removal of only the tumor with muffling of the excretory part of the intestine( sewn tightly) and excretion of colostomy. It is used in weakened, elderly patients with complications( intestinal obstruction).The operation is named after the surgeon who developed it - Hartmann's operation.

    5. Colostomy without tumor removal - performed at stage 4 of the tumor process with the threat of complications( to eliminate intestinal obstruction).It is used only to prolong life.

    6. Combination of several operations - removal of the rectum with part or all of the other organs during their tumor growth( removal of the wall of the bladder, uterus, vagina), single metastases to the liver.

    In addition, radiotherapy is successfully used for tumors of the rectum.

    Radiation treatment is radiation irradiation on a special device in a small dose daily for about 1 month, which has a harmful effect on tumor cells. This method can be used both before surgery to reduce the tumor in size and transfer of an unremarkable tumor to a removable condition, and after surgery with detected metastases to the lymph nodes adjacent to the organ in order to prevent the return of the disease. Can be used as external irradiation and internal( introduction of the sensor into the rectum) or a combination thereof. Internal irradiation has less harmful effect on surrounding tissues and organs, to a lesser extent damaging them.

    In old age and in the presence of contraindications to surgery on the rectum for the condition of the patient or cardiac pathology, tumor irradiation can be used as an independent treatment method, certainly inferior to the surgical one, but giving good results.

    In some cases, with severe pain and inflammation, if a tumor can not be removed, a small dose of radiation is used to relieve the painful symptoms and facilitate the patient's life.

    When detecting a large number of metastases in the surrounding lymph nodes, chemotherapy is mandatory. It is also used to detect multiple metastases in other organs that can not be surgically removed. Chemotherapy is an intravenous injection of various toxic synthetic substances that are detrimental to tumor cells. In some cases, the same drugs are prescribed, but in tablet form with better assimilation and fewer side effects. This treatment is applied by courses from 4 times or more. Chemotherapy is designed to reduce metastases in size, relieve painful symptoms, prolong life.

    Rehabilitation after operation

    The characteristics of the recovery period in patients after operations on the rectum can be as follows: wearing a bandage( special compression belt) designed to reduce the tension of abdominal muscles and reduce intra-abdominal pressure, which creates the best conditions for healing the postoperative wound;active behavior after surgery - getting up on the 5-7th day, walking to the toilet, on the procedures themselves;sparing food - restriction of fat and intractable food, vegetables and fruits, is included in food: cereals( cereals), broths, dairy products - kefir, fermented milk, yogurt, baby food.

    In the long term after the operation, the normalization of the stool is important: the diarrhea can be disturbing, the regular consequence of the decrease in the size of the intestinal tube associated with the removal of its part, this need not be feared, the body will soon adapt to the new condition and the stool will return to normal again;so patients should not allow long constipation, which traumatizes the mucous membrane of the small intestine, absorbed waste toxic products from its lumen. For patients with a withdrawn colostomy, it is important to wear a kalopriemnika( a packet for collection of feces on the adhesive tape), proceed to it no less than a month after the operation, after wound healing and engraftment of the colostomy.

    There are various devices to reduce the negative effects( allocation of stools) in patients with colostomas: special muscular training for the formation of muscular pulp from the abdominal press that covers the stoma during the day, valve plugs inserted into the lumen of the colostomy, and so on.

    Treatment with "folk" remedies for patients suffering from colorectal cancer has no effect, here the main thing is not to harm, that is, do not use poisonous and toxic substances( amanita, celandine, hemlock, etc.), the use of which can aggravate the patient's condition. With preventive purpose against the emergence of metastases, none of the "folk" means the results do not.

    Complications of rectal cancer can be:

    - first of all, intestinal obstruction, tumor overlap in the lumen of the intestine and stool retention, until the stool and gas are completely stopped, which in turn is dangerous by rupturing the bowel wall from overfilling and malnutritioncompression of the calves with the effusion of the contents of the colon and the development of fecal peritonitis( inflammation of the serous membrane of the abdominal cavity) - a serious complication of almost 100% leading to death.;
    - bleeding from a tumor - may be minor and determined only by laboratory tests( Gergersen's reaction is obsolete) to massive, capable of leading a patient to death from loss of blood and anemia;
    - depletion( cancer intoxication) of the body - in far-reaching stages, occurs as a result of poisoning the body with toxic products of tumor destruction.

    Prophylaxis of rectal cancer consists in the annual examination: a finger examination of the rectum and fibrocolonoscopy in all persons over 50 years of age;timely treatment of diseases of the rectum( anal fissures, proctitis), quitting smoking, normalizing the diet, a healthy lifestyle.

    Prognosis and survival rate for colorectal cancer.

    About 25% of patients with cancer of the colon and rectum, at the time of detection already have distant metastases, that is, every third patient. Only 19% of the patients had cancer diagnosed in 1-2 stages. Only 1.5% of tumors are detected during preventive examinations. Most of the gut lesions occur in stage 3.Another 40-50% with the first diagnosed tumors of the colon develop distant metastases.

    The five-year survival rate for bowel cancer is no more than 60%.Colorectal cancer is one of the most common causes of death from cancer.
    Cancer of the colon and rectum is more common in economically developed countries: USA, Canada, Japan. There is a sharp increase in colon cancer in Russia.
    In Russia, the incidence rate of colon cancer is approaching 16 per 100 thousand of the population, the highest levels of this indicator are noted in St. Petersburg and Moscow.

    Intestinal tumors have recently come in 3rd place in men and in 4th place in women in frequency of occurrence, in 5th place is cancer of the rectum.

    The peak incidence falls on the age of 70-74 years and is 67.1%.

    The incidence of disease progression as the appearance of distant metastases depends on the stage of the disease:

    1. Stage: The tumor does not go beyond the mucous membrane, occupies no more than 1/3 of the intestine, there are no metastases;the survival rate of patients is close to 80%.
    2. Stage: Tumor up to 5 cm( more than 1/3 of the intestine);b - tumor with metastases in the surrounding lymph nodes;the survival rate is not more than 60%
    3. Stage: More than half of the circumference or length of the gut;b- with metastases to the lymph nodes;
    4. Stage: Tumor sprouts adjacent organs: uterus, vagina, urethra, bladder, or pelvic bones.
    In the last two stages, the prognosis is very poor, with a 5-year survival rate of no more than 10-20%.At 4 stages of 5 years, no patient survives.
    Early detection of a tumor is accompanied by a 15-fold increase in survival.

    Doctor's consultation on rectal cancer:

    Question: Is it obligatory for colon cancer to remove the colostomy on the stomach?
    Answer: Not always, it depends on the level of the tumor location( closer to the output department), as well as on the age of the patient and the level of his recovery capabilities. Young and relatively healthy patients tend to maintain the natural course of the intestinal tube without kolostomy, while in elderly patients such operations are not justified, since their recovery abilities are significantly reduced.

    Question: How often does rectal cancer occur?
    Answer: Tumors of the colon and rectum stand in 3rd place among the entire tumor pathology and mortality among patients. In men - after lung and prostate cancer, in women - after breast cancer and female genital organs( uterus and ovaries).

    Question: Which contingent of people most often has cancer of the rectum?
    Answer: Most of them are elderly and old people( after 60-70 years).The younger patients are ill if there is a family history of colon cancer, female genitalia and the breast, as well as diffuse intestinal polyposis.

    Oncologist doctor Barinova Natalya Yurevna