Rectal cancer is a malignant neoplasm that develops from the tissues of the intestine (its internal epithelium). The resulting tumor can affect not only the intestinal wall, but also grow and block the digestive tract, grow into the lymph nodes, liver and other organs.
How cancer is manifested in the rectum in men and women, which is prescribed as a diagnostic and treatment of this disease – consider next.
What is rectal cancer?
Rectal cancer is a disease that develops as a result of tumor degeneration of epithelial cells of the mucous membrane lining any of the sections of the rectum and has characteristic signs of cellular polymorphism and malignancy.
Life expectancy for rectal cancer depends on many characteristics: structure, type of growth and location of the tumor. But the most important factor is the early diagnosis of the disease, which tenfold increases the chances for a further full life!
At the initial stages, unfortunately, there are no very bright signs of the presence of a tumor in the body. The neoplasm itself develops rather quickly and has a malignant nature. In a certain phase, it begins to metastasize to the nearest lymph nodes and organs.
If we consider in more detail the anatomical structure of the rectum, we can distinguish three main areas:
- Anal part. It is here that the sphincters with which help defecation are located. This is the final section of the intestine and its length is about 3 cm.
- Ampular part. In this area, the excess fluid is removed from the feces and its further formation before removal from the body. Its length is slightly less than 10 cm.
- Nadampular The initial section of the rectum is about 5 cm long, which is closed by the peritoneum.
If we talk about the areas most often affected by a tumor, here the ampulary part of the rectum is the most popular. It is in this part that cancer cells are formed in 80% of cases of intestinal lesions.
- Highly differentiated – the tumor grows rather slowly and is not aggressive.
- Poorly differentiated – fast-growing malignant tissue quickly metastasizes.
- Medium differentiated – Has a moderate rate of growth and development.
Another type of classification of rectal cancer, based on the localization of malignant tumors, subdivides them into tumors:
- Anal section (found in 10% of cases);
- rectosigmoid department (30%);
- the lower, middle and upper ampular (60%) sections of the rectum.
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 intestine – endophytic, from the Latin endo – inside);
- towards the fatty tissue and the organs of the small pelvis (as such, there is no external component of the tumor, it forms a single mass with the surrounding tissues — exophytic, from the Latin “exo” – out).
The alleged causes of the disease:
- Proctitis is an inflammation of the sigmoid colon and its mucous membrane. It has a specific nature (helminthic invasions, gonorrheal, syphilitic, tuberculous and
Intestinal tumors have recently reached the 3rd place in men and the 4th place in women in terms of frequency of occurrence, rectal cancer is in the 5th place. The peak incidence occurs in the age period of 70-74 years and is 67.1%.
Cancer is an insidious disease, its symptoms may not appear for a long time, until the tumor reaches a significant degree of development.
At first, the disease does not manifest itself externally, whereas cancer cells are formed and spread in the body. When answering the question of how to recognize intestinal cancer at an early stage, doctors do not give a definite answer. The disease is detected by chance – during the passage of a planned medical examination or the treatment of another diagnosis. Over time, the inflammation makes some adjustments to the patient’s usual life.
When the patient progresses, the first signs of colorectal cancer may be as follows:
- painful defecation;
- change in the consistency of fecal masses during defecation;
- the presence of mucus and blood in the stool;
Note that at an early stage of the disease, the symptoms can be confused with hemorrhoids and other similar diseases. However, the hallmark of the disease should be noted the emergence from the anus of blood, which, unlike hemorrhoids, occurs before the act of defecation, and not after it. Also as a result of the development of a tumor, mucus and pus are often observed in the feces.
The classification of colorectal cancer depending on the stage of the tumor process is based on the following characteristics of the disease:
- Size of primary tumor;
- The prevalence of the tumor against the intestinal wall and lumen;
- Involvement of adjacent organs in the tumor process;
- The presence of metastases in the lymph nodes;
- The presence of metastases in distant organs.
Rectal cancer is accompanied by metastases – screenings from the main lesion, the same in structure and able to grow, disrupting the functions of organs in which they fell.
Stages of colorectal cancer take into account the characteristics of the neoplasm itself, its size, ingrowth into the surrounding tissue, and the nature of metastasis. Thus, domestic oncologists distinguish four clinical stages in the course of a tumor:
- Stage 1, when the tumor is no more than two centimeters, grows no deeper than the submucosal layer and does not metastasize.
- At stage 2, a neoplasm of up to 5 cm does not extend beyond the boundaries of the organ, but can manifest itself as metastases in local lymph nodes.
- Stage 3 is accompanied by germination of all layers of the intestinal wall and the appearance of metastases in local lymph nodes.
- With stage 4 cancer of the rectum, the whole body suffers. The spread of metastases is accompanied by a failure of the organ in which the new tumor growth began. With the defeat of vital organs (heart, lungs, brain, and so on), the syndrome of multiple organ failure develops, which is the main cause of death in cancer patients.
Symptoms of rectal cancer in adults
Most often, the following pattern is observed in the development of the disease. Initially, an adenomatous polyp is formed in the rectum. This neoplasm is not a direct threat to life and is not malignant. However, over time, changes occur in the polyp. The tumor becomes malignant and turns into a cancer that spreads through the body in the form of metastases.
The symptoms of colorectal cancer are determined by the stage and level of the location of the formation. These include:
- Various dyspeptic disorders;
- Bleeding and other pathological impurities in the feces;
- Violation of the stool up to intestinal obstruction;
- Signs of general intoxication;
- Pain syndrome.
The first symptoms depend on the location of the neoplasia. In addition to bleeding that occurs in almost all patients, pain is possible as the first sign in the case of low incidence of cancer with the transition to the anal sphincter. In some cases, the disease occurs with impaired stool, more often – in the form of constipation.
As the tumor begins to grow, constipation will not alternate with diarrhea, they begin to acquire a sustained nature. If the malignant tumor of the rectum begins to develop rapidly, then the patient has an acute intestinal obstruction — a critical condition in which an urgent surgical intervention cannot be avoided.
The condition of a patient suffering from rectal cancer depends on the presence or absence of metastases.
- If the tumor is located within the rectum, the patient is concerned only with digestive disorders, bowel pain, admixture of pus, blood and mucus in the feces.
- If a tumor grows into neighboring organs, then symptoms occur that are characteristic of their damage. With germination in the uterus and vagina – pain in the lower abdomen, violation of menstruation.
- During germination in the bladder – pain in the lower abdomen, impaired urination. With the spread of metastases to the liver – jaundice, pain under the rib.
- In case of multiple metastases, the general condition of the patient is disturbed: weakness, increased fatigue, exhaustion, anemia, and an increase in body temperature occur.
Cancer of the rectum in women can germinate in the tissue of the uterus or vagina. Cancerous lesion of the uterus does not affect the overall clinical picture of the disease, but the germination of the tumor in the tissue of the posterior wall of the vagina can lead to the formation of a rectovaginal fistula. As a result, gases and fecal masses begin to be released from the female vagina.
Cancer cells under the action of the movement of blood and lymph spread even further throughout the body, which leads to the formation of metastases that can occur in the lungs, in the liver, or in closely located lymph nodes.
Symptoms of colorectal cancer in women are diverse:
- the presence of blood in the feces;
- pain symptoms in the abdomen and in the anus;
- constipation, increased stools, diarrhea;
- mucous, purulent discharge in the anus;
- constant feeling of weakness or fatigue;
- flatulence, spontaneous discharge of feces;
- perineal itching sensation;
- the presence of dysfunction in the genitals;
- metabolism is disturbed, which causes a decrease in the overall development and growth of the patient.
Cancer in men often grows into the wall of the bladder, also causing a rectovesical fistula, from which stools and gases are brought out. The bladder is often infected. Pathogenic flora penetrates the kidneys through the ureters, causing pyelonephritis.
Signs of rectal cancer in men:
- sharp weight loss;
- sensation of pain in the sacrum, genitals;
- blood impurities in stool consistency;
- frequent trips of need;
- chronic constipation.
Malignant growth in the absence of the necessary diagnostics is growing rapidly, affecting other systems and organs. It creates increased pressure inside the peritoneum, thereby aggravating the problem. That is why it is important to identify in time the initial stage of the development of the disease and take all necessary actions.
Some symptoms of this disease are characteristic of a number of diseases of the gastrointestinal tract, the most common of which are:
- intestinal ulcer;
- disorders of the digestive processes;
Very often, due to the similarity of symptoms, patients do not pay enough attention to them in time, because of which the chances of recovery are rapidly reduced.
Only 19% of patients with cancer are diagnosed at stage 1-2. Only 1.5% of tumors are detected during preventive examinations. Most of the tumors of the intestine falls on stage 3. Another 40-50% with newly diagnosed colon tumors develop distant metastases.
In the early detection of colorectal cancer, the leading place belongs not to the symptoms of the disease, which the patient himself notices, but to objective signs. Therefore, preventive medical examinations are a really effective method for diagnosing rectal cancer in the early stages!
The diagnosis is made by the proctologist doctor, after the study of the ball. He is able to feel a tumor with his fingers if she is located near the anus. Otherwise, a sigmoidoscopy is prescribed. This procedure allows you to take a fragment of the tumor for biopsy studies, which will help determine the nature of the formation.
In the study of women at the same time conducted a study of the vagina to assess the degree of involvement of the reproductive organs in the tumor process.
For a more accurate diagnosis using other procedures:
- full proctological examination;
- biopsy followed by histological examination of the sample under a microscope;
- computed tomography;
- radiography of the abdominal cavity;
- Irrigography to assess the state of the large intestine;
- laboratory tests of blood for antigens and tumor markers (this method is used both in the initial diagnosis and in monitoring the effectiveness of the treatment);
- diagnostic laparoscopy.
In the treatment of colorectal cancer, the priority is the surgical method, which consists in removing the affected organ.
Is it possible to do without surgery? In fact, most likely not, since this is the main type of treatment. You must understand that chemotherapy and radiotherapy does not give 100% of the result and does not destroy all cancer cells – that is why it is necessary to remove the tumor in time with all the damaged tissues.
Possible options for surgical treatment of colorectal cancer:
- The organ preservation variant (resection). Such an operation is possible only if the tumor is located in the middle and upper parts of the rectum.
- A complete removal of the rectum (resection with the reduction to the anal canal of the colon) is carried out, followed by the formation of an artificial rectum from the healthy sections above.
Due to this stage, the probability of tumor progression decreases, its growth slows down and the prognosis for the patient is significantly improved. It is performed in patients with any stage of a rectal tumor. The size of the dose and the need for chemotherapy drugs is determined by the oncologist, depending on the degree of cancer development.
Only radiation treatment is usually used with a slight growth of the tumor (grade 1 or 2). At grades 3 and 4, any chemotherapy (Fluorouracil, Leucovarin) is necessarily combined with the patient’s radiation.
The recovery process after surgery includes:
- Wearing a bandage (special compression belt), which reduces abdominal muscular tension and reduces intra-abdominal pressure.
- Active behavior – getting out of bed 5-7 times a day.
- Self go to the toilet and procedures.
- Gentle food – eating fruits, vegetables and limiting difficult and fatty foods.
Radiation therapy for cancer of the rectum is shown during periods:
- before the operation – the area where the tumor is located is irradiated for 5 days. At the end of the course, the operation is performed in 3-5 days
- after surgery – in case of confirmed metastases in regional LUs, after 20-30 days, a 5-day course of irradiation in the tumor zone and all LUs of the pelvic region begins.
Patient care during treatment
The diagnosis of rectal cancer postoperative care is as follows:
- frequent change of linen: bed and underwear;
- in the prevention of bedsores: changing the position in bed and turning on the other side or back, using anti-decubitus or orthopedic mattresses;
- feeding the patient, using a special probe;
- hygiene procedures;
- provision of special diapers and linings for incontinence of urine and feces;
- care for colostomy and in the replacement of the colostomy bag.
Proper nutrition for cancer of the rectum should be given increased attention. The diet should be sufficiently nutritious and balanced in qualitative and quantitative terms, and not cause irritation of the intestine.
The diet after surgery for the first time should be as gentle as possible, not cause diarrhea and intestinal swelling. Begin a meal after resection with rice broth, low-fat broth, berry jelly without fruit. A few days allowed:
- Mucous soups (this is strained croup broth).
- Liquid, well-grated porridge, boiled in water. Preference is given to coarse rice, oatmeal, buckwheat.
- Cream (only in dishes up to 50 ml).
- Broths with semolina.
- Soft-boiled egg and protein omelette.
- A little later, mashed fish and meat is introduced.
In order not to miss the re-development of the disease, the patient should regularly monitor the oncologist. Currently, the following visit frequency is recommended:
- The first 2 years after remission – no less than 1 time in 6 months (recommended 1 time in 3 months);
- After 3-5 years – 1 time in 6-12 months;
- After 5 years – every year.
Prognosis of rectal cancer
No specialist will give an unambiguous answer to how much people live with rectal cancer, since the survival prognosis is made individually for each patient and is made up of many indicators.
We present the average values for 5-year survival of patients after adequate treatment: