Oncology of the rectum is often found 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 often leads to death. In 2012, a record number of deaths from the development of malignant tumors was noted - about 8 million people, according to WHO statistics, and 450 thousand of these people died from cancer of the rectum. 70-80% of deaths can be prevented with early diagnosis.
Oncology of the rectum is the occurrence of a malignant tumor in the distal colon, 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, studies of feces for occult blood, identification of laboratory markers, biopsy followed by morphological examination, sigmoidoscopy are used. Treatment is surgical (extirpation or rectum resection), with the possible use of chemotherapy for metastases to regional lymph nodes.
In this case, elderly people suffer from this disease, and there are significantly more men among patients than women.
Predisposing factors
The emergence of rectal oncology is facilitated by several categories of factors. These include:
- The presence in the medical history of information about relatives suffering from bowel cancer. For example, adenomatous familial polyposis is a rather rare genetic pathology in which there is a violation in the division of cells of the intestinal epithelial layer. Such a disease occurs with a frequency of 1: 11000. From the onset of the first symptom, it always passes into cancer. Lynch syndrome is also a fairly common gene mutation that causes a tendency to rectal oncology. It is the cause of approximately 5% of all cases of the disease.
- Chronic intestinal pathologies, for example, Crohn’s disease, ulcerative colitis of a non-specific type (abbreviated as UC), Whipple’s disease, adenomas and polyps in the intestines (benign tumors), chronic proctitis, as well as diseases that provoke impaired motility (irritable bowel syndrome, motor dyskinesia, complications of stem vagotomy, etc.). What else can provoke rectal oncology?
- The wrong lifestyle, nutrition factors often leads to cancer: lack or insufficient amount of fiber (pearl barley and corn, fruits, vegetables, black bread, etc.), the prevalence of irritating and indigestible foods (flour, spicy, fatty and salty foods ), plentiful and rare meals. Smoking is also a factor that to some extent affects the digestive system. 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 misconception. Since hemorrhoidal formations are not part of the mucous membrane, they cannot affect the epithelium of the rectum. However, with prolonged absence of therapy, this disease leads to the occurrence of 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 a pathology, you should pay attention to the specific symptoms that accompany the development of a malignant neoplasm.
Classification
The therapeutic tactics, symptoms and signs of the disease in oncology of the rectum 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 can be located:
- Anorectal - above the anus, a hole (in the sphincter area). Such tumor localization occurs in 6% of cases. The disease is characterized by early symptoms in the form of constant pain of a piercing nature, which is not relieved by NSAIDs. Because of this, the patient has the so-called "symptom of a stool"), when a person is forced to sit on one buttock.
- Ampoule - in the middle section of the rectum. This is the most common localization (84%). The initial symptom is bleeding.
- Nadampular - the tumor is localized in the upper zone of the rectum (10% of cases) and does not cause any symptoms for a long time. Often people seek help due to bowel obstruction.
In addition to the above criteria, an important role is played by the level of differentiation of the oncological process - how much tumor cells look like normal cells of the rectum. To date, there are 4 main categories of rectal oncology (cancer is different):
- Adenocarcinoma (highly differentiated tumors) - more than 90% of the cells have a normal structure.
- Moderately differentiated - half of all cells are “atypical” (do not resemble healthy cells in the body).
- Low-differentiated (small, large and squamous cell carcinoma) - 90% of 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 reacts worse to therapy.
Stages
Symptoms of rectal oncology depend on the stage. To assess the development of the tumor and the spread of pathological cells throughout the body, the clinicians determined the stages:
- Stage I of oncological pathologies of the intestine is characterized by the absence of obvious clinical symptoms and complaints of the patient. If manifestations are still present, then they are rather nonspecific - a person may complain of general weakness, a slight increase in temperature, malaise, and during bowel movements he may experience unpleasant symptoms. In this case, the tumor is very small and permeates the epithelium of the intestinal wall without penetrating deeper. Along with this, the defeat of regional lymph nodes and metastases to other organs are absent.
- II stage. At this stage, colorectal cancer is characterized by the size of the tumor, which can reach 5 cm. However, malignant cells do not penetrate into other parts of the intestine. There are no metastases at this stage, but sometimes a single lesion of the lymph nodes is observed. At this stage, damage to nearby healthy tissues develops, due to which the symptoms can worsen. Digestive disorders, increased intestinal bleeding are possible. The patient may complain of tenesmus (painful urges) or persistent constipation. General well-being is significantly deteriorating. The growth of the tumor causes a narrowing of the lumen of the intestine, intestinal obstruction develops, manifested by constipation and pain. In the second stage, the lumen is blocked by 50%.
- Stage III, the features of which are the sizes of the malignant neoplasm - more than 5 cm, the presence of metastases in the lymph nodes, damage to neighboring organs and tissues, germination of cells in the thickness of the intestinal wall. Symptoms of this stage are significantly pronounced. Patients complain of frequent bleeding, bowel obstruction, pain, which is associated with tumor invasion into the intestinal wall, chronic digestive disorders. With rectal oncology, the symptoms and signs of the disease are exacerbated in the last stage. In the feces of the patient, pus, blood and mucus are present.
- IV stage. Oncology of the rectum at stage 4 is characterized by multiple metastatic lesions of the internal organs, both neighboring (reproductive, bladder, liver), and remotely located lungs and bones. A malignant neoplasm is large, its cells penetrate the entire thickness of the intestinal wall. The clinical picture of stage 4 of rectal oncology is rather difficult. The patient complains of severe digestive disorders, he is constantly worried about pain and abdominal discomfort. Harmful substances formed during metabolism are not disposed of from the patient’s body, but enter the bloodstream. This contributes to the occurrence of intoxication syndrome, manifested by a deterioration in general condition, a decrease in body weight.
Symptoms and signs of rectal oncology
This disease may not manifest itself for a long time with specific symptoms. The patient’s situation is aggravated by the fact that when symptoms appear, people often do not pay attention to it.
The main groups of symptoms of rectal oncology are:
- Allocations and their nature. It can be blood or mucous discharge, which is represented by pure blood as in rectal bleeding (low tumor location). A neoplasm localized in the upper and middle ampullar sections is manifested by the presence of undigested blood.
- Bowel irritation. This can be periodic abdominal pain like spasms, a foreign body sensation in the rectal zone, false urge to defecate, diarrhea. Such symptoms often occur in the initial stages of cancer and precede intestinal obstruction, characteristic of large tumor sizes.
- As a sign of rectal oncology, a violation of intestinal patency can be distinguished. The patient's tendency to constipation or exacerbation of the existing problem in the presence of such an anamnesis. In addition, bloating often occurs, rumbling, which is accompanied by soreness. Complete obstruction is characterized by gas and stool retention, severe bloating, severe pain, and vomiting.
- Common symptoms General weakness, fatigue, lethargy, pallor of the skin, a slight increase in temperature, loss of body weight, a change in taste preferences and a decrease in appetite are not caused by anything.
What should alert you?
The complexity of the early diagnosis of rectal oncology is that its first manifestations are rather nonspecific. Usually these are conditions that are periodically observed in each person.
Therefore, in relation to this disease, the following signs should be alarming:
- The primary occurrence of any symptoms characteristic of this pathology and their long-term preservation (low-grade fever, weakness, loss of appetite and weight, constipation, discomfort in the rectum zone).
- The gradual progression of the symptoms characteristic of any pathology of the rectum, with their presence in the past.
- The appearance of any pathological discharge, especially with an admixture of blood. Patients with chronic hemorrhoidal bleeding must pay attention to their intensity and the quality of blood secreted, which changes with rectal oncology.
- The first symptoms of cancer in the form of intestinal obstruction or severe bleeding always indicate the late stages of the development of the malignant process.
Prognosis for oncology of the rectum
The five-year survival rate for oncological diseases of the rectum of the fourth stage is not 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 rather unfavorable - the chances of recovery in these patients are practically zero.
In this case, the tactics of specialists, which consists in palliative care aimed at improving the general condition of a person, is very important. This is achieved through measures of symptomatic therapy.
Features of the course in men and women
Despite the fact that the bulk of the symptoms of colonic oncology (especially in the initial stages) are in no way related to the gender of the patients, there are still some differences in its clinical course in men and women. Signs of rectal oncology are important to identify in a timely manner.
An oncological tumor of the intestine in women can grow in the tissue of the vagina or uterus. Cancerous lesions of the uterus, as a rule, do not affect the clinical picture of the pathological process, but the germination of a malignant tumor in the tissue of the vagina can lead to rectovaginal fistula. As a result, fecal masses and gases can be released from the vagina.
What are the signs of rectal oncology in men? A malignant tumor in men can grow into the walls of the bladder, causing the development of rectovesical fistula, which leads to the release of feces and gases from the urethra. In this case, the bladder is often infected. An infection in its cavity through the ureters penetrates the kidneys and causes pyelonephritis.
Diagnostics
In addition to collecting complaints and searching the history of the case with colorectal cancer and oncology of predisposing factors, the diagnosis requires examination of the perianal region and rectum. To this end, the patient should take a knee-elbow position. To detect a tumor using this procedure is possible only with its low location.
In addition, a digital study 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 of the patient for the implementation of this diagnostic measure is not required. The study takes no more than 10 minutes.
Colonoscopy
With diagnostic measures, if there are signs of oncology of the intestine and rectum, instrumental techniques come to the forefront, thanks to which it is possible to detect a neoplasm and establish its malignant origin. Currently, the following standards for diagnostic measures are valid, which are approved by the Russian Association of Oncologists.
Colonoscopy followed by biopsy is an endoscopic examination of the intestine, which is carried out using special instruments in the form of an elastic tube. At the end of such a device there is a light source and a video camera that allow you to examine in detail the wall of the intestine and detect pathological formations on it. In the process of conducting a 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 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 immediately from two layers - submucous and mucous. To minimize the likelihood of error, the latest modifications of colonoscopy have been developed:
- Magnifying, in which the endoscopic instrument has powerful lenses for enlarging the image up to 100-115 times, which allows you to examine not only the inner surface of the rectum, but also its small structures (as under a microscope). Thanks to this technique, “atypical” cells are detected during the procedure.
- Fluorescence colonoscopy. For this method, the instrument is equipped with a source of ultraviolet radiation in a special spectrum, which causes the malignant cells to fluoresce.
- Chromoendoscopy, in which a special dye is introduced into the intestinal cavity (for example, iodine solution). This allows you to determine the area where malignant cells are localized. In this case, they are completely discolored, while healthy structures become dark in color.
- Narrow-spectral endoscopy, which is characterized by the use of two additional narrow-band light sources (green and blue) during colonoscopy. With this method, rectal vessels become accessible to a routine examination. Oncology can be detected by an increased number of arterioles and capillaries of irregular shape in a particular area.
If a complete diagnostic examination of the rectum is not possible, then sigmoidoscopy can be performed - this is an identical procedure that allows you to study only the lower intestine (30-35 cm long). In this case, the information will be incomplete, since the condition of such intestines as colon and sigmoid remains unknown.
Pelvic MRI
This is the most informative study to study the tumor. With its help, the sizes of the neoplasm, the level of its germination in the intestinal wall and in neighboring tissues, the presence of metastases in the lymph nodes are determined. Without this study, any treatment is not recommended.
Ultrasound of the abdomen
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Among laboratory research methods, a blood test is performed for tumor markers (diagnosis of a malignant process in the body) - a cancer-embryonic antigen. This is a kind of test for oncology of the rectum, which is used in 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 rectal oncology is the surgical removal of the tumor itself, affected lymph nodes and adjacent tissues. The choice of technique is made by an oncologist surgeon and depends on the stage of the pathological process, the size of the neoplasm, the degree of metastasis of other tissues and organs.
Removal of the polyp in the rectum is often carried out during colonoscopy through electrocoagulation. If, with further histology of the polyp, malignant cells are found that do not grow on the base of the tumor, the therapy at this stage can be considered complete. However, such an approach is considered justified only at the initial stage of the disease. In most cases of rectal oncology, extirpation (removal) or radical resection of the rectum with the introduction of a permanent colostomy is necessary, in some cases, reconstructive surgery is necessary.
If late stage cancer with deep germination in the tissue and the development of multiple metastases is detected, a palliative operation is performed: removal of the 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 radiotherapy to prevent the suppression of the spread of “atypical” cells and prevent the recurrence of the pathological process.
The method of chemotherapy involves the use of medications that inhibit the growth of malignant cells. Cytotoxic drugs that are used during such treatment are not specific enough to cancer cells and provoke a wide range of side effects. However, the integrated use of chemotherapy and surgical treatment for timely diagnosed colorectal cancer helps to obtain a positive effect and significantly reduce the likelihood of a relapse of the disease, increasing the survival of patients.
Radiation therapy for rectal oncology is sometimes used as an additional technique for the prevention of relapse after surgical removal of a cancerous tumor, and can also be used to reduce the size of the formation and alleviate existing symptoms.
The consequences of the operation
Surgical intervention may entail certain risks, especially if it is an operation on the rectum in oncology. Among the unpleasant consequences should be noted:
- bleeding into the abdominal cavity;
- infection development;
- long recovery period;
- severe digestive upsets;
- rupture of the stitched intestinal edges and the occurrence of an inflammatory process, in some complex cases - up to peritonitis;
- urinary and fecal incontinence;
- sexual dysfunctions;
- adhesive process.
After surgery to remove the rectum, oncology can recur within two years. In order to timely detect metastases, it is necessary to constantly be observed by an oncologist, conduct a 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 the effect of high doses of ionizing radiation on tissues, cells and the body’s environment. This condition occurs with symptoms of hemorrhagic diathesis, neurological signs, hemodynamic disorders, an increased tendency to infectious consequences, skin and gastrointestinal lesions.
Disability
Is disability coming? In rectal oncology, a group can be defined as the first, and the second or third. In 95% of the patients, the first or second group is assigned, since oncology of the rectum, in severity of consequences, takes first place among oncological tumors of other locations.
Nutrition
Features of nutrition in oncology of the rectum after surgery may be the same as before the development of the disease. Good stool control will help prevent digestive upsets and bloating.
The field of complete cure is advisable to follow a diet: completely abandon the spicy, fatty and fried - it is better to cook, stew or cook steamed. It is recommended to consume a lot of fluids, in particular between meals, at least 2 liters per day. The food should be fractional (5-6 times a day), the patient is recommended to chew the food thoroughly, not to eat very cold or hot.
Dietary nutrition for oncology of the rectum allows the ingestion of only baked, boiled or raw vegetables. The best option is steaming, which allows you to save nutrients, vitamins and trace elements during heat treatment.
There is a belief: bread with rectal oncology must be completely excluded 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 fancy pastry, but you can eat wheat bread from coarse flour. Basically, patients are advised to use dryers and crackers.
A special issue in the diet are liquid foods. The best option after surgery would be soups based on lean meat broth. Boiled vegetables are added to them, but it is recommended to forget about roasting vegetables for the first dish for a long time.
Doctors also do not prohibit the use of cold soups - beetroot soup and cabbage soup. In limited quantities, you can eat lean meat, which should be baked or boiled. Boiled marine fish is especially useful after rectal surgery. This product promotes rapid tissue repair.
Cabbage and beets are recommended as side dishes or vegetable dishes. You can eat greens, as an indispensable component of any diet. Doctors also recommend including buckwheat in the diet.
A gentle balanced diet is needed for the symptoms and signs of rectal oncology. Legumes during the rehabilitation period are strictly prohibited, since they cause increased gas formation in the intestine. The number of eggs in the diet is limited: not more than one per day, and it is recommended that the product be added to salads or other dishes. Fat intake is also limited, but in a small amount, butter and vegetable oil should be added to dishes.