Colorectal Cancer information: Rectal Cancer Treatment,Stages,causes,symptoms: Rectal cancer is a malignant transformation of the epithelial cells of the mucous membrane of any of the lower intestinal tract. The tumor grows rapidly and penetrates into adjacent tissues, prone to metastasis. The disease most often occurs between the ages of 40 to 75 years. The incidence rate is 1.6 cases per 10 thousand people.
Signs of colorectal cancer in the lower part do not appear in the early stages of its development. With this oncology, statistics show that the earlier the treatment is started, the person has a greater chance of recovery.
Classification of Rectal or Colorectal Cancer
There is the following generally accepted classification of malignant neoplasms of the lower intestine. In the form of growth of rectal tumors distinguish exophytic, endophytic and mixed cancer.
In the exophytic form of pathology there is a clearly visualized pathological node. It grows into the intestinal lumen. In endophytic cancer, the growth of a malignant tumor occurs predominantly deep into the rectum. The mixed form is characterized by the presence of tumors of different types. Often she can behave unpredictably.
On the histological basis, cancer is divided into the following types:
- Adenocarcinoma (glandular cancer). It makes up approximately 95% of all cases of the disease. Such a tumor develops from glandular tissue of the intestine.
- Mucous adenocarcinoma. Unlike the glandular tumor of the rectum, this species is characterized by a pathological proliferation of mucosal tissue. A distinctive feature of the disease is an increase in mucus production. Often this form of the disease is prone to extremely rapid development.
- Signet ring. It is a rare and dangerous type of rectal tumor. Pathology is prone to excessively rapid metastasis, and metastases can appear in distant organs, which complicates the prognosis. Often this disease occurs in young people.
- Squamous. It is found in the distal part (located farther from the center) of the intestine. The disease is characterized by a fairly rapid growth and pronounced progression. It quickly affects the nearby lymph nodes.
- Glandular squamous carcinoma. This type of cancer belongs to undifferentiated malignant neoplasms. Formed in limited areas of the mucous membranes. It is characterized by aggressiveness and propensity to increase rapidly.
- Undifferentiated carcinoma. This is a malignant tumor of the rectum, which does not belong to any of the existing groups of oncological formations. It does not have clearly defined and defined structures.
- Skirr This is a type of fibrotic colon cancer. The structure of the tumor is dominated by stroma (this education, which consist of soft or fibrous connective tissue).
- Melanoma can affect the anorectal rectum. It refers to rapidly growing malignant neoplasms. In this case, the body wall is covered with poorly differentiated tumor formations.
The level of differentiation of the tumor of the rectum can be highly differentiated, moderate and undifferentiated. Cancer of the first type means that the features of a normal cell and tissue are preserved. It is characterized by slow germination in neighboring tissues.
In moderately differentiated tumors of the rectum, the number of cells that retain the properties of healthy, much less. Tumors are more malignant.
Poorly differentiated malignant tumors differ from healthy ones. They behave aggressively, actively germinate in closely located tissues and give metastasis early. Undifferentiated types of tumors are especially dangerous if the human body is weakened or the patient suffers from anemia. These types of colorectal cancer often occur in old age.
Depending on the location, there are the following types of tumors of the rectum:
- Nadampular Most often, it is a dense tumor, which annually narrows the intestinal lumen. In advanced cases, it quickly leads to stenosis, i.e., contraction and obstruction of the rectum with feces. This type of cancer occurs in about 15% of cases of malignant colon tumors.
- Ampullary cancer is most often its endophytic variety. It occurs most frequently: the number of cancer cases of this form is about 85%. Prone to bleeding.
- Anal cancer is less common – about 5% of all cases. This type of oncology occurs too close to the anus. His treatment is associated with a number of difficulties, because the patient has to impose a colostomy (unnatural anus). This complicates the rehabilitation of a person after surgery on the rectum.
Rectal or Colorectal Cancer Causes
Under the causes of carcinoma of the rectum refers to all changes in the human body, leading to the appearance of a malignant neoplasm. This group includes any type of decrease in the activity of the immune system, the supply of carcinogenic substances (including with food), mutations, adverse genetic predisposition and other factors.
The main reasons for the formation of oncopathology of the rectal in humans:
- The presence of inflammatory diseases of this intestine – especially such as proctitis, proctosigmoiditis.
- All benign tumors that are in the rectum, including polyps. They are prone to malignant degeneration.
- Ulcerative colitis nonspecific.
- Improper nutrition. Excess amount of protein in the diet is especially harmful to the intestine. This causes frequent constipation, slowing of peristalsis. Lack of fiber intake also leads to cancer.
- Severe constipation causes microdamages in the mucosa. They are a contributing factor in the development of atypical elements on it.
- Improper setting of a cleansing enema, which often happens with constipation. The mucosa of the rectum is injured, creating favorable conditions for the appearance of cancer cells.
- Unfavorable heredity is considered the “trigger” of human development of oncology of the rectum.
- Chronic hemorrhoids, especially with the presence of large internal and external nodes, are often the cause of cancer. Sometimes the nodes themselves can degenerate into malignant tumors.
- Cracks anus.
- In men, a prostate adenoma can become a frequent factor in the development of a malignant lesion of the rectal mucosa. When urinating disorders, men are forced to strain themselves strongly, which leads to the appearance of microcracks in the intestinal mucosa.
- The development of this disease is promoted by smoking and drinking strong alcoholic beverages.
Rectal or Colorectal Cancer SYMPTOMS
For oncopathology of the rectal are characterized by such signs:
The appearance of unnatural painful impurities in the feces. Patients should be alerted to the fact that mucus, blood and pus are observed in the feces. Often in portions of feces may appear streaks of bright red blood. This suggests that fresh wounds formed on the mucous membrane resulting from tumor growth.
Severe stool disorders may be the first signs of a rectal tumor at an early stage. If the patient has a tendency to constipation, then this may indicate that he has a tumor in the rectal lumen. The danger of this situation is that patients begin to take laxatives uncontrollably. Peristalsis is further disturbed, which leads to a further deterioration of the situation.
- The appearance of pain during defecation. The intensity of the discomfort can be different.
- A decrease in body weight is a symptom that often occurs with the development of cancer. If the patient has pain, he tries to eat less food so that bowel emptying occurs as little as possible. These eating disorders lead to weight loss and the development of symptoms of beriberi.
- In women, the first signs may be similar to those that occur with menstrual dysfunction.
- Decreased performance, fatigue, fatigue.
- Long-term rise in body temperature up to 37 ºС, sometimes up to 38 ° С. Although this is a nonspecific symptom of rectal oncopathology, it should be alerted.
- Painful sensations of different intensity. Moreover, they can spread throughout the abdomen, radiating to the lumbar region, coccyx or sacrum. Soreness may be permanent or periodic, have a cutting, pressing, piercing character. When the pathological process is neglected, a person may experience discomfort in the liver area (this most often indicates the formation of metastases in it).
- A change in the color of the integument of the skin is observed if there are metastases in the liver. At the same time they turn yellow. Often with oncology of the rectum, the skin may be grayish.
- Tenesmus, i.e. false urge to empty the bowel. They may be overly painful.
These signs can be found alone or manifest together. Some people have an asymptomatic course of oncology of the rectum.
Rectal or Colorectal Cancer STAGES
They may vary depending on how quickly the cancer of the organ develops. There are 4 stages of malignant rectal disease:
- The initial stage 1 cancer is diagnosed if the tumor is small, characterized by mobility. Does not penetrate deeper submucosal layer. Metastases are not detected.
- Stage 2-A is diagnosed if the malignant neoplasm has spread from a third to half of the circumference of the rectum and is clearly located within the intestinal lumen. There is no metastasis at this stage of the disease.
- At stage 2-B, there are metastases in the regional lymph nodes. The size of the tumor is the same as in stage 2-A.
- If the tumor occupies more than half of the intestinal lumen, then the patient is diagnosed with stage 3-A. The malignant process includes all the walls of the rectum. Begin to be amazed and fiber around the body. There are few metastases in the lymph nodes.
- At stage 3-B, there are numerous metastases in any lymph nodes. The sizes of the malignant tumor are the same as in stage 3-A.
- At stage 4, metastases begin to spread to the lymph nodes and internal organs. A tumor may measure more than half the rectal lumen. It begins to gradually break down, and the tumor grows into the pelvic floor.
Consequences Of Rectal or Colorectal Cancer
The consequences of cancer of the rectum can be systematized in this form:
- the spread of the tumor in the adjacent tissues (organs of the small pelvis) with the formation of fistulas;
- vaginal damage in women, bladder;
- the formation of perifocal suppurative inflammatory phenomena: purulent paraproctitis, phlegmon of the retroperitoneal region, pulmonary pelvic lesion;
- perforation of the tumor with the appearance of pelvioperitonitis;
- hemorrhage with the development of progressive anemia;
- obstructive intestinal obstruction.
Sometimes rectal cancer metastasizes to the liver tissue. Symptoms of liver metastases are as follows:
- feeling of heaviness and pressure in the right hypochondrium;
- strong discomfort (they occur in the later stages of the development of pathology);
- discoloration of the skin (it turns yellow);
- the expansion of the vessels in the abdomen;
- severe skin itching (it is not associated with dermatological pathologies).
The appearance of lung metastases is associated with the following symptoms:
- strong and frequent cough;
- impaired respiratory function;
- squeezing in the chest;
- small portions of blood while coughing.
Metastatic bone damage is characterized by pain. It is most often localized in the back or limbs.
Complications of colorectal cancer after surgery and the spread of metastases is an unfavorable sign indicating neglect of the oncological process.
Rectal or Colorectal Cancer DIAGNOSTIC METHODS
It is necessary to consider how to recognize rectal oncology. For this purpose, complex diagnostics is applied, which includes several stages:
- Collect information and study case history. The specialist draws attention to the presence of a patient of various complaints, indicating the possible presence of cancer. Often, the presence of pathology may indicate an increase in body temperature to 37ºC and more.
- Digital rectal examination. It helps to determine the presence of extraneous formation in the intestines.
- Blood test for hemoglobin. Should be marked by a marked decrease in the amount of hemoglobin in the blood, an increase in the erythrocyte sedimentation rate and a strong drop in their level. Such indicators of blood tests for rectal cancer may indicate a neglected process.
- Analysis of fecal occult blood. Sometimes its result can be false positive with a fissure of the anal passage and false negative if the malignant neoplasm does not bleed.
- Blood test for tumor markers. This specific study helps determine the presence of cancer-sensitive antibodies in the patient’s body.
- Biochemical analysis of blood helps to identify specific violations of the number and activity of liver enzymes. The growth of their level in the body indicates the possible presence of metastases in the liver.
- Ultrasound helps to see the tumor with the presence of metastases. It is advisable to conduct transrectal ultrasound.
- Irrigoscopy, i.e. examination of the colon and rectum using x-ray apparatus. To improve its results, a contrast agent (barium sulfate) is introduced.
- Rectoromanoscopy (endoscopic examination of the intestines) and biopsy (tissue sampling followed by microscopic examination) help establish the final diagnosis. A biopsy is performed using a sigmoidoscope, which reduces the invasiveness of the procedure and reduces the discomfort with it.
- Colonoscopy (endoscopic examination of the entire large intestine).
- Chromoscopy (staining method of tumor cells) gives an accurate result in the process of differential diagnosis of the disease.
Differential diagnosis of cancer is carried out in order to exclude such pathologies:
- Hemorrhoids. The blood in this disease appears at the end of the act of emptying the intestines. Patients need to conduct sigmoidoscopy.
- Syphilis. For a definitive diagnosis, a biopsy and a Wasserman reaction are necessary.
- Tuberculosis produces multiple ulcers with an uneven bottom and edges. For the purpose of differential diagnosis biopsy is shown.
- In the inguinal lymphogranulomatosis the lymph nodes are enlarged, the lower parts of the direct intestine are affected.
- Much less common benign tumors. For their differentiation biopsy is shown, ultrasound.
- Melanoblastoma is localized in the anal part. It is characterized by the appearance of dark, almost black nodes.
The patient is required to diagnose the effects of radiation therapy in rectal cancer. It will allow time to adjust the treatment.
Rectal or Colorectal Cancer Treatment
This disease is well treatable under conditions of early diagnosis, the patient undergoes annual preventive medical examinations. Treatment of oncogenesis of the rectum, even before the onset of its symptoms, gives sufficiently high results and almost completely relieves the patient from possible relapses.
The leading and most common cancer treatment is surgery to remove a malignant neoplasm. Interventions are radical and palliative. Among the radical operations are the following:
- Anterior resection of the direct intestine, regional lymphadenectomy. Under resection understand the removal of the affected department and stitching its ends. During this type of operation, an anastomosis is imposed (an artificial message of the abdominal organ), which allows the intestines to be emptied. The operation is indicated in the early stages of cancer, when the malignant tumor has not yet reached a large size. Resection to a small extent limits the life of the patient, allows him not to reduce activity and maintain working capacity.
- Abdominal resection of the rectum. At the same time the sigmoid part of the intestine is lowered, and the sphincter of the anus in most cases can be preserved. Such an operation is shown, provided that the cancer is in the lower sigmoid region.
- Abdominal-perineal extirpation of the rectum. This is a more complicated operation, since at the same time the large intestine is brought into the iliac region. Emptying the usual way becomes impossible, because the patient is superimposed colostomy, bred on the anterior abdominal wall.
- Resection of the rectum with the removal of colostomy. It is often performed if the nodes are low.
- Anal resection is performed if the foci of the cancer are too close to the anus.
All surgical interventions on the rectum are traumatic, they require preliminary examination and accompanying treatments.
Along with radical operations for this disease, palliative interventions are also performed. They are performed in patients with inoperable tumors. Conducting palliative interventions involves the imposition of double-barreled colostomy, combined treatment using radiation therapy methods.
Of great importance is the use of radiation therapy. They are used primarily in cases where for some reason a surgical operation is contraindicated. During radiation therapy, the affected area is subjected to specially selected radiation. It allows you to destroy cancer cells formed in the intestine.
This treatment helps to prevent the possible spread of tumor cells throughout the intestine. Radiation and radiotherapy for rectal cancer are performed 3 weeks after surgery. Exposure to rays occurs not only in the intestinal area, but also in the region of regional lymph nodes. Especially shown radiotherapy in metastatic lesions.
In the postoperative period, the use of chemotherapy drugs is also used in drug therapy for colorectal cancer. The most commonly prescribed agents are based on 5-fluorouracil. Treatment with this substance gives satisfactory results. Other medications used in the treatment of rectal cancer are Tegafur, Eloxatin, Irinotecan.
If metastases are formed, the use of agents for targeted treatment is indicated. They allow you to slow the formation of blood vessels in the tumor. Proper chemotherapy for colorectal cancer significantly reduces the likelihood of complications. Such complex drugs as Bevacizumab, Cetuximab, Oxaliplatin are increasingly used.
With common tumors and the presence of metastases, chemotherapy is not always effective and appropriate. The use of potent drugs, radiation therapy after radical or palliative intervention can prolong life and improve the prognosis of five-year survival in cancer.
Palliative chemotherapy can last for a long time with Fluorouracil or Leucovorin. In some cases, the doctor may prescribe these drugs even for several months. Such radical actions help to prolong the life of the patient. Together with chemotherapy can be used protein medication Zaltrap. It affects protein growth factors and slows down tumor growth.
In case of cachexia and severe pain, palliative measures are reduced to the appointment of painkillers and the introduction of drugs that improve the human condition.
Enemas in rectal cancer are shown in the early stages of the development of pathology. They are included in the complex of national treatment for this disease. For enemas, infusions of medicinal herbs with antimicrobial and antiseptic action are used.
The use of soda as a therapeutic agent dramatically worsens the condition of a person, and can lead to a pronounced disruption of the acid-base balance. The same applies to the use of “shock” doses of vitamin C for getting rid of cancer: such actions cause hypervitaminosis and chronic poisoning.
If you put the enema in the later stages of development of oncopathology of the rectum, such procedures can cause bleeding. The presence of a patient with hemorrhages greatly weakens it.
NUTRITION AFTER SURGERY
Food after surgery for cancer of the rectum should not irritate the mucous membrane. Food should be as gentle and exclude any fermentation processes. Should sharply limit carbohydrates, hot, cold food is strictly prohibited.
The first day after surgery, patients are on a starvation diet. Medical nutrition in the form of a diet number 4 is appointed only from the second day after surgery and carefully so as not to cause irritation of the intestine.
Rectal or Colorectal Cancer prognosis & Prevention
The prognosis of a rectal tumor depends on the following factors:
- stage of the disease;
- the histological structure of a malignant neoplasm;
- tumor growth forms;
- the presence or absence of metastases;
- surgical intervention during cancer treatment;
- the number of affected lymph nodes (if there are more than 5, then the prognosis is considered unfavorable).
Adverse predictors of oncology of the rectum after surgery:
- intestinal perforation;
- low degree of differentiation of tumor cells;
- germination of cells in adipose tissue;
- the spread of the tumor in the venous wall;
- cachexia (i.e., dramatic exhaustion of the patient).
Relapses of the disease can develop in the first 4 years after a radical surgery. If they did not occur within the next 5 years after complete radical removal of the cancer, then this is a good prognostic sign. It shows that in the next 5 years the risk of developing cancer, provided that it is a supportive treatment, remains low.
If the blood contains an elevated content of the cancer-embryonic antigen, then the risk of a recurrence of a malignant neoplasm increases significantly. This indicator does not always depend on the stage of pathology.
The life expectancy of patients with rectal cancer stage 4 is significantly reduced. Approximately 2/3 of people suffering from this disease are diagnosed with liver metastases. In a third of patients metastases are found in the brain, which is an unfavorable sign. The presence of metastases in the lung tissue leads to pulmonary edema and pulmonary embolism when it is blocked.
If distant metastases are found in a patient, his life expectancy does not exceed 9 months. If there are single metastases in the liver, then the likely life expectancy of such a patient is from 2 to 2.5 years.
Prevention of colorectal cancer are reduced to the implementation of such recommendations:
- correction of nutrition with the exception from the diet of fried, spicy, salty;
- complete cessation of smoking and drinking alcohol, and in any form;
- the fight against constipation, diarrhea;
- timely treatment of hemorrhoids;
- passing annual preventive examinations;
- compliance with sufficient motor activity, the fight against physical inactivity (immobility).
Pathologies such as acute or chronic colitis cannot be ignored in any way. Early treatment can reduce the likelihood of malignant cell degeneration.
Be sure to visit a doctor when the following symptoms appear:
- mucus, blood and impurities of pus in the feces;
- development of feelings of discomfort, pain in the anus, not only during or after a bowel movement, but also at rest;
- frequent urge to empty the bowel (especially if they are accompanied by pain, pain);
- bleeding, especially if there are red blood drops on the laundry;
- discharge from the anal orifice.
It is important to comply with hygiene requirements. Never use newsprint after defecation. The paint irritates the mucous membrane and may contain carcinogens. After each bowel movement, it is advisable to wash away. Such a good habit must be developed from childhood.