Rectal Cancer - Signs, First Symptoms, Stages And Treatment Of Rectal Cancer. Operation And Prognosis Of The Disease

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-17 02:10

First symptoms, stages and treatment of rectal cancer

Content:

• Rectal cancer symptoms
• Rectal cancer signs
• Rectal cancer causes
• Rectal cancer stages
• Disease prognosis
• Rectal metastases
• Rectal cancer diagnostics
• Rectal cancer treatment
• Diet for rectal cancer
• Rectal cancer prevention

What is rectal cancer?

Rectal cancer is a tumor transformation of epithelial cells of the mucous membrane of any part of the rectum, which has all the signs of malignancy and cellular atypism. This means that such a tumor manifests itself with the usual properties of malignant neoplasms, namely: rapid and infiltrative growth with penetration into the surrounding tissues, a tendency to metastasis, and frequent relapses after treatment. Modern oncologists combine rectal cancer with colon cancer into one group and call it colorectal cancer. The disease is equally common among men and women in the age range from 40 to 75 years. Prevalence - 16 cases per 100 thousand population per year.

Despite the frequent occurrence, this type of oncological pathology ends with a favorable outcome much more often than other cancerous tumors. This is due to the fact that the anatomical location of the primary tumor in rectal cancer is available for diagnosis in the early stages of development. To detect a tumor, the doctor needs a simple digital examination or endoscopic examination in the presence of the slightest complaints. In addition, most cases of early stages of rectal cancer (with the exception of low-lying forms) lend themselves well to surgical removal, are quite sensitive to radiation and chemotherapy.

When planning treatment tactics and making predictions for specific cases of rectal cancer, several of its most important characteristics are guided:

1. Growth zone in the rectum:

   • Rectosigmoid section - a tumor at a height of more than 12 cm from the anus;
   • Upper ampullar - a tumor at a height of 8 to 12 cm from the anus;
   • Medium ampullar - a tumor at a height of 4 to 8 cm from the anus;
   • Lower ampullar section - from the dentate line to 4 cm;
   • Anal cancer - the tumor is located within the anus;

2. The type of cancer growth:

   • Exophytic - into the lumen of the rectum in the form of a tumor node;
   • Endophytic - the tumor grows through the wall of the organ and slightly protrudes into its lumen;
   • Infiltrative - cancer that quickly involves all tissues around the rectum in the tumor process, in the form of an inflammatory conglomerate;

3. The presence of metastases:

   • Damage to the peri-rectal lymph nodes;
   • Metastases in the pelvic tissue;
   • Involvement of the para-aortic and inguinal lymphatic collectors;
   • Distant metastases in the liver, lungs and other organs;
   • The degree of histological differentiation of a cancer tumor:
   • Poorly differentiated - slowly growing and rarely metastasizes;
   • Highly differentiated - very quickly shows all signs of malignancy;
   • Moderately differentiated - occupies an intermediate position between the previous types of cancer.

Life expectancy with rectal cancer

The statistics for rectal cancer are not always optimistic, but they are much better than for other types of malignant tumors:

• Despite the availability of diagnostics, the detection of the disease at stages 1-2 does not exceed 20%. About the same number of patients already have metastases in the lymph nodes and internal organs;
• In most patients (about 60-70%), the disease is detected at 3 stages;
• On average, about 60% of patients experience a 5-year line after treatment;
• In stage 4 rectal cancer, five-year survival has not been recorded. The average life expectancy of such patients is 3 to 9 months;
• Life expectancy of patients with an established diagnosis of highly located, poorly differentiated rectal cancer at stages 1-2 is the highest and is measured in decades;

Life expectancy in rectal cancer depends on many characteristics: structure, type of growth and location of the tumor. But the most important factor is early diagnosis of the disease, which tenfold increases the chances of a further full life!

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Rectal cancer symptoms

Rectal cancer does not manifest itself with specific symptoms for a long time. The situation is aggravated by the fact that when symptoms appear, patients often do not pay attention to them. Indeed, more than 75% of such people have a burdened history of the pathology of the rectum and anal canal (chronic hemorrhoids, paraproctitis and rectal fistulas, anal fissure and itching, proctitis of various origins). Therefore, perceiving the true symptoms of cancer for the next exacerbation of their chronic disease, a person seeks help only when the symptoms shown in the table arise.

Detailed characteristics
Discharge from the rectum	Mucous discharge; Brown discharge; Bloody issues. They can be represented by pure blood as rectal bleeding with a low location of the tumor. Cancer localized in the middle, upper ampulla and rectosigma is manifested by the presence of undigested blood on the stool during bowel movements.
Bowel irritation	Recurrent pain in the entire abdomen, such as spasms; Discomfort in the lower abdomen; Pain and foreign body sensation in the rectum; False urge to defecate; Loose stools. Often occurs in the initial stages of the disease and precedes intestinal obstruction, which is characteristic of the large size of the tumor focus.
Intestinal obstruction	The appearance of a tendency to constipation or their aggravation in the presence of such an anamnesis; Bloating; Rumbling with pain; Complete obstruction of the intestine in the form of stool and gas retention, severe abdominal distention, vomiting, severe pain.
General symptoms	Unexplained general weakness, lethargy, fatigue; Pallor of the skin; An unreasonable slight increase in body temperature; Weight loss; Decreased appetite and change in taste preferences.

The first symptoms of rectal cancer

The whole difficulty of early diagnosis of rectal cancer lies in the non-specificity of its first manifestations. Usually these are symptoms that every person periodically observes.

Therefore, in relation to rectal cancer, you should always be wary:

• The primary appearance of any of the symptoms characteristic of this disease and their long-term preservation (weakness, low-grade fever, loss of weight and appetite, constipation, discomfort in the rectal area);
• Progression of symptoms characteristic of any diseases of the rectum, if present in history;
• Any discharge, especially with blood impurities. Patients with chronic hemorrhoidal bleeding must necessarily note their intensity and the nature of the secreted blood, which changes in rectal cancer;
• The first symptoms of the disease in the form of intestinal obstruction or severe bleeding always indicate the late stages of the tumor process.

Rectal cancer signs

The clinical picture of rectal cancer, consisting of complaints and objective signs of the disease, is based on the data given in the table.

Detailed characteristics
Data from digital rectal examination	When a digital rectal examination is carried out by a proctologist, urologist, gynecologist or surgeon, a cancerous tumor can be detected at a height of up to 10 cm. Its signs are a tumor-like formation or deformation of the mucous membrane in the form of tuberosity, painless or slightly painful, elastic or dense, of various sizes; Exophytic growing tumors with a low degree of differentiation are well displaced and can have a long or short stem; Endophytic-infiltrative forms of cancer circularly narrow the intestinal lumen, they are dense and motionless; Tumors of the anal canal are determined visually during a routine examination in the form of a tumor-like protrusion from the anus; Stage 4 tumors, growing through the entire intestinal wall and causing its destruction, appear in the form of acute paraproctitis due to fecal leakage on the perineum and perineal tissue; After finger examination on a glove, feces with blood or brown discharge.
Palpation data of the abdomen	Rectal cancer stage 1-2. Has no objective manifestations when examining the abdomen; When a large tumor is located in the rectosigmoid section, it can sometimes be palpated as a tumor-like formation in the lower-left abdomen; Abdominal distension with tympanitis over the entire surface is noted on percussion; Signs of intestinal obstruction (pronounced bloating with high tympanitis, splashing noise, noise of a falling drop).
General data of physical examination	Exhaustion of the patient; Pallor of the skin with a gray or icteric tint; Coating of the tongue with white bloom; Enlargement of the liver.

In the early detection of rectal cancer, the leading place belongs not to the symptoms of the disease, which the patient himself notes, but to objective signs. Therefore, preventive medical examinations are a really effective method for diagnosing rectal cancer in the early stages!

Rectal cancer causes

The main reasons for the development of rectal cancer include:

• Immune imbalance in the body, in which the immune surveillance cells responsible for the elimination of tissues with signs of cellular atypism are unable to provide anti-tumor protection. Against this background, defective cells of the rectal epithelium, which are constantly formed during the renewal of the mucous membrane, remain unnoticed. As a result, their further multiplication in the form of a tumor. This mechanism of colorectal cancer is usually associated with other causative factors;
• Precancerous conditions from the mucous membrane of the rectum and anal canal. These include any chronic diseases of the anorectal zone: hemorrhoids, paraproctitis, rectal fistulas, chronic anal fissure, chronic proctitis and proctosigmoiditis, Crohn's disease and NUC (ulcerative colitis). The launch of tumor growth in this case is caused by a disruption in the process of normal cell division, caused by their prolonged damage;
• Single large polyps or polyposis of the colon and rectum. The presence of benign growths of the mucosa in the form of tumor-like thickenings is accompanied by their constant growth. In this case, there is an extremely high risk of malignancy of polyps with their transformation into a cancerous tumor;
• Carcinogens. These include chemicals (nitrates, pesticides, industrial poisons and emissions), ionizing radiation, food (the predominance of meat dishes, fast food, cholesterol and animal fats in the diet), oncogenic viruses. Carcinogenesis is structured in such a way that any of the carcinogens causes direct damage to the genetic material of the cells of the rectal mucosa, or affects indirectly through the formation of toxic products of lipid peroxidation. Cells with damaged DNA at the p53 gene locus, which triggers apoptosis (automatic death of a tumor cell), become immortal and multiply as a tumor;
• Genetic predisposition. A burdened hereditary history of colorectal cancer is one of the main risk factors for the development of this disease in first-line relatives.

See also: Other Cancer Causes and Risk Factors

Rectal cancer stages

The classification of rectal cancer depending on the stage of the tumor process is based on the following characteristics of the disease:

• The size of the primary tumor;
• The prevalence of the tumor in relation to 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.

All these signs coincide with the TNM classification of rectal cancer. The stage reflects only a combination of different degrees of the indices of each of the components of this abbreviation (from the first to the fourth degree, for example, T2N1M0). Isolation of the stage of the disease should be intertwined with the necessary therapeutic tactics.

Stage 1 rectal cancer Stage 1 is said to be when the cancer in the form of a tumor or ulcer is small, mobile, and occupies a clearly limited area of the mucous membrane. According to the degree of distribution, it does not penetrate deeper than the submucosal layer. Regional and distant metastases are not detected.
	Rectal cancer stage 2 Stage 2A is defined if the cancerous growth extends to an area from 1/3 to 1/2 of the mucosal circumference, but is located strictly within the intestinal lumen and its wall. There is no metastatic lesion; Stage 2B. The fundamental difference between this stage is that there are already metastases to the regional peri-intestinal lymph nodes. The primary tumor has a size similar to stage 2A or less.
	Rectal cancer stage 3 Stage 3A - the tumor occupies more than half the circumference of the rectum. The depth of germination is characterized by the involvement of the entire organ wall and peri-rectal tissue in the tumor process. In this case, single metastases in the lymph nodes of the first order are recorded. Stage 3B. Any size and depth of tumor spread. In this case, multiple metastatic foci are recorded in all rectal lymphatic collectors;
	Rectal cancer stage 4 Stage 4 can be either a tumor of any size in the presence of distant metastases in internal organs and lymph nodes, or a disintegrating tumor with destruction of the rectum and growth through the surrounding tissues of the pelvic floor in combination with regional metastases.

Disease prognosis

Colorectal cancer outcomes can be predicted based on the following data:

• Stages of the disease;
• Type and degree of tumor differentiation;
• The age and general condition of the patient;
• The presence of concomitant pathologies;
• Timeliness, adequacy and effectiveness of the treatment.

Depending on this, the prognosis for rectal cancer may be as follows:

• Cancer of the anal canal and lower ampullar rectum has the worst prognosis, even at stages 1-2, as it requires a disabling operation and often recurs. Such patients are forced to use colostomy bags for life;
• Poorly differentiated tumors always have a much better prognosis than tumors with a high degree of cancer cell differentiation;
• Forecasts for life and recovery are significantly aggravated by old age, concomitant diseases and disorders of the general condition of patients. These factors not only limit the possibilities for performing radical surgery, but also accelerate the progression of the tumor process;
• The survival rate of patients in relatively satisfactory general condition with stage 1-2 cancer ranges from 60% to 85%;
• With stage 3 tumors in patients with relatively good health, the survival rate for 5 years after the diagnosis, subject to radical treatment, is about 30%;
• With stage 4 cancer, the prognosis for life is poor. Almost all patients die within 6-8 months.
• Refusal from radical treatment of operable forms of cancer of any stage has a poor prognosis and ends with death within a year.

Rectal metastases

Cancer tumors of the rectum with a high degree of cell differentiation are most prone to metastasis. Even their small size does not exclude the presence of distant metastatic foci.

Favorite places of metastasis of such tumors:

• Regional, pelvic and retroperitoneal lymph nodes;
• Liver;
• Lungs and pleura;
• Hollow organs of the abdominal cavity and peritoneum;
• Brain;
• Flat bones and spine.

Primary distant metastases in 95% of patients appear in the liver. At the same time, it increases its size and becomes denser, which is manifested by discomfort and heaviness in the right hypochondrium. As new metastases grow and appear, they gradually replace the liver tissue, which disrupts the functional abilities of the liver and is manifested by yellowness of the skin.

The second most common type of distant metastases is the lesion of the peritoneum, which is called carcinomatosis. As a result of its irritation and impairment of functional abilities, ascites is formed with the accumulation of a huge amount of ascites fluid. Similar changes occur in the pleural cavity in the presence of pleuropulmonary metastasis. In this case, one - or two-sided hydrothorax is stated.

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Rectal cancer diagnostics

Directions and methods for diagnosing rectal cancer can be as follows:

1. Confirmation of the presence of a tumor in the rectum:

   • Digital rectal examination;
   • Sigmoidoscopy. Informative for low-lying cancers;
   • Fibrocolonoscopy. More appropriate for cancerous lesions of the rectosigma;
   • Irrigoscopy;
   • Determination of tumor markers of rectal cancer in the blood.

2. Identification of metastases and tumor spread:

   • Transabdominal ultrasound examination of the abdominal cavity and pelvis;
   • X-ray examination of the chest organs;
   • TRUS - transrectal ultrasound examination of the pelvis;
   • Tomography in the mode of computer or magnetic resonance imaging.
3. Identification of the histological type of tumor. Achieved only by biopsy during endoscopic examination with further study of the preparation from the biopsy under a microscope;
4. Other research. They include general and biochemical blood tests, gastroscopy, ECG, determination of blood coagulation and other data that may be required when drawing up a treatment program.

Rectal cancer treatment

The localization of rectal cancer is such that it can be used in its treatment all the methods used in oncological practice. The choice of a particular method or their combination depends on the depth and degree of tumor growth, stage of the process and the general condition of the patient. In any case, surgery is rightfully considered the central method of treatment. But in an isolated version, it can be used only for small, poorly differentiated stage 1-2 tumors. In all other cases, an integrated approach is shown.

An integrated approach includes:

• Contact and external beam therapy in the pre- and postoperative period;
• Surgery;
• Polychemotherapy.

Features and possibilities of surgical treatment

The choice of a specific type of operation is carried out depending on the height of the location of the tumor focus.

Surgical tactics can be as follows:

1. Any forms of cancer at the height of intestinal obstruction require the removal of the unloading transverse stoma. After stabilization of the patient's condition, a radical operation is performed to remove the tumor;
2. Cancer of the rectosigmoid flexure. Obstructive rectal resection is performed with the removal of the unnatural anus in the form of a flat sigmostomy. The procedure is better known as the Hartmann operation;
3. Cancer of the upper ampullary, sometimes mid-ampullar section. Shown is anterior rectal resection with lymphadenectomy and removal of pelvic tissue. Bowel continuity is restored through the primary anastomosis. Sometimes a unloading preventive transverse stoma is applied;
4. Cancer of the middle and lower ampullarongo of the rectum. Peritoneal-anal extirpation of the rectum is performed. In this case, almost all of the rectum with the tumor is removed, leaving only the sphincter apparatus. By bringing down the sigmoid colon and fixing it to the anal press, the possibility of natural defecation is restored;
5. Cancer of the anorectal region and any tumors with damage to the sphincter. Peritoneal-perineal rectal extirpation (Quesnu-Miles operation) is performed. In this case, the entire rectum with the closing apparatus and lymph nodes is removed. An unnatural anus is removed, with which the patient remains for life.

Chemotherapy for rectal cancer

Chemotherapy plays an important role in the prevention of recurrence of rectal cancer. This method of treatment involves intravenous infusion of combinations of several anticancer chemotherapy drugs to which the tumor cells of colorectal cancer are sensitive. Among these drugs: 5-fluorouracil, oxaliplatin, leucovorin. Chemotherapy using these drugs is indicated as the only treatment when the tumor cannot be removed, or in combination with surgical treatment. If at the time of the operation multiple metastases in the lymph nodes or single metastatic foci in the liver were detected, chemotherapy for rectal cancer is carried out in periodic courses for a long time.

See also: Other treatments

Diet for rectal cancer

Proper nutrition for rectal cancer should be given special attention. The diet should be sufficiently nutritious and balanced in quality and quantity, and not cause intestinal irritation. Therefore, spicy and fatty foods, spices, alcohol, smoked meats, pickles and canned food are excluded from the menu. They are replaced with fresh vegetable salads, lean fish and dietary meats, nuts, and fermented milk products. It is very important to properly organize the diet in relation to the distribution of the daily volume of the diet between meals.

An indicative menu for a week for a patient with an established diagnosis of rectal cancer is shown in the table:

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Rectal cancer prevention

Rectal cancer prevention is not easy. This is due to the fact that it is not always possible to influence all its causes.

But it is in the power of each person to eradicate those risk factors, the presence of which increases the likelihood of developing this disease tenfold, or to do everything so that the disease that has arisen is detected as early as possible:

• Timely treat chronic diseases of the rectum and anal canal (hemorrhoids, fissures, fistulas, etc.);
• Combat constipation;
• Refuse excess consumption of animal fats, fast food and enrich the diet with vegetable oils;
• Minimize contact with hazardous chemicals;
• Undergo preventive examinations once or twice a year.

Of course, all these activities do not guarantee 100% protection against rectal cancer, but they significantly reduce the risk of its occurrence.

The author of the article: Bykov Evgeny Pavlovich | Oncologist, surgeon

Education: graduated from residency at the Russian Scientific Oncological Center. N. N. Blokhin "and received a diploma in the specialty" Oncologist"