Colon cancer cells. Rectal cancer - symptoms, stages and treatment of the disease

In modern oncology, malignant neoplasms of the rectum, combined into one group with malignant tumors, are often called.

Definition and Statistics

Rectal cancer is a disease that develops as a result of tumor degeneration of the epithelial cells of the mucous membrane lining any part of the rectum and has characteristic signs of cellular polymorphism and malignancy.

This means that this disease is characterized by rapid infiltrative growth with germination into adjacent tissues, a tendency to metastasize and frequent relapses even after qualified treatment.

According to medical data, this disease occupies third position in the structure of cancerous tumors of the gastrointestinal tract.

It accounts for 43% of all malignant neoplasms of the intestine and 5% in the general structure of cancerous tumors of any location.

The disease affects representatives of both sexes with equal frequency, belonging to the age category of 45-75 years. Every year, 18 new cases are detected for every 100,000 Russians. Despite its extreme prevalence, rectal cancer ends in a favorable outcome much more often than other oncological pathologies.

The photo clearly shows what a cancerous tumor looks like - adenocarcinoma of the lower ampullary rectum

This is due to the peculiarities of the anatomical location of the rectum, the primary tumors of which make it possible to detect them at the earliest stages of the disease. It is enough for a specialist to perform only a digital examination or an endoscopic examination of the rectum at the first complaints of the patient.

Causes

The main causes of colorectal cancer in men and women are considered to be:

long-term presence of feces in the ampullary part of the rectum;
the presence of any chronic ailments of the anorectal area (hemorrhoids, chronic anal fissures, paraproctitis, chronic proctitis, proctosigmoiditis);
hereditary predisposition (patients who have blood relatives who have had rectal or colon cancer are automatically included in the risk group for this disease);
the presence of family and colon cancer (if left untreated, by the age of forty it will inevitably end in colon cancer);
presence of an oncological history (patients who have undergone, as well as women who have recovered from, or ovaries, continue to remain at high risk for rectal and colon cancer);
belonging to the age category over 60 years;
increases the risk of developing a malignant tumor of the rectum (women who smoke are 40% more likely to become victims of this disease; in men who smoke, this occurs in 30% of cases);
the presence of certain strains in the patient’s body (this may be a precancerous condition for a malignant neoplasm of the anal canal);
exposure to carcinogenic substances (primarily chemicals: nitrates, industrial emissions and poisons, pesticides) and ionizing radiation;
unhealthy diet, replete with fast food, cholesterol, animal fats and red meat.

Classification

There are several types of classifications of malignant tumors of the rectum. Depending on the location, rectal cancer can be :

Supraampullary (high). Represented predominantly by dense scirrhus, this form of cancer is characterized by a ring-shaped narrowing of the intestinal lumen, accompanied by rapidly developing stenosis.
Ampullary, which is the most common and has the structure of adenocarcinoma. This form of tumor can develop as a bulging neoplasm or a bleeding ulcer with a crater-shaped base.
Anal located in the anal canal area. This form of cancer, which looks like a tumor or ulcer, most often has a squamous cell type of structure.

Another type of classification of rectal cancer, based on the location of malignant neoplasms, divides them into tumors:

anal region(occurs in 10% of cases);
rectosigmoid department (30%);
lower-, middle- and upper ampullary(60%) parts of the rectum.

Classification based on the type of growth of cancerous tumors divides them into three forms:

exophytic(20%), growing into the lumen of the affected intestine;
endophytic(30%), developing inside the tissues that make up the wall of the rectum;
mixed(50%), characterized by a combination of exophytic and endophytic growth.

Depending on the characteristics of the histological structure of tumor tissues rectal cancer can be represented by:

mucous;
solid;
fibrous;
undifferentiated malignant neoplasms.

Squamous cell carcinoma of the rectum

The histological structure of squamous cell carcinomas is represented by atypical epithelial squamous cells, which in rare cases have the ability to become keratinized.

Externally, squamous cell cancers of the rectum resemble ulcers with undermined edges; in every tenth case they look like overgrown cauliflower.

Ulcerated tumors are characterized by early metastasis to the lymph nodes and internal organs, rapid growth, the most malignant course and a disappointing prognosis.

Features of squamous cell carcinoma include:

the highest degree of malignancy (once it appears, the tumor soon occupies more than a third of the intestinal lumen);
large (over 5 cm) length along the length of the rectum;
germination into the tissue of adjacent organs (ureters and bladder, prostate, vagina);
rapid penetration into the lymph nodes through the lymphatic vessels;
dependence on the level of cell differentiation (well-differentiated squamous cell tumors have a better prognosis and patient survival rate);
high ability to recur (most often relapses occur within two years after surgical treatment).

Survival for squamous cell carcinoma directly depends on the extent of the tumor process in the intestine, the number of metastases in the lymph nodes and distant organs, the patient’s age, the duration of the disease, and the depth of tumor growth into the intestinal wall.

Patients who begin treatment six months after the onset of the disease have the best chances of survival. The five-year survival prognosis for squamous cell rectal cancer overall is 33%. Most patients die within the first three years.

Clinical manifestations

The insidiousness of rectal cancer lies in the complete asymptomatic nature of the initial stages of its development.

Over a fairly long period of time, the malignant neoplasm increases in size and steadily grows into the tissue of the intestinal wall, without showing itself in any way.

The appearance of specific signs of cancer, when the patient, suspecting something is wrong, goes to the doctor, indicates that the oncological process has already gone quite far. In many patients, by that time the tumor has metastasized to other organs and lymph nodes.

What are the first symptoms?

The initial symptom of rectal cancer, which occurs in 60% of cases, is slight bleeding, the presence of which can be guessed only by noticing minor blood impurities or dark clots in the stool.

They differ from bleeding hemorrhoids in that the release of blood precedes the act of defecation.

In addition to bloody discharge from the anus, the patient may experience:

unexplained fatigue caused by iron deficiency anemia due to constant blood loss;
shortness of breath that appears even after minor physical exertion;
feeling of insufficient bowel movement after bowel movement;
constant nausea caused by self-poisoning of the body with a disordered digestive system.

General symptoms

General symptoms, indicating a sharp deterioration in the patient’s condition, develop when the whole organism is involved in the tumor process. This includes:

extreme weakness;
decreased ability to work;
increased fatigue;
a sharp decrease in body weight;
complete loss of appetite;
pale and dry skin;
sallow complexion.

All these phenomena are caused by daily blood loss and severe tumor intoxication.

Signs of anal tumor

The most common and early symptom of this disease is a slight admixture of scarlet blood in the stool. Since this same symptom is a characteristic manifestation of hemorrhoids, it often misleads inexperienced doctors and patients themselves. In addition to blood, pus and mucus are often released from the patient's anal canal. This symptom, indicating the development of a concomitant perifocal (located next to the tumor focus) inflammatory process, is characteristic of the late stages of the disease.
The second characteristic symptom is pain in the anus. At first they occur only during bowel movements; Intensifying day by day, they become permanent, radiating to the lower abdomen, genitals and thighs. A number of patients experience such pain after sitting on a hard chair for a long time. Pain syndrome is associated with rich innervation of the rectum.
Constipation, often occurring with this type of cancer, are caused both by conscious retention of feces, associated with the patient’s fear of experiencing severe pain during bowel movements.
The most painful manifestations of the disease are tenesmus– frequent (from five to fifteen times during the day) false urge to defecate, ending with a slight discharge of pus, blood and mucus. After such a bowel movement, the patient, who does not experience satisfaction, continues to feel the presence of a foreign body in the rectum.
Pathological discharge from the anus often causes severe anal itching.
Tumor growth into the anal sphincter leads to incontinence of gases and feces, and if the pelvic floor and urethra are affected - to urinary incontinence.
The narrowing of the narrowest part of the rectum inevitably ends in the development intestinal obstruction.

Ampullary department

Rectosigmoid region

A cancerous tumor of this section can be represented by either ulcerated adenocarcinoma (in this case it manifests itself with mucous secretions and blood at the time of bowel movement), or scirrhus, characterized by progressive constipation.
As the tumor grows, constipation becomes more frequent and prolonged, accompanied by bloating of the left abdomen.
Further development of the tumor process, accompanied by the inevitable addition of inflammatory changes, leads to partial or complete intestinal obstruction. This stage of the disease is characterized by the presence of cramping pain in the abdominal cavity, frequent retention of stool and gas, and periodic bouts of vomiting.

Differences in signs of colorectal cancer in men and women

Although most symptoms of rectal cancer (especially in the initial stages) are in no way related to the gender of patients, there are still some differences in its clinical course in women and men.

Rectal cancer in women can grow into the tissue of the uterus or vagina. Cancer of the uterus does not affect the overall clinical picture of the disease, but tumor growth in the tissue of the posterior vaginal wall can lead to the formation of a rectovaginal fistula. As a result, gases and feces begin to be released from the female vagina.

A malignant tumor in men can grow into the wall of the bladder, causing the formation of a rectovesical fistula, leading to the release of feces and gases from the urethra. The bladder often becomes infected. The infection that enters it penetrates through the ureters into the kidneys, causing.

How is it different from hemorrhoids?

Chronic hemorrhoids can be distinguished from rectal cancer by a combination of signs:

With hemorrhoids, scarlet-colored blood is released after defecation and ends up on the surface of the stool, while with rectal cancer, the release of blood that has a darker color and mixed with feces precedes the act of defecation.
In case of rectal cancer, this act can also be preceded by mucous discharge mixed with pus, which has an unpleasant color and a repulsive odor. After a bowel movement, fragments of tumor tissue may be present in the stool, detached from the malignant neoplasm itself. With hemorrhoids there is no such discharge.
The shape of stool during hemorrhoids is practically no different from the stool of a healthy person during occasional constipation. A malignant tumor, which blocks the intestinal lumen as it grows, changes the shape of feces over time, making it ribbon-like (the thickness of this “ribbon” in cross-section does not exceed one centimeter).
In a patient with hemorrhoids, constipation is most often caused by the fear of experiencing pain during bowel movements; in cancer they are associated with intestinal obstruction.
The weight loss of a patient frightened by pain due to hemorrhoids may be associated with his conscious refusal to eat (neither his appetite nor the feeling of hunger disappears). Unexplained weight loss in rectal cancer is accompanied by a persistent lack of appetite.
The oncological process, as a rule, is accompanied by an increase in body temperature to the level of subfebrile values.

Only a competent doctor can evaluate the listed symptoms.

To make a correct diagnosis, a physical examination of the patient is required, including palpation of the abdomen and digital examination of the rectum, as well as a series of endoscopic examinations and laboratory tests.

A preliminary answer to the question of what the patient is suffering from: rectal cancer or hemorrhoids, may be the result of a laboratory test.

Stages and survival prognosis

Rectal cancer, which goes through stage 4 in its development, develops quite slowly over several years.

Having first affected the tissues of the mucous membrane, it begins to spread up and down the intestinal wall, growing through it, increasing in size and gradually filling the entire lumen of the rectum.

Stage 1 rectal cancer has the form of an ulcer or a small (up to 2 cm) mobile tumor occupying an area of the mucous membrane that has clear boundaries. The depth of penetration is limited to the submucosal layer. The life expectancy of patients with high-grade, low-grade rectal cancer detected at stage I is 80% and lasts for decades. Unfortunately, at this stage the disease is detected only in a fifth of patients.
A stage 2 cancerous tumor, which has grown to five centimeters, is limited to the intestine and occupies approximately half of its circumference. Metastases are either absent (stage IIA) or affect single lymph nodes localized in the tissues of the perirectal tissue (stage IIB). The prognosis for five-year survival at this stage depends on the onset of metastasis. In the absence of metastases, 75% of patients survive; with their appearance in single lymph nodes, this figure drops to 70%.
A stage 3 tumor process is characterized by the presence of a tumor whose diameter exceeds five centimeters. Having occupied more than half of the intestinal lumen, it grows through all layers of the intestinal wall and gives multiple metastases to the adjacent lymph nodes. The five-year survival rate of patients with single metastases in the lymph nodes is no more than 50%. With metastatic damage to more than 4 lymph nodes, only 40% of patients survive.
A grade 4 malignant neoplasm is a significant disintegrating tumor that actively grows into adjacent organs and tissues, and also gives numerous metastases to lymph nodes and distant organs, entering them hematogenously. There are no cases of five-year survival of patients with this stage of rectal cancer. On average, they have three to nine months to live.

How long do patients live?

No specialist will give a definite answer to how long people live with rectal cancer, since the survival prognosis is compiled individually for each patient and consists of many indicators.

This indicator mainly depends on the depth of damage to the mucous layer. If the tumor process has not crossed its boundaries, the chance of five-year survival remains in 90% of patients.

The most disappointing prognosis (even at stages 1-2) is for cancer tumors localized in the lower ampullary region and in the anal canal of the rectum, which require disabling surgical intervention and often recur.
The prognosis for poorly differentiated tumors is always more favorable than for highly differentiated ones.
Life expectancy is significantly reduced by the patient’s advanced age and the presence of concomitant diseases.
If surgical treatment of operable forms of rectal cancer (stages I-III) is refused, the patient dies within a year.

Metastasis

Highly differentiated malignant tumors of the rectum have the highest propensity to metastasize.

Most often they metastasize into tissues:

(retroperitoneal, regional, pelvic);
peritoneum;
hollow abdominal organs;

Complications

Rectal cancer may be accompanied by:

acute intestinal obstruction;
the formation of interorgan fistulas (pararectal, vesico-rectal, vaginal-rectal);
cancer intoxication of the body;
bleeding from a tumor;
perforation of the rectal wall.

The cause of intestinal perforation is excessive stretching of its walls located above the location of the tumor, which provoked intestinal obstruction. There are also frequent cases of perforation of the intestinal walls in the area of the tumor itself.

With perforation into the abdominal cavity, fecal peritonitis develops; with perforation in the tissue of the perirectal tissue, phlegmon or an abscess develops.

How to define a disease?

The level of modern oncology allows at any stage of development. For this purpose, a clear diagnostic algorithm has been developed. Here is a diagram of the examination of a patient with suspected rectal cancer. A biopsy is possible only with an integrated approach that involves the use of:

surgical exposure;
remote or contact before or after surgery;

Leading importance is attached to surgical treatment; Chemotherapy and radiotherapy are auxiliary.

The tactics of surgical intervention primarily depend on the localization of the tumor process:

If intestinal obstruction develops, a unloading transversostomy is performed and the patient's condition is stabilized. After this, radical surgery is performed to remove the cancerous tumor.
For rectosigmoid cancer, a Hartmann operation is performed, which consists of obstructive resection of the rectum with the application of a flat sigmoid stoma.
For cancer of the upper and middle ampulla, anterior resection of the rectum is performed with removal of lymph nodes and lymphatic vessels (lymph dissection) and pelvic tissue. To restore intestinal continuity, a primary anastomosis is performed.
If the middle and lower ampullary sections are affected, the rectum is removed almost completely, leaving only the sphincter apparatus intact. To preserve natural bowel movements, the sigmoid colon is brought down and fixed to the anal sphincter.
In case of anorectal cancer and damage to the musculoskeletal system, the Quenu-Miles operation is performed, during which the rectum is completely removed along with the lymph nodes and sphincter, replacing it with an unnatural anus (removed for life).

Chemotherapy, which consists of the intravenous administration of a combination of anticancer chemicals, can be used:

in combination with surgical treatment;
as the only method of treating inoperable tumors;
to prevent relapses during postoperative treatment.

In modern oncology, two types of radiation treatment are used: external, consisting of exposure to small doses of radiation using special equipment, and internal (with the introduction of a sensor into the rectum).

Radiation treatment can be used:

before surgery to reduce the tumor to a resectable state;
as an independent therapeutic method for the treatment of elderly or inoperable patients;
for palliative purposes: to alleviate the condition of hopelessly ill people.

Consequences after surgery

Surgeries related to the removal of rectal cancer are sometimes associated with a number of consequences that can disrupt the functioning of the intestinal tract.

They can lead to:

fecal incontinence.

In addition, an inflamed unnatural anus can provoke intestinal prolapse and cause a delay in bowel movement.

Prevention

The best prevention of rectal cancer is to eliminate the main risk factors that increase the likelihood of its development. To do this you need:

Treat all chronic diseases of the rectum (fistulas, hemorrhoids, anal fissures, polyposis) in a timely manner.
Prevent constipation.
Eat healthy foods, stop eating fast food, limit the consumption of animal fats, replacing them with vegetable oils if possible, and do not overuse red meat.
Minimize exposure to harmful chemicals.
Get rid of excess weight.
Lead an active lifestyle.
At least once a year, undergo a preventive medical examination.

Video about resection of a rectal tumor with the formation of a colostomy:

If symptoms of rectal cancer develop, urgent consultation with a specialist is required. In this case, malignant and atypical cellular signs may be observed. The pathology under consideration is combined with a colon tumor into a single pathology - colorectal cancer. The prognosis of the disease is favorable, as it can be detected at an early stage of development.

Medical indications

The rectum is located in the pelvic area and is the last segment of the large intestine. The causes of colorectal cancer have not been identified. But the factors that provoke the disease have been established:

poor nutrition;
heredity;
passive life;
smoking and alcoholic drinks;
inflamed intestines.

Colorectal cancer does not appear for a long time. Common symptoms of the disease include pale skin, unexplained fatigue and lethargy. With rectal cancer, discharge of different types appears. In the early stages, the intestines may become irritated. In this case, the following symptoms arise:

periodic abdominal pain;
discomfort in the lower abdomen;
sensation of a foreign object in the intestine;
feeling of false bowel movement.

If the patency of the organ is impaired, bloating may occur. Symptoms of rectal cancer include:

constipation;
rumbling with pain;
gas retention.

The first stage is characterized by a nonspecific manifestation of the disease. This makes early diagnosis of the cancer process difficult. The first symptoms of rectal cancer should alert the patient:

constipation, discomfort in the rectal area;
worsening symptoms;
various secretions.

Clinical picture

In the early stages, the doctor takes into account objective signs. Therefore, preventive medical examinations help diagnose colorectal cancer in the early stages of its development. Experts include the results of a digital examination of the affected organ as similar signs:

detection of a tumor or deformation of the mucosa;
exophytic tumor has a short or long stalk;
with the endophytic-infiltrative form, the intestinal lumen narrows;
at stage 4 there is acute paraproctitis.

After a finger examination, traces of stool with blood or brown discharge remain on the medical glove. What signs can be detected for rectal cancer by palpating the abdomen? In this case, the following symptoms are observed:

at stages 1-2, the abdomen is unchanged;
a large tumor localized in the rectosigmoid region is easily palpable;
late cancer process is accompanied by bloating and tympanitis;
at the last stage, damage to the rectum by cancer is manifested by high tympanitis.

Doctors include the following objective general data in a separate group:

patient weight loss;
pale skin with a yellow tint;
covering the tongue with a white coating.

Stages of the disease

Colon cancer is characterized by stages, which are based on the following characteristics of the disease:

size of the primary tumor;
penetration of cancer into the wall and lumen of the organ;
involvement of other organs in the cancer process;
metastases in the lymph nodes;
metastases in other organs.

What is the initial cancer process? The occurrence of the disease in question at the first stage is the appearance of an ulcer or small tumor. The neoplasm is mobile and has clearly limited areas of mucosa. Given the degree of spread, the cancer does not penetrate deeper than the submucosa. There are no distant or regional metastases.

Rectal cancer in men, detected at the second stage, is characterized by neoplasms that spread to the mucous membrane of the organ. Moreover, they are located within the lumen and its wall. There are no metastases. If the pathology occurs at stage 2B, then metastases appear in the regional lymph nodes. The primary neoplasm has dimensions corresponding to stage 2A.

At stage 3A, the size of the tumor exceeds 1/2 the diameter of the circumference of the rectum. The pathology involves the walls of the organ and adjacent tissue. At this stage, single metastases in the lymph nodes can be detected. At stage 3B, multiple metastases appear.

Stage 4 colorectal cancer is manifested by a tumor of various sizes and individual metastases in the internal organs, or a disintegrating tumor and a destroyed rectum. In this case, the attending physician diagnoses regional metastases.

Detection of pathology

What causes and where do metastases appear? Cancer cells with high differentiation are prone to this process. More often, a similar clinic is observed in the liver, brain, liver, and lymph nodes. In 95% of cases, metastases appear in the liver. With this type of colorectal cancer, the symptoms are as follows:

discomfort;
heaviness in the right hypochondrium;
icteric cover.

The emerging process can be diagnosed in the peritoneum. Against this background, ascites forms. A similar clinic is observed in the pleura, which can lead to hydrothorax. To find out what the cause of colorectal cancer is, a comprehensive examination is carried out. Diagnostics includes the following methods:

finger examination;
irrigoscopy;
fibrocolonoscopy.

TRUS and tomography are indicated to identify metastases. Other methods include ECG, biopsy, gastroscopy.

Therapy methods

To eliminate the first signs of rectal cancer in women or men, any oncological techniques are used. The choice of specific therapy depends on the depth of the affected cells. The main way to eliminate all symptoms of colorectal cancer in women and men is surgery. But this technique is effective if the cancer process is at stage 1-2. In other cases, complex treatment is prescribed, including:

various types of radiation therapy;
surgery;
polychemotherapy.

Before treating rectal cancer with surgery, the doctor takes into account the area of the organ affected. If cancer is detected in the area of intestinal obstruction, unloading transferzostomy is performed. If the patient's condition has stabilized, the malignant tumor of the rectum is removed.

To treat cancer in the area of the rectosigmoid flexure, obstruction is indicated. It is possible to cure a tumor in the mid-ampullary region with anterior resection. If necessary, subsequent lymph node dissection and removal of pelvic tissue are performed. To restore the continuity of the organ, a primary anastomosis is performed.

Treatment of rectal cancer in the lower ampullary region is aimed at extirpation of the organ. After removal, the sphincter remains. A tumor in the anorectal area is removed by extirpation. In this case, the closure apparatus and lymph nodes are cut out.

Chemotherapy and diet

Treatment of rectal cancer and prevention of its recurrence involves chemotherapy. The technique involves infusions using a combination of antitumor chemotherapeutic agents (Leucovorin, Oxaliplatin). Such treatment is indicated if it is impossible to remove the tumor. This technique can be combined with surgery. If before surgery metastases are detected in the lymph nodes or liver, chemotherapy is carried out periodically, but for a long time.

For colorectal cancer, treatment includes diet. It is recommended to follow a nutritious and balanced diet. The patient should avoid spicy and fatty foods, smoked foods, and canned food.

At an early stage, you can use folk remedies. There are medicinal plants with antitumor properties:

milestone - this poisonous plant contains the substance cicutoxin. But if you use the plant in a small concentration, then a therapeutic effect is observed. More often, a tincture is prepared from vekha and celandine;
celandine – used for various forms of colon cancer. It is recommended to drink one hour after tincture of Vekha. Additionally, a microenema based on celandine is given. This complex treatment quickly reduces inflammation, reducing swelling;
burdock root - 3 tbsp. l. The plants will need a glass of boiling water. The finished product is diluted with water;
soda - prepare a water-soda solution for an enema;
cabbage - juice from the vegetable is mixed with beet juice. You can add honey to the resulting product;
St. John's wort tincture: at st. l. raw materials - a glass of boiling water;
Hemlock is a poisonous plant from which the tincture is prepared. Hemlock leaves and flowers are poured with vodka. Take 2-3 drops in the morning, washed down with water;
alder cones – to prepare the decoction, you will need to boil the cones with water;
calendula - the flowers of the plant are infused with medical alcohol. The product is drunk, pre-diluted with water;
Plantain juice - a plant collected in the spring, is crushed and mixed with sugar. The resulting mass is used in 1 tbsp. l. 4 times a day;
wormwood infusion - 2 tbsp. l. raw materials take 500 ml of boiling water. The composition is infused for 30 minutes;
Propolis is a universal remedy that effectively relieves the symptoms of colorectal cancer. Propolis tincture diluted with warm milk is taken 2 times a day.

Therapy with hemostatic folk remedies

Since the disease in question is accompanied by various bleedings, folk hemostatic agents are used to eliminate them. You can prepare the following medicine from stinging nettle: pour boiled water over the leaves or roots for 2 hours. The infusion is consumed before meals, 1/2 cup. Meadowsweet is a plant with hemostatic and wound-healing properties. A decoction of meadowsweet is taken before meals.

At the rehabilitation stage, the patient is treated with restorative and preventive medicinal plants. This therapy is prescribed to patients who have undergone radiation therapy or who have taken potent medications. In such cases, you can prepare a universal decoction, which is used for microenemas or internal use. Method of preparation: the bark of aspen, sea buckthorn, and elderberry is ground into powder. At the station l. You will need a glass of boiling water. For a microenema you will need 50 ml of the product.

If the pathology occurs at the last stage, it is recommended to use sebaceous ointment. To prepare it, you will need to melt 200 g of pork fat, adding vekha root and comfrey powder. The composition is kept in a water bath for 2 hours. Then it is diluted with celandine juice. The ointment is introduced into the rectum warm.

Birch mushroom is a medicinal plant that is effective against tumors. At the rehabilitation stage, chaga prevents relapse of the disease. The plant can be used at the initial stage of the disease in the form of a warm microenema. Constant consumption of mushroom decoction significantly reduces the risk of tumor development.

Pathology prognosis

Experts predict the outcome of the disease based on the following data:

stage of the cancer process;
type and degree of differentiation of the neoplasm;
age and condition of the patient;
presence of concomitant diseases;
timeliness and correctness of prescribed treatment.

Acceptable prognosis of the disease:

Cancer of the lower ampullary region has the worst prognosis already at stage 1, since a disabling operation is prescribed. In this case, a relapse is observed. Patients with this diagnosis require lifelong use of a colostomy bag.

The prognosis for recovery and life is aggravated with age and in impaired condition. Such factors limit the possibilities for surgery. This accelerates tumor progression. The survival rate of patients with satisfactory condition for stage 1 cancer is 60-85%.

For stage 3 cancer in patients in good health, survival is about 5 years after detection of the disease, but with radical therapy it is 30%. For stage 4 cancer, the prognosis is unfavorable. Patients with this diagnosis die within 8 months. Patients who refuse surgery can live no more than 12 months.

Preventive measures

It is difficult to prevent the disease in question. This is due to the lack of ability to influence the causes of its occurrence. Doctors admit the possibility of eliminating risk factors, the presence of which increases the likelihood of cancer 10 times:

timely treatment of chronic processes occurring in the rectum and anal canal;
fight against constipation;
refusal of food that contains animal fats;
minimizing contact with chemicals;
preventive examinations.

The above measures do not guarantee 100% protection from the pathology in question. This reduces the risk of its occurrence.

Rectal cancer treatment stages 1, 2, 3. Symptoms, signs, metastases, prognosis.

Rectum- the most terminal section of the digestive tube. It is a continuation of the large intestine, but in its anatomical and physiological features it differs significantly from it.

The length of the entire rectum is 13-15 cm, of which the perineal section and anal canal (the final section of the intestine, which opens on the skin with the opening of the anus - the anus) account for up to 3 cm, the subperitoneal section - 7-8 cm, and the intraperitoneal part - 3-4 cm.

In the middle part, the rectum expands, forming an ampulla. The circumference of the ampullary part of the intestine is 8-16 cm (with overflow or atony - 30-40 cm). The final section of the rectum - the anal canal - is directed back and down and ends at the anus.

The rectum consists of a mucous membrane, a submucosal layer and a muscular layer. On the outside, it is covered with a rather powerful fascia, which is separated from the muscular layer by a thin layer of fatty tissue. This fascia surrounds not only the rectum, but in men also the prostate gland with seminal vesicles, and in women the cervix.

The rectal mucosa is covered with columnar epithelium with a large number of bacilli cells. It also contains a lot of so-called liberkühn glands, consisting almost entirely of mucous cells. That is why, during pathological processes, copious amounts of mucus are released from the rectum.

Epidemiology

In civilized, economically developed countries, colorectal cancer is one of the most common malignant tumors.

In the structure of cancer incidence in the world, colorectal cancer currently ranks fourth.

Every year, about 800 thousand newly diagnosed patients with colorectal cancer are registered in the world, more than half of them (440 thousand) die. Colorectal cancer causes death in approximately 3.4% of the general population and is the second leading cause of death in the United States. In the European population, the risk of developing colorectal cancer is 4–5%. This means that one in 20 people will develop cancer of this location during their lifetime.

Although all economically developed countries have seen a steady increase in the incidence of colorectal cancer, nevertheless, this indicator is not a fatal companion to civilization.

Thus, in some US states, a slight decrease in the incidence of colorectal cancer has been observed among the white population over the past decade, while among the non-white population this figure has been steadily increasing.

This is due to a number of preventive measures taken:

changing the nature of nutrition as a result of enhanced sanitary propaganda (reducing the consumption of animal fats, increasing the consumption of fresh fruits and vegetables, combating excess weight);
early diagnosis of colorectal cancer.

The incidence rate of colorectal cancer in Belarus is typical for Eastern Europe and was 21.1 per 100,000 population in 2013; Rectal cancer is slightly more common in men than in women.

The increase in incidence begins at the age of 45, with the peak incidence occurring at the age of 75-79 years.

Risk factors in the development of colorectal cancer

1. Nutritional patterns of the population

Dietary factors that increase the risk of colon cancer include:

excessive consumption of animal fats;
eating food with insufficient plant fiber content;
excess nutrition;
drinking alcohol (especially beer).
A diet high in red meat and animal fats and low in fiber is an important causative factor in the development of colorectal cancer.

A diet high in fruits, vegetables, and fiber-rich foods low in saturated fat is designed to protect the colon lining from the aggressive effects of bile acids and food carcinogens.

Reduce the risk of colorectal cancer:

eating foods high in plant fiber;
vitamins D and C;
calcium.

2. Genetic factors

Most cases of colorectal cancer are sporadic, meaning they are not associated with any currently identified hereditary factors.

The role of hereditary mutation has been proven in two syndromes: total (familial) adenomatous polyposis (FAP) and hereditary nonpolyposis colon cancer (Lynch syndrome), together they account for only about 5% of CRC cases.

Familial adenomatous polyposis this is a less common pathological process than hereditary colorectal cancer; The risk of developing colorectal cancer in patients with familial adenomatous polyposis is almost 100%.

Familial adenomatous polyposis is usually characterized by:

hundreds of colorectal adenomatous polyps at a young age (20-30 years);
adenomatous polyps of the duodenum;
multiple extraintestinal manifestations (block 2-6);
mutation in the tumor suppressor gene for adenomatous polyposis of the colon (APTC) on chromosome 5d;
inheritance in an autosomal dominant manner (descendants of those affected have one of two chances of inheriting FAP).

The second (after familial adenomatous polyposis) syndrome with a significant contribution of hereditary predisposition is hereditary nonpolyposis colon cancer (NPCC).

This syndrome is characterized by the following criteria:

three cases of colon cancer (one of which occurred before the age of 50) in 2-3 different generations;
two morphologically verified colon cancers in 2-3 different generations and one or more cases of cancer of the stomach, endometrium, small intestine, ovaries, urethra, renal pelvis (one of the cases of any cancer must be under the age of 50 years);
young age of onset of colon cancer (up to 50 years) in both relatives in two different generations;
the presence of synchronous, metachronous colon tumors in one relative and a case of colon cancer in a second relative (one of the cases of any cancer must be before the age of 50 years).

The molecular genetic cause of NNRTC is hereditary mutations in a number of genes, but 95% of these mutations are concentrated in 2 genes - MLH1 and MSH2. If a mutation in these genes is detected in a patient, it is recommended to search for this mutation in his relatives.

Dynamic monitoring of those relatives who are carriers of mutations is also recommended to identify the possible occurrence of colon cancer at an early stage, which will undoubtedly lead to more effective treatment.

Other risk factors:

single and multiple adenomas (polyps) of the colon;
nonspecific ulcerative colitis;
Crohn's disease;
history of female genital or breast cancer;
immunodeficiencies.

Identifying polyps is extremely important in preventing cancer, since colon cancer most often develops from polyps rather than de novo.

The risk of colon polyp degenerating into cancer is high:

for a polyp less than 1 cm in size – 1.1%;
1–2 cm – 7.7%;
more than 2 cm – 42%;
on average - 8.7%.

Although most polyps remain benign, some, if not removed, can degenerate or transform into malignant (cancerous) tumors.

The process of transformation of polyps is most likely caused by genetic mutations in the cells.

There are different types of polyps, but only one type is thought to develop into cancer. This type of polyp is called adenomatous polyp.

Until you have a special examination (colonoscopy), you cannot be sure that there are no polyps in your intestines, because polyps do not cause any symptoms.

Large polyps or tumors may cause symptoms:

bleeding;
blood in stool;
anemia or intestinal obstruction.

These symptoms are quite rare and only begin to appear when the polyps become very large or cancerous.

Modern principles of colorectal cancer screening

Timely detection of colorectal cancer involves diagnosing it in the early, preclinical stages, when there are no clinical manifestations of this disease.

Screening or early detection of colorectal cancer, is carried out using digital examination, hemoccult test and endoscopic method. Digital examination of the rectum can detect up to 70% of rectal carcinomas.

The basis for performing a hemoccult test is that colorectal adenomas and carcinomas bleed to varying degrees.

When screening among a formally healthy population, from 2 to 6% of those examined have a positive hemoccult test.

Upon further examination of patients who have a positive hemoccult test, colorectal cancer is detected in 5–10% of cases, and glandular adenomas in 20–40% of cases. In 50–70% of cases the test is false positive.

Sigmoidoscopy and total colonoscopy are important components of colorectal cancer screening.

Using modern flexible sigmoidoscopes 60 cm long, it is possible to detect 55% of adenomas and carcinomas of the sigmoid and rectum that develop de novo. The sensitivity of this method is 85%. These are methods for actively identifying individuals with risk factors for developing colorectal cancer or with asymptomatic colorectal cancer, based on the use of special diagnostic methods.

Screening studies for colorectal cancer help to significantly reduce the likelihood of its development, as they make it possible to identify precancerous intestinal disease or cancer at an early stage and provide timely treatment.

First of all, persons who have among their first-degree relatives (children, parents, brothers and sisters) cases of colon or rectal cancer, adenomas and inflammatory bowel diseases are subject to screening.

Having a relative with such a diagnosis increases the risk by approximately 2 times compared to the population as a whole.

Recommendations from a number of scientific societies for the study of colorectal cancer (American College of Gastroenterology, Multisociety Task Force on Colorectal Cancer from the American Cancer Society, American College of Radiology) contain guidelines for the timing of the first colonoscopy in the following patients:

early, before 40 years of age, in patients who have close relatives with intestinal adenoma diagnosed before the age of 60 years;
10-15 years earlier than the “youngest” colorectal cancer in the family was identified, and/or this diagnosis was made at 60 years of age or younger.

Symptoms of colorectal cancer

In the early stages of development (no germination into the muscular layer of the intestine, no regional and distant metastases), rectal and colon cancer is almost 100% curable.

Rectal cancer can be manifested by the discharge of blood, mucus from the anus, and disruption of the usual stool pattern. You may experience bloating and abdominal pain. The development of cancer can lead to weight loss, anemia, pain in the anus, and painful urge to defecate.

Most people are uncomfortable discussing their bowel function. However, if you don't tell your doctor about unusual symptoms, such as a change in the shape of your stool, he will never know about it and most likely won't even ask!

Here's a quick rundown of what to look for (most of these symptoms affect many people and are not cancer-related, but let your doctor decide):

change in the mode and nature of bowel movement - one-time or chronic diarrhea or constipation, discomfort during bowel movement, change in the shape of the stool (pencil-thin or thinner than usual), a feeling of incomplete bowel movement;
unusual sensations associated with the intestines, such as increased gas formation, pain, nausea, bloating, a feeling of fullness in the intestines;
bleeding (light red or very dark blood in the stool);
constant fatigue;
unexplained weight loss;
unexplained iron deficiency;
unexplained anemia.

However, in the early stages, cancer can develop asymptomatically.

The only way to detect cancer or a precancerous disease (adenomatous polyp) in such cases is preventive colonoscopy.

Even very developed healthcare systems are unable to perform a colonoscopy on all residents of the country without exception; in addition, the instrumental examination is invasive in nature, which means there is a minimal risk of complications.

Therefore, in Belarus, as in most socially oriented countries, so-called stool occult blood screening tests are carried out. If a positive reaction is detected, such a patient is advised to undergo a colonoscopy.

Diagnosis of rectal cancer

The main method of making a diagnosis is morphological: the so-called biopsy, when a fragment of tumor tissue is removed for microscopic examination.

It is possible to reach a tumor in the intestinal lumen using endoscopic examinations:

sigmoidoscopy (insertion of a rigid tube into the anus to a depth of 28 cm);
colonoscopy (elastic optics, the entire length of the intestine).

Medical imaging techniques are used to determine the extent of the tumor:

Ultrasound (including through the lumen of the rectum - transrectal ultrasound);
computed tomography;
magnetic resonance imaging.

Treatment of rectal cancer

If rectal cancer grows deeply into the mucous and submucosal layer, it is sufficient to carry out only surgical treatment. Moreover, if the tumor is small, it is possible to remove the tumor through the anus using a colonoscope.

If you have the appropriate equipment and qualified surgeons, it is possible to remove tumors of the rectum and rectosigmoid junction (up to 15 cm from the anus) using the TEM technique (transanal endomicrosurgery) or transanal removal of low-lying tumors (up to 8-10 cm from the anus). However, the possibilities of organ-preserving treatment may be limited by the size of the tumor, even in stage I of the disease.

If tumor growth into the muscle layer is detected, only surgical treatment is also indicated (resection or extirpation of the rectum, i.e. complete removal). However, removal of all or part of the rectum along with the surrounding fatty tissue, where metastatically affected lymph nodes may be located (with a probability of 20%) is indicated. Oncological results using laparotomy or laparoscopic approaches do not differ.

If before surgery it is revealed that the tumor has invaded all layers of the intestinal wall or the presence of metastatic lymph nodes near the intestine, preoperative radiation therapy is indicated at the first stage. Traditionally, in the Republic of Belarus, a “short” course of radiation therapy is used, lasting 5 working days, followed by surgery after 0-5 days.

For locally advanced rectal cancer, which includes immobile or fixed tumors relative to the pelvic walls with or without involvement of regional lymph nodes, as well as tumors with invasion of the visceral fascia of the rectum (according to CT or MRI of the pelvis), chemoradiation treatment is carried out within 1.0 -1.5 months.

Surgical treatment is carried out 6-8 weeks after the end of radiation therapy. At the first stage, in the case of planning chemoradiotherapy and the presence of a stenotic tumor, before starting treatment, it is possible to form an unloading colostomy to prevent the development of intestinal obstruction.

Often the location of the tumor does not allow saving the anus, and surgical intervention ends with a permanent colostomy.

If it is possible to preserve the anus, a so-called preventive colostomy is often formed, which is designed to reduce the frequency and severity of postoperative infectious complications from the intestinal suture. If the postoperative period is favorable, the attending surgeon performs an operation to close the colostomy after 2 months.

In cases of tumor spread to adjacent organs and tissues, combined operations are performed with removal of the drug in a single block, and in the presence of distant synchronous metastases (in the liver, lungs, ovaries, etc.) - their simultaneous or stage-by-stage removal (as determined by a council of doctors ).

The feasibility of other treatment methods (radiation and chemotherapy) is determined after staging the disease, based on the receipt of the final morphological report of the pathologist (approximately 7-10 days after surgery).

Dispensary observation

Surgical removal of the tumor is the most effective treatment for colorectal cancer. Even after all the cancer is removed, cancer cells may remain in other organs and parts of the body. These clusters of cancer cells may be so small at the time of the first surgery that they cannot be detected.

However, after some time they may begin to grow. The possibility of developing a recurrence of colorectal cancer (return of the disease) depends on the stage and characteristics of the course of the disease. The occurrence of tumor recurrence may complicate subsequent treatment with chemotherapy and/or radiation therapy.

With early diagnosis of recurrent colon and rectal cancer, patients have a greater chance of successful treatment, including surgery.

Periodic monitoring of patients allows us to detect the formation of new polyps in the colon in patients who have previously had colon cancer (after surgery, new polyps form in approximately every fifth patient who had previously been diagnosed and treated for colon cancer), as over time Over time, polyps can degenerate and become malignant; it is very important to detect and remove them without waiting.

Most cancer recurrences are detected within the first two years after surgery. Therefore, the intensity of monitoring is maximum during this period of time, and the purpose of the examination is primarily to exclude the development of a return of the disease.

The likelihood of cancer recurrence after the first five years after surgery is sharply reduced.

The main task of observation during this period is to detect new polyps of the colon and rectum.

During the follow-up examination, your health status is assessed and an examination is prescribed:

once every six months for the first two years after surgery;
Once a year for the next 3-5 years and includes:
physical examination;
blood test for the tumor marker CEA or CEA (an abbreviation for carcinoembryonic antigen or cancer embryonic antigen) is a special protein that is found in the blood. With an active tumor process, the level of this protein in the blood of patients with colon and rectal cancer can sometimes increase);
colonoscopy (examination of the lumen of the colon and rectum);
chest x-ray;
computed tomography;
examination of the abdominal and pelvic organs using ultrasound.

Rectal cancer is a malignant degeneration of epithelial cells of the mucous membrane of any of the lower intestines. The tumor grows rapidly and penetrates into neighboring tissues and is prone to metastasis. The disease most often occurs between the ages of 40 and 75 years. The incidence rate is 1.6 cases per 10 thousand population.

Signs of lower rectal cancer do not appear in the early stages of its development. With this oncology, statistics show that the earlier treatment is started, the greater the chance of recovery.

Varieties

There is the following generally accepted classification of malignant neoplasms of the lower intestine. Based on the form of rectal tumor growth, exophytic, endophytic and mixed cancer are distinguished.

In the exophytic type of pathology, there is a clearly visualized pathological node. It grows into the intestinal lumen. With endophytic cancer, the growth of a malignant tumor occurs mainly deep into the rectum. The mixed form is characterized by the presence of tumors of different types. She can often behave unpredictably.

Based on histological characteristics, cancer is divided into the following types:

Adenocarcinoma (glandular cancer). It accounts for approximately 95% of all cases of the disease. This tumor develops from the glandular tissue of the intestine.
Mucous adenocarcinoma. Unlike glandular tumors of the rectum, this type is characterized by pathological proliferation of mucous 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 cell. It is a fairly rare and dangerous type of rectal tumor. The 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 occurs in the distal (further from the center) intestine. The disease is characterized by fairly rapid growth and pronounced progression. It quickly affects nearby lymph nodes.
Glandular squamous cell carcinoma. This type of cancer belongs to undifferentiated malignant neoplasms. Formed in limited areas of mucous membranes. Characterized by aggressiveness and a tendency to rapidly increase.
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 limited and definable structures.
Skirr. This is a type of fibrous colorectal cancer. The structure of the tumor is dominated by stroma (these are formations that consist of soft or fibrous connective tissue).
Melanoma can affect the anorectum. Refers to rapidly growing malignant neoplasms. In this case, the organ wall is covered with poorly differentiated tumor formations.

According to the level of differentiation, a rectal tumor can be highly differentiated, moderate, or undifferentiated. Type 1 cancer means that the features of normal cells and tissue are preserved. Characterized by slow germination into adjacent tissues.

In moderately differentiated rectal tumors, the number of cells that retain the properties of healthy ones is much smaller. Tumors have a higher degree of malignancy.

Poorly differentiated malignant neoplasms differ from healthy ones. They behave aggressively, actively grow into nearby tissues and metastasize 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 older people.

Depending on the location, the following types of rectal tumors are distinguished:

Supradampullary. Most often, it is a dense tumor that narrows the intestinal lumen in a ring-shaped manner. In advanced cases, it quickly leads to stenosis, i.e. narrowing and blockage of the rectum with feces. This type of cancer occurs in approximately 15% of cases of rectal malignancy.
Ampullary cancer is most often its endophytic variety. It occurs most often: the number of cases of cancer of this form is about 85%. Prone to bleeding.
Anal cancer is the least common, occurring in approximately 5% of all cases. This type of cancer occurs too close to the anus. Its treatment is associated with a number of difficulties, because the patient has to undergo a colostomy (an unnatural anus). This complicates a person’s rehabilitation after rectal surgery.

Reasons for development

The causes of rectal carcinoma mean all changes in the human body that lead to the appearance of a malignant neoplasm. This group includes any type of decreased activity of the immune system, intake of carcinogenic substances (including through food), mutations, unfavorable genetic predisposition and other factors.

The main reasons for the formation of rectal cancer in humans:

The presence of inflammatory diseases of this part of the intestine - especially such as proctitis, proctosigmoiditis.
All benign tumors located in the rectum, including polyps. They are prone to malignant degeneration.
Ulcerative colitis is nonspecific.
Poor nutrition. Excessive amounts of protein foods in the diet are especially harmful to the rectum. This causes frequent constipation and slower peristalsis. Insufficient intake of fiber into the body also leads to cancer.
Severe constipation causes microdamage in the mucous membrane. They are a contributing factor in the development of atypical elements on it.
Incorrect administration of a cleansing enema, which often happens with constipation. The rectal mucosa is injured, creating favorable conditions for the appearance of cancer cells.
Unfavorable heredity is considered a “trigger” for the development of rectal cancer in a person.
Chronic hemorrhoids, especially those with large internal and external nodes, are often the cause of cancer. Sometimes the nodes themselves can degenerate into malignant tumors.
Anal fissures.
In men, prostate adenoma can be a common factor in the development of malignant lesions of the rectal mucosa. When urinating problems occur, men are forced to strain very hard, 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.

General symptoms

The following signs are typical for rectal cancer:

The appearance of unnatural, painful impurities in feces. Patients should be alert to the fact that there is mucus, blood and pus in the stool. Often, streaks of bright red blood may appear in a portion of stool. This suggests that fresh wounds have formed on the mucosa, resulting from tumor growth.
Severe bowel movements may be the first signs of a rectal tumor at an early stage. If a patient has a tendency to constipation, this may indicate that he has a tumor in the lumen of the rectum. The danger of this situation is that patients begin to take laxatives uncontrollably. Peristalsis is further disrupted, which leads to further deterioration of the situation.
The appearance of pain during bowel movements. The intensity of discomfort may vary.
Weight loss is a symptom that often occurs during the development of cancer. If the patient experiences pain, he tries to eat less food so that bowel movements occur as rarely as possible. Such eating disorders lead to weight loss and the development of symptoms of vitamin deficiency.
In women, the first signs may be similar to those of menstrual dysfunction.
Decreased performance, fatigue, fatigue.
A prolonged increase in body temperature up to 37 °C, sometimes up to 38 °C. Although this is a nonspecific symptom of rectal cancer, it should alert you.
Painful sensations of varying intensity. Moreover, they can spread throughout the abdomen, radiating to the lumbar region, tailbone or sacrum. Soreness can be constant or periodic, have a cutting, pressing, stabbing nature. When the pathological process is advanced, a person may experience discomfort in the liver area (this most often indicates the formation of metastases in it).
A change in skin color is observed if there are metastases in the liver. At the same time they turn yellow. Often, with rectal cancer, the skin may be grayish.
Tenesmus, i.e. false urge to have a bowel movement. They can be excessively painful.

These signs can appear alone or appear together. Some people have asymptomatic rectal cancer.

Stages

They may change depending on how quickly the cancer in an organ develops. There are 4 stages of rectal malignancy:

The initial stage 1 of cancer is diagnosed if the tumor is small in size and characterized by mobility. Does not penetrate deeper than the submucosal layer. Metastases are not detected.
Stage 2-A is diagnosed if the malignancy has spread from a third to half the circumference of the rectum and is clearly located within the intestinal lumen. There are no metastases at this stage of the disease.
At stage 2-B there are metastases in 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 cancer. All walls of the rectum are included in the malignant process. The fiber around this organ also begins to be affected. A few metastases are observed in the lymph nodes.
At stage 3-B, numerous metastases are observed in any lymph nodes. The size of the malignant tumor is the same as in stage 3-A.
At stage 4, metastases begin to spread to the lymph nodes and internal organs. The tumor may be larger than half the lumen of the rectum. It begins to gradually collapse, and the neoplasm grows into the pelvic floor.

Complications

The consequences of rectal cancer can be systematized as follows:

spread of the tumor to adjacent tissues (pelvic organs) with the formation of fistulas;
damage to the vagina in women, bladder;
the formation of perifocal purulent inflammatory phenomena: purulent paraproctitis, phlegmon of the retroperitoneal region, phlegmonous lesions of the small pelvis;
perforation of the tumor with the occurrence 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:

sensations of heaviness and compression in the right hypochondrium;
strong discomfort (they occur in the later stages of pathology development);
change in skin color (it turns yellow);
dilation of blood vessels in the abdominal area;
severe skin itching (it is not associated with dermatological pathologies).

The appearance of metastases in the lungs is associated with the following symptoms:

severe and frequent cough;
respiratory dysfunction;
dyspnea;
compression in the chest area;
small amounts of blood when coughing.

Metastatic bone lesions are characterized by pain. It is most often localized in the back or limbs.

Complications of rectal cancer after surgery and the spread of metastases are an unfavorable sign indicating the advanced stage of the oncological process.

Diagnostic methods

It is necessary to consider how to recognize rectal cancer. For this purpose, a complex diagnosis is used, which includes several stages:

Gathering information and studying medical history. The specialist draws attention to the presence of certain complaints in the patient that indicate the possible presence of cancer. Often, the presence of pathology may be indicated by an increase in body temperature to 37ºC or more.
Digital rectal examination. It helps determine the presence of foreign formation in the intestines.
Blood test for hemoglobin. A pronounced decrease in the amount of hemoglobin in the blood, an increase in the erythrocyte sedimentation rate and a strong drop in their level should alert you. Such blood test indicators for rectal cancer may indicate advanced stages of the process.
Fecal occult blood test. Sometimes its result can be false positive in case of anal fissure and false negative if the malignant neoplasm does not bleed.
Blood test for tumor markers. This specific test helps determine the presence of cancer-sensitive antibodies in the patient's body.
A biochemical blood test helps determine specific abnormalities in the amount and activity of liver enzymes. An increase in their level in the body indicates the possible presence of metastases in the liver.
Ultrasound helps to see a tumor with the presence of metastases. It is advisable to perform a transrectal ultrasound.
Irrigoscopy, i.e. examination of the colon and rectum using an X-ray machine. To improve its results, a contrast agent (barium sulfate) is introduced.
Sigmoidoscopy (endoscopic examination of the intestines) and biopsy (taking a tissue sample followed by microscopic examination) help establish a final diagnosis. The biopsy is performed using a sigmoidoscope, which reduces the invasiveness of the procedure and reduces the discomfort associated with it.
Colonoscopy (endoscopic examination of the entire large intestine).
Chromoscopy (a method of staining tumor cells) gives an accurate result in the process of differential diagnosis of the disease.

Differential diagnosis of cancer is carried out to exclude the following pathologies:

Haemorrhoids. In this disease, blood appears at the end of a bowel movement. Patients need to undergo sigmoidoscopy.
Syphilis. To make a final diagnosis, a biopsy and the Wasserman reaction are necessary.
With tuberculosis, multiple ulcers with an uneven bottom and edges are formed. For the purpose of differential diagnosis, a biopsy is indicated.
With inguinal lymphogranulomatosis, the lymph nodes become enlarged and the lower parts of the rectum are affected.
Benign tumor formations are much less common. To differentiate them, a biopsy and ultrasound are indicated.
Melanoblastoma is localized in the anal region. It is characterized by the appearance of dark, almost black nodes.

The patient needs to be diagnosed with the effects of radiation therapy for rectal cancer. This will allow you to adjust your treatment in time.

Treatment tactics

This disease is highly treatable if diagnosed early and the patient undergoes annual preventive medical examinations. Treatment of rectal cancer even before the onset of its symptoms gives fairly good results and almost completely relieves the patient of possible relapses.

The leading and most common method of treating cancer is surgery to remove the malignant tumor. Interventions can be radical or palliative. Among radical operations, the following should be highlighted:

Anterior resection of the rectum, regional lymphadenectomy. Resection means removing the affected area and suturing its ends. During this type of operation, an anastomosis is performed (an artificial connection of the cavity organ), which allows for bowel movements. The operation is indicated in the early stages of cancer, when the malignant tumor has not yet reached a large size. Resection slightly limits the patient’s life, allowing him not to reduce his activity and maintain his ability to work.
Abdominoanal resection of the rectum. In this case, the sigmoid intestine descends, and the anal sphincter in most cases can be preserved. Such an operation is indicated provided that the cancerous tumor is located in the lower sigmoid region.
Abdominoperineal extirpation of the rectum. This is a more complex operation, because in this case the large intestine is removed into the ileal region. Evacuation in the usual way becomes impossible, because the patient has a colostomy placed on the anterior abdominal wall.
Resection of the rectum with colostomy. It is often performed if the nodes are located low.
Anal resection is performed if the cancer is too close to the anus.

All surgical interventions on the rectum are traumatic and require preliminary examination and accompanying treatments.

Along with radical operations for this disease, palliative interventions are also performed. They are performed on patients with inoperable tumors. Palliative interventions involve the application of double-barreled colostomies, combined treatment with the use of radiation therapy methods.

The use of radiation therapy methods is of great importance. They are used primarily in cases where, for some reason, surgery is contraindicated. During radiation therapy, the affected area is exposed to specially selected radiation. It allows you to destroy cancer cells formed in the intestines.

This treatment helps prevent the possible spread of tumor cells throughout the intestine. Radiation and radiotherapy for rectal cancer are carried out 3 weeks after surgery. The effect of rays occurs not only on the intestinal area, but also in the area of regional lymph nodes. Radiation therapy is especially indicated for metastatic lesions.

In the postoperative period, the administration of chemotherapy drugs is also used for drug therapy for rectal cancer. The most commonly prescribed agents are those based on 5-fluorouracil. Treatment using this substance gives satisfactory results. Other drugs used in the treatment of colon cancer are Tegafur, Eloxatin, Irinotecan.

If metastases form, then the use of targeted treatment agents is indicated. They help slow down the formation of blood vessels in the tumor. Correctly administered chemotherapy for colorectal cancer significantly reduces the likelihood of complications. Such complex drugs as Bevacizumab, Cetuximab, Oxaliplatin are increasingly used.

For widespread tumors and the presence of metastases, chemotherapy is not always effective and appropriate. The use of potent drugs and radiation therapy after radical or palliative surgery can prolong life and improve the prognosis of five-year cancer survival.

Palliative chemotherapy can be carried out over a long period of time using Fluorouracil or Leucovorin. In some cases, the doctor may prescribe these drugs even for several months. Such radical actions help to somewhat prolong the patient’s life. The protein drug Zaltrap can be used together with chemotherapy. It affects protein growth factors and helps slow down tumor growth.

In case of cachexia and severe pain, palliative measures are reduced to the prescription of painkillers and the administration of drugs that help improve the person’s condition.

Enemas for rectal cancer are indicated in the early stages of pathology. They are included in the complex of traditional treatment for this disease. For enemas, infusions of medicinal herbs that have antimicrobial and antiseptic effects are used.

The use of soda as a remedy sharply worsens a person’s condition and can lead to a pronounced disturbance of the acid-base balance. The same applies to the use of “shock” doses of vitamin C to get rid of cancer: such actions cause hypervitaminosis and chronic poisoning.

If you give enemas at later stages of development of rectal cancer, such procedures can cause bleeding. The presence of hemorrhages in a patient greatly weakens him.

Nutrition after surgery

Food after surgery for rectal cancer should not irritate the mucous membrane. Nutrition should be as gentle as possible and exclude any fermentation processes. Carbohydrates should be sharply limited; hot and cold foods are strictly prohibited.

For the first day after surgery, patients are on a fasting diet. Therapeutic nutrition in the form of diet No. 4 is prescribed only from the second day after surgery and carefully so as not to cause intestinal irritation.

Prognosis and prevention

The prognosis for a rectal tumor depends on the following factors:

stages of the disease;
histological structure of the malignant neoplasm;
forms of tumor growth;
presence or absence of metastases;
method of surgical intervention during cancer treatment;
the number of affected lymph nodes (if there are more than 5, the prognosis is considered unfavorable).

Unfavorable prognosis factors for rectal cancer after surgery:

intestinal perforation;
low degree of differentiation of tumor cells;
cell growth into fatty tissue;
tumor spread into the venous wall;
cachexia (i.e., severe exhaustion of the patient).

Relapses of the disease can develop in the first 4 years after radical surgery. If they do not occur within the next 5 years after complete radical removal of the cancer, then this is a good prognostic sign. It indicates that in the next 5 years the risk of developing cancer, subject to supportive treatment, remains low.

If there is an increased content of carcinoembryonic antigen in the blood, then the risk of relapse of a malignant neoplasm increases significantly. This indicator does not always depend on the stage of the pathology.

The life expectancy of patients with stage 4 rectal cancer is significantly reduced. Approximately 2/3 of people suffering from this disease are diagnosed with liver damage by 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 thromboembolism of the pulmonary artery when it is blocked.

If a patient has distant metastases, 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 and prevention of rectal cancer comes down to following these recommendations:

correction of nutrition with the exclusion of fried, spicy, salty foods from the diet;
complete cessation of smoking and drinking alcohol, in any form;
fight against constipation, diarrhea;
timely treatment of hemorrhoids;
undergoing annual preventive examinations;
maintaining sufficient physical activity, combating physical inactivity (inactivity).

Pathologies such as acute or chronic colitis should never be ignored. Timely initiation of treatment can reduce the likelihood of malignant cell degeneration.

You should definitely visit a doctor if the following signs appear:

mucus, blood and pus in the stool;
development of a feeling of discomfort, pain in the anal area, not only during or after defecation, but also at rest;
frequent urge to empty the bowels (especially if they are accompanied by pain, cramping);
bleeding, especially if drops of scarlet blood appear on the underwear;
discharge from the anus.

It is important to comply with hygiene requirements. It is strictly forbidden to use newsprint after defecation. The paint irritates the mucous membranes and may contain carcinogenic substances. After each bowel movement, it is advisable to wash yourself. This useful habit must be developed from childhood.

Rectal cancer is one of the most serious diseases of our civilization, which ranks 4th among all oncological pathologies and 2nd among gastrointestinal tract tumors.

Rectal cancer - what is it?

This malignant cancer originates from the epithelium of the rectum. This tumor has the characteristic features of any malignant formation - rapid growth, invasion of neighboring tissues, metastasis.

Men and women are equally susceptible to the disease. An increase in the number of cases is observed from the age of 45, and the peak incidence occurs among 75-year-olds.

About the disease

The mucous membrane of the final portion of the colon is covered with columnar epithelium with a large number of glands. Their cells produce mucus. Under the influence of risk factors, pathological cells appear with uncontrolled division and loss of the apoptosis mechanism - programmed death. Gradually, a tumor of the rectum is formed from them.

Presumably the causes of rectal cancer have been established:

Poor nutrition.
The predominance of meat foods and animal fats in the diet with a simultaneous deficiency of plant fiber impairs the passage of feces, contributes to constipation and the development of colorectal tumors.
The role of heredity has been noticed in the occurrence of certain forms of neoplasms.
Precancerous pathologies - polyps, Crohn's disease, ulcerative colitis.
Immunodeficiency conditions, carcinoma of the genital organs or breast in women.

Types of rectal cancer

The type of tumor is determined by its location:

Anorectal location is typical for 5-8% of cases.
Ampullary occurs more often than others, up to 80%. This is a pathology in the widest part of the intestine.
Supraampullary localization in up to 12% of patients.

The nature of tumor growth can be:

exophytic – grows into the intestinal lumen;
endophytic - grows through the thickness of the wall, infiltrates it, and can cover it circularly;
mixed growth.

According to the histological picture, the neoplasm can be:

glandular cancer (adenocarcinoma);
solid;
signet ring cell;
skirr;
squamous.

Symptoms of colorectal cancer, first signs

Discussing rectal problems is something shameful for many people. Therefore, the first signs of pathology often remain without due attention. The initial symptoms of rectal cancer are changes in stool character. Frequent changes in constipation and diarrhea appear, and the shape of stool changes. It becomes much thinner than before. The feeling of incomplete defecation, discomfort, and increased formation of gases are disturbing.

The development of the tumor process causes long-term signs of rectal cancer:

mucus and blood in stool;
purulent discharge;
feeling of fullness in the intestines;
bloating;
pain in the rectal area;
chronic fatigue, fatigue;
anemia;
weight loss.

In the initial stages, there may be no manifestations of the disease. If anemia of unknown origin is detected, it is worth looking for the cause of hidden bleeding. Perhaps it's cancer.

Late stages are characterized by damage to other organs:

germination into neighboring organs, formation of interorgan fistulas;
purulent-inflammatory processes – paraproctitis, pelvic phlegmon;
perforation of a tumor of supramullary localization with the development of peritonitis;
bleeding.

What does colon cancer look like - photo

In the photo of rectal cancer, you can see that it significantly narrows the intestinal lumen. This causes constipation, a full stomach, and flatulence.

In this photo, the carcinoma is growing infiltratively, covering the wall.

Diagnostics

After contacting a doctor, they determine the symptoms that bother the patient and suggest a disease of the rectal region.

Screening study

A stool occult blood test is ordered

Laboratory research

A general analysis of urine and blood reflects the condition of the body, the presence of inflammation, anemia, kidney and bladder function

Endoscopic methods

To examine the inner surface of the rectum in more distant areas:
- sigmoidoscopy - examination of the intestines using a rigid tube with an optical device at the end;
- colonoscopy - examination using a flexible endoscope, allows you to examine the entire intestine.

Parts of tissue are taken from suspicious and altered areas and examined for cancer cells or dysplastic precancerous processes.

Parallel examination of the large intestine

For differential diagnosis of cancer, detection at an early stage of changes that can lead to cancer.

Ultrasound of the intestine

To determine the prevalence of a malignant process. It can be performed abdominally - through the abdominal wall, and transrectally - through the anus.

Gynecological examination (for women)

Often there is a combination of intestinal tumors with gynecological carcinomas - cancer of the uterus, ovaries, and breast.

X-ray methods for diagnosing rectal cancer

Using a contrast agent. The photographs show defects in intestinal filling, pathological tissue growths, and stenoses caused by neoplasms.

MRI diagnostics

It detects even small-sized pathological foci, metastases and tumor invasion into neighboring organs, and its topographic position relative to other structures. The method is safe and does not create radiation exposure, unlike CT.

Radioisotope methods

Tumor metastases are detected.

Diagnostic laparoscopy

carried out to clarify the diagnosis. It can be used to detect metastases in the peritoneum.

Stages of rectal cancer

The course of the cancer process progresses in the absence of proper treatment. The stage is determined by the degree of damage to the intestine itself, its growth through the wall, the presence of metastases in the lymph nodes, and distant lesions of other organs.

In this regard, tumors are divided into 4 stages. This distribution is universal for any malignant tumors.

Stage 1 – the tumor is small in size, grows on the mucous layer, does not affect neighboring organs and lymph nodes.

Stage 2 is divided into A and B. 2A - this is a lesion from a third to half the circumference of the intestinal tube, but grows strictly in the wall or lumen, there are no metastases. 2B – the size of the lesion is the same, but there are metastases in the peri-intestinal lymph nodes.

3A – the tumor occupies more than half the circumference of the intestine, grows through all layers and peri-intestinal tissue. There may be single metastases in nearby lymph nodes.

3B – any tumor size, metastases in distant lymph nodes receiving lymph from the rectal area.

Stage 4 – metastases spread to internal organs and distant lymph nodes. The primary tumor can be of any size.

Treatment methods for colorectal cancer

The small size of the tumor and its growth only through the mucous and submucosal layer of the rectum, without affecting the muscular and serous layer, allows surgical removal of the tumor itself. Sometimes it is possible to perform surgery through the colon using a colonoscope.

If it has grown into the muscle layer, then rectal resection or extirpation (complete removal of the organ) is indicated. The perirectal tissue and lymph nodes are also removed, in which metastases are already detected in 20% of cases. To perform the operation, two approaches are used - laparotomy (dissection of the abdominal wall) and laparoscopy (operation using video equipment through several punctures in the abdomen).

The type of surgery is selected based on the location of the tumor. The high position makes it possible to remove the tumor and temporarily bring the end of the intestine to the abdominal wall - to form a colostomy for defecation. Such manipulation is necessary if it is not yet possible to sew the ends of the intestine together. The second stage, after some time, restores the integrity of the intestines.

If the tumor process is located low, if there is no healthy tissue left below it, the affected area and anus are removed, and a colostomy is applied to the abdominal wall.

Survival prognosis

After radical surgery, survival rate for 5 years ranges from 34-68%. The outcome of treatment is influenced by the stage at which the tumor was diagnosed, the condition of the patient himself, his age, and concomitant diseases.

Depending on the stage of the tumor process, five-year survival rate is determined by the following figures:

Stage 1 – up to 77%;
Stage 2 – up to 73%;
stage 3 – 46%;
Stage 3b – 43%.

Stage 4 is not considered in these statistics. Radical operations are often impossible to carry out, because tumor metastases are disseminated throughout the body. The lethal outcome depends on the general condition of the patient.

Contraindications

The operation is contraindicated under the following conditions:

severe chronic diseases of the patient - arterial hypertension, coronary heart disease, when it is impossible to give anesthesia;
advanced age of the patient;
advanced stages of cancer.

In case of a widespread process with metastasis to many organs, palliative resections are used, aimed at alleviating the patient’s condition. Symptomatic operations - the application of bypass anastomoses to relieve the intestines and avoid complications in the last stages of cancer.

Treatment before and after surgery

Chemotherapy and radiation therapy are indicated for patients with stage 2 or higher tumors.

If before the operation metastases were detected in several lymph nodes, and the tumor has grown into the muscle layer, then at the stage of preparation for the operation a short course of radiation therapy is carried out for 5 days. This allows you to destroy early metastases and reduce the size of the formation itself.

Treatment of rectal cancer after surgery is carried out after obtaining pathomorphological data on the removed tissues. The issue of radiation or its combination with chemotherapy is being decided. Radiation therapy after surgery destroys the remaining cells in the area of the primary tumor and prevents its recurrence. In inoperable patients, it alleviates the condition.

Sensitivity to chemotherapy is detected in 30% of patients. It is prescribed for therapeutic purposes to destroy metastases.

Chemotherapy is also carried out adjuvantly - to prevent the spread of carcinoma if damage to several lymph nodes is detected. This method of therapy improves the quality and life expectancy of patients with metastases. Platinum preparations, 5-fluorouracil, leucovarin, and calcium folinate are used. Medicines are administered intravenously in courses of several days. Chemotherapy is also used in combination with radiation before surgery for locally advanced cancer. This combined treatment is carried out for 1-1.5 months, and after the end of irradiation, surgery is performed 6 months later.