Rectal cancer - causes, symptoms and signs, diagnosis, treatment and diet

A cancer tumor is a group of pathologically altered cells located in the tissues of various organs and systems of the human body. Neoplasms affecting the rectum are a fairly common pathology, occurring in 5% of cases of all cancers (and among tumors of the gastrointestinal tract, lesions of the rectum account for more than 45%). And this figure is constantly growing, especially among the older generation. The disease has an extremely unfavorable course, the tumor is prone to metastasis, growing into the deeper tissues of the digestive system, lymph nodes and other tissues. In this case, the patient faces death.

What is rectal cancer

Rectal cancer (Cr) is a disease that develops due to cancerous degeneration of epithelial cells (epithelial neoplasia) of the rectal mucosa and has all the signs of malignancy and cellular polymorphism. This means that this disease is characterized by rapid infiltrative growth with germination into neighboring tissues, frequent relapses and a tendency to metastases.

This type of cancer is diagnosed approximately equally among patients of both sexes; the age category of patients is 45-74 years.

Important! According to statistics, this disease is placed in third place in terms of frequency of diagnosis in the list of cancerous tumors of the gastrointestinal tract.

Although this disease is quite common, it is more likely than other oncologies to have a favorable outcome, that is, it is curable. This is due to its special anatomical location, which allows the disease to be detected at the earliest stages. To detect it, it is enough for the doctor to conduct a digital examination (to detect lumps) or endoscopy at the first complaints received from the patient.

Risk group

The risk group includes people whose life circumstances or improper volitional actions increase the risk of developing a tumor disease. Oncology identifies a number of probable factors influencing the occurrence of tumors in the rectum. These include:

alcohol abuse;
nicotine addiction;
bad heredity;
age from 40 years;
parasites;
improper diet;
exposure to harmful chemicals;
infections, intestinal diseases and other reasons.

If a person falls under the list of factors, one must be extremely attentive to the manifestation of symptoms of the disease and immediately undergo examination by qualified physicians. Rarely occurs in children. There is no gender predisposition; the pathology manifests itself in men and women.

The complexity of the manifestation of symptoms in patients with tumors lies in the sometimes impossibility of distinguishing overt and hidden (latent) forms of manifestations of the disease.

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The anatomical structure of the rectum consists of three main sections:

The suprampullary section is the initial section, its length is about 5 cm and it is closed by the peritoneum;
Ampullary section. Here the preparation of feces takes place for their further removal (removal from the body) - excess liquid is removed. The length of this section is about 10 centimeters. This region is the most common target of cancer - about 80% of cases.
The anal part serves to remove feces; the sphincter (anal opening) is located here, which removes them. The length of this part is about 3 cm.

What is a tumor

A rectal tumor is an exclusively pathological process when cell division ceases to obey the internal processes that control the vital functions of the body. It becomes a wrench in the well-functioning and delicate mechanism of the human body and disables its elements. Tissue cells begin to divide uncontrollably, which leads to atypicality.

Histology of colon cancer

A neoplasm in the body is the subject of study of the science of oncology. Depending on the degree of harm to the body, there are two types of tumors: benign and malignant.

Benign ones are distinguished by slow growth without the formation of metastases. The remaining organs remain intact. There is a possibility that the development process will stop; oncology will remain in a static state for many years. In this case, the tumor does not threaten the patient’s life. Deaths from them are almost never mentioned in medicine. But even benign can cause concomitant diseases (for example, intestinal obstruction). And complications will already provide different consequences and even the risk of death for the patient.

Malignant tumors exhibit aggressive growth and spread throughout the body. Time in these diseases is the leading factor in healing. The ICD-10 code is C20.

It is worth mentioning separately the stages of cancer development:

The first stage is characterized by the absence of metastases, and the tumor has clearly defined edges and is well structured. This is an early stage in the development of the disease. Only tissue with atypical cells is damaged.
The second stage almost completely corresponds to the first. The difference lies in size and possible local metastasis.
At the third stage, the pathological process of division of atypical cells grows into organs so aggressively that it ruptures the damaged tissue. Metastases penetrate the lymph nodes. Hence the name of the disease: in cross-section, the damage from tumor growth resembles cancer claws.
At the fourth stage, the tumor becomes most widespread, and metastases affect a large number of organs. This is the final stage of the disease. And the survival rate at this stage is extremely low and amounts to less than ten percent. The risk of relapse of the disease is higher, even with complete remission during treatment.

Rectal cancer significantly predominates over cases of benign neoplasms. Statistics highlight them in a ratio of 70 to 30 in favor of malignancy. This is a particular risk for lower bowel cancer.

Classification of the disease

Rectal cancer has several classifications (ICD 10 code – C15-C26), depending on the location it is:

Supraampullary (high). With this form of cancer, the intestinal lumen narrows and stenosis quickly develops;
Ampullary. It most often occurs and has the structure of adenocarcinoma. Such a tumor develops according to the principle of a bulging neoplasm or ulcer with a crater-shaped base of a bleeding type;
Anal. This form of cancer is more often squamous cell in structure and is located in the anal canal area (above the anus).

There is also a classification of rectal cancer (Bl), which is based on the location of the oncology and is divided into tumors:

Lower-, middle-, upper ampullary sections of the rectum (almost 60% of cases);
Rectosigmoid region (usually a circular tumor) (30% of cases);
Anal region (10% of cases).

If we classify by type of growth, we can define three varieties:

Endophytic (30%), which forms inside the tissues of the walls of the rectum;
Exophytic (20%), a tumor that penetrates the lumen of the rectum;
A mixed type tumor (50%), combining features of endophytic and exophytic growth.

According to histology, this type of oncology can be the following types of cancer (morphology of neoplasms):

Adenomocarcinoma;
Mucous;
Solid;
Squamous;
Fibrous;
Undifferentiated malignant.

Based on aggressiveness, rectal cancer is divided into well-differentiated, moderately differentiated and poorly differentiated tumors (signet ring cell). In the first case, the tumor grows slowly and is not aggressive, the low-differentiated one has high tumor growth and gives metastases (it is the most dangerous), the moderately differentiated one is characterized by a moderate rate of growth and development. Malignant neoplasms have a code according to ICD10 - C20.

Risk factors in the development of colorectal cancer

There are several causes of the disease:

Nutritional features. The more animal fats, alcohol, and red meat a person consumes, the higher the risk of developing malignancy. The development of the disease is aggravated by the absence or small amount of calcium in the diet, plant foods rich in fiber, as well as vitamins D and C. The sedentary life of a modern person and excess nutrition lead to pathology in the intestines.
Heredity. Among genetic factors, experts consider two syndromes to be important: FAP (familial adenomatous polyposis) and HNPTC (hereditary nonpolyposis colon cancer). If there have been similar diagnoses in your immediate family, regular preventive examinations are important, since hereditary predisposition increases the risk of malignancy.
Diseases of the colon (presence of polyps, colitis, Crohn's disease, adenomas, inflammatory processes, etc.). If such diagnoses are present, patients should regularly undergo appropriate examinations to avoid the development of cancer. Patients with polyps should pay special attention to the examination, as they tend to degenerate into a cancerous tumor.
The causes of tumors include unhealthy habits (drinking alcohol and smoking). They weaken the immune system and can provoke (if there is a predisposition to cancer) the appearance of a tumor in the intestine. Immunodeficiency is also a risk factor.
Malignant tumors in the mammary glands and genitals of women can cause the development of intestinal cancer.
Patients 50 and older. Rectal cancer is often found in older people.

Features of squamous cell carcinoma

Externally, this cancer looks like a non-keratinizing ulcer with undermined edges. These types of tumors are prone to early metastases, are characterized by rapid growth and have a disappointing prognosis.

These neoplasms are large in extent, tend to grow into the prostate, vagina, ureters, quickly penetrate the lymph nodes, and have a tendency to recur.

The survival rate for this type of cancer depends on the extent of spread of the cancer process, the number of metastases, the age of the patient and other factors. Patients who began treatment for the disease no later than six months after the onset of the disease have a greater chance. The 5-year survival rate for this type of cancer is almost 33%. The vast majority of patients with this diagnosis die within the first 3 years.

Vivid symptoms of tumors

An example of obvious symptoms is the appearance of bloody discharge in the stool during defecation. Symptoms include:

abdominal pain with the urge to defecate;
other discharge from the anus (purulent or mucus);
pulsation in the perineum with a return to the lower back;
sensation of a foreign object in the intestine.

After the patient exhibits the described symptoms, he seeks help from doctors. But often the problem is already advanced, and more complex medical intervention will be required. Basically, the patient is confused by the presence of latent signs characteristic of most pathologies.

Stages of the disease

Classification of oncology depending on the stage of development of the tumor process is based on the following characteristics:

Tumor size;
Prevalence of cancer;
The presence of metastases in nearby lymph nodes;
The presence of metastases in distant organs.

As a rule, four stages of tumor formation are recognized and, along with them, signs specific to this stage develop:

Stage 1 - there is a small tumor - seals (diameter within 2 cm), which does not metastasize and does not penetrate deeper than the submucosal layer (locally advanced type of cancer). Primary symptoms of rectal damage occur: nausea, constipation, digestive disorders. At this stage, it is possible to identify the disease using MRI;
The second stage has a neoplasm with a diameter of up to 5 cm, which does not spread beyond the boundaries of the organ, but there may be metastases in local lymph nodes. There is a urge to defecate, which may be accompanied by discharge of blood or mucus. In women at this stage, the disease can be diagnosed during a gynecological examination, since the tumor can be felt through the posterior vaginal fornix;
Stage 3 has metastases in nearby lymph nodes, and the tumor penetrates all layers of the intestinal wall. Swelling occurs, cutting pains are felt in the abdomen, the urge to vomit, a feeling of pressure in the anus, cracks in the anus;
Stage 4 is characterized by the spread of metastases to the entire body, and when vital internal organs (heart, brain, etc.) are involved in the process, multiple organ failure syndrome may develop, which is the cause of death in cancer patients. Clinical signs of the disease are noticeable even to a non-specialist, loss of appetite occurs, and various pains may occur due to the development of metastases.

There is also Duke staging of rectal cancer (sarcoma):

Stage A – the tumor is limited to the mucous and submucosal layer, there are no metastases;
Stage B is divided into B1 and B2, in the first case the cancer is limited to the muscular layer, and in the second it has grown into the thickness of the intestine;
Stage C – if there are metastases only in the lymph nodes;
Stage D – metastases are present in distant organs.

The TNMP system is also used, which also determines the extent of the cancer process, where T - means tumor - the size of the tumor, N - involvement of regional lymph nodes in the cancer process, M - metastases in distant lymph nodes and organs, P - depth of tumor germination. For example, T4n0m0 means that the tumor has spread to neighboring organs, but there are no metastases in the lymph nodes and distant organs, T3n0m0 means that the tumor infiltrates the subserous layer, and there are no metastases of near or distant localization.

In the classification of cancer according to the TNMP medical system, it is also advisable to include the G indicator, which can characterize the degree of differentiation of cancer cells from high to low - G1-G3

Bowel cancer stages and prognosis

The malignant tumor itself takes a long time to develop, and the disease drags on for several years. At the same time, the malignant cells themselves begin to develop and grow up and down. Only after identifying the stage of the tumor can we talk about prognosis and therapy.

Stage 1

The cancer itself in the early stages is small in size - up to 2 cm. Cancer cells have a clear shape and do not extend beyond the mucous membrane of the rectum. The disease detected at this stage is treated in 80% of cases. Everything also depends on the degree of differentiation of the tumor.

Stage 2

At the second stage, metastases may already appear in the nearest lymph nodes. The tumor itself is 5 cm in size and occupies half of the inner intestine. If there are metastases, then the survival rate is 70%, if not - 75%.

Stage 3

Most pathology is detected at this stage. Metastases can spread to both the nearest lymph nodes and internal organs: bladder, uterus, prostate gland. The survival rate is 40-50%.

Stage 4

As the tumor grows, blood vessels are damaged and constant internal bleeding occurs. Plus, due to metastases, all nearby lymph nodes and organs are affected. Subsequently, it spreads to all human organs. The 5-year survival rate for patients with this diagnosis has not been reported. In the final stage, it can spread and become colon cancer.

Causes (etiology and pathogenesis) of cancer

What can cause colorectal cancer? The following risk factors are considered the main reasons for the onset of rectal cancer in both men and women:

Hereditary predisposition (the presence of relatives with a similar disease places the patient at risk);
The presence of chronic diseases of the anorectal area (hemorrhoids, Crohn's disease, proctosigmoiditis, ulcerative colitis, rectal fistulas);
Long-term presence of feces in the ampullary section of the rectum;
Age after 60 years;
Familial polyposis (growths) of the rectum and colon;
Oncological history (patients who have had colon cancer and cancer of the breast, ovaries, uterus (women) are at risk);
Smoking (in women the risk of this cancer increases by 40%, in men by 30%);
Exposure to carcinogenic substances;
The presence of certain strains of the human papillomavirus in the body (which is considered a precancerous condition);
Poor nutrition.

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The rectum is 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 fact that a pathological process is taking place in the final section of the intestinal tube is indicated by the appearance of polyps, adenomas, and inflammatory foci. , rectal cancer develops against their background . Treatment for this disease is usually successful, as the disease has been well studied. Even if it is neglected, a cure is possible if the therapy is carried out by qualified experienced oncologists.

According to world statistics, almost 800 thousand people are diagnosed with colorectal cancer every year. It ranks 4th in the global ranking of cancer diseases.

The disease most often occurs in patients living in developed countries. Their stable economy leads to a decrease in people's physical activity, and this leads to a high risk of developing obesity - and, as a result, to colon cancer. For example, in the USA, 145 thousand people are diagnosed with colorectal cancer every year.

In Belarus, rectal cancer most often affects men and people over 45, especially after 75 years.

Clinical manifestations and first signs of cancer

Note! The main insidiousness of this disease is considered to be the complete asymptomatic nature of the initial stage of the disease - the tumor can grow for quite a long time, increase in size, without showing itself in any way.

The first specific signs in a patient may appear when the cancer process has developed sufficiently - when cancer cells metastasize to neighboring organs and lymph nodes.

The first symptoms that can be noticed in 60% of cases are the presence of minor bleeding. You can guess the presence of bleeding by noticing small amounts of blood or blood clots in the stool. Unlike bleeding with hemorrhoids, this bleeding precedes the process of defecation in time. (The primary symptoms can be confused with those of hemorrhoids and similar diseases.) Also, when cancer develops, there is mucus or pus in the stool.

In addition to this first sign of rectal cancer in an adult, there may be:

Feeling of fullness of the intestines even after bowel movement;
Pain during bowel movements;
Constant nausea;
Shortness of breath, even after minor physical exertion;
Unexplained fatigue, which may be caused by anemia due to constant blood loss.

General symptoms indicating the presence of a tumor process in the body may be as follows:

General weakness, body fatigue;
A sharp, unjustified decrease in body weight;
Lack of appetite;
Pale and dry skin;
Earthy complexion.

These symptoms occur due to daily blood loss and cancerous intoxication of the body.

As the tumor grows, other symptoms may appear or existing ones may intensify. In the presence of metastases, other symptoms of the disease may be observed:

If metastases are located in the uterus or vagina, then pain is felt in the lower abdomen and menstrual irregularities occur;
If the tumor penetrates the bladder, the process of urination is disrupted;
With metastases in the liver - jaundice, pain under the rib;
Multiple metastases are characterized by general malaise, anemia, fever, and exhaustion.

In addition, the location of the tumor in various parts of the rectum can be determined by its own characteristics.

Primary signs of anal cancer:

Pain in the anus (initially pain occurs only during bowel movements, later this symptom intensifies, radiating to the thighs and genitals);
False urge to defecate (tenesmus), which ends with slight discharge of blood, mucus or pus;
Anal itching, inflammation of the sphincter, change in the shape of stool, which becomes ribbon-like (this is a characteristic sign);
When the tumor penetrates the sphincter, fecal and gas incontinence may occur, and if the urethra is affected by metastases, it can lead to urinary incontinence.

Ampullary section - first signs:

The main symptom of ampullary cancer is the presence of impurities in the stool;
Later, this symptom may be accompanied by intestinal upset, alternating constipation and diarrhea;
An increased urge to urinate is also possible if the tumor penetrates the bladder.

Initial signs of oncology of the rectosigmoid region:

In this case, the cancerous tumor is represented by adenocarcinoma, the sign of which is discharge with blood and scirrhus;
Abdominal bloating occurs due to frequent constipation;
Further development of the tumor is accompanied by partial or intestinal obstruction - vomiting, stool retention, pain.

Of course, only a competent specialist can correctly assess the symptoms of the disease; it is difficult to determine this on your own. To make an accurate diagnosis, you need not only an examination, but also palpation of the abdomen and digital examination of the rectum, as well as an extensive diagnostic study, some laboratory tests and tests for tumor markers.

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What are the first symptoms and signs of rectal cancer in women and men?

The disease is insidious and in the first stages there are no specific manifestations of the disease. But even when symptoms begin to appear, patients do not attach any importance to this, since about 80% of people suffer from chronic pathologies of the rectum (hemorrhoids, fissures, paraproctitis, etc.), so the alarming symptoms are attributed to these ailments.

A characteristic symptom of the disease is discharge from the anus. They can be mucous, purulent, or bloody. If the tumor is located low, a slight discharge of unchanged blood may appear, and if the tumor is localized higher (in the ampullary or rectosigmoid sections), then streaks and clots of dark blood are found in the stool.

Intense bleeding is usually not observed.

Pain syndrome occurs in advanced stages of cancer. Patients experience pain and discomfort in the lower abdomen and during defecation, a sensation of a foreign body and incomplete bowel movement, false urges to defecate (tenesmus) up to 15-20 times a day, unformed stools, and as the formation grows, constipation.

There is bloating, flatulence, and increased intestinal motility.

When the intestinal lumen is obstructed (blocked) by a growing tumor, a terrible complication occurs - intestinal obstruction, the symptoms of which are severe pain, retention of stool and gases, and vomiting.

If the condition is not diagnosed in time, perforation of the intestinal walls occurs, and feces exit into the abdominal cavity - fecal peritonitis develops.

When the rectal sphincter is destroyed, stool and gas incontinence occurs.

Tumors in the lower parts can spread to the prostate gland, causing men to have difficulty urinating.

In women, the formation grows into the vagina, cervix and uterine body. As the tumor spreads, a rectovaginal fistula forms, causing stool to leak into the vagina.

General symptoms

The disease is often accompanied by nonspecific symptoms, which manifest themselves in the form of causeless general weakness, drowsiness, apathy, loss of appetite, and decreased performance.

As the condition progresses, weight loss is observed. The temperature may rise to subfebrile levels (up to 38 C).

With chronic blood loss, an anemic syndrome develops: pale skin and mucous membranes, rapid heartbeat, weakness, dizziness. Laboratory tests determine a decrease in hemoglobin in the blood.

Metastases in disease

Metastases can appear within two years from the onset of the disease.

Primary metastatic foci are localized in nearby lymph nodes and pelvic tissue, then with the flow of blood and lymph, cancer cells spread throughout the body, forming secondary foci in the liver, serous membrane of the peritoneum, lungs, pleura, brain, and spine.

The formation of metastatic foci is accompanied by disorders of the affected organs.

Metastases in the liver

Heaviness in the right hypochondrium, yellowness of the skin and sclera, ascites (accumulation of fluid in the abdominal cavity), unexplained itching of the skin.

Metastases in the brain

Neurological symptoms: headache, dizziness, convulsions, tinnitus. Possible loss of vision and hearing, impaired motor functions.

Metastases in the lungs

Prolonged cough, shortness of breath, hemoptysis, feeling of constriction in the chest.

Metastases in bones

Secondary lesions in the bones are determined, as a rule, in advanced forms of pathology. The lumbosacral spine is most often affected.

Symptoms of the pathological process are pain, loss of sensitivity in the lower extremities, muscle weakness, and spontaneous vertebral fractures. When the spinal cord is compressed, paresis and paralysis develop.

Symptoms of cancer

In women, rectal cancer can grow into the tissue of the vagina or uterus. But if damage to uterine cancer may not affect the overall picture of the disease, then penetration of the tumor into the muscle tissue of the posterior wall of the vagina leads to the development of a rectovaginal fistula. In this regard, feces and gases are released from the vagina.

In women, symptoms of colorectal cancer include:

Bloody discharge in stool;
Constipation or diarrhea (impaired bowel movements);
Purulent discharge in the anus;
Spontaneous defecation, flatulence;
Dysfunction in the genital organs;
Itching in the perineum.

A rectal tumor in men usually penetrates the wall of the bladder, causing a fistula from which air (gases) and feces can escape. The bladder itself is often infected; pathogenic flora penetrates through the ureters into the kidneys and causes pyelonephritis. In men, a rectal tumor can cause the following symptoms:

Unpleasant sensations in the sacral area, genitals;
Blood in stool;
A sharp decrease in body weight;
Frequent urge to defecate;
Chronic constipation.

What are the differences in the clinical symptoms of rectal cancer between symptoms in men and women? A cancerous tumor in women can grow into the uterus or vagina, and in men - into the bladder, hence there may be specific signs.

Prevention

Some diseases of the rectum give rise to further development of a cancerous tumor. That is why you should not delay treatment: hemorrhoids, fistula, anal fissures, etc.
Prevent constipation and consult a doctor if it occurs frequently.
Eat less red meat and junk food. Try to eat more plant foods.
Try to give up alcohol and smoking, as well as exposure to chemicals.
Try to move more and lead an active lifestyle.
Be sure to be examined by a doctor once a year and take a general and biochemical blood test.

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Diagnosis of the disease

Diagnosing a disease includes several stages of research methods:

Collecting patient complaints, compiling an anamnesis of the disease;
Palpation of the abdominal cavity and ascultation;
Rectal examination of the rectum;
Endoscopic examination – sigmoidoscopy;
Blood tests - general and biochemical, urine and feces tests (for latent presence of blood);
Colonoscopy (during which a biopsy of tumor tissue is taken);
If the results are questionable, the patient may be prescribed an X-ray examination - irrigoscopy;
Profilometry;
Blood for tumor markers (for rectal carcinoma, a specific tumor marker CA-242 is detected);
Ultrasound (in clinostasis - lying down) of the abdominal organs;
In cases where oncology is in an advanced state (last stage), an MRI or CT scan is prescribed to obtain a three-dimensional image.

In women, in addition to checking the rectum, a vaginal examination is performed to assess the degree of involvement of the reproductive organs in the cancer process.

In the initial stages, only 19% of patients are diagnosed with rectal cancer, and only about one and a half percent of diseases are diagnosed during preventive examinations. The bulk of tumor diagnosis occurs at stage 3.

Diagnostics

Only 19% of patients were diagnosed with cancer at stages 1-2. Only 1.5% of tumors are detected during routine examinations. Most of the intestinal neoplasms occur at stage 3. Another 40-50% of newly diagnosed colon tumors develop distant metastases.

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

The diagnosis is made by a proctologist after examining the score. He can use his fingers to feel the tumor if it is located near the anus. Otherwise, sigmoidoscopy is prescribed. This procedure allows you to take a fragment of the tumor for biopsy, which will help determine the nature of the formation.

When examining women, a vaginal examination is simultaneously performed to assess the degree of involvement of the reproductive organs in the tumor process.

For more accurate diagnosis, other procedures are used:

full proctological examination;
biopsy followed by histological examination of the sample under a microscope;
Ultrasound;
computed tomography;
abdominal radiography;
irrigography to assess the condition of the large intestine;
scintigraphy;
laboratory blood tests for antigens and tumor markers (this method is used both in primary diagnosis and to monitor the effectiveness of treatment);
diagnostic laparoscopy.

Treatment methods and consequences after surgery

The main treatment for rectal cancer is surgery, and chemotherapy and radiation therapy are auxiliary. But the best treatment results can be achieved only with the integrated use of these treatment methods.

Surgical operations depend on the location of the tumor and are of the following types:

If intestinal obstruction develops, a unloading transversostomy is performed, and after that the cancerous tumor itself is removed;
If cancer of the rectosigmoid region is diagnosed, then a Hartmann operation is performed (it involves obstructive resection of the rectum and the application of a flat sigmoid stoma);
If a blastoma of the upper and middle ampullary section is diagnosed, then a rectal resection is performed and lymph nodes and vessels are removed - lymph node dissection;
The rectum is completely removed if the middle and lower ampullary sections are affected;
Anorectal cancer involves removal of the rectum with lymph nodes and sphincter (the operation is called Quenu-Miles), and later a prosthesis of the unnatural anus is made (the so-called colostomy, which is removed to the side).

The consequences of surgery can be some complications, such as intestinal prolapse, fecal incontinence, and colitis.

Chemotherapy (the use of drugs) is used for small tumors, inoperable tumors, and to prevent relapses.

Radiation therapy is used in two types: external and internal. It can also be used in combination with surgical treatment, in the treatment of older patients (as an independent treatment, without surgery) or for palliative purposes (to alleviate the condition of hopeless patients).

Traditional methods of treatment and diet for cancer

Separately, it should be said about folk (non-traditional) methods of treatment. They can only be used in combination with the main one and are used to relieve inflammation, strengthen the immune system, and normalize stool. For example, angelica root is used (it can be bought in pharmacies in briquettes of 100-500 g) as a diuretic that improves intestinal function, etc.

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You should also be careful about your diet: it should not include fatty, spicy, smoked foods, it should be as healthy as possible, and contain the necessary vitamins and minerals. The entire diet must be nutritious and balanced.

Nutrition after surgery should be as gentle as possible and not cause bloating and diarrhea. You can start eating after surgery with rice water, low-fat broths, and jelly. After a couple of days, the diet can be slightly diversified. Slimy soups, thin porridges, broths with semolina, and soft-boiled eggs are allowed.

Treatment methods

In medical practice, there are three main methods of treating intestinal malignancies:

Drug therapy , which includes chemotherapy, the use of analgesics and painkillers, as well as drugs to normalize bowel function.
Radiation therapy.
Surgery : radical removal of the rectum or sphincter-preserving surgery.
Treatment with folk remedies : using herbal decoctions and infusions to relieve inflammation and normalize stool, drinking ginger, cranberry or sage teas to strengthen the immune system.

During and after treatment, the patient must adhere to the principles of proper nutrition and not eat fatty or spicy foods. Timely treatment and a healthy lifestyle will help prevent rectal cancer from recurring.

Survival prognosis

Life expectancy for such stage 1 cancer is 80% of all cases and is calculated in decades. Unfortunately, diagnosing cancer at an early stage is quite rare (only in one fifth of patients). If a patient is diagnosed with stage 2 and there is no process of metastasis, then the prognosis for five-year survival can reach up to 75% of cases; in the presence of metastases, the figure drops to 70%. Five-year survival in stage 3 is guaranteed in only 50% of patients; if more than 4 lymph nodes are affected by metastases, five-year survival is possible in only 40%. With stage 4 adenocarcinoma, the prognosis for patients is disappointing - they have a chance to live only up to 3-9 months.

The question of exactly how long patients with a malignant tumor live is difficult to answer unambiguously, since the survival prognosis is individual for each patient and consists of many indicators. The location of the tumor and the stage of the disease are of decisive importance.

The most disappointing prognosis is for patients with a cancer tumor located in the lower ampullary region and in the anal canal.

Hidden symptoms

Such symptoms are easily confused with many diseases. They do not alarm the patient, and the person does not have a desire to immediately consult a doctor. Similar symptoms include:

frequent feeling of weakness in the body and fatigue;
low performance;
I have a stomachache;
problems with bowel movements;
temperature.

If a symptom manifests itself in a single variant, many suppress it with the appropriate drug. An improvement appears for a while, then the symptom returns again, since the root cause of the disease is not affected during the treatment process. As a bonus, such personalized treatment of an individual symptom makes it difficult to understand the original source of the problem, which often turns out to be a rectal tumor. In the early stages the disease is asymptomatic.

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 medications used in the treatment of colorectal cancer are Tegafur, Eloxatin, and 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 cases 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.

Causes

Malignant and benign tumors located in the rectum are formed under the influence of approximately the same factors:

presence of illness in close relatives;
nature of work;
bad habits;
one-sided nature of nutrition;
other intestinal diseases;
excess weight;
hypovitaminosis;
age over 60 years;
immunosuppressive conditions;
constipation.

If a malignant process was observed in parents or in another generation, then the person is at risk for oncology. Working in a workshop with harmful emissions, the nature of activities with heavy metals, toxic gases also contribute to the development of abnormal phenomena.

A tumor in the rectum can form if a person drinks or smokes, especially in cases where the quality of the product is low. Cigarettes contain dozens of carcinogenic substances, which has been confirmed by research. Alcohol is transformed in the liver, but passes through the entire digestive tract. It disrupts the activity of the enzymatic system, dulls the reaction rate, poisons the brain, and damages sensitive cells.

Human nutrition must contain the main groups of substances, for which the diet is made up of vegetables and fruits, cereals, meat and dairy products. From each of these categories the body draws a source of energy. In addition, plant foods are a source of fiber, which has a soluble and insoluble part, due to which the digestive tract is “cleansed” of excess. If a person does not eat vegetables and fruits, the intestines become filled with waste, the excess is not excreted, which damages its walls. Tumors of the rectum and other parts become the result of this process.

Chronic constipation, which occurs due to a malignant process, is associated with a predominance of meat in the diet, especially pork and beef.

A healthy organ that receives a balanced diet cannot get sick. The presence of damage in the form of anal fissures and hemorrhoids, as well as colitis (inflammation of the mucous membrane) are favorable conditions for cell transformation.

Crohn's disease is a precancerous disease that combines several symptoms. It affects the small intestine and the beginning of the large intestine, but affects all parts of the structure. The essence of chronic inflammation is the presence of inflammation of the small or large intestine, which penetrates into the deep layers of the wall, forming ulcers. Leukocytes accumulate around the erosions, forming infiltrates. When the elements heal, rough scars form. Cancer cells can divide in this tissue.

Antioxidants are designed to neutralize substances that cause cancer. If they enter the body in short supply, the protection is weakened. With a sedentary lifestyle and obesity, the risk of tumor increases.

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The occurrence of rectal oncology is influenced by a decrease in immunity; it develops due to a deficiency in the synthesis of lymphocytes and natural killer cells, which are responsible for the fight against tumor cells.

Classification of rectal tumors

The following types of benign rectal tumors are distinguished:

Villous tumor is difficult to diagnose. Description: a type of reddish ball that is covered with papillae. Prone to developing into cancer.
Myoma. Formed on the intestinal mucosa from muscle fibers. Often there are types of polyps that arise due to hormonal imbalance or due to severe heredity.
Lipoma - forms in the submucosal layer. It grows slowly. The condition of the tumor is mild and rarely causes discomfort.
Fibroma is dense in structure. Formed from connective tissue.
Diffuse polyposis - the formation of polyps on the walls of the rectum.

These pathologies affect and transform the intestinal epithelium. Malignant ones are formed from the overgrowth of one of the types of benign neoplasms. Research shows that polyposis almost always becomes cancer, while lipoma is extremely rare. But there is a risk.

Patient survival prognosis

To predict survival, a number of factors must be taken into account.

Tumor type

If a patient is diagnosed with a benign tumor, the prognosis is defined as survival in 100% of cases with timely medical intervention. No cases of relapse have been described in practice. It is necessary to adhere to the established diet and medication.

In malignant neoplasms, the stage of development of malignancy is of decisive importance. If the disease is detected at the first stage, the survival rate is 85%. On the second – 70%, on the third – 45%. And in the case of widespread metastasis of the 4th stage, the prognosis does not exceed 5%.

The importance of timely diagnosis of the disease is not discussed!

Responsibility of the patient himself

When preparing a survival prognosis, an important role is played by the patient’s desire to survive, recover, and live as before the illness. Steps to achieve the stated goals require compliance with all established medical prescriptions for each specific case. The psychological attitude during treatment is placed on a par with medication.

It is important to work on your own habits and attitudes. If the patient smoked, quit, and drank, too. Diet and prescribed medications will improve your overall health; an active lifestyle will help mobilize the internal reserves necessary for the final victory over the disease.

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.

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, the 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.

Diagnosis of the disease

Let's consider ways to determine the presence of a tumor in the rectum. This diagnosis establishes the location and stage of development of the tumor.

Palpation. Determines the presence of a tumor near the anus. Examined by inserting a finger.
Irrigoscopy. The method involves performing radiography using a contrast agent.
Computed tomography (CT). Used to study tumor size.
Laparoscopy. Determines the presence and location of metastases. The optical device is inserted through the outer walls of the peritoneum.
Ultrasound examination. It also determines the presence and location of metastases.
Blood test for the presence of tumor markers.
Fibercolonoscopy. A special device is used to examine the length of the colon. Allows you to obtain damaged tissue for biopsy and remove insignificant benign tumors.
Sigmoidoscopy. This test examines up to 50 centimeters of the rectum. Allows tissue to be taken for biopsy.

Based on the data obtained as a result of the diagnosis and the general condition of the patient, the doctor will be able to build the most appropriate treatment plan.

Treatment

When prescribing treatment, the main role is played by the type and stage of tumor development. For benign neoplasms, removal surgery is performed and does not require further intervention other than general restorative postoperative therapy. The main thing is to follow the doctors’ orders in the future. For cancerous tumors, treatment is more difficult. The influence of a number of factors is taken into account, such as:

tumor growth;
localization and degree of metastasis;
stage of the disease;
general health of the patient.

Other factors are also possible, depending on the individual criteria of the human body (age, concomitant diseases).

If the tumor is located in close proximity to the anus and if it has not yet grown, removal is performed directly through the anus.

If the tumor is small but located at a distance greater than 15 centimeters, transanal microsurgery is used.

But when a tumor grows into the muscle layer, strip surgery is indispensable. The rectum is subject to complete or partial removal along with nearby tissues, lymph nodes, and fat.

The most difficult operation in the presence of metastases. The patient is first prepared and the person is exposed to radiation. When infected with cancer cells, adjacent organs must be removed.

After the operation, the patient is prescribed courses of chemotherapy and radiation therapy for final recovery.

Stages of rectal cancer

Stage 0

The tumor growth in this case reaches a small size; the tumor does not spread beyond the epithelial inner layer of the rectum. This stage has a fairly high five-year survival rate, it can be cured and 95% cope with the problem.

Stage I

The neoplasm remains small in size, but may extend beyond the inner layer of the intestine, which is affected, but the scale of inflammation reaches a level that does not have a harmful effect on the muscle layer. The survival rate for a five-year period at this stage is 90%.

Stage II

It is distinguished by the large size of the tumor; in this case, the spread of the neoplasm passes to the inner and outer layers of the rectum. Survival for a period of 5 years in this case is possible, but is only 55-85%.

Stage III

At this stage, the rectum, like the entire intestine, suffers; the inflammatory process, as well as the spread of the tumor, spreads, in addition to all layers of the intestinal walls, to the nearest lymph nodes. The five-year survival rate for this stage does not fluctuate between 20-55%.

IV stage

This is the last stage, which is characterized by the spread of the tumor to other nearby organs, and the process of metastasis begins. In most cases, they move to the liver, ovaries and lungs. Treatment in this case does not always help, and the five-year survival rate does not exceed 1%.

How does the intestine function?

Symptoms of a rectal tumor directly depend on the overall functioning of the intestine and its structure.

The food and drinks we consume daily pass through the esophagus and then end up in the stomach, where the digestive process begins in the intestines. This is the first stage.

The second stage is the passage of consumed products to the large intestine.

At this point, the body receives the necessary nutritional vitamins and minerals from food.

The large intestine, also called the colon, is where water is absorbed.

The large intestine originates in the abdominal cavity and is located on the right side, below.

The first part of the colon goes up, stretches along the left side, closer to the peritoneum - called the transverse colon.

Next comes the descending colon: it descends down to the abdominal cavity.

The large intestine ends at the base of the colon, the sigmoid colon, just below the rectum and the anus, which completes the process.

The rectum is considered the control point for waste from the digestive process.

Defecation ends with the exit of processed products through the anus.

The rectum is located next to the lymph nodes, their size is insignificant, no more than a pea.

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.

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 a glandular tumor 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 have a colostomy (unnatural anus). This complicates a person’s rehabilitation after rectal surgery.