Cancer of the rectum - Causes, Symptoms and Treatment .MF .
Symptoms of colorectal cancer
Treatment of rectal cancer
Rehabilitation after surgery
Complications and prognosis
Rectal cancer - a malignant tumor disease that develops from the epithelium of the rectal (its inner lining).
Causes of colorectal cancer
Causes of colorectal cancer are not fully understood, it is assumed that it can be chronic inflammatory diseases - proctitis, ulcerative colitis and chronic anal fissures.A considerable role in cancer played by genetic factors: a family history of colorectal cancer, familial polyposis, and other diffuse.Last characterized by the development of multiple polyps (tens or hundreds) - benign tumors of the mucosa of the colon and rectum, many of which quickly degenerate into cancer, in these cases, the cause of the disease is a genetic mutation (change in the structure of the cell nucleus - the chromosomes) inherited.On the development of cancer of the rectum can affect eating habits: the excess fat
The connection of excessive smoking and increase the risk of cancer of the digestive system.In addition, it noted a sharp decline in the number of cases of cancer among vegetarians.Also, important professional factor: the risk of developing asbestos workers have plants and sawmills.
Symptoms of colorectal cancer
Symptoms of colon cancer are divided into the following groups:
1. Non-specific: fatigue, weight loss, loss of appetite and aversion to food, taste perversion, and odors, body temperature rises to the low numbers (within 37deg C).
- the first symptom is abnormal release of impurities during the act of defecation is typical for all rectal tumors: the mucus in a moderate or large numbers (as many tumors develop from the mucous glands and are slime), alone or in a mixture withpus or blood, sometimes in the form of bleeding (blood may be bright crimson, if the tumor is located in the lower rectum and dark - a coiled in the form of liquid or black stools clots, when the tumor is in a more upper sections);in some cases can be isolated tumor pieces.
Often, bleeding from the rectum, patients suffering long-term increase of hemorrhoids, do not go to the doctor, regarding the allocation of blood symptom of hemorrhoids.To distinguish the source of the bleeding can be as follows: hemorrhoids blood appears at the end of the act of defecation in the stool, in tumors blood mixed with feces rectum, as the bleeding occurs as a result of injury to the tumor stool;
- gives pain in the lower back, sacrum, coccyx, perineum: develops as a result of germination of the tumor outside (serous) membrane of the rectum, rich in nerve endings, or directly involved in tumor mass of nerves and nerve trunks of the pelvis;In addition, the pain may result from inflammation surrounding the tumor tissue and organs;
- changing the shape of feces - "tape-like";
- frequent, painful, frequent urge to defecate;
- a sense of "foreign body" in the presence of the rectum caused by the tumor itself;
- constipation (for tumors of the upper rectum) from periodic, with a frequency of 1-2 days before the long-term more than 1 week, accompanied by heaviness in the abdomen, swelling, aching pain in the lower abdomen.Older people often do not pay attention to this symptom, as age progresses atony bowel and decrease the activity of the digestive glands (bile, pancreatic enzymes), disturbing the majority of patients and leads to constipation;
- for tumors of the anus and the output of the rectum: the presence of visually defined tumor in the anus or rectum initial determined times by the patient.Violation of the act of defecation (fecal incontinence and gas) - at germination muscles, narrowing the anus.Urinary incontinence - during germination of the pelvic floor muscles and the urethra (the muscular pelvic bases).
3. Symptoms of far-gone process:
- strong almost constant pain in the lower abdomen;
- the selection of feces during urination or vaginal discharge in women alone (during germination tumor of the bladder and the formation of fistulous between the lumen of the intestine and the bladder or the vagina), a consequence of this - a chronic inflammation of the bladder (cystitis) and female sexual organs, inflammationcan climb the ureters to the kidneys;
- urine from the rectum at rest or during the act of defecation (during germination tumor of the bladder wall).
The figure shows the anatomy (departments) of the rectum on the outside and the inside.
are the following forms of colorectal tumor growth:
- into the lumen of the intestine (the tumor has a component in the lumen of the intestine - endophytic, from the Latin "endo" -Inside);
- towards the fat and the pelvic organs (such as an external component of the tumor is not present, it forms a single mass with the surrounding tissues - exophytic, from the Latin "exo" - outside).
Distinguish the following stages of colorectal cancer:
1. The tumor does not extend beyond the mucous membrane, it takes no more than 1/3 of the colon, no metastases;
2. Tumor 5 cm (more than 1/3 of the gut);b- tumor with metastases in the surrounding lymph nodes;
3. More than half the circumference or length of the intestine;b- with metastases in the lymph nodes;
4. The tumor invades adjacent organs: the uterus, vagina, urethra, bladder, or pelvis.
prima tumor cancer, as well as any malignant tumor that metastasizes to other organs.
Metastases - a screenings of the main tumor, with its structure and capable of growing, disrupting the function of those organs where they develop.metastases appearance is connected with the natural growth of the tumor: tissue grows fast food enough not to all its elements, part of the cell loses contact with the rest, breaks away from the tumor and into the blood vessels, spreads throughout the body and into the bodies of a small and well-developed vasculature (liver, lungs, brains, bone), they are deposited from the blood begin to grow and form colonies - metastases.In some cases, metastases can reach huge sizes (10 cm) and lead to the death of patients by poisoning the tumor waste products, and disruption of the body.
Rectal cancer metastasizes first thing to nearby lymph nodes - located in the intestine surrounding fatty tissue of the pelvis and in the course of supplying its vessels in tumors of the anus metastases may be in the groin.From distant organs in the first place in frequency of defeat is the liver, it is connected with the peculiarities of the system of blood supply of the rectum from the upper sections of blood flowing directly to the liver metastases and settle in it, as a natural filter.The second highest frequency of metastasis are the lungs, the blood from the lower rectum flows off into the inferior vena cava system (the central vein of the abdominal cavity), and from there straight to the heart and lungs.Furthermore, metastases may be affected bone, serous lining of the abdominal cavity and other organs.If metastases are rare possible to remove them - it gives a better chance for a cure.If they are numerous - only maintenance chemotherapy.
Besides cancer in the rectum can develop other cancers:
• Melanoma - vysokozlokachestvennye tumor of pigment cells;
• sarcoma - tumor of muscular, circulatory or lymphatic tissue.
Survey for suspected cancer of the rectum
case of suspected colorectal tumors first of all, the following survey methods:
- digital examination of the rectum - a very important method;experienced doctor this simple technique can detect tumors at a distance of 15 cm from the anus.Through this study determined: the location of the tumor (as a wall - front, back, side), tumor size and the degree of overlap of her intestinal lumen, the involvement of other organs (pelvic soft tissues of the vagina).This study should be performed by any physician with a patient complaining of a violation of defecation, stool or pain in the rectum.Technique is this: the patient takes the knee - elbow position (based respectively on the knees and elbows) or lays down on the left side with legs bent to the abdomen, the doctor inserts a finger into the anus and explores the inner relief of the rectum.
- sigmoidoscopy (from the Latin "rectus" - rectum) is carried out using a special apparatus, which is inserted into the rectum to a distance of 50 cm, with the help of the physician visually inspects the mucous intestine and takes pieces of research from suspicious sites.Quite painful and unpleasant procedure, but absolutely necessary for suspected colon cancer.
- irrigoscopy - old but proven method, the introduction of the colon by enema contrast fluid, followed by X-rays right away and after a bowel movement, if necessary, can be filled with air intestine - the so-called double-contrast.The method used for the detection of cancer to other parts of the intestine, for suspected combination of several tumors in frail and elderly patients who can not perform endoscopic examinations.The method has lost its role in the emergence of fibrocolonoscopy.
- fibrocolonoscopy - is an endoscopic method of research (examination of the large intestine mucosa just from the inside), the most effective and reliable method of investigation.It allows you to set the exact location of the tumor, to take the pieces for examination under a microscope to remove small tumors without incisions (benign - polyps);
|tumor from the wall of the intestine|
|tumor overlaps lumen|
The photos show colon cancer - the view through fibrocolonoscopy
- IVP- if you suspect that the germination of the tumor in the ureter, the bladder;
- ultrasound of the abdomen and pelvic organs: used to detect metastases in other organs and nearby lymph nodes in the presence of free fluid in the abdomen (ascites), allows us to estimate its amount.
- computed tomography of the abdomen and pelvis - effective method to detect germination tumor to other organs, communication between authorities (fistulas), which enters the urine and feces, metastases in the surrounding lymph nodes and other organs of the abdominal cavity, the length of the tumor;
- laparoscopy - a surgical intervention, through punctures in the abdominal wall of the chamber is introduced and examined the various departments of the abdominal cavity and organs with suspected common process - for peritoneal metastases in the liver.
- in recent years, a new blood test for onkomerkery - proteins produced by the tumor and not present in the healthy body.For colon cancer tumor markers are called Ca 19.9 and carcinoembryonic antigen, but they have very low diagnostic value, and therefore rarely used.
Treatment of rectal cancer
main treatment for rectal cancer is certainly a surgical method - removal of the affected organ tumor.Any other treatment gives support, a temporary effect.
various options transactions:
1. organ-- ie the removal of the affected bowel as low as possible and the formation of a sealed intestinal tube at a lower level in the basin depth, such an operation is possible only when the location of the tumor in the upper and middle parts of the colon.Is called a resection of the rectum.
2. Removal of the entire colon with the movement in her bed part overlying the health department and the formation of "artificial" rectal sphincter preservation.This operation is possible in the presence of a long descending colon, under certain conditions of its blood supply.Is called resection with bringing down the colon to the anal canal.
Other possible operations have one thing in common: their result is the removal of an artificial anus in the abdomen (colostomy).
3. Deleting the entire colon with a tumor and surrounding lymph nodes and fiber in it, without saving the anal sphincter and with breeding colostomy.
4. Removing only the tumor with muting the output department intestine (sutured tightly) and elimination of a colostomy.It is used in frail, elderly patients with complications (intestinal obstruction).The operation is called by the name of the surgeon who developed it - the operation of Hartmann.
5. Withdrawal colostomy without the removal of the tumor - is performed at 4 stages of tumor process with the threat of complications (for elimination of intestinal obstruction).It is used only for the purpose of prolonging life.
6. The combination of several operations - removal of the rectum with a part or all of the other bodies in their tumor invasion (removal of the bladder wall, uterus, vagina), isolated liver metastases.
addition to rectal tumors has been successfully used radiotherapy.
radiation therapy - radiation exposure is a special unit in the low dose daily for about 1 month, detrimental effect on tumor cells.This method can be applied both prior to surgery to reduce tumor size and tumor to be permanently transfer condition to remove the oil, and after surgery with metastases detected in nearby lymph nodes to the body to prevent the return of the disease.It can be used as external and internal exposure (introduction of the sensor into the rectum) or a combination thereof.Internal exposure less detrimental effect on surrounding tissue and organs, less damaging them.
in old age and in the presence of contraindications to surgery on the rectum of a patient or a cardiac pathology of tumor irradiation can be used as an independent method of treatment, certainly inferior to surgery, but giving good results.
In some cases, severe pain and inflammation when it is impossible to remove the tumor is used a small dose of radiation to relieve painful symptoms and alleviate the patient's life.
In identifying a large number of metastases in the lymph nodes surrounding the intestine necessarily require chemotherapy.Also it is used in the identification of multiple metastases to other organs, which can not be surgically removed.Chemotherapy - is intravenous administration of various toxic synthetic substances detrimental effect on tumor cells.In some cases, they are assigned the same preparations, but in tablet form with better absorption and fewer side effects.This treatment is applied rates of 4-fold or more.Chemotherapy is designed to reduce metastasis in size, remove the painful symptoms, prolong life.
Rehabilitation after surgery
features of the recovery period in patients after operations on the rectum may be: wearing a bandage (special compression zone), designed to reduce stress abdominal muscles and lower abdominal pressure, which creates the best conditions for the healing of surgical wounds;active behavior after the operation - getting up to 5-7 hours, walking to the toilet on their own procedures;sparing diet - limiting fat and trudnousvoyaemoy food, fruit and vegetables is included in food: cereals (porridge), soups, dairy products - yogurt, fermented baked milk, yogurt, baby food.
In the long-term after surgery is important normalization of stool: diarrhea can be confusing, a natural consequence of reducing the size of the intestinal tube associated with the removal of part of it, do not be afraid, soon the body adapts to a new state and a new chair will return to normal;