Rectal cancer – symptoms, treatment

Proven content

Rectal cancer most often occurs between the ages of 50 and 60. Rectal cancer is rare in young people (under 30), but its course is very malignant. It is much more common in men than in women.

What is rectal cancer?

Rectal cancer is a disease that develops very slowly, it accounts for about 25% of colorectal cancers. The most common cancer occurs in people between 50 and 60 years of age, more often it affects men than women. At first, cancer does not show any particular symptoms, but there may be some disturbing changes, for example in bowel movements (diarrhea, constipation, mucus often with blood). The incidence of rectal cancer in Poland is constantly increasing. In 2011, 3461 new cases were reported in men and 2247 in women. Such statistics place this neoplasm in 7th place in men and 8th in women. The death rate in this period was 1842 in men (8th place) and 1275 in women (10th place).

Rectal cancer causes

Among the factors affecting the risk of developing rectal cancer, there are external and internal causes.

1. Internal causes of rectal cancer:

1. ulcerative colitis;
2. adenomas – especially villous and polyps, the base of which is more than 2 cm in diameter;
3. Crohn’s disease;
4. family history of polyposis;
5. congenital nonpolyposis colorectal cancer syndrome (Lynch I syndrome) – this disease increases the risk of developing the disease by 60%;
6. Lynch II syndrome – these are cancers located elsewhere and Lynch I;
7. cystic and skin neoplasms (Muir-Torre syndrome);
8. a malignant tumor of the nervous system (Turcot’s syndrome);
9. epidermal cysts and mesodermal tumors (Gardner’s syndrome) – increase the risk of developing colorectal cancer up to 100%.

2. External (environmental) causes of rectal cancer:

1. heavy tobacco smoking;
2. low content of fruit and vegetables in the daily diet;
3. too much fat in the diet;
4. eating foods containing carcinogens (e.g. ethanol, aromatic hydrocarbons). They are found especially in grilled dishes;
5. eating too much red meat;
6. a small amount of vitamins A, C and E and selenium in the daily diet;
7. frequent constipation caused by a small amount of fiber or obesity – they cause the formation of mutagens produced by the bacterial flora.

In addition, women who have not yet had children are at risk of rectal cancer.

Rectal cancer – Symptoms

Rectal neoplasm development is slow and usually goes unnoticed for a long time. Changes in the normal function of passing stools (constipation or diarrhea or both, pressure on the stool and passing some mucus, often with blood in it) must always raise the suspicion of rectal cancer. In the event of such symptoms, please contact your surgeon immediately. In all cases, a medical examination, and especially a finger examination of the rectum, is essential. However, it should be clarified that the appearance of fresh blood in the stools is not yet evidence of cancer. The most common causes of such bleeding are lumps (hemorrhoids).

Therefore, the most common symptoms of rectal cancer include:

1. lack of appetite;
2. a tumor palpated;
3. pain in the lower abdomen is felt;
4. stool with an admixture of mucus;
5. weight loss;
6. high temperature;
7. flatulence;
8. latent or overt bleeding;
9. digestive system obstruction;
10. enlargement of the liver due to metastasis;
11. abdominal enlargement;
12. changing the rhythm of bowel movements.

The above-mentioned symptoms usually occur in advanced neoplasm, therefore it is important that the diagnosis is made as soon as possible so that appropriate treatment can be initiated.

Rectal cancer diagnosis

The following diagnostic tests are performed to diagnose rectal cancer and determine its severity:

1. x-ray,
2. palpation is performed in each case (up to 50% of rectal tumors are within the reach of the finger),
3. histopathology (taking a sample),
4. colonoscopy/sigmoidoscopy,
5. Abdominal ultrasound,
6. rectal infusion,
7. Ultrasound before the anus,
8. assessment of tumor mobility by rectal examination under general anesthesia,
9. computed tomography,
10. magnetic resonance imaging.

With the help of ultrasound examination through the rectum or palpation under general anesthesia, specialists are able to most accurately assess the mobility of the tumor and the infiltration of adjacent structures. The relevance of these studies affects the choice of treatment, whether it will be surgery, radiotherapy or chemotherapy first.

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1. Oncology package for men – diagnostic tests,
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Study of tumor markers

In rectal cancer, the CEA marker (carcinoembryonic antigen) is of diagnostic importance. Its elevation may suggest the presence of liver metastases. It also happens that some people have normal CEA despite having colon cancer. The CEA value after radical surgery should return to normal (in people who have an elevated marker). If the marker does not go down, it means that the treatment was ineffective.

Rectal Cancer – Treatment

What treatment will be implemented depends, among other things, on the patient’s nutritional status. If the patient is in a poor nutritional state, surgery or chemotherapy is impossible, this condition also affects the possibility of complications and the prognosis. Each patient should be properly prepared for treatment, poorly nourished patients should be given high-protein and high-calorie preparations. Treatments for rectal cancer are listed below.

1. Surgical treatment:

1. Hartmann’s method – the procedure is performed when the nodules are located in the upper part of the rectum and there is a fear that the anastomosis of the distal part of the rectum with the proximal part of the large intestine may not be tight (e.g. fecal peritonitis in the case of perforation of a cancerous tumor);
2. Miles’s method of abdomino-perineal rectal amputation – performed when the tumor is in the lower part of the rectum or when there is a risk that the anal sphincters may be damaged, or when they are infiltrated by cancer;
3. Dixon resection – performed when the nodules are located adjacent in the middle and upper part of the rectum and in the lower part;
4. local excision – performed in specialized centers, by surgery with extensive experience, according to specific recommendations, such as: poor condition of the patient or old age, which precludes the safe operation of the operation; adenomas with varying degrees of dysplasia; informed consent of the patient to the excision;
5. decompression colostomy – performed in the case of low anastomosis (after prior radiotherapy of the lower part of the rectum);
6. mesorectum excision – reduces the risk of local recurrence and increases the chances of recovery. Perianal tissues containing neoplastic infiltrates and lymph nodes are cut out (as wide as possible).

2. Preoperative radiotherapy: aims to shrink the tumor or destroy its mass, so it is possible to excise it without fear that the cancer cells will spread to the surrounding tissues. Doctors say that preoperative irradiation increases the chance of having sphincter-sparing surgery.

3. Postoperative radiotherapy: is used when the following factors have an unfavorable prognosis:

1. metastases in perianal lymph nodes,
2. infiltration of perianal adipose tissue,
3. high malignancy of the tumor,
4. tumor perforation during surgery,
5. blockages of cancer cells in the lymph and blood vessels.

Due to postoperative radiotherapy in B2, C1, C2 grades, it is possible to reduce recurrence by half.

4. Postoperative chemotherapy: is the standard method of treatment in the case of B2, C1, C2 advancement and invasion of the neighboring organs. During chemotherapy, folinic acid is given in combination with 5-Fluorouracil for 5 consecutive days and on day 29-33 of the cycle. The chemotherapy cycle is repeated 4-6 times.

5. Palliative treatment: it includes cryotherapy, laser therapy, local excision, fecal decompression fistula, radiotherapy, and palliative resection.

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