Fact: Early detection of colorectal cancer, although unlikely, is possible. What are the signs of rectal cancer in women? Rectal cancer in women treatment

Pathologies of the rectum in most cases are detected already in the later stages of their existence. This trend is explained by the fact that patients consult a doctor only after symptoms force them to do so. If we talk about cancer, then such slowness leads to death. In 2012, a record number of deaths caused by malignant tumors was recorded - about 8 million people, and this is only according to WHO statistics. Of this horrifying number, 450 thousand patients died from colorectal cancer. Moreover, 70-80% of deaths could be avoided if the disease was diagnosed at an early stage.

In order for such diagnostics to be carried out on time, special attention must be paid not only by doctors, but also by the patients themselves. If you notice symptoms of this cancer or predisposing factors to its occurrence, you should immediately contact a medical institution for diagnosis and consultation.

Predisposing factors

Several groups of factors can contribute to the formation of a malignant tumor in the rectum. These include certain errors in nutrition, the presence of chronic diseases of the final sections of the intestine, and family history. The most complete list of factors looks like this.

Myth about the cause of cancer. There is a widespread belief among the population that hemorrhoids can cause colorectal cancer. It's a delusion. Since hemorrhoids are not part of the intestinal mucosa, they cannot affect the intestinal epithelium. But it is worth remembering that prolonged absence of treatment for hemorrhoids can lead to the development of chronic proctitis, which is a risk factor for the development of rectal cancer.

Rectal cancer does not always depend on the presence of one of the above factors (rectal polyps and adenomatous familial polyposis are exceptions). For timely detection of the disease, one should carefully monitor the formation of symptoms accompanying the malignant process.

Classification

Symptoms and treatment tactics depend on the location of the tumor and its size, degree of differentiation (similarity of cancer cells to normal ones) and spread to other organs and lymph nodes.

Location of the tumor in the rectum:

Supraampullary (10% of cases) – in the very upper part of the intestine. For a long time it does not show symptoms. Quite often, patients consult a doctor about acute intestinal obstruction. In most cases, such complaints reveal cancer.

Ampullary (84% of cases) – the tumor is located in the middle part of the intestine. The most common location. The first symptom of a mid-gut mass is bleeding.

Anorectally (6% of cases) – the formation appears at the anus itself (sphincter). It is characterized by the presence of early symptoms, manifested by stabbing pains that are not eliminated even by NSAIDs (Citramon, Ketorol, Analgin). This leads to the fact that the patient can only sit on one half of the buttock.

To assess the spread throughout the body and tumor growth in medical practice, the stages of rectal cancer are used. According to national recommendations for oncologists from 2014, it is customary to distinguish 13 stages. Using this classification, you can describe the cancer as accurately as possible and make the most correct decision regarding the patient’s treatment method.

The structure of the rectal wall. In order to understand the principle of cancer germination, it is necessary to navigate the layer-by-layer structure of the organ. The layers in the wall of the rectum are located in this way, deep into:

serous membrane (outer layer);

muscle layer;

submucosal layer;

mucous

Metastasis is a tumor cell or several cells that penetrate into other organs and tissues with the flow of lymph and blood from the site of the primary manifestation of cancer. After penetration into the organ, they begin to grow rapidly and in some cases can exceed the size of the primary tumor.

In addition to the criteria listed above, the degree of differentiation of cancer, or how similar a tumor cell is to a standard (normal) cell, plays a significant role. Today it is customary to distinguish 4 main groups of pathological formations:

undifferentiated – over 95% of cells are atypical;

poorly differentiated (squamous, small and large cell cancer) – 90% of cells are atypical;

moderately differentiated - about 50% of cells are atypical;

highly differentiated (adenocarcinomas) - over 90% of cells have a normal structure.

The lower the degree of differentiation of cancer, the faster its spread and growth, the slower and worse it responds to treatment.

Symptoms of colorectal cancer

The malignant process develops gradually. The first signs depend on the location of the tumor in the rectum:

With an anorectal position, a stabbing pain appears, which intensifies when taking a sitting position. A characteristic sign is the “stool symptom” (the patient can only sit on half of the buttock) and a poor response to anti-inflammatory treatment.

When the tumor is localized in the supramullary or ampullary region, a small amount of blood appears in the stool. There are certain differences that make it possible to differentiate rectal cancer from other pathologies. Blood in cancer forms streaks in the stool, rather than covering it, as in hemorrhoids. In addition, the bleeding is not painful or increases in constant pain, which is typical for ulcerative colitis.

In 92% of patients with rectal cancer, the pathology is accompanied by the release of blood during bowel movements, regardless of the stage of the disease. This process is explained by the growth of blood vessels along with the tumor, which begin to be damaged when stool passes. The patient does not feel pain because there are no nerve endings in the cancerous formations.

Symptoms of cancer in the early stages (0-I) may be supplemented by intestinal disorders:

Tenesmus is a false urge to defecate. The patient feels the urge to visit the toilet, pain appears throughout the abdomen, which subsides after taking antispasmodics (No-shpa, Drotaverine). This condition can occur up to 15 times a day.

Gas and fecal incontinence is present in anorectal cancer.

Bloating and flatulence.

Diarrhea, constipation.

If the tumor grows mainly in the intestinal cavity (extremely rare), acute intestinal obstruction or acute intestinal obstruction may occur. The tumor blocks the passage in the final sections of the intestine, which leads to disruption of the passage of feces. Due to stagnation of feces, intestinal rupture may occur, leading to fecal peritonitis.

To diagnose OKN, it is enough to determine the number of bowel movements over 3 days. If intestinal gases and feces are not excreted, and the patient experiences cramping pain throughout the entire peritoneum, and there is bloating, then acute intestinal obstruction can be suspected. The most reliable symptom is vomiting of food eaten more than 2 days ago, with a characteristic fecal odor.

At stage II, in most cases, pain begins to appear, with supramullary and ampullary cancer, as the tumor begins to grow into the tissue and organs. The pain is aching in nature and is constant; the pain does not ease even after taking antispasmodics and NSAIDs. General symptoms of “tumor intoxication” appear: decreased attention, increased sweating, low-grade fever for months, weakness.

At stage III, pronounced “tumor intoxication” appears. The patient may begin to rapidly lose weight, despite maintaining the same diet and physical activity. The fever persists, and the level of work capacity drops significantly, since the patient is constantly accompanied by weakness.

At stage IV, rectal cancer affects the entire body. The penetration of metastases into organs is accompanied by a disruption in the functionality of each of the organs that have undergone the tumor process. When organs that are especially important for life (brain, lungs, heart) are damaged, multiple organ failure syndrome develops. This syndrome is the cause of death in most cancer patients.

Diagnostics

In addition to collecting complaints and analyzing the anamnesis for predisposing factors, it is necessary to perform an examination of the perinatal area and rectum. To carry out the procedure, the patient must take a knee-elbow position and completely relax. This way you can get maximum visual access. Detection of a tumor using this method is only possible if it is located low enough (anorectally).

Digital examination allows you to determine the presence of a tumor in the rectal cavity and determine its approximate size. This is possible if the tumor is located in the anorectal or ampullary region. No preparation is required on the part of the patient. During the examination, the patient should take a knee-elbow position or a position on his side with his legs drawn up, after which the doctor inserts a finger into the rectum. The study requires no more than 10 minutes.

However, instrumental methods come first in the diagnosis of rectal cancer, with the help of which it is possible to accurately determine the location of the formation and determine the degree of its malignancy. Today, the Russian Association of Oncologists has established such examination standards.

Complete colonoscopy with biopsy

A complete endoscopic examination of the entire colon is performed. The procedure is performed with an elastic tube. At the end of this tube there is a flashlight with a video camera, with which you can examine the intestinal wall for the presence of pathological formations. During endoscopy, the doctor takes material from the mucous membrane to further examine the pathological areas under a microscope for the presence of “atypical” cells.

A false negative result may be present if the tumor is deep. In such cases, a deep biopsy is required, during which material for research is taken from the submucosal and mucosal layers.

To reduce the likelihood of error, modern variations of colonoscopy have been developed:

If it is not possible to conduct a complete examination of the rectum, then a sigmoidoscopy examination can be performed. In essence, this is a procedure similar to a colonoscopy, with which only the final section of the intestine can be examined. In this case, the data will not be complete, since the condition of the colon and sigmoid colon remains unknown.

Preparing the patient for such procedures is similar and is carried out according to the following scheme:

A 3-day diet before sigmoidoscopy or colonoscopy, during which foods high in fiber should be excluded. These are juices, vegetables, fruits, cereals (millet, pearl barley, corn), rye bread;

if the study is scheduled for the morning, then the night before you can eat a light dinner that does not contain the products listed above;

30-50 minutes after dinner, the patient receives several enemas until clean rinsing water appears; in most cases, 2 enemas are sufficient;

before the examination, the patient should not have breakfast to avoid the formation of feces that interfere with viewing;

another series of enemas is performed, but if preparatory measures are taken, one is usually sufficient;

Before inserting the endoscope, the doctor performs a digital examination to reduce the risk of trauma to the rectum and anal ring.

If a colonoscopy was not performed before the start of therapy for the disease, it must be performed 3 months after the start of therapy.

MRI of the pelvis

It is the most popular method for studying tumors. With its help, you can determine the size of the tumor, the degree of tumor growth through the wall and into surrounding tissues, and the presence of metastases in the lymph nodes. It is not recommended to prescribe treatment without an MRI. The MRI procedure does not require special preparation of the patient.

CT and ultrasound of the abdominal cavity

The procedure is required to assess the presence of metastases in the tissues and organs of the abdominal cavity. The availability and low cost of ultrasound examination is obvious in comparison with CT. However, the information content of ultrasound is much lower, since during this study it is difficult to determine the degree of growth of the formation and its malignancy. To perform tomography, patient preparation is also not required. Obtaining reliable ultrasound results is more likely if you follow the 3-day diet described above.

Additionally, a CT scan or chest x-ray is performed to look for metastases in the heart, lungs and other organs, as well as mediastinal lymph nodes. Among the laboratory methods, a blood test for tumor markers is used: CA 19.9, carcinoembryonic antigen. CA 19.9 is a kind of test that is used in the early stages of diagnosis.

Based on a set of indicators, it is possible to determine the stage of the cancer process and determine treatment tactics.

Treatment

Modern standards of treatment for rectal cancer include 3 stages:

preoperative radiation and chemotherapy;

surgical intervention;

postoperative chemotherapy or radiation therapy.

The exception is patients for whom surgical treatment is not recommended. These include elderly patients, with severe concomitant diseases, and patients with stage IV cancer. In such cases, the operation not only does not guarantee a positive result, but can also cause aggravation of the process and the general condition of the patient.

Preoperative therapy

At this stage, the main goal is to reduce the likelihood of tumor progression, slow its growth and significantly improve the prognosis. It is carried out for patients regardless of the stage of the process. The need and dose size of chemotherapeutic agents are determined by the oncologist individually for each patient, depending on the degree of development of the oncology.

Exclusively radiation therapy is used for insignificant tumor growth (grades 1 and 2). If stage 3 or 4 cancer is present, then treatment should be combined with the use of chemotherapy (Leucovarin, Fluorouracil).

Surgery should be scheduled at certain intervals, depending on the severity of the patient’s condition. On average, the interval ranges from 3 days to 6 weeks.

Surgical intervention

There are various techniques for removing tumors in the rectum. The surgical option is selected individually for each patient based on the degree of differentiation and stage of tumor development. It is important for the surgeon to try to preserve the rectum, since the patient’s quality of life depends on this, however, such an opportunity is not always presented and is most likely in the early stages of cancer.

At stage 4 cancer, surgical treatment is performed only in the case of intestinal obstruction, since the operation does not have a significant effect on the process. Chemotherapy is of primary importance in later stages.

Preparation for surgery. After admission to the hospital, the patient is prescribed a laxative. 16-20 hours before the operation, the patient should drink 3 liters of lavage solution to cleanse the intestines. The dose is 200 ml for 30 minutes. Cleansing enemas are not recommended in our time. Also, antibiotics are not used for prevention purposes.

In each individual case, the technique and extent of the operation are decided jointly by the surgeon and the oncologist.

Postoperative therapy

For patients with stage 2 cancer, postoperative treatment is not carried out in most cases. At stages 2-3, a combination of chemotherapy and radiation therapy is prescribed for 3-6 months. The volume is determined by the oncologist.

At stages 1-3, it is usually possible to achieve stable remission within 6 months. In the presence of stage 4 rectal cancer, constant medical care is required, on which the patient’s life expectancy depends.

Observation after remission

In order not to miss the recurrence of the disease, the patient should be systematically monitored by an oncologist. Today we recommend the following frequency of visits:

in the first two years after remission - at least once every six months;

after 3-5 years once a year, six months;

after five - annually.

It is also worth remembering that if a patient has complaints, they should undergo an unscheduled examination by an oncologist.

Forecast

Life expectancy is the main issue of interest to cancer patients. Oncological diseases are the most severe for humans. They lead not only to the destruction of tissues of neighboring structures, but can also affect absolutely any organs due to metastases. Constant “tumor intoxication” further depletes the body, due to which it is exposed to various infections. All of the above factors and the lack of a 100% cure cannot guarantee the patient’s survival after therapy.

For rectal cancer, the prognosis depends on the degree of tumor growth and the presence of metastases. The following are the average 5-year survival rates after adequate treatment:

However, it must be remembered that these values ​​are statistical averages. Each case of cancer development is purely individual; life expectancy can be affected by various factors, including not only the general condition of the body, but also the psychological mood.

Rectal cancer is a dangerous disease that practically does not manifest itself in the early stages. The success of therapy depends mainly on early diagnosis and oncological alertness of the patient. As long as the tumor has not spread throughout the body, there is a good chance of getting rid of it forever. If the process is at stage 4 and foci of tumor processes are present in several organs, then all efforts are aimed at ensuring the maximum quality and life expectancy of the patient.

Colorectal cancer (RCC) accounts for almost half of all cases. significantly ahead in frequency of colon tumors. The disease is insidious in its localization, since the rectum is closed by the muscular sphincter, the defeat of which entails the need for traumatic operations, often resulting in disruption of the natural act of defecation, which significantly complicates the patient’s usual lifestyle.

Rectal tumors are common everywhere, but they are most often diagnosed in Western and central Europe, the USA and Great Britain. Residents of Asia and Africa are less susceptible to cancer due to their diet, which includes a large number of plant components.

The average age of patients is 50-60 years, that is, as they approach old age, the risk of tumor increases. It is believed that men and women are equally affected by rectal tumors, but according to some data, there are still more men among patients. It is also possible to detect cancer in young people, in whom the tumor often progresses more aggressively and with a worse prognosis.

The rectum, unlike other parts of the gastrointestinal tract, is quite accessible for inspection, but the number of advanced forms of the disease remains high. Late diagnosis leads to extensive and traumatic operations, but they are not always effective. The prognosis is still serious, and every year the number of patients with such a tumor is only increasing, which makes the problem of rectal cancer very relevant.

Causes and types of rectal cancer

It’s no longer a secret that the increase in the incidence of colon cancer is associated with the lifestyle and nutrition of modern people. This connection is especially clear among residents of large cities in economically developed countries. The rectum, being the final section of the digestive system, experiences the full range of negative effects of carcinogens and toxic substances, which not only come from outside with food or water, but are also formed during digestion in the intestine itself.

Among the causes of PKK, the most important are:

• The nature of the diet, when animal fats, meat products, and semi-finished products predominate, while there is not enough plant fiber in the diet;
• Changes in the intestine in the form of chronic inflammation (colitis, proctitis), polyps, chronic anal fissures, as well as Crohn's disease and ulcerative colitis, accompanied by recurrent damage to the mucosa with subsequent cicatricial changes;
• Constipation, causing mechanical damage to the inner layer of the intestine by dense contents and increasing the time of contact of the mucous membrane with carcinogenic substances;
• Drinking alcohol, even in small quantities, smoking and a sedentary lifestyle, often combined with obesity and metabolic disorders;
• Heredity.

Among pre-tumor changes Particular importance is attached to these, which are considered an obligate precancer when they are located in the rectum. This means that any polyp of this localization without timely removal threatens to develop into cancer.

As a rule, patients suffering from RPC can indicate the presence of several predisposing factors, among which the main place belongs to nutrition, physical inactivity and chronic inflammatory changes.

The tumor can be located in the upper, middle or lower parts of the rectum; the nature of treatment and prognosis will depend on its location.

The higher the cancer is from the anal canal and its sphincters, the better the outcome and the less traumatic treatment awaits the patient, all other conditions being equal.

Depending on the growth characteristics of the PKK, it may be exophytic when the neoplasm is directed inside the organ, and endophytic, growing in the thickness of the wall. Endophytic cancer causes a significant narrowing of the intestinal lumen and is prone to ulceration.

From the point of view of histological features, most malignant tumors of the rectum are adenocarcinomas(glandular crayfish), however, there are also mucous membranes, undifferentiated, fibrous tumors that are more malignant and therefore have a worse prognosis.

Having arisen in the mucous membrane, PKK gradually covers an increasingly larger area, growing into the muscular and serous layer of the organ, entering the pelvic tissue, affecting the uterus and appendages, vagina, bladder in women, seminal vesicles, prostate, urinary tract in men. Tumor cells, once in the lymphatic and blood vessels, spread through them and give rise to metastases: lymphogenous in the lymph nodes, hematogenous in the internal organs. Hematogenous metastases are most often found in the liver, which collects blood from all parts of the intestine and enters it through the portal vein for neutralization. The entry of cancer cells into the serous covering of the intestine entails so-called implantation metastasis, when the tumor spreads over the surface of the peritoneum.

The stages of rectal cancer take into account the characteristics of the neoplasm itself, its size, ingrowth into the surrounding tissue, as well as the nature of metastasis. Thus, domestic oncologists There are four clinical stages of the tumor:

• Stage 1, when the tumor is no more than two centimeters, grows no deeper than the submucosal layer and does not metastasize.
• At stage 2, the neoplasm is up to 5 cm, does not extend beyond the boundaries of the organ, but can manifest as metastases in local lymph nodes.
• Stage 3 is accompanied by germination of all layers of the intestinal wall and the appearance of metastases in local lymph nodes.
• Stage 4 characterizes large neoplasia that invades the surrounding tissues, pelvic tissue with lymphogenous and hematogenous metastasis to the lymph nodes and internal organs.

Manifestations and diagnosis of rectal cancer

Rectal cancer is a common disease, there is a lot of information about it on the Internet and relevant literature. The increase in the number of patients makes it necessary to carry out educational work among the population, encouraging them to visit a doctor. Having read about the symptoms of the disease, people with intestinal pathology often tend to exaggerate their complaints and independently diagnose themselves with a tumor. In other cases, especially impressionable patients completely refuse to be examined by doctors, considering themselves doomed to die from cancer. This approach is fundamentally wrong, because

Only a specialist can confirm or deny the presence of neoplasia, and the symptoms of both the malignant process and other diseases are often similar, which confuses people who do not have sufficient medical knowledge.

Colorectal cancer can be suspected at an early stage based on its characteristic symptoms. Of course, if a patient suffers from hemorrhoids, anal fissure or a chronic abscess in the rectal area, then it is unlikely to be possible to distinguish cancer from these diseases on your own, because some of their manifestations are similar. At the same time, the commonality of symptoms should not lead to panic and the search for a dangerous disease. Bleeding, pain, or bleeding does not always indicate cancer. after all, blood can be with hemorrhoids, pus and mucus - with inflammatory processes. To distinguish these diseases, you need to be examined by a proctologist; you cannot diagnose a tumor yourself.

Symptoms of rectal cancer are determined by the stage and level of location of the tumor. These include:

• Various dyspeptic disorders;
• Bleeding and other pathological impurities in the stool;
• Abnormal stool up to intestinal obstruction;
• Signs of general intoxication;
• Anemia;
• Pain syndrome.

The first symptoms depend on the location of the neoplasia. Besides bleeding, which occurs in almost all patients, is possiblepainas the first sign in the case of a low location of cancer with transition to the anal sphincter. In some cases, the disease occurs with stool disorders, more often in the form ofconstipation, which can be regarded as manifestations of another pathology (proctitis, anal fissure, hemorrhoids).

The early stage of the tumor may not give specific symptoms, however in 9 out of 10 patients, signs of tumor bleeding appear already during this period. Bleeding is one of the most characteristic symptoms of colorectal cancer. Massive bleeding usually does not occur; blood is released in small portions, mixed with stool or appears before it.

Patients with hemorrhoids will also commonly experience bleeding from the rectum, but blood will be released after a bowel movement, coating the outside of the stool, which may be a hallmark of these diseases. In order to exclude cancer, which can also occur in the presence of hemorrhoids, an examination by a proctologist and additional studies are necessary; self-diagnosis in this case is impossible.

In addition to blood, mucus and pus can be found in the stool, the presence of which reflects secondary inflammation in the tumor and intestines (proctitis, proctosigmoiditis). These signs, in the absence of anal fissures and chronic abscesses, most likely indicate a malignant process.

The second most common after bleeding is the syndrome of intestinal disorders, which is indicated by the vast majority of patients with any stage of cancer. Characteristic is constipation and the inability to completely empty the intestines. The presence of a tumor gives a feeling of a foreign body and a false urge to defecate, sometimes painful and painful. When trying to empty the intestines, the patient observes the release of a small amount of blood, mucus, pus, while there may be no feces. Such urges happen up to 15 times a day.

As the size of the neoplasia increases, constipation becomes more persistent and prolonged, the abdomen swells with accumulated gas, rumbling and pain appear, which are initially periodic, but as the cancer progresses, they become constant. When the intestinal lumen is completely closed by a neoplasm, the movement of feces stops and develops intestinal obstruction. Pain with intestinal obstruction is intense, cramping, accompanied by vomiting and a complete absence of stool and gas discharge.

The severity and time of onset of pain depend on the location of the tumor. When it is in the upper or middle section, the pain is not constant and is caused by the penetration of the tumor into the surrounding tissues, while with cancer of the anal canal involving the sphincter, pain occurs at an early stage of the disease and may be the first sign of trouble. It is typical that a patient experiencing pain due to RKK tries to sit on one half of the buttock - the so-called “stool symptom”.

Late stages of the disease, when the tumor affects the pelvic structures, actively metastasizes, disintegrates and becomes inflamed, are accompanied by general intoxication, weight loss, weakness, and fever. Chronic blood loss leads to anemia.

If suspicious symptoms or any intestinal disorders appear, you need to go to the doctor to clarify the diagnosis. The rectum is accessible to direct examination and digital examination; these methods do not require complex equipment and can be performed everywhere, but the frequency of advanced forms of cancer continues to remain high. This is due not only to the aggressiveness of some tumors or the nonspecificity of symptoms in the early stages, but also to the reluctance of many patients to see a doctor and undergo appropriate research.

For the purpose of diagnosing cancer The specialist will examine the rectum, ask in detail about the nature of the complaints and prescribe additional studies, including:

1. Sigmoidoscopy, during which it is possible not only to examine the surface of the mucous membrane, but also to collect suspicious fragments for histological analysis;
2. X-ray examination (irrigography) with a barium suspension for contrast can detect the presence of pathology not only in the rectum, but also in the overlying parts of the intestine;
3. Ultrasound of the abdominal cavity and pelvis is necessary to search for metastases and determine the extent of the malignant process;
4. CT, MRI - to search for metastases and determine the characteristics of the tumor itself;
5. Laboratory tests - blood, urine, feces tests, including occult blood tests;
6. Laparoscopy and laparotomy (the latter allows you to accurately determine the extent of the tumor).

Among the laboratory methods, it is possible to conduct a test for colon cancer, which consists in determining carcinoembryonic. Typically, with RPC these indicators increase, however, their increase is possible in some other diseases (nonspecific ulcerative colitis, for example). In addition, carcinoembryonic antigen is often elevated in active smokers, which must be taken into account when performing the analysis.

The most accurate way to find out the structure of the tumor is histological examination of its fragments. The histological type (adenocarcinoma, mucinous, undifferentiated cancer) and the degree of differentiation determine the growth rate, behavior of the neoplasm and prognosis for the patient.

Features of treatment of rectal cancer

Unlike other parts of the digestive tract, the rectum has a structural feature in the form of an anal sphincter, which regulates the process of defecation. Without adequate functioning of this muscle structure, it is difficult to imagine normal life activity, social and work adaptation. During operations on the rectum, special importance is attached to the possibility of preserving the sphincter or performing reconstructive operations, which will determine the patient’s future lifestyle.

The choice of a specific treatment method and type of intervention is determined by the location of the tumor relative to the anal sphincter, the depth of ingrowth into the intestinal wall and surrounding structures, the general condition of the patient and the stage of the tumor. Radiation, chemotherapy and surgery are usually combined, but surgical removal continues to be the main treatment for bowel cancer.

When you can't do without surgery...

Removal of neoplasia is the most effective way to get rid of formation, but, at the same time, the most traumatic. Surgeries on the rectum are complex and often require the participation of two teams of surgeons simultaneously. In some cases, there is a need for subsequent plastic surgery, because life with a fecal fistula on the anterior abdominal wall cannot be called easy, including psychologically for the patient.

Certainly, early detection of a tumor can help avoid extensive operations, however, the low location of the tumor is a factor that does not depend on the patient, but determines the essence of surgical treatment. Today, proctological surgeons try, whenever possible, to resort to less traumatic interventions, if this does not come at the expense of radicality. There are techniques for preserving or recreating the anal sphincter, which significantly improves the quality of life of patients in the postoperative period.

During intestinal operations, proper preparation plays an important role, which is only possible with planned interventions. It includes prescribing laxatives (vaseline oil, oral magnesium) and following a gentle diet. Cleansing enemas, which are used everywhere, are increasingly giving way to intestinal lavage with a special solution that can be taken orally or administered through the duodenum. Lavage solution (Fortran) is prescribed in an amount of 3 liters 18-20 hours before the planned operation.

If the tumor is accompanied by an inflammatory process, then antibiotics are necessarily prescribed, possibly in a loading dose before surgery to prevent infectious complications.

The type of intervention is determined, first of all, by the proximity of the tumor to the anal sphincter. Analysis of the results of the operations performed showed that in order to comply with the basics of radicalism, it is enough to retreat 2-5 cm from the lower pole of neoplasia and 12 cm from the upper one. Depending on whether the sphincter falls into the area of ​​the tissue being removed, a specific surgical technique will be selected. It is clear that the greatest difficulties will arise with tumors of the lower rectum, but in each specific case the surgeon will try to preserve the patient’s sphincter with the possibility of good social adaptation in the future.

Surgical treatment of lower ampullary rectal cancer

Until recently, the main and only possible method of treating cancer located in the lower rectum was considered abdominal–perineal extirpation(WPT). The operation consists of excision of the entire rectum along with the muscular sphincter, pelvic tissue and lymphatic system. The intervention is carried out in two stages: first, the sigmoid colon is removed to the anterior wall of the abdomen, forming a colostomy to drain feces, and then the rectum and pelvic tissue are removed from the perineal area (perineal stage). With the participation of two teams of surgeons, these stages are carried out simultaneously.

Indications for BPE are cancer located closer than 6-7 cm from the anus, neoplasia that grows into neighboring tissues and metastasizes to local lymph nodes, as well as advanced cases of the disease complicated by intestinal obstruction.

There is no longer any possibility of restoring intestinal continuity after BPE, and the patient is forced to live with an unnatural anus in the abdomen or perineum. Postoperative rehabilitation is complex, and not all patients are able to adapt to their usual way of life and, especially, work activity. In this regard, surgeons, whenever possible, resort to more gentle treatment methods, if they do not contradict radicalism.

The creation of a perineal colostomy and an artificial rectal sphincter can somewhat improve the quality of life of patients after radical intervention. After abdominoperineal extirpation, in this case, the preserved end of the colon is brought to the perineal area and an artificial sphincter is formed using smooth muscle tissue. In addition, it is possible to create an additional reservoir from the colon in the pelvic cavity. Such modifications of radical treatment are preferable for young patients who want to maintain an active lifestyle and the ability to work. The conditions for their implementation are considered to be the absence of metastasis, germination of pelvic tissue, and the neoplasm should occupy no more than 1/2 of the circumference of the rectum.

In men with common types of colorectal cancer, when the affected area includes the bladder, prostate and seminal vesicles, the only option is to evisceration pelvis with the removal of all affected structures, fiber and lymph nodes. The operation is extremely traumatic and requires not only the creation of an unnatural anus, but also the ability to divert urine in the absence of a bladder.

Sphincter-sparing operations

example of sphincter-sparing surgery

• Sectoral resection of the rectum and anal sphincter, when a section of the sphincter and organ wall is excised, restoring intestinal continuity. The condition for its implementation is considered to be the spread of the tumor to no more than a third of the circumference of the intestine with its ingrowth into the internal muscle sphincter.
• Transanal resection consists of excision of a fragment of the intestine and is feasible in case of tumor invasion no deeper than the submucosal layer. After excision of the affected tissue, the connection between the rectum and the anal sphincter is restored.
• Abdominal-anal resection is indicated for tumors located above 5-6 cm from the anus and occupying no more than 1/2 of the circumference of the rectum. After excision of the affected intestine, the upper end of the large intestine is brought to the preserved sphincters, and a connection is formed that allows the movement of feces to the anus. In some cases, abdominal-anal resection is performed with excision of the internal sphincter, which is recreated from the muscle layer of the large intestine.

Operations for tumors of the middle ampullary and upper sections

sections and anatomy of the rectum

The location of the neoplasia at a relative distance from the anal sphincter allows it to be removed without disrupting the continuity of the intestine and preserving the natural act of defecation. Possible abdominal-anal resection with the sigmoid colon brought to the anus. For high-growing neoplasias, it is indicated anterior resection, when the affected organ fragment is removed and the ends are stitched together to restore intestinal patency. Sutures can be placed on the intestinal wall using special stitching devices, which greatly facilitates and speeds up the operation.

If the tumor is complicated by intestinal obstruction, then resection will not be possible, and then the method of choice becomes operation Hartmann when, after removing the tumor, the rectum is sutured, and a colostomy is placed on the anterior wall of the abdomen to drain feces. Subsequently, it is possible to restore intestinal continuity, but certain difficulties must be taken into account due to the reduction in the size of the remaining rectum and the development of adhesions in the pelvic cavity.

Since the risk of infection, postoperative complications and tumor progression during intestinal interventions is quite high, the basic principles of surgical technique for such patients have been developed:

1. Administration of antibiotics on the eve of the planned operation;
2. Early ligation of the vessels feeding the intestinal wall, strict delimitation of the dissected tissues from each other using napkins;
3. Washing the pelvic cavity and surgical wound with antiseptic solutions;
4. Careful ligation of blood vessels, replacement of linen and gloves when moving from one stage of the operation to the next.

Palliative care

Unfortunately, rectal cancer is often detected at a stage when radical treatment is no longer possible. and only palliative operations aimed at reducing pain, eliminating intestinal obstruction and other complications of the tumor can help the patient.

Palliative interventions include the creation of a fecal fistula (colostomy) on the anterior wall of the abdomen by removing the sigmoid colon with suturing of the rectum or forming a double-barreled colostomy by dissecting and fixing the intestine to the abdominal wall. Removing intestinal contents through such an artificially created hole eliminates intestinal obstruction, reduces pain and helps to somewhat alleviate the patient’s general condition.

Features of lifestyle after rectal surgery depend on the nature of the intervention. If the surgeon manages to preserve the anal sphincter without compromising radicality, then the patient will be required to follow a diet and regularly visit the oncologist. In cases where the doctor is forced to create an unnatural anus, the patient is doomed to difficulties in further rehabilitation. Such patients will need to carefully monitor the condition of the colostomy, paying due attention to hygiene procedures and diet. Work activity is often difficult and even impossible. After operations on the rectum, in some cases, patients are assigned disability.

Radiation and chemotherapy

Radiation and chemotherapy are usually not used independently for cancer of the distal intestine, but are part of combination therapy for the tumor.

Radiation is possible both before and after surgery. Before surgery, radiation therapy aims to reduce the mass of tumor tissue and is prescribed in a total dose of 20 Gy for five days. A few days later the operation is performed. Such a short period of time between irradiation and removal of neoplasia is associated with the possible development of radiation damage at the site of cancer growth, which can cause intestinal perforation.

If, upon examination of the removed lymph nodes, it was confirmed that they were affected by the metastatic process, the patient will additionally undergo postoperative radiation therapy in the amount of 40 Gy to the area of ​​the removed lymph nodes and the tumor growth area. Radiation after surgery helps prevent the cancer from recurring and spreading through the lymphatic and blood vessels.

Chemotherapy is used after surgery or as a palliative care option. Polychemotherapy regimens have been developed for patients with rectal cancer, including 5-fluorouracil, ftorafur, Adriamycin, and eloxatin as the most effective. This adjuvant chemotherapy aims to remove remaining cancer cells at the surgical site and prevent metastasis. If chemotherapy is prescribed for inoperable forms of the disease, then its goal is to reduce the size of the tumor and, accordingly, the pain syndrome, facilitate the passage of intestinal contents, and also fight metastases.

At all stages of treatment, patients need supportive and symptomatic therapy, intravenous infusions of fluid, nutritional and saline solutions. Adequate pain control is an essential component during both surgical treatment and palliative care. Patients with intestinal cancer need constant monitoring of electrolyte metabolism and timely correction of disorders that often accompany this disease. Sodium bicarbonate (soda) can be used as a means to normalize electrolyte balance, but this does not mean that you need to follow recipes from the Internet and consume soda orally yourself or even inject it into the rectum. Such experiments are fraught with serious complications and even death, so a doctor must regulate subtle metabolic processes, taking into account the tests.

The prognosis for rectal cancer is always very serious. In the absence of metastasis, up to 70% of patients survive five or more years, but the presence of secondary tumor lesions reduces this figure to 40%. It is clear that the more pronounced the tumor process and the more advanced the stage of the disease, the worse the prognosis. In young patients, who often suffer from aggressive types of rectal cancer, especially when the anal sphincter is affected, it is not always possible to achieve satisfactory treatment results.

Prevention of rectal cancer consists of regular visits to the proctologist by all persons suffering from any intestinal lesions (polyps, inflammation, anal fissures). An examination by a specialist should be carried out annually or more often if indicated. Everyone, without exception, especially older people, needs to pay due attention to the nature of their diet, increasing the proportion of plant components and fiber and giving up large amounts of animal fat and alcohol. If you suspect a tumor in the intestine, do not hesitate, you should immediately go to the doctor. Only if you seek help early can you expect a good treatment result.

Video: diseases of the rectum in the program “Live Healthy!”

The author selectively answers adequate questions from readers within his competence and only within the OnkoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not provided at this time.

is a malignant neoplasm. In the epithelial cells of the rectum, when exposed to carcinogenic factors, persistent changes occur. Colonocytes divide uncontrollably, the apoptosis mechanism is disrupted (the cell does not die after a certain number of divisions) and cancer develops. Since the rectum is a department, its malignant neoplasms are classified as colorectal cancer (colon cancer).

Despite the fact that there are screening methods of examination and the rectum is accessible for visual examination, rectal cancer is detected in the last stages in 30% of patients. This is due to the fact that patients do not attach importance to the first signals of a developing disease.

In the initial stages, the disease is practically asymptomatic; the main signs of cancer appear periodically. As the disease progresses, they intensify and new symptoms appear.

First symptoms

A characteristic sign of the initial stages of the appearance of a neoplasm is pathological discharge. Found in stool:

Early signs of cancer are symptoms of impaired intestinal function:

• Constipation. Cancer is characterized by the fact that feces, after a long delay in stool, are excreted profusely and have a foul odor. Patients often complain of a feeling of incomplete bowel movement after defecation, leading to. Obstruction is typical for tumors located in the rectosigmoid region.
• Diarrhea. Persistent diarrhea, unresponsive to medication, occurs due to the development of proctitis and is associated with excessive production of intestinal mucus. “False” diarrhea occurs (with frequent urges, a small amount of mucus and bloody masses are released).
• Alternating constipation and diarrhea. This symptom occurs against the background of partial intestinal obstruction. The rhythm of bowel movements is inconsistent.
• Change in the shape of the stool column. With rectal cancer, symptoms rarely appear. Fecal masses are flattened, in the form of balls, strands, threads. Although this symptom is more typical for spastic colitis, if the symptom appears systematically, it is imperative to be tested for cancer.

Since the rectum is divided into 3 anatomically different sections, the symptoms of cancer depend on the location of the tumor.

Anorectal cancer is characterized by:

• spread beyond the mucous membrane of the anal canal;
• violations of the act of defecation;
• discharge of blood, mucus, pus from an ulcer or fistula around the anus;
• impaired urination (if the urethra is involved in the tumor process).

With ampullary cancer, the tumor does not appear for a long time. When it becomes significant in size, the feces injure it, and then the following occurs:

• bleeding during or after defecation;
• frequent, painful urges.

Supramullary manifests itself:

• frequent constipation, occasionally alternating with diarrhea;
• pain in the anus that intensifies with defecation or walking.

Such symptoms are also characteristic of benign diseases of the rectum. Patients often simply do not pay attention to the first signs of a dangerous disease, especially if they previously had colitis, proctitis, or hemorrhoids. They begin to take medications that eliminate symptoms (this makes early diagnosis of cancer difficult), and use anti-hemorrhoid suppositories. Sometimes, they are simply embarrassed to see a doctor, because the symptoms appear periodically and are easily explained. And pain in the early stages is often absent. Meanwhile, the tumor is growing. The patient's condition worsens.

Further development of symptoms

If the tumor is exophytic (grows into the intestinal lumen), it rarely grows into the thickness of the wall, and does not bother the patient for a long time until mechanical obstruction occurs or the tumor “falls out” of the anus. By this time, it is already capable of metastasis.

An endophytic tumor quickly grows through the wall of the rectum, reaches the peritoneum, the tissue surrounding the ampullary and anorectal parts of the rectum, and spreads to the adjacent pelvic organs.

As the pathology progresses, the main symptoms intensify:

Rectal cancer is characterized by late onset of general symptoms:

• anemia;
• weakness;
• weight loss;
• irritability;
• earthy skin tone.

As the tumor grows, patients complain of pain in the coccyx, lower back, and sacrum. Performance is significantly reduced due to frequent false urges at night, and insomnia occurs.

Untimely or late access to a doctor leads to the tumor metastasizing. Secondary lesions occur in any organ. Most often, rectal cancer metastases affect:

• liver;
• lungs;
• brain, spinal cord;
• adrenal glands;
• bones.

The main danger of cancer is precisely that they occur with minor clinical manifestations, and only in the last stages does pain and intensification of other leading signs force the patient to seek medical help.

Causes and risk factors

Cancer is difficult to treat, not only because it is often discovered late. To cure a disease, you need to know the cause of its occurrence. Despite centuries of research into cancer, no one can say exactly why a malignant tumor appeared. Only factors contributing to the appearance of atypical cells have been identified:

Although nicotine does not cause colorectal cancer (it promotes the development of cancer of the respiratory tract and lungs), it significantly increases the risk of tumor metastasis.

The body is affected by various carcinogenic substances, viruses and microorganisms (and even) producing toxins that cause cell mutation. With prolonged exposure to factors, atypical cells appear. Normally, as soon as such a failure occurs, the immune defense is triggered and the atypical cells are destroyed. If, due to exposure to carcinogenic substances, the body's defenses are weakened, cancer develops. To select adequate treatment and predict the further course of the disease, it is necessary to determine the stage of the disease.

Classification and stages of cancer

Various cancer classification systems are now widely used. The most significant:

• Dukes.

The following designations are accepted in the TMN system:

• Tis is a non-invasive cancer. Atypical cells appeared on the surface layer of the epithelium.
• T1 – tumor less than 1/3 of the circumference and length of the rectum, not affecting the muscle layer of the intestinal wall.
• T2 – the size of the tumor does not exceed 1/2 of the circumference and length of the rectum, infiltrates the muscle layer, and does not cause restrictions on the displacement of the rectum.
• T3 – a tumor measuring more than half the length or circumference of the rectum, causes restrictions in displacement, but has not spread to neighboring organs.
• T4 – the tumor affects neighboring structures.
• N0 – regional lymph nodes without changes;
• N1 – there are metastases to regional lymph nodes. In intestinal cancer, the presence of metastases is determined using lymphography.
• M0 – no distant metastases (in other organs);
• M1 – there are distant metastases.

Dukes classification:

• A – only the mucous membrane is affected by the tumor;
• B – germination of the intestinal wall, regional lymph nodes without changes, no distant metastases.
• C – the tumor has grown through all layers of the intestinal wall, there are regional metastases;
• D – distant metastases were detected.

Classification of cancer by stages

If we evaluate cancer by stages, then:

• 1 – the tumor or ulcer is small, clearly demarcated, located in a small area of ​​the mucous membrane, changes do not affect the muscular layer of the intestinal wall.
• 2 – the tumor does not exceed half the length or circumference of the rectum in size, does not grow into adjacent tissues, and there are no more than 1 regional metastases.
• 3 – the tumor is larger than the semicircle of the intestine, pathological changes affect neighboring organs, there are multiple metastases in regional lymph nodes.
• 4 – the tumor is extensive, disintegrating, or a tumor of any size, but there are distant metastases.

This division into stages is necessary in order to choose a treatment method and predict the approximate life expectancy.

It is impossible to determine not only the stage of cancer, but also the fact that discomfort is caused by this disease, based on clinical symptoms. You definitely need to get tested.

Diagnostics

As soon as a patient consults a doctor with complaints of pathological discharge, constipation, or simply comes for an annual preventive examination, the presence of a malignant formation can be suspected when carrying out. Even if the tumor is located at a height of 10–12 cm from the anus, it is possible to feel a pathological change in the wall, especially if you ask the patient to strain. Cancer of the upper and supraampullary rectum is not available for digital examination. Therefore, if the patient complains of false urges or bleeding, in addition to digital examination, the following is necessary:

All patients with rectal cancer are referred for additional testing to accurately determine the stage of the disease. Required:

• lymphography.

For early diagnosis of rectal cancer, screening studies are carried out in risk groups (age over 50 years, presence of blood relatives diagnosed with colorectal cancer). Be sure to prescribe:

• digital examination of the rectum;
• hemoculttest;
• colonoscopy (once every 5 years).

Almost all of them present with the same clinical symptoms. And with a digital examination and a blood culture test, it is difficult to distinguish it from cancer. These diseases are characterized by bleeding. Upon digital examination, the tumor can be mistaken for enlarged hemorrhoids.

In addition, differential diagnosis must be carried out with the following pathologies:

• inflammatory diseases of the rectum;
• dysentery;
• ulcerative colitis;
• other tumors (polyps, lymphomas, metastatic tumors);
• haemorrhoids;
• tumors of the pelvic organs;
• sarcomas.

Comparative characteristics of the symptoms of cancer and other most common diseases of the rectum:

A diagnosis cannot be made based on symptoms alone. It is possible to definitively determine whether it is cancer or a benign disease of the rectum only after.

A biopsy sample is taken during sigmoidoscopy or during fibrocolonoscopy. Material for histological examination is taken from several of the most suspicious places and sent for examination (see). Only under a microscope can one detect the presence or absence of atypical cells. All other methods are necessary to determine the presence and location of tumors and ulcers.

Treatment is prescribed by an oncologist after identifying not only colon cancer, but also determining the stage of the disease. And for early diagnosis of the disease, you should consult a proctologist or gastroenterologist.

Treatment

Any cancer can be treated comprehensively. Use:

• surgical method;
• chemotherapy;
• radiation therapy.

Diet

Patients who exhibit symptoms of impaired intestinal function are prescribed. In addition, it should be taken into account that there are many products that have a carcinogenic effect:

• fats;
• alcohol.

Even fruits, vegetables and grains can have a carcinogenic effect if they contain nitrates, molds, and pathogenic microorganisms. You should not consume products that have expired, or that there are even barely noticeable areas of rot on products of plant origin.

Cancer patients need to limit their consumption;

• fatty foods;
• canned food;
• smoked meats;
• salty food;
• alcohol.

You need to eat more foods that have anti-carcinogenic effects. First of all, these include vegetables and fruits with a high content of vitamins A, C, E:

• carrot;
• sea ​​​​buckthorn;
• rose hip;
• garden rowan;
• parsley.

Foods containing dietary fiber reduce the risk of developing colorectal cancer. Recommend:

• tomatoes;
• apples;
• plums;
• pears;
• legumes

• Gerson diet;
• starvation diet.

The Gerson diet excludes:

• salt;
• animal proteins;
• refined sugar;
• flour products.

Before you “sit down” on such diets, you must take into account that in case of cancer, the body needs essential amino acids, and their source is meat and egg whites. A starvation diet is hard to tolerate even for healthy people, but for cancer patients, especially if the disease is accompanied by weight loss, fasting days will be harmful.

Diet is not a substitute for surgery. Surgery for rectal cancer is mandatory.

Surgery

The main treatment method for rectal cancer is surgery. An operation should be performed when a neoplasm is detected at any stage of the disease. At the initial stages, a radical method will prevent the progression of the disease; at the last stage, surgical intervention is palliative (reduces the manifestation of symptoms, helps improve the quality of life). Depending on the location of the tumor and its size, the following is used:

• anterior resection;
• abdominal-anal resection;
• abdominoperineal extirpation.

Abdominal-perineal extirpation is used only for low-lying tumors, or when the tumor has excessively grown into adjacent tissues, when other operations are impossible. During this operation, an unnatural anus is formed. Although this is painful for patients, there is no other way to save life.

Hartmann's operation is also forced.

Economical operations (excision, electrocoagulation and other operations performed under local anesthesia) are used when:

• malignant polyps;
• moderately or highly differentiated tumors;
• if the tumor is less than 4 cm and has not grown into the muscle layer.

Such operations are necessarily complemented by radiation and chemotherapy.

Chemotherapy

Chemotherapy without surgery is used if surgical and radiation treatment is not possible. Prescribed:

Chemotherapy is most often used in combination with radiation.

Radiation therapy

It is advisable to use radiation therapy as the main method of treatment for the treatment of stage 1–2 anal cancer. In other cases, it is prescribed as an addition to surgery.

Forecast for life

Cancer is a disease in which the effectiveness of treatment is assessed not by whether the patient has fully recovered, but by the probability that he will live at least another 5 years. Only after treatment for stage 1–2 cancer, if there are no relapses after 8–10 years, can we talk about recovery.

If rectal cancer can be detected in the initial stages, then the probability that the patient will live over 10 years without relapses or metastases is about 74%. At stage 4, especially when accompanied by numerous metastases, the prognosis is unfavorable. Most patients die within a year, but still 5 out of 100 people live 5–10 years. This depends on the number of metastases, the size of the tumor and the patient (his psychological mood, desire for recovery, compliance with medical recommendations).

For early detection of cancer, medical examinations are necessary, which relate to preventive measures for the spread and detection of colorectal cancer.

Prevention

To prevent cancer you need to:

• balanced diet (limiting fat, increasing foods rich in fiber and vitamins);
• normalization of intestinal function (stool should be regular);
• early detection and treatment of diseases contributing to the development of cancer.

Since it is impossible to exclude all effects of carcinogenic factors, the main prevention is early detection of cancer.

Patients at risk undergo preventive examinations. Prescribed:

• (once a year);
• flexible sigmoidoscopy (once every 5 years);
• colonoscopy (once every 10 years);
• irrigoscopy (once every 5 years).

When conducting a stool test for occult blood, tests are carried out for several days in a row. This is necessary, since in the initial stages of cancer, spotting occurs periodically.

In order to avoid getting a false positive result of the hemocult test, before performing it, you should exclude from the diet:

• beef;
• radish;
• horseradish;
• cabbage;
• tomatoes;
• cucumbers;
• mushrooms;
• iron supplements.

Taking high doses of ascorbic acid contributes to obtaining a false negative test.

The basic rule for the prevention of rectal cancer is timely seeking medical help when it appears. You should definitely follow all the doctor’s recommendations regarding not only taking medications, but also diet and lifestyle.

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Clinical signs of rectal cancer

The period from the appearance of the first clinical signs to diagnosis ranges from several months to 1.5 years.

In the initial stages, the disease is asymptomatic and the tumor is often discovered by chance during routine examinations.

Distinct local clinical signs and general manifestations usually appear when the tumor reaches a large size, causes intoxication, or generalization of the cancer process occurs.

Then local and general symptoms can no longer be determined by the tumor itself, but by developing complications. Most patients with rectal cancer are admitted to stages III-IV of the disease or due to complications.

In Table 24.1. presents the frequency of the most characteristic clinical symptoms in the patients we observed with rectal cancer.

Table 24.1. Frequency of main clinical symptoms in rectal cancer

When the tumor ulcerates and the inflammatory process joins, the mucous discharge becomes mucopurulent. With massive decay of tumor tissue, the amount of foul-smelling purulent discharge can be significant.

Due to the same degenerative-destructive processes, blood may be released in the tumor with feces. Initially, these are small streaks of blood in the mucus. Then an admixture of blood appears in the stool. These discharges are periodic and associated with defecation. Blood impurities are often dark in color, but there may also be a scarlet color. As a rule, profuse bleeding is observed rarely and only in the late stages of the tumor process with significant tumor disintegration. It should be said that in 28% of patients the first reason for visiting a doctor was bloody discharge from the rectum.

The nature and severity of pathological discharge syndrome in rectal cancer depend on the characteristics of the tumor. With exophytic tumors, pathological discharge occurs early and is more pronounced, which is associated with rapidly developing necrosis and ulceration, and injury from feces. With endophytic cancer, pathological impurities may be scanty and do not attract the patient’s attention.

Common symptoms of colorectal cancer are those associated with bowel dysfunction. These include irregular bowel movements, diarrhea alternating with constipation, and tenesmus. These manifestations are less specific than pathological discharge. However, their appearance should always be alarming.

Alternating diarrhea and constipation is a sign characteristic of the initial stages of rectal cancer. As the tumor size increases, constipation becomes more frequent and clinically significant.

Frequent false urge to stool (tenesmus) is a painful symptom. They are usually accompanied by pathological discharge. After defecation, patients do not experience a feeling of satisfaction; they experience the sensation of a foreign body in the rectum. False urges can be observed from 3-5 to 20-25 times a day.

Some patients note changes in the shape of stool. The shape of the stool may be ribbon-like, “sheep-like” in nature. The act of defecation can be multiphase with the release of a small portion of feces in each phase.

One of the early and frequent complaints of patients with a rectal tumor is associated with disturbances in the passage of contents through the intestine, but it appears in the later stages. This happens especially often when localized in the supramullary region. Constipation becomes persistent. Patients begin to use enemas or laxatives.

The increase in these symptoms can gradually develop into a clinical picture of chronic partial intestinal obstruction with periodically appearing complete obstruction. These complications are manifested by cramping abdominal pain, periodic vomiting, bloating, and gas retention.

Of our 221 patients, the phenomenon of partial intestinal obstruction occurred in 54 patients (24.4%), acute intestinal obstruction in 10 patients (4.5%).

Pain in the tumor area is characteristic of anal canal cancer. As a rule, they occur during defecation and then persist for a long time, similar to what happens with anal fissures.

Painful sensations with tumors localized in other parts of the rectum indicate local spread of the process to surrounding organs and tissues. Pain is more typical for endophytic tumors, when cancer infiltration involves multiple nerve endings of the intestinal wall. Then pain can be observed in the early stages of the disease.

Pain in the abdomen, sacrum, and lumbar spine are a manifestation of serious complications, generalization of the tumor process, and tumor invasion of neighboring organs and tissues. This is also evidenced by the appearance of pain when urinating, frequent urination.

General clinical manifestations characteristic of cancer of other locations, in particular, other parts of the gastrointestinal tract (weight loss, anemization, weakness, pallor, dry skin, icterus of the skin) are observed less frequently in rectal cancer. If they appear, they are an expression of the later stages of the disease. Long-term intoxication and dietary restrictions due to intestinal discomfort can lead to these phenomena.

Thus, the general condition of patients with rectal cancer suffers only when the tumor process is widespread, without changing significantly in the early stages of the disease. This explains the high level of late presentation of patients for medical care and the large number of advanced cases of the disease during the initial diagnosis.

According to V.R. Braitsev (1952), the life expectancy of patients with rectal cancer from the appearance of the first signs of the disease to death is 12-19 months. If we consider that the duration of the latent period is approximately 15 months, then the total life expectancy from the onset of the disease to death is 27-34 months.

Objectively determined signs of rectal cancer are the detectable primary tumor and secondary metastatic lesions. The primary rectal tumor can be assessed clinically if it is reached by digital examination. The cancerous tumor has a dense consistency, its surface is lumpy, and bleeds easily on contact.

In the center of the tumor you can find a crater-shaped defect with a lumpy bottom and uneven edges. Even with endophytic tumors, usually a significant part of the tumor will survive into the lumen of the rectum. A mobile or displaceable tumor occurs only in the early stages of the disease.

A cancerous tumor of the anal canal in the form of a dense, tuberous formation is often discovered by patients themselves. During examination, the doctor can visually assess the main characteristics of such a tumor. Tumors located in the lower ampullary region and having small dimensions (2-3 cm) and a stalk may also fall into the anus during defecation or straining.

The described symptoms are generally characteristic of uncomplicated rectal cancer. However, various features of the clinical course of the disease are possible depending on the location of the tumor, its shape and the nature of the complications that have developed.

Features of the clinical course of uncomplicated rectal cancer

When cancer is localized in the supraspullar and proximal half of the ampullary compartment, the most common symptom is pathological discharge. The initial period of the disease is sometimes characterized by alternating diarrhea and constipation. Pain and tenesmus appear only in the later stages of the disease.

For this localization of the tumor, the addition of perifocal inflammation is typical, which is accompanied by fever, tenesmus, and mucopurulent discharge. It is this localization of cancer that is often complicated by low obstructive intestinal obstruction, invasion of the bladder in men, uterus and vagina in women, and ureters.

Cancer of the lower ampullary region occurs in the early period with very poor symptoms. Characteristic features are pathological discharge and the sensation of a foreign body, “something interfering” in the rectum. As the tumor grows, symptoms of spread to surrounding tissues appear: pain in the sacrum in the lumbar region, coccyx, difficulty urinating, formation of rectal-urethral and rectovaginal fistulas.

An early sign of anal cancer is pain. Ulceration of the tumor is accompanied by bleeding during bowel movements. Spreading to the pararectal tissue, cancer in these cases leads to the formation of paraproctitis, pararectal fistulas, through which feces, mucus, pus, and blood are released.

As the tumor grows and the anal sphincters infiltrate, their functional failure may develop, manifested by fecal incontinence. On the other hand, the tumor can cause a sharp narrowing of the anus and associated rectal obstruction. Anal cancer metastasizes quite early to the inguinal lymph nodes, which is clinically determined by their enlargement and density.

Generalization of the tumor process with the formation of distant metastases is also accompanied by certain clinical symptoms. Metastases most often occur in the liver. As a rule, only multiple metastases in both lobes are accompanied by characteristic signs: pain in the right hypochondrium, fever, chills, jaundice.

Peritoneal carcinomatosis is accompanied by bloating and ascites. With metastatic bone damage, severe pain appears in the sacrum and other parts of the spine. We observed one patient with metastases to the ribs, which was accompanied by severe manifestations of intercostal neuralgia.

The typical clinical picture of rectal cancer is characteristic of the typical histological form - adenocarcinoma, which occurs in most patients. With less differentiated types of cancer, a more rapid and aggressive course of the disease is observed. At an earlier stage, local involvement of nearby organs and distant metastases develop.

The clinical course of the disease is influenced to a certain extent by the age of the patients. In patients under 40 years of age, the disease develops rapidly. The period from the appearance of the first clinical signs to seeing a doctor is short. As a rule, they have tumors of larger sizes and earlier generalization of the process.

The operability rate in this group is lower. Low-grade forms of cancer are more common in this group of patients. In patients aged 60-70 years, these prognostic factors look more favorable. Anaplastic cancers are less common in them, and tumor growth is slow. Over a long period, no metastases are observed.

The clinical course of rectal cancer is affected by the diseases against which it develops. In patients with polyposis, the growth pattern and histological picture of cancer do not differ from that of the primary tumor. Cancer due to polyposis can be located in any part of the intestine and is usually surrounded by polyps of different shapes and sizes. It should be remembered that in this case, malignancy is possible in more than one polyp and in different parts of the intestine.

In rare cases, anal cancer can develop against the background of chronic paraproctitis. We observed 3 patients with malignant perirectal fistulas. The main complaint was pain in the anus, aggravated by sitting and walking. Abundant mucopurulent discharge was observed from the fistulas. The discharge was of the same nature from the rectum. The appearance of the fistula also has characteristic features. Around the external opening of the fistula there is dense tissue swelling, pain, and infiltration.

Tumor tissue in all patients in the form of dense tuberous formations was identified in the area of ​​the internal opening of the fistula, the edges of which were uneven and pitted.

According to L.S. Boguslavsky et al. (1974) frequent exacerbations of chronic paraproctitis do not affect the frequency of malignancy. The duration of the disease in only 2 of 19 patients did not exceed 3 years; in the rest, the duration of the period preceding malignancy ranged from 5 to 40 years.

The prognosis for rectal cancer that develops against the background of chronic paraproctitis is unfavorable: most patients are admitted in stages III-IV of the disease.

The prognosis is the same for rectal cancer that develops against the background of ulcerative colitis or Crohn's disease. These tumors are characterized by a high degree of malignancy, early metastasis, and rapid growth. The tumor is usually endophytic in nature.

A disorienting influence on diagnostic tactics is often exerted by the fact that both diseases have similar symptoms and pain, tenesmus, frequent loose stools, and pathological discharge are often regarded as another exacerbation of colitis. Careful diagnostic tests, including biopsy, are needed to establish the correct diagnosis.

Information about the clinic of anal cancer is the most vague and briefest in the literature. Most authors limit themselves to listing possible symptoms of the disease and indicating the frequency of their detection.

V.D. Fedorov (1979), considering the main manifestation of anal cancer to be pain, bloody discharge from the anus and intestinal dysfunction, describes the clinic of this disease as follows: an early symptom is pain caused by sphincter spasm, since the tumor often grows endophytically and tends to ulcerate early, the second symptom is bloody discharge from the anus during bowel movements; as the tumor grows, it filters the rectal sphincters, leading, on the one hand, to fecal incontinence, and on the other, to a sharp narrowing of the anus, accompanied by the development of intestinal obstruction; As a rule, a tumor of the anal canal is complicated by concomitant inflammation, which leads to increased pain, mucopurulent discharge appears; often the infection penetrates into the perirectal tissue, fistulas are formed through which feces, pus, and blood are released; since anal canal cancer early metastasizes to the inguinal lymph nodes, this is clinically manifested by their enlargement; Often such patients also have general symptoms caused by chronic intestinal obstruction, loss of protein through blood and pus, as well as chronic inflammation of the rectal tissue.

V.B. Alexandrov. (1977), E.S. Skoblya (1975) note that the most common symptom of anal cancer is bleeding from the anus, at the beginning of the disease in the form of streaks of blood in the stool, later - varying intensity of discharge, often dark, less often scarlet blood.

The frequency of the appearance of bloody discharge also, according to the authors, depends on the stage of the disease. The early stages of the disease are characterized by the persistence of this symptom with little bleeding. The periodicity of the appearance of mucous-bloody discharge is also characteristic, when after 2-3 weeks of apparent well-being, an admixture of blood regularly appears in the stool for several days or weeks.

Pain, a characteristic symptom that can appear very early, is typical only for cancer affecting the anal canal. Tenesmus, false urge to lower down, ending with discharge of blood, pus and mucus - symptoms of an advanced process rarely accompany anal cancer.

B.C. Morson (1960) presented the results of observation of 39 patients with anal cancer. In 22 of them, the main symptom of the disease was rectal bleeding, in 17 - pain. An analysis of the clinical picture of anal cancer conducted by G. Queen (1970) showed that the most common symptoms of the disease were bleeding from the anus, general weakness, and intestinal discomfort.

Of the 234 patients, the main symptom of the tumor was bleeding in 116, constipation in 61, diarrhea in 21, and prolapse of a foreign body in the anus in 17. Progressively increasing pain was observed in almost all patients.

E. McConnell (1970) analyzed the clinical picture of anal cancer depending on the location of the tumor - in the anal canal or at the edge of the anus. The material for the study was 96 observations, of which in 55 the tumor was located in the anal canal, in 41 - at the edge of the anus. The result is the following picture (Table 24.2).

Table 24.2. Frequency of clinical symptoms in anal cancer (E. McSoppell 1970)

Many patients showed several symptoms at once. There was a difference in the appearance of the tumor depending on its location; for tumors located in the anal canal, the most characteristic were anal hemorrhages, pain, and intestinal discomfort; for carcinomas located at the edge of the anal canal - bloody discharge from the anus, intestinal discomfort (tenesmus) and pain.

Having studied 48 cases of squamous cell carcinomas of the rectum, P. Paradis et. al. (1975) concluded that the main symptoms of the tumor are bleeding from the anus and pain, often in combination, less often tenesmus and a feeling of fullness in the rectum.

G.A. Bivera et. al. (1977), based on 29 observations for 1962-1974, consider persistent anal itching, bleeding from the anus, and disturbances in the rhythm of bowel movements to be the main symptoms of anal cancer. E. Pauliguon, M. Hugnier (1978), studying the symptoms of anal cancer, came to the conclusion that in the first place (in terms of frequency of detection) are rectal bleeding, then pain, the presence of the tumor itself, itching, constipation, etc.

R. Single et. al. (1981), comparing the clinical picture of squamous cell and cloacogenic cancer, identified the main symptoms of anal cancer: bleeding (12 patients), exhaustion (5 patients, sensation of a foreign body in the anal canal (4 patients), pain (2 patients), tenesmus (2 patients), a combination symptoms were observed in 18 patients.

For comparison, let us present the data of the same authors regarding cloacogenic cancer: bleeding was detected in 5 patients, exhaustion - in 2, tenesmus - in 1 patient, a combination of symptoms - in 11. From the above data it is clear that in the clinic of anal cancer (in this case, squamous cell and cloacogenic) the symptom of bleeding significantly prevailed.

IN AND. Knysh et al. (1983), analyzing data from the All-Russian Scientific Research Center of the Academy of Medical Sciences of the Russian Federation for the period from 1952 to 1981, came to the conclusion that anal cancer has clear symptoms already in the earliest stages. The authors identified nine symptoms of the disease. The most common symptoms of anal cancer are pathological discharge from the anus and pain in it.

Discharge in the form of blood was noted in 38 out of 44 cases (86.4%), pain was present in 33 patients. The pain was constant or appeared during bowel movements, sometimes radiating to the sacrum or groin areas. Often the pain was very intense, burning: in 9 patients the use of analgesics was required, and in 7 even narcotics.

Other symptoms include constipation (14 patients), less often diarrhea (1), tenesmus (10), itching in the anus (4), feeling of a foreign body in the anus (3), dysuric disorders (2 patients). One patient with a rectovaginal fistula had stool and gas incontinence. Various manifestations of intestinal obstruction were noted in 5 people.

R. Horch et. al. (1992) provide an analysis of 37 cases of anal cancer from 1977 to 1988. Bleeding and pain dominated the clinic and occurred in almost all patients, regardless of the stage of the disease.

Difficulty holding stool with pressure on the anoperineal area can signal the presence of pathological processes in this area, as well as changes in the nature of bowel movements (narrowing of stool, pain when passing through the narrowed anal canal). Finally, high sensitivity when inserting a finger, in itself, warns of a significant pathological change in the ano-perineal or anorectal zone.

Of great, if not decisive, importance in the early diagnosis of anal cancer is knowledge of clinical signs that allow a differential diagnosis with various proctological diseases, which, as mentioned above, accompany anal cancer in more than half of the observations.

Complications of colorectal cancer

Patients complain of cramping abdominal pain, nausea, sometimes vomiting, gas and stool retention. The clinical picture of obstruction develops slowly. Tachycardia is noted. The tongue is coated and dry. The abdomen is distended evenly in all parts, soft, painless, there is no tension in the anterior abdominal wall. Slightly increased peristaltic noises and “splashing noises” may be detected. Rectal examination rarely reveals a tumor, but emergency sigmoidoscopy and x-ray examination are of great diagnostic value.

One of the serious complications of rectal cancer is intestinal perforation. As a rule, it occurs in areas proximal to the tumor and is diastatic in nature. If perforation occurs in the abdominal cavity, fecal peritonitis develops.

If, which is rare, perforation occurs in the area of ​​the intestine below the peritoneal fold, then severe fecal phlegmon of the pelvic tissue develops. We observed this complication in 6 patients. In 4 cases there was fecal peritonitis, in 2 cases there was pelvic phlegmon. It should be noted that this complication often occurs against the background of long-standing partial obstruction and the use of a large number of laxatives.

The clinical picture of perforation is very characteristic. With the development of fecal peritonitis, severe pain in the abdomen appears, initially in the lower parts on the left. Within 1-2 hours the pain spreads throughout the abdomen. Shock or collapse often develops. Intoxication quickly increases and the well-known classic clinical signs of peritonitis are determined, the presence of free gas in the abdominal cavity, dullness in sloping areas.

With the development of pelvic phlegmon, rapidly progressing general and local signs of pelveorectal paraproctitis are observed with the development of severe intoxication.

A tumor process in men, spreading to the bladder, can cause the formation of a rectovesical fistula. The clinical picture of this complication in 2 patients we observed was characterized, in addition to the symptoms of rectal cancer, by an increase in temperature to 49-30.

When urinating, gases and intestinal contents are released along with fecal-smelling urine. Ascending urinary tract infection, pyelonephritis rapidly increases, and patients die from severe intoxication and acute renal failure.

In women, tumor growth in the posterior vaginal wall leads to the formation of rectovaginal fistulas. Four of our patients had rectovaginal fistulas. The main clinical manifestation of this complication is the release of gases and feces through the vagina. The occurrence of this complication does not always indicate that the tumor process is advanced. In three of our patients, the fistula developed at stage IV of the disease (two underwent radiation therapy); in one patient, radical surgery turned out to be feasible.

Among non-epithelial malignant tumors of the rectum, the most common are various types of sarcomas and melanoma. We observed 3 patients with sarcomas (lymphosarcoma (2) and fibrosarcoma (1), one patient with melanoma and 3 patients with carcinomas.

Melanoma is more often observed at a young age and is localized in the anorectal area. The tumor quickly spreads towards the ampulla of the rectum and to the tissue of the perineum. Below, it is an exophytically growing tuberous tumor protruding from under the mucous membrane or from under the skin of the anorectal area.

The tumor has a characteristic black-blue color. Often, smaller nodules of the same color are located next to the main tumor. Clinical manifestations of rectal melanoma are the same as for cancer. A characteristic feature is rapid dissemination after relatively long growth of the primary tumor. Metastases appear in the inguinal, iliac lymph nodes, and in the liver.

Sarcoma also appears more often at a young age. The most typical localization is in the ampullar region. Clinically no different from rectal cancer. Rapid growth and rapid metastasis lead to the death of the patient within several months.

Yaitsky N.A., Sedov V.M.

These are neoplasms of the rectal intestine of a malignant or benign nature. Symptoms of neoplasia of this localization include discomfort in the anal canal, constipation, mucous and bloody discharge from the anus, as well as disturbances in general condition. Clinical tests, intestinal endoscopy with biopsy, computed tomography and x-ray studies are used for diagnosis. Therapeutic measures include radical surgical interventions, drug and radiation therapy.

ICD-10

C19 C20 D12.8

General information

Rectal tumors are a heterogeneous group of neoplasms, varying in histostructure, growth rate and clinical course, developing in the distal segment of the large intestine. The most serious problem is considered to be colorectal cancer, the mortality rate of which is one of the most critical in the world. Recently, the incidence of colorectal cancer has increased several times. The prevalence of rectal tumors is about 35-40% of all intestinal neoplasms. The pathology is more often detected in older patients; it mainly affects residents of highly developed countries in North America, Western Europe, Australia, and Russia. Specialists in the field of clinical oncology and proctology study the features of the development of tumor processes in the rectum.

Causes

The main causes of the development of rectal tumors are precancerous diseases, single and multiple intestinal polyps, chronic constipation, bedsores and rectal ulcers, immune system disorders, the negative effects of carcinogens and genetic factors. Most patients with cancer of this localization experience an immune imbalance, in which antitumor immune cells cease to function properly. As a result, the formation and further proliferation of tumor cells occurs. The immune mechanism for the development of rectal tumors is usually combined with other mechanisms of carcinogenesis. In particular, chronic intestinal inflammation plays a large role in the formation of the oncological process.

Precancerous intestinal pathologies include such common diseases as proctitis, hemorrhoids, anal fissure, paraproctitis, proctosigmoiditis, ulcerative colitis and Crohn's disease. Carcinogens such as nitrites, industrial poisons, chemicals, radiation, saturated fats, various viruses, and so on play an important role in the development of tumors. One of the most important factors in the appearance of rectal tumors is hereditary predisposition: an increased risk of incidence is observed in people whose immediate relatives have colorectal cancer.

Classification

Rectal tumors can be benign or malignant. Benign neoplasms include epithelial, nonepithelial tumors, and carcinoid. Epithelial neoplasms are represented by polyps, villous tumors and familial diffuse polyposis of the colon. The following types of rectal polyps are distinguished: glandular and villous-glandular (adenopapillomas, adenomas); miliary (hyperplastic); fibrous; juvenile (cystic-granulating). A submucosal carcinoid tumor of the rectum may be mistaken for a polyp. A villous tumor is characterized by multiple papillary growths of the rectal epithelium, represented either by a separate pedunculated node or by a fairly large area of ​​neoplasia affecting a significant part of the rectum. Such a tumor has a very high potential for malignancy and therefore must be radically removed as soon as possible after detection.

Non-epithelial neoplasms of the rectum are extremely rare; they develop from muscle, fat, nervous and connective tissue, vessels of the blood and lymph circulatory system. These neoplasms are usually localized in the submucosal or muscular layer, under the serous membrane, and in those areas where it is absent, they spread to the surrounding perirectal tissue. Among benign tumors of the rectum of a non-epithelial nature, fibromas, myomas, lipomas, cavernous angiomas, neurofibromas, and lymphangiomas are most often diagnosed.

Carcinoid is a neuroendocrine neoplasm that produces hormone-like substances (serotonin, prostaglandins, histamine and others). The clinic is determined by the substance that the tumor secretes and its concentration. Carcinoid requires surgical treatment.

Malignant tumors of the rectum are also divided into epithelial (cancer: glandular - adenocarcinoma, squamous cell, signet ring cell, solid, scirrhus, mixed; melanoma, melanoblastoma) and non-epithelial (leiomyosarcoma, lymphoma, angiosarcoma, neurilemmoma, rhabdomyoma and unclassified tumors). About 70% of rectal tumors are cancer. Based on the growth pattern of the tumor node, endophytic, exophytic, diffuse tumors and squamous cell carcinoma of the skin of the anus and anus are distinguished. In 85% of cases, cancer is localized in the ampullary part of the rectum.

Symptoms of tumors

Benign tumors of the rectum are often asymptomatic, especially when they are small. If the neoplasm is large, it manifests as intestinal obstruction and slight bleeding from the anus. Benign neoplasms usually do not disturb the general condition of the patient and are not accompanied by copious discharge from the rectum, although the development of the inflammatory process against the background of multiple polyposis can lead to chronic bleeding, diarrhea with the release of large amounts of blood-stained mucus, anemia of the patient, an increase in general weakness and exhaustion. Polyps located in the anal sphincter area can fall out and become pinched.

Malignant tumors of the rectum in the early stages of development may not manifest themselves in any way. The situation is further complicated by the fact that many patients often do not pay due attention to the symptoms. Most patients diagnosed with rectal cancer have chronic proctological pathology, for example, hemorrhoids, anal fissure, rectal fistula or paraproctitis. These diseases have clinical symptoms similar to tumors. Therefore, patients may perceive colorectal cancer clinics as just another manifestation of their chronic disease. In general, people go to the hospital only if they have severe symptoms.

Tumors of the rectum are manifested by discharge from the anus, symptoms of intestinal irritation, obstruction of stool and signs of deterioration in general condition. The discharge may be mucous or bloody. When the tumor is low localized, the discharge looks like scarlet blood. If the neoplasm is located in the ampullary, middle and upper segment of the rectum or in the rectosigma, then mucous-bloody discharge during defecation is characteristic. A symptom of rectal irritation is paroxysmal pain. Patients may also experience discomfort in the lower abdomen and a feeling of squeezing of the intestines. Patients note the appearance of a false urge to defecate.

Initially, the disease may manifest itself as stool disorder, followed by intestinal obstruction. Large rectal tumors, on the contrary, manifest themselves predominantly as constipation. The disease is often accompanied by symptoms such as bloating and painful rumbling. If a patient has developed a violation of intestinal patency, he is worried about retention of stool and the passage of gases, intense pain along the intestines, vomiting, etc. As rectal cancer progresses, it manifests itself with general symptoms, such as unmotivated general weakness, pallor of the skin, decreased performance, decreased weight body up to cachexia, loss of appetite. Also, with this disease, long-term persistent low-grade fever is often observed.

For early detection of rectal cancer, it is very important to know all possible clinical manifestations of the disease. Early signs of malignant tumors of the rectum are mostly nonspecific. They can be observed in many other diseases. However, prolonged persistence of symptoms such as general weakness, low-grade fever, constipation and discomfort in the rectum should alert the patient and the doctor. Blood discharge during bowel movements and signs of intestinal obstruction indicate late stages of the disease.

Complications

A malignant tumor of the rectum is often complicated by such life-threatening conditions as growth of the tumor into the surrounding tissue and neighboring organs, perforation of the tumor with the development of paraproctitis, pelvic phlegmon or pelvioperitonitis, profuse bleeding and obstructive intestinal obstruction.

Diagnostics

Despite the availability of rectal tumors for imaging, their diagnosis today is most often delayed. A comprehensive examination of a patient suspected of this pathology consists of collecting clinical data (complaints, family history, digital examination, examination in mirrors), conducting instrumental and various laboratory research methods.

Of the instrumental techniques, sigmoidoscopy with biopsy, pathohistological and cytological examination of tissues are of greatest importance; Ultrasound and CT to assess the extent of the process, visualize metastases; plain radiography of the OBP, irrigoscopy; laparoscopy for visualization and removal of intraperitoneal metastases. Laboratory diagnostics include general clinical tests of blood, feces, urine, biochemical screening, and occult blood tests.

Treatment of rectal tumors

The choice of tactics for managing patients with tumors of this localization is the prerogative of the oncologist surgeon and proctologist. Surgical, radiation and drug techniques are used to treat rectal tumors. Treatment of benign rectal tumors involves resection of the tumor. For this group of diseases, chemotherapy and radiation therapy are not prescribed.

The main method of treating malignant tumors of the rectum is surgery, during which all nearby lymph nodes are removed along with the tumor. The principle of surgical intervention is determined taking into account the degree of progression of the process. If the pathological process has spread to nearby tissues and organs, then surgeons use combined surgical techniques. Surgical operations for rectal tumors must be radical.

Radiation therapy plays an important role in the treatment of malignant tumors of the rectum. It is used if the neoplasm grows into the muscular lining of the intestine or metastasizes to regional lymph nodes. Radiation therapy can be carried out immediately before surgery to prevent recurrence of the tumor process. The maximum focal radiation dose for rectal cancer is 45 Gy.

Chemotherapy is used when the disease has progressed slightly. It is performed either before surgery to reduce the size of the tumor (neoadjuvant treatment) or after surgery to reduce the risk of postoperative relapses (adjuvant treatment). For the treatment of malignant forms, 5-fluorouracil is used in combination with oxaliplatin or folinic acid. In some cases, chemotherapy is combined with radiation therapy to obtain better results in achieving remission.

Prognosis and prevention

The prognosis of survival for malignant tumors of the rectum is mainly influenced by the level of prevalence of the oncological process. In the initial stages of cancer, the 5-year survival rate of patients is 95-100%. However, at stage 4 of the disease, only 10% of patients survive a year. If a patient has distant metastases, the average life expectancy is 10 months. A sign of a good prognosis for intestinal cancer is the absence of relapses for 4 years after surgical treatment. For benign neoplasms of the rectum, the prognosis is usually favorable.

Prevention of rectal tumors involves stopping drinking alcohol and smoking, as well as maintaining a proper diet, which includes a large amount of vegetables and fruits, as well as timely treatment of pre-tumor conditions. Individuals at risk are advised to undergo regular medical examinations, including intestinal endoscopy and stool testing for occult blood.