Rectum cancer – the malignant tumor of disteel department of a large intestine proceeding from a rectum epithelium. Clinically cancer of a rectum is shown by availability of pathological impurity in Calais (slime, blood), bleeding from a rectum, pain in a sacrum and a crotch, weakness, weight loss, anemia. Methods of diagnosis of cancer of rectum is the research a calla on the hidden blood, definition of laboratory markers, a rektoromanoskopiya, a biopsy with a morphological research. Treatment surgical (a rectum resection/extirpation), with possible purpose of chemotherapy at cancer metastasises in regionarny lymph nodes.
Rectum cancer – malignant new growths of a rectum and the anal channel, various on a histologic structure and localization. Among malignant damages of a GIT cancer of a rectum makes 45%; at the same time, 70% of cases of cancer of large intestine are localized in its disteel department. This pathology meets in the countries with the western character of food less often in more often - Asia and Africa. Cancer of a rectum one and a half times more often arises at men, the risk of its development increases with age, persons enter into risk group is more senior than forty years. Presumably it is connected with age changes in epitelialny cages of an intra intestinal vystilka. Despite availability of a rectum to survey and a research, the majority of cases of cancer of this localization it is diagnosed already on late terms when radical methods of treatment are ineffective. Five-year survival at cancer of a rectum makes 40-60% that causes relevance of this problem for a proktologiya and oncology.
Reasons of development of cancer of rectum
Dependence of development of cancer of rectum on features of food is noted. The disease meets at the people eating food rich with fats and poor in vegetable cellulose more often. The food allowance overloaded with meat products promotes developing of malignancies in a large intestine. Besides, the factors increasing risk of development of a cancer tumor are chronic inflammatory diseases of a large intestine, a disease Krone, nonspecific ulcer colitis, congenital pathologies (family diffusion polyposes, fermental insufficiency). Exchange diseases (diabetes, a metabolic syndrome, obesity) are also cancerogenic factors.
Polyps of a rectum are one of widespread precancer states, approximately in 4% of cases (the risk of an ozlokachestvleniye is directly proportional to the size and prevalence of polyps), in particular is dangerous concerning a malignization family polyposes. The hereditary factor also plays a part in cancer cases of a rectum. Increase risk of development of malignant process and reduce probability of a favorable outcome at treatment smoking and abuse of alcohol.
Classification of cancer of rectum
Cancer of a rectum is classified according to the international classification of TNM where T – the size of a tumor and extent of defeat by it of a wall of a gut, N – damage of regionarny lymph nodes, and M – existence of metastasises in the remote bodies.
In addition, in our country classification of cancer by stages is quite often applied (I; IIa; IIb; IIIa; IIIb; IV) depending on the size of a tumor, extent of germination of a wall of intestines by it and the surrounding fabrics which are available metastasises. The final diagnosis of cancer of rectum is carried out after surgical removal and a cytologic research of a tumor and lymph nodes.
Rectum cancer symptoms
Most often early stages of cancer of rectum proceed without clinical symptomatology that considerably complicates diagnosing and timely identification of malignant process. Over time progressing of a tumor begins to be shown by various symptoms.
The most widespread manifestations: defecation violation (locks or ponosa), intestinal impassability, bleeding from back pass, blood impurity in Calais, anemia of not clear etiology, weight loss, pain in a stomach bottom, a "tape" ("pencil") chair.
Diagnosis of cancer of rectum
Diagnostic actions include the patient's poll, detection of complaints, collecting the anamnesis. At the same time pay attention to the cancerogenic risks taking place tumoral educations and family . Laboratory methods include the general and biochemical blood test, testing on onkomarker, to a koprogramm.
Of cancer tumors of a rectum it is characteristic identifications of a cancer embryonic anti-gene and an onkomarker of CA-19-9. Identification of onkomarker can testify to nonspecific ulcer colitis, benign tumors also. Concentration of an embryonic cancer anti-gene increases at heavy smokers.
The rektoromanoskopiya belongs to tool methods of diagnosis of tumors of a large intestine (the internal wall of a direct and sigmovidny gut), a kolonoskopiya (an endoscopic research of all large intestine), an irrigoskopiya (a radiographic research of a large intestine with contrast substance is examined). Endoscopic techniques allow to study in detail a condition of a mucous membrane of an intestinal wall, the available tumoral educations, to make a biopsy for the subsequent histologic and cytologic research. Diagnosis of cancer of rectum is made only on dashing about of detection of cancer cells at a cytologic research of a bioptat.
Besides, it is possible to find tumoral education in intestines by means of ultrasonography (make intrarektalny ultrasonography for inspection of a rectum), a magnetic and resonant and computer tomography. The spiral computer tomography (MSKT) is applied to a research of bodies and systems regarding identification of metastasises, and also allows to carry out an aim biopsy of a liver at existence in it of sites, doubtful concerning metastasis.
Technique from high specificity degree concerning identification of metastasises is the positron and issue tomography (PIT). The technique consists in maintaining in an organism a positron - the radiating isotopes and scanning of their distribution in fabrics. The fabrics struck with malignant cages are inclined to accumulate radioisotopes and to decide when scanning in the form of sites on the increased radiation. The angiography is made for visualization of vascular network before operation (in order to avoid post-operational complications and massive bleedings).
Cancer therapy of a rectum
The main technique of cancer therapy of a rectum is surgical removal of a tumor, adjacent fabrics and lymph nodes. The choice of a technique is carried out depending on a stage of a disease, the size of a tumor, extent of defeat by metastasises of lymph nodes and other bodies and fabrics.
Removal of a polyp of a rectum is often carried out in the course of carrying out a kolonoskopiya by an electrothermic coagulation method. If at the subsequent histology of fabrics of a polyp find malignant cages which however do not extend to the polyp basis, treatment at this stage it is possible to consider rather full. In most cases cancer of a rectum the radical resection or an extirpation (full removal) of a rectum with the subsequent reconstructive operation is carried out.
It is sometimes possible to tumor of the average sizes to remove in the laparoscopic way. At the same time tissues of regional lymph nodes for identification of possible defeat by malignant cages also take. The laparoscopic technique is transferred by patients much easier, demands smaller measures of postoperative leaving, and the frequency of emergence of a recurrence after treatment does not exceed that when carrying out traditional operation.
At detection of cancer at late stages with deep germination in surrounding fabrics and presence of multiple metastasises, make palliative operation: removal of a tumor for release of a gleam of intestines and simplification of a condition of the patient. Treatment at late stages of cancer tumors is impossible. In oncological practice in most cases surgical removal of a tumor is combined with chemotherapy or radio radiation therapy for prevention of a retsidivirovaniye and suppression of distribution of malignant cages.
The method of chemotherapeutic treatment means use of the medicines suppressing growth of malignant cages. Unfortunately, the cytotoxic medicines which are applied at chemotherapy are insufficiently specific concerning cancer cells and such treatment has the mass of side effects. However the combined application of chemotherapy and surgical treatment at in due time revealed cancer of a rectum gives noticeable positive effect and considerably reduces risk of a recurrence of a disease, increasing survival of patients.
Radiation therapy at cancer of a direct and thick gut is sometimes applied as an additional measure of prevention of a recurrence after expeditious removal of a tumor, and also can be used for reduction of the amount of education and simplification of symptomatology.
Prevention of cancer of rectum
Preventive measures of malignant new growths of a large intestine include regular inspection of the persons entering into risk group (people are more senior than 50 years, patients with chronic diseases of a large intestine). Special attention is paid to patients with polyps of a large intestine.
Enter screening actions: the annual analysis a calla on the hidden blood, a sigmoidoskopiya each 5 years, each 10 years – a kolonoskopiya. The persons suffering from a family polipoz are surveyed each 2-3 years. The plan of inspection of the citizens entering into group of oncological risk is discussed with the doctor individually.
General measures of prevention of cancer of rectum include active lifestyle, the healthy balanced nutrition rich with vegetable cellulose without congestion animal fats, refusal of smoking and abuse of alcoholic beverages, timely detection and treatment of the diseases provoking development of malignant tumors.
Complications of cancer and side effects of therapy
Cancer of a rectum is complicated by bleeding, and at regular losses of blood – anemia, decrease in body weight up to exhaustion. Patients with oncological pathologies of late stages suffer from organism intoxication from products of a necrosis of tumoral fabric. Cancer of a rectum can promote development of an infectious inflammation. The chemotherapy promotes development of such side effects as baldness, weakness, appetite loss, diarrhea, nausea.
The forecast at rectum cancer
Identification and removal of cancer of rectum at early stages promotes 5-year survival in 90% of cases. However, only 39% of the revealed kolorektalny malignant tumors are at a stage, suitable for successful treatment, in other cases, even with application of palliative removal of a tumor, the forecast is adverse. If within 5 years after removal of a tumor its recurrence is not celebrated, then confirm recovery. Cancer of the IV stage is not subject to treatment.