Rectum tumors - new growths of rectal department of intestines of the malignant or good-quality nature. As symptoms of new growths of this localization serve unpleasant feelings in the field of the anal channel, locks, mucous and bloody allocations from back pass, and also violation of the general state. For diagnosis of tumors of a rectum clinical analyses, endoscopy of intestines with a biopsy, a computer tomography and radiological researches are used. Medical actions at new growths of a rectum provide radical surgical interventions, medicamentous and radiation therapy.
Tumors of a rectum represent heterogeneous group of new growths, various on a gistostruktura, growth rates and a clinical current, developing in a disteel segment of a large intestine. Rectum cancer at which death rate one of the most critical in the world is considered the most serious problem. Recently cancer cases of a rectum grew several times. Prevalence of tumors of rectal department makes about 35-40% of all new growths of intestines. Pathology comes to light at age patients more often, residents of the advanced countries of North America, Western Europe, Australia, Russia generally are ill. The proktologiya and oncology is engaged in studying of features of development of tumoral processes of a rectum.
Classification of tumors of a rectum
Tumors of a rectum can have good-quality or malignant character. Good-quality new growths include epitelialny, neepitelialny tumors and . Epitelialny new growths are presented by polyps, fleecy tumors and a family diffusion polipoz of a large intestine. Allocate the following types of polyps of a rectum: ferruterous and fleecy and ferruterous (adenopapilloma, adenomas); miliarny (hyper plastic); fibrous; juvenile (cystous granulating). The submucous kartsinoidny tumor of a rectum can be taken for a polyp. The fleecy tumor is characterized by the multiple sosochkovy growths of a rectal epithelium presented or separate knot on a leg, or rather extensive site of a neoplasia striking a considerable part of a rectum. Such tumor has very high potential of a malignization and therefore is subject to radical removal in the shortest possible time after identification.
Neepitelialny new growths of a rectum meet extremely seldom, they develop from muscular, fatty, nervous and connecting tissue, system vessels krovo-and a limfoobrashcheniye. These new growths are usually localized in a submucous or muscular layer, under a serous cover, and in those sites where it is absent – extend to surrounding pararectal cellulose. Among benign tumors of a rectum of the neepitelialny nature most often diagnose fibromas, myomas, lipomas, kavernozny angioma, neurofibromas, limfangioma.
Kartsinoid represents the neuroendocrine new growth producing gormonopodobny substances (serotonin, prostaglandins, a histamine and others). The clinic is defined by substance which allocates a tumor, and its concentration. Kartsinoid demands expeditious treatment.
Malignant tumors of a rectum are also divided on epitelialny (cancer: ferruterous - an adenocarcinoma, planocellular, cricoid and cellular, solid, , mixed; a melanoma, a melanoblastoma) and neepitelialny (a leyomiosarkoma, a lymphoma, an angiosarkoma, a nevrilemmoma, a rabdomioma and not classified tumors). About 70% of tumors of a rectum are presented by cancer. On the nature of growth of tumoral knot allocate endofitny, ekzofitny, diffusion tumors and planocellular cancer of skin of an anus and back pass. In 85% of cases cancer is localized in an ampulyarny part of a rectum.
Reasons of tumors of a rectum
Precancer diseases, single and multiple polyps of intestines, chronic locks, decubituses and ulcers of a rectum, violation of immune system, negative impact of carcinogens and genetic factors are the main reasons for development of tumors of a rectum. At most of patients with cancer of this localization the immune imbalance at which cages of antineoplastic immunity cease to function properly is observed. Education and further reproduction of tumor cells results. The immune mechanism of development of tumors of a rectum is, as a rule, combined with other mechanisms of carcinogenesis. In particular, the large role in formation of oncological process is played by a chronic inflammation of intestines.
Carry such widespread diseases to precancer pathology of intestines as proktit, hemorrhoids, an anal crack, paraproktit, proktosigmoidit, nonspecific ulcer colitis and a disease Krone. An important role in development of tumors is played by carcinogens, such as nitrites, industrial poisons, chemicals, radiation, saturated fats, various viruses and so on. One of the most important factors of emergence of tumors of a rectum is hereditary predisposition: the increased risk of incidence is noted at people whose immediate family has a colorectal cancer.
Symptoms of tumors of a rectum
Benign tumors of a rectum often can not be shown in any way, especially at their small sizes. If the new growth has the large sizes, then it demonstrates intestinal impassability and insignificant bloody allocations from an anus. Good-quality new growths usually do not break the general condition of the patient and are not followed by plentiful allocations from a rectum though the polypose can lead development of inflammatory process against the background of multiple to emergence of chronic bleedings, ponos with allocation of a large number the painted blood of slime, the patient's anemization, to increase of the general weakness and exhaustion. The polyps located in an anal sphincter can drop out outside and be restrained.
Malignant tumors of a rectum at early stages of development can not be shown in any way. The situation becomes complicated also the fact that many patients often do not give due consideration to symptoms. Most of patients for whom rectum cancer is diagnosed has a chronic proktologichesky pathology, for example, hemorrhoids, an anal crack, fistulas of a rectum or paraproktit. These diseases have clinical symptomatology, similar to tumors. Therefore patients can perceive clinic of cancer of rectum as the next displays of the chronic disease. Generally people address to hospital only in the presence of serious symptoms.
Tumors of a rectum are shown by allocations from an anus, symptoms of irritation of intestines, violation of passability of kalovy masses and signs of deterioration in the general state. Allocations can be mucous or bloody. At low localization of a tumor of allocation have an appearance of scarlet blood. If the new growth is in an ampulyarny, average and top segment of a rectum or in a rektosigma, then mucous and bloody allocations are characteristic during defecation. A symptom of irritation of rectal department of intestines is pristupoobrazny pain. Also sick the discomfort in the bottom of a stomach and feeling of squeezing of intestines can disturb. Patients note emergence of false desires on defecation.
In the beginning the disease can be shown by frustration of a chair which intestinal impassability follows. Tumors of a rectum of the large sizes, on the contrary, demonstrate mainly locks. The disease often is followed by such symptoms as swelling of intestines and painful rumbling. If at the patient violation of passability of a gut developed, he is disturbed by a delay of a chair and an otkhozhdeniye of gases, intensive pains on the intestines course, vomiting, etc. When progressing cancer of a rectum is shown by the general symptoms, such as unmotivated general weakness, pallor of integuments, decrease in working capacity, reduction of body weight up to a kakheksiya, a loss of appetite. Also at this disease it is often observed it is long persistiruyushchy subfebrilny temperature.
For early detection of cancer of rectum it is very important to know all possible clinical displays of a disease. Early symptoms of malignant tumors of a rectum are generally not specific. They can be observed at many other diseases. However long preservation of such symptoms as the general weakness, subfebrilitt, locks and discomfort in a rectum, has to guard the patient and the doctor. Release of blood at defecation and signs of intestinal impassability testify to late stages of a disease. Rectum cancer quite often is complicated by such states as germination of a tumor menacing for life in surrounding cellulose and the next bodies, perforation of a tumor with development of a paraproktit, phlegmon of a small pelvis or a pelvioperitonit, profuzny bleeding and obturatsionny intestinal impassability.
Diagnosis of tumors of a rectum
Despite availability of tumors of a rectum to visualization, their diagnostics most often is today overdue. Comprehensive examination of the patient with suspicion of this pathology consists in collecting clinical data (complaints, the family anamnesis, a manual research, survey in mirrors), carrying out tool and various laboratory methods of a research.
From tool techniques have the greatest value a rektoromanoskopiya with a biopsy, a patogistologichesky and cytologic research of fabrics; Ultrasonography and KT for assessment of prevalence of process, visualization of metastasises; survey X-ray analysis of OBP, irrigoskopiya; a laparoscopy for visualization and removal of vnutribryushinny metastasises.
Laboratory diagnostics includes all-clinical blood tests, a calla, urine, biochemical screening, tests on the hidden blood.
Treatment of tumors of a rectum
The choice of tactics of maintaining patients with new growths of this localization is a prerogative of the proctologist and oncologist. For treatment of tumors of a rectum surgical, beam and medicamentous techniques are used. Treatment of benign tumors of a rectum consists in a new growth resection. At this group of diseases the chemotherapy and radiation therapy is not appointed.
The main method of treatment of malignant tumors of a rectum - surgery during which with a tumor all nearby lymph nodes are removed. The principle of surgery is defined taking into account extent of progressing of process. If pathological process passed to nearby fabrics and bodies, then surgeons use the combined quick technicians. Surgeries at tumors of a rectum have to be radical.
An important role in treatment of malignant tumors of a rectum is played by radiation therapy. It is used in case the new growth sprouts in a muscular cover of intestines or spreads in regionarny lymph nodes. Radiation therapy can be carried out just before operation for prevention of a recurrence of tumoral process. The maximum focal dose of radiation at cancer of a rectum makes 45 Gr.
The chemotherapy is used at insignificant progressing of a disease. It is carried out or before intervention for reduction of the amount of education (neoadjyuvantny treatment), or after operation for decrease in risk of emergence of a postoperative recurrence (adjyuvantny treatment). To therapy of malignant forms it is applied 5-ftoruratsit in combination with oksaliplatiny or folinovy acid. In a row a case the chemotherapy is combined with radiation therapy for obtaining the best result in achievement of remission.
Forecast and prevention of tumors of a rectum
The forecast of survival at malignant tumors of a rectum is generally influenced by the level of prevalence of oncological process. At initial stages of cancer 5-year survival of patients makes 95-100%. However, at the 4th stage of a disease within a year only 10% of patients survive. If the remote metastasises are found in the patient, then the average duration of his life makes 10 months. A sign of the good forecast at cancer of intestines is lack of a recurrence for 4 years after the carried-out expeditious treatment. At good-quality new growths of a rectum the forecast, as a rule, favorable.
Prevention of tumors of a rectum assumes refusal of alcohol intake and smoking, and also observance of healthy nutrition which includes a large number of vegetables and fruit, and also timely treatment of pretumoral states. Regular passing of medical examination with performance of endoscopy of intestines and a research a calla on the hidden blood is shown to the persons belonging to risk group.