- Resection of the rectum and anal sphincter sector. Indication for surgery is the presence of a tumor localized in the anal canal( near the sphincter), occupying not more than a third of their circumference and not sprouting through the walls of the rectum. During the operation, a part of the affected tissues is subjected to removal( with their subsequent complete restoration).
- Removal( resection) of part of the rectum. This operation is indicated for patients with a cancer tumor located just above the anal canal and located in the T1N0 stage. The affected area of the rectum is removed, and the remainder of it is sewn to the anal canal.
- A typical abdominal-anal resection. This type of surgery is performed in the presence of a malignant neoplasm located five centimeters above the level of the anal canal occupying less than half the circumference of the intestinal wall located in stage T1-2N0.During the operation, the rectum is removed, but the anal canal is preserved along with a group of anal sphincters.
- Abdominal anal resection with removal of muscle pulp( internal sphincter). Indication for surgery is the localization of the tumor in the lower sector of the ampullar part of the rectum, sprouting into the muscular layer of the intestinal wall, but not yet left its limits. The tumor should be in stage T1-2N0.This type of surgery resembles the above operation, except that, together with the tissues of the rectum removed from the anal canal, the internal sphincter is excised. To create a new artificial sphincter, muscle tissue of the sigmoid colon directed downwards is used.
- Abdominal crotch extirpation of the rectum with reduction of the sigmoid or colon to the wound. The basis for performing such an operation is the presence of a fairly large cancerous tumor that occupies less than half the circumference of the intestinal wall and is localized in the ampullar part of the rectum. Germination of malignant neoplasm in neighboring tissues is not observed, there are no metastases to the lymph nodes. The development of the tumor corresponds to stage T1-2N0.The operation consists in the complete removal of the rectum. The site of the removed organ occupies the lower part of the sigmoid or colon, which is lowered downwards. In the field of the anal canal, the surgeon creates an artificial cuff, designed to play the role of pulp.
- Abdominal crotch extirpation of the rectum with the formation of the intestinal reservoir. Indication for this type of operation is the presence of a malignant tumor, located in the stage T1-2N0 and having a significant length. During the operation, the rectum is first removed together with the anal canal. After this, the sigmoid colon is lowered and an artificial cuff is formed, which will take over the functionality of the pulp. In order for the patient to be able to keep the forming fecal masses more easily, the surgeon folds the sigmoid colon, creating a reservoir of W- or S-shaped form.
- Typical abdominal crotch extirpation of the rectum. A similar surgical procedure is performed in the presence of a cancerous tumor corresponding to stage T3-4 N0-2, occupying the lower part of the ampullar part of the rectum and sprouting into the fatty tissue filling the pelvic cavity. At this stage of the tumor process, metastases in the lymph nodes may or may not be present. The surgeon performing the operation removes the rectum together with the anal sphincter apparatus. After that, he applies a colostomy, removing the released end of the sigmoid colon to the skin of the abdominal wall.
- Pelvis evisceration. This operation is performed in the late stages of the pathological process, when the tumor has already reached the stage T4N0-2, sprouted into the adjacent organs and gave metastases to the lymph nodes. During this surgical intervention, all organs located in the pelvic cavity and involved in the tumor process are removed. In addition to the rectum, this includes: the vagina, uterus, ovaries, prostate, bladder, seminal vesicles, urethra, ureters, part of fatty tissue and affected lymph nodes.
- Overlap of double barrel colostomy. This type of surgery acts as a palliative operation designed to alleviate the condition of a patient who is hopelessly ill. Its main goal is to ensure the escape of stool in a patient with developed intestinal obstruction. The rectum is not removed during this operation. The surgeon makes a hole in the wall of the colon or sigmoid colon, which is then removed to the surface of the abdominal wall.
Rectal cancer treatment is performed by all methods of modern oncological practice.
For each specific case, an individual treatment strategy is developed that takes into account a number of factors: the depth of malignant neoplasm localization, the stage of its development, the general condition of the patient, and his age.
The leading importance is given to surgical intervention, but it is really effective in relation to small low-grade malignant tumors of stages I-II.
In such cases, a surgical operation can be used as the only method of treatment. If the pathological process has gone further, therapy requires an integrated approach.
Modern methods of treatment of rectal cancer
Treatment of colon cancer is carried out by methods:
- of the Operative intervention.
- Radiation therapy.
Is it possible to cure the disease?
In case of detection of a cancer of the rectum in the early( I-II) stages, this question can be answered positively. In this case, after qualified treatment, 99% of patients survive.
Types of therapy depending on the stage
The choice of treatment tactics is primarily determined by the stage of the tumor process, as well as the presence or absence of metastases in the lymph nodes and internal organs.
- For the treatment of the disease identified in stages I-II of the ( if the tumor is not closer than ten centimeters from the anal sphincter apparatus), sphincter-saving operations are performed that allow the patients to subsequently perform defecation naturally( for example, anterior resection and transanal section).
- To cure a disease that has reached stage III-IV , resort to abdominal-perineal extirpation( removal) of the rectum. Since during this operation the patient is deprived not only of the intestine, but also of the anal canal, a colostomy is formed from the free area of the sigmoid colon, deduced onto the skin of the abdominal wall.
Operations on the rectum are extremely traumatic.
When choosing a surgical procedure, first of all, the following is taken into account:
- value and localization of malignant neoplasm;
- features of the cellular structure of tumor structures;
- classification of cancerous growth according to the international TNM system.
In case of rectal cancer, the following surgical operations are performed:
Diet before and after surgery
The pre-operative diet is designed to prepare the patient's body for the forthcoming surgical intervention.
Food should be freshly prepared and saturated with vitamins and selenium, which inhibits the growth of abnormal cells( selenium is found in sea fish, greens, nuts, beans and Brussels sprouts).
It is necessary to exclude from the diet of the patient:
- All kinds of sweets stimulating fermentation in the intestine, fraught with the development of secondary infection. The use of sweet dishes will provoke diarrhea, dehydrating and weakening the body of a sick person.
- Flour products.
- Food containing a large number of animal fats( for this reason it is unacceptable to eat fried foods, fat, pork and mayonnaise).
During the postoperative period, the patient is obliged to observe the strictest diet based on the following principles:
- All food should be wiped or well ground.
- The content of coarse vegetable fibers and animal fats in dishes intended for the operated patient should be minimized.
- The best food of this period are cereal mucous soups and vegetable purees( from pumpkin, broccoli, spinach).
To eliminate bloating, you need:
- Take food slowly, methodically chewing it.
- Completely abandon the use of beer, carbonated drinks, chewing gum, onions and legumes.
- Enter the leaf greens( very useful fresh dill), tea with mint, herbal medicinal herbs.
The operation to remove a malignant tumor of the rectum can lead to:
- Insufficiency of an anastomosis( a place of fastening of intestines).For a number of reasons, superimposed seams can disperse or weaken, provoking the development of fecal peritonitis.
- Digestive disorders. Most often, patients have a violation of the process of solidifying the stool, leading to the development of diarrhea, increased flatulence and a very unpleasant odor. For another category of patients characterized by the development of constipation.
- Incontinence of feces caused by nerve damage during surgery.
- Sexual disorders of associated with traumatization of nerve fibers.
- The appearance of adhesions, which manifest themselves as painful sensations arising in the operated area. Spikes of small size do not pose a great danger. Significant fusion can cause a persistent violation of the evacuation of the edema from the intestine( up to the occurrence of intestinal obstruction).
How many live after the operation?
There is no single answer to this question. In the most favorable position are the patients, in whom the tumor was detected at the earliest stages of development. Timely treatment provides a five-year survival rate of 90% of patients.
Even with metastasis of a cancerous tumor in the liver and lung tissue, qualified treatment, consisting of a combination of surgery and chemotherapy, results in a five-year survival of a significant proportion of patients.
Treatment after operation
- Rehabilitation of the patient begins at the hospital. From anesthesia, he departs under the supervision of medical staff. Due to this control, possible complications and the possibility of bleeding are stopped.
- For the elimination of discomfort and pain in the abdomen, the patient takes analgesics.
- Epidural or spinal anesthesia( in the form of injections) may be prescribed to the patient for ease of health.
- In some cases, the administration of pain medications is carried out through a dropper.
- To remove excess fluid from the operating wound, some patients are installed a special drain for several days.
- On the second day after the operation the patient is allowed to sit, on the fifth day - to move for short distances( to the toilet, in the ward).
- For a faster and more successful healing of the postoperative sutures, the patient is required to wear a special bandage. With its help, not only does the load on the muscles of the abdominal press decrease, but even pressure is exerted on the organs of the abdominal cavity.
- After discharge from the hospital( usually on the seventh day after surgery), the patient should follow a strict diet.
- If the doctor has doubts about the effectiveness of the performed operation, the patient is prescribed a course of chemical preparations that depress the division of cancer cells. Sometimes it takes several courses of chemotherapy.
- To reduce the pain syndrome and improve the effectiveness of chemotherapy, the patient is subjected to radiation therapy.
Radiation treatment( using gamma-therapeutic devices that produce a beam of hard rays with very high penetrating activity) is used both in the preoperative and postoperative period.
With the help of radiotherapy before surgery, doctors can reduce the size of the tumor, which improves the result of the operation. Radiotherapy, carried out during the postoperative period, helps to destroy cancer cells that have remained in the body of the operated patient.
In modern oncology, two types of radiation therapy are used: remote X-ray therapy( when the effect on the tumor is carried out by external irradiation of the desired site) and direct radium therapy( consisting of the introduction of a radioactive element into tumor tissues).
The degree of severity of side effects after radiation therapy for colorectal cancer depends on the dose of radiation received by the patient. Irradiation may cause:
- urinary incontinence;
- redness and irritation of the skin( to prevent this effect, you need to use a special cream).
Reception of chemical drugs that help to stop the rate of division of cancer cells and reduce the size of the malignant neoplasm is prescribed before and after the operation.
If chemotherapy is used to treat early stages of a tumor, it is given an auxiliary value( surgery is the main one).
In the treatment of inoperable stages of colorectal cancer, chemotherapy is the only therapeutic method that can alleviate a patient's condition. Such treatment, reduced to injections or infusion( intravenous administration via a dropper) of fluorouracil, is palliative.
The introduction of large doses of chemical products inevitably leads to side effects:
- permanent nausea and vomiting;
- development of allergies;
- dyspeptic disorders;
- to mental disorders;
- active hair loss.
The manifestation of these effects can be significantly reduced with the use of regional chemotherapy, consisting in the introduction of chemicals directly into the artery, located next to a malignant tumor.
A number of progressive clinics practice the method of introducing artificial proteins( monoclonal antibodies) included in the chemical formula of drugs.
For the analgesia of patients with rectal cancer, a three-stage therapy system is used, according to which painkillers are divided into three groups designed for one of three stages.
The first stage of antiplaque therapy involves the use of the weakest analgesics, the latter - the most powerful. Pain relief is started with first-line drugs.
If they were ineffective or stopped helping after a certain time, the patient is prescribed drugs of the second, and then - the third stage.
- On the first , the stages of pain therapy are removed with the help of non-steroidal anti-inflammatory drugs: piroxicam, paracetamol, ibuprofen, aspirin, diclofenac, ketotifen, indomethacin.
- On the second , steps are taken to weak opiates: codeine, oxycodone, tramadol, hydrocodone, tramal.
- The third stage of can not do without strong opiates: morphine, fentanyl, norfine, buprenorphine.
To intensify the action of analgesics, a number of adjuvant drugs are used at each of the stages: antidepressants( mirtazapine, paroxetine, naloxone), neuroleptics( risperidone, amitriptyline), glucocorticoids( hydrocortisone, dexamethasone).
The tactics of treating colorectal cancer may include the use of laxatives:
- During the postoperative period, the patient is prescribed petroleum jelly( 15-40 ml per night).
- When preparing the rectum, preparations that can increase the osmotic pressure of the contents of the intestine can be used for the operation: suppositories with glycerol, golite, lactulose or sorbitol.
- Strictly prescribed by the doctor during the preparation for the procedures of irrigoscopy and colonoscopy, as well as for operation on the rectum, drugs intended for stimulation of the intestine function are used: castor oil, phenolphthalein, magnesia solution, bisacodyl, herbal medicinal herbs( buckthorn bark, senna leaves,rhubarb root).
Nutrition for a patient with rectum cancer
- Nutrition of the patient must be complete, containing a certain amount of carbohydrates, proteins and fats.
- Foods included in the diet should be rich in vitamins and minerals, so it is so necessary for fruits and vegetables.
- From the diet of the patient completely excluded, acute, sour and fatty foods, and meat dishes are limited.
- Great role of a full breakfast and thorough chewing each piece.
- Food should include at least five meals, while the volume of servings should be controlled: they should be small.
Prognosis of colon cancer depends on many factors: the stage of the tumor process, the cellular structure of the malignant neoplasm, the presence of metastases in the lymph nodes, the level of medical care provided.
Depending on the stage at which the pathological process was detected, the five-year survival of patients is as follows:
- I - 82%;
- II - 76%;
- IIIА - 52%;
- IIIB - 43%.
- IV - 5%.
The most important factors affecting the survival of a patient after a cancer of the rectum, is not so much the qualification of his treating physician, as the firmness of dieting during the postoperative period, the psychological mood of the patient and his desire to survive.
It is possible to significantly reduce the risk of developing colorectal cancer with a whole range of measures. Everyone needs:
- Do not allow the appearance of constipation.
- In time to treat all chronic diseases of the anal canal and rectum( primarily it concerns hemorrhoids, as well as fistulas and cracks of these organs).
- Exclude from its diet fast food( so-called fast food), restrict the consumption of animal fats, replacing them with vegetable oils.
- Contact as little as possible with harmful chemicals.
- Refuse from smoking and drinking alcoholic beverages.
- Maintain an active lifestyle.
- Monitor your weight by not allowing the development of obesity.
- Regularly( at least once a year) undergo a medical preventive examination.
- Patients who are at risk for inheritance, after reaching the age of fifty, it is necessary every year to undergo a screening test consisting of performing fecal matter analysis for occult blood, ultrasound and sigmoidoscopy.
Video on current trends in the treatment of rectal cancer: