Cancer of the rectum is an extremely formidable disease, which annually takes millions of lives of our planet. In Russia alone, every year, there are 50,000 patients with this diagnosis.
The main reason for the high lethality in colorectal cancer is too late the treatment of patients for medical care, since the insidious disease does not manifest itself at the first stages of development.
Only a fifth of all cases of rectal cancer are diagnosed at the level of the first or second stage: as a rule, this happens by chance - during preventive medical examinations or examinations about completely different diseases.
The same number of patients in the initial detection of a disease recognizes that a malignant tumor has already metastasized into internal organs and lymph nodes. In the vast majority( about 60%) of cases of cancer of the rectum is detected in the third stage.
Early detection of rectal cancer gives the patient hope for a complete cure, which virtually eliminates the possibility of relapse afterwards.
Methods for diagnosis of colorectal cancer in both men and women
Because the cancer of the rectum affects both sexes equally and has a similar clinical picture, the same set of diagnostic procedures is used to identify it.
Patient survey
Correctly conducted patient questioning can significantly speed up the diagnosis and choice of treatment tactics.
During the interview the patient collects information:
- about the presence of any complaints and the prescription of their appearance;
- on his attitude to drinking and smoking;
- about his eating habits and the nature of his daily diet;
- on whether he suffered from any diseases of the rectum and what treatment he took in this regard;
- on the occurrence of cancer or precancerous diseases of the rectum in close relatives;
- on what kind of lifestyle he leads;
- about the nature of his professional activities.
Clinic of manifestation
At the very beginning of development, rectal cancer manifests itself as a series of nonspecific symptoms:
- with general weakness;
- with a prolonged rise in body temperature;
- by weight loss;
- loss of appetite;
- frequent constipation;
- uncomfortable sensations in the rectal area.
As the malignant tumor develops, a specific symptomatology is attached:
- The appearance of a blood admixture in the stool mass of ( occurs in 70-95% of cases).The blood is excreted either by drops( before the beginning of the feces departure), or mixed with caloric masses and is represented in them with veins and dark clots.
- The development of anemia due to persistent bleeding during defecation.
- Isolation of mucus and pus from the rectum due to inflammation of the mucous membranes of the rectum and tumor disintegration.
- Disruption of bowel functioning , manifested in the constant alternation of constipation and diarrhea, incontinence of gases and stools, agonizing and frequent( up to 15 times daily) urge to defecate, severe swelling and rumbling of the abdomen.
- The formation of intestinal obstruction. This symptom, characteristic of late stages of intestinal cancer, occurs due to the complete overlap of the lumen of the rectum with the tissues of an overgrown malignant tumor. With the development of this symptom, the patient suffers from periodic vomiting, cramping pains in the abdomen. The chair may be absent for five days.
- Pain in the rectal area. With the defeat of its lower part, in which the sphincter muscle is located, the pain sensations develop already at the early stages of the pathological process. When the tumor is localized in its upper regions, the pain appears and intensifies as the malignant formation spreads to neighboring organs. A patient with a pain syndrome develops a "stool symptom" - the tendency to squat only on one of the buttocks when sitting on a hard surface.
Finger inspection
With this method, the proctologist can detect the presence of bulk pathological neoplasms in the rectal cavity.
For the study, the patient takes a knee-elbow position, standing on all fours and leaning on the couch.
After putting on rubber gloves, a specialist injects a finger smeared with petroleum jelly into the rectum of the patient and thoroughly probes its walls in search of any suspicious neoplasms.
Their detection is the basis for a variety of diagnostic studies that can either confirm or exclude the presence of cancer.
Instrumental methods
To detect cancer of the rectum, a large number of modern medical equipment are used today, which makes it possible to detect oncology at early stages of its appearance.
Recto-manoscopy
To perform this type of endoscopic examination, a special device is used - a sigmoidoscope made in the form of a hollow tube having an air pumping device and a built-in lighting device.
During the procedure the patient can:
- take the knee-elbow position;
- lie on your left side, pulling your knees to your stomach.
After the introduction of the rectoscope into the lumen of the rectum( from the side of the anal canal), the doctor, using a special device, pushes a little air into it. This manipulation, which widens the lumen of the organ under examination, facilitates the examination of the mucous membranes of the rectum.
With the help of sigmoidoscopy, it is possible to detect the presence:
- of malignant tumors and polyps on the surface of mucous membranes;
- ulcers, erosions and other pathologies;
- sites with increased bleeding;
- pus and blood in the lumen of the intestine.
In the course of performing a sigmoidoscopy the doctor can take a piece of the affected mucosa for a subsequent laboratory examination - a biopsy.
Irrigoscopy
Irrigoscopy is a kind of X-ray examination consisting of examination of the rectum filled with contrast medium( barium suspension is injected into the rectum by enema).
Since the picture is displayed on the screen, the doctor has the opportunity to conduct the procedure in real time. During the procedure, images of the rectum are performed in several projections.
After its emptying, consider the relief( the residual amount of barium sulphate allows it to be done) and make a series of additional shots.
Irrigoscopy allows to reveal:
- the presence of voluminous neoplasms on the walls of the rectum( due to their flow around the contrast medium);
- extent and size of detected neoplasms;
- ulceration of the intestinal wall;
- the direction of growth of tumor tissues( their germination into the wall, into the lumen of the intestine or outwards).
Fibro colonoscopy
The procedure for fibrocolonoscopy is performed by careful introduction of a thin and very long fibrocolonoscope through the rectum into the upper parts of the large intestine.
With the help of fibrocolonoscopy, doctors can detect polyps with a tendency to malignancy, as well as the process of spreading malignant neoplasm to the walls of other( colon and sigmoid) intestines.
In the process of fibrocolonoscopy, small polyps and benign tumors are often removed, as well as samples of tumor tissues for biopsy.
US
Using ultrasound examination of the affected rectum, specialists identify:
- the fact of metastasizing a malignant tumor into adjacent lymph nodes;
- degree of spread of the tumor process to nearby organs.
Computed tomography and MRI
The reason for the procedure for computed tomography is the inconsistency of the data obtained during X-ray and ultrasound.
With the help of a CT scan, the oncologist can identify:
- the presence of metastasis of a malignant tumor into adjacent abdominal organs and nearby lymph nodes;
- the fact of the formation of fistulas, providing a pathological communication between organs through which they receive urine and feces;
- extent of malignant neoplasms.
An even more informative method, which does not require any preparatory measures and allows to detect the presence of a cancer of the rectum, is the MRI procedure.
X-ray of the abdominal cavity and radioisotope scanning of the liver
To reveal the presence of intestinal obstruction and assess the state of the intestine allows an overview radiography of the abdominal cavity, consisting in performing a series of X-rays taken without the introduction of a contrast agent.
Given the frequent metastasis of colon cancer in the liver, to obtain information about the presence of metastases in this organ resort to the procedure of its radioisotope scanning( scintigraphy).
Isotopes injected into the patient's body by intravenous route immediately fall into tumor tissues and, accumulating in them, begin to emit gamma rays, making scans( images obtained during the survey) as informative.
Intravenous urography
This study is radiopaque, providing intravenous administration of a contrast agent, which after a while is excreted from the patient's body by the organs of the urinary system. In this case, staining of the tissues of the kidneys, ureters and bladder occurs.
X-ray images performed during the procedure give the doctor a clear picture of the state of the organs of the urinary system and the situation with the presence or absence of metastases.
Laparoscopy
In laparoscopy, which has the status of surgical intervention and conducted under anesthesia, several punctures are performed in the abdominal wall of the patient, through which several miniature video cameras are inserted into the cavity of his stomach.
With their help the doctor can get an idea of the state of the organs of the abdominal system and the degree of their involvement in the metastasis process. Typically, for laparoscopy, samples of tumor tissue for biopsy are taken.
Laboratory methods
The data of laboratory studies of tumor tissues, urine, feces and blood of the patient allow us to confirm and clarify the preliminary diagnosis.
General blood test and oncomarkers:
indications Indirect confirmation of the cancer process of the rectum in the patient's body can be the following indicators of the general blood test:
- elevated white blood cell count and change in the structure of white blood cells;
- high level of ESR, not decreasing after using antibacterial agents;
- a decreased level of hemoglobin, indicating a chronic posthemorrhagic anemia, which develops as a result of permanent intestinal bleeding.
The blood test for tumor markers( antigens produced by tumor cells) is a specific laboratory test performed only during a comprehensive examination of a patient with suspected intestinal cancer.
Fecal and urine analysis
Fecal occult blood test is performed at least four times.
The presence of blood in at least one of the samples examined is the basis for the appointment of a colonoscopy, as it can bleed not only a cancerous tumor, but also a benign neoplasm.
The general analysis of urine in colorectal cancer does not have the leading clinical significance, however, the presence of atypical cells and impurities of blood is an alarming factor that indicates the development of a malignant process in the patient's body.
Biopsy
Biopsy - a method of intravital sampling of tumor tissue from the patient's body for subsequent histological and cytologic examination - is recognized as one of the most effective ways to diagnose colon cancer.
Biopsy is often combined with procedures for instrumental diagnostics( laparoscopy, fibro colonoscopy, sigmoidoscopy and surgical removal of a tumor of the rectum).
Histological examination of
Subjects of histological examination are laboratory sections of tumor tissues. To obtain a quick( within half an hour) result, they are frozen and stained with a special dye.
The implementation of a planned study giving more accurate results requires at least five days. Preparing the sample for the study, it is treated with paraffin and a special solution, followed by tinting.
To obtain the most reliable conclusion, laboratory preparations are examined under a microscope by at least two specialists.
Cytological study of
The object of the cytological study is not the laboratory sections, but the individual cells that make up the tumor tissue. Cytology provides information about the composition of cancer cells and the nature of their malignant degeneration.
Test for the definition of colon cancer: indications and price
Noticing the alarming symptomatology, each person can perform a simple test for latent blood in stool. The test kit can be purchased at the pharmacy or ordered online.
The cost of one tester produced in Russia is 220 rubles. The imported analogue will cost the buyer 2,100 rubles.
The test is performed:
- People who have any disorders in the functioning of the digestive system.
- Patients after 50 years.
- Persons over forty years of age with a history of family history of intestinal cancer.
Home testing has several advantages:
- The reliability of the result is 99%.
- It does not require any preliminary preparation.
- Taking medication is not a contraindication to its conduct.
- The speed of the result does not exceed 7 minutes.
The testing process is extremely simple. Using a paper kalopriememnikom included in the kit, take a small amount of feces and put it in a test tube with a reagent. After vigorously shaking the vial, a drop of contents is placed on the screen of the test plate.
If a positive result is obtained, the patient should immediately contact a qualified specialist for a comprehensive examination.