Rectal adenocarcinoma is an ailment, the danger of which is that, not being transmitted neither by airborne, nor by sexual intercourse, and not being the result of medical oversight, it is most often found in the genetic code of the human body.
That's why he can not escape from condoms, disposable syringes, or gauze bandages.
The concept of
An adenocarcinoma( glandular cancer) of the rectum is called a malignant tumor, the tissues of which consist of cells of glandular epithelium lining the inner surface of its walls.
In men, this disease is detected somewhat more often than in women. Once activated, the cancer process can take the life of a completely healthy person for one year.
Adenocarcinoma is the most common type of malignant neoplasm of the rectum.
Causes of
Due to scientific research, physicians managed to establish that rectal adenocarcinoma develops as a result of genetic mutation only in isolated cases.
Most often, this disease is the result of the interaction of hereditary and external factors.
Iron cancer can develop through fault:
- Genetic predisposition. In a risk group, people who have blood relatives who have ever undergone this illness are automatically entered.
- Chronic diseases of the colon( hemorrhoids, fistulas, rectal cracks, polyps, colitis).The greatest danger in this regard is ulcerative colitis. If the patient suffers for five years, the risk of developing a glandular cancer is about 5%, if the duration of the disease is estimated in two decades, the risk probability increases to 30%.In Crohn's disease, this risk is 20%.
- Hereditary diseases( diffuse polyposis, Gardner's syndromes and Tyurko syndromes), creating favorable conditions for malignant polyps. If the polyps( and sometimes the affected bowel) are not removed in time, there is a high probability of multiple oncological lesions.
- Accessories for the age category over fifty years.
- Constant stress.
- Prolonged constipation.
- The effects of certain medications.
- of papillomavirus and anal sex.
- Certain food cravings. The diet, full of red meat, pastries, fatty dishes and almost free of fresh fruits, vegetables and all kinds of cereals, is in every way conducive to the development of adenocarcinoma. A convincing confirmation of this assumption is the fact that the inhabitants of Africa and India, who eat only plant food, do not suffer from this affliction. Due to the processing of fatty and meat dishes, fatty acids are produced which, after entering the intestine, can turn into carcinogenic substances. Some types of carcinogens are formed in products due to some methods of preparation( for example, during frying and smoking).Epithelial cells, often in contact with these substances, can degenerate into malignant cells.
- Prolonged exposure to harmful chemicals( asbestos, amides, tyrosine) in hazardous production.
- The sedentary lifestyle.
- Excess weight.
- Abuse of alcohol and smoking.
Classification of
Various parameters can be used as the basis for the classification of glandular colorectal cancer. The main indicator, which is the basis for dividing the ailment into different types, is the degree of differentiation of tumor tissues.
Rectum adenocarcinoma can be:
- highly differentiated;
- moderately differentiated;
- is a low-grade;
- is undifferentiated.
A variety of low-grade adenocarcinomas is represented by:
- Mucous( colloidal) cancer. Its main feature is the abundant secretion of mucus.
- Mucocellular( ring-like) cancer, capable of affecting even young patients. Tumor of this species, characterized by a tendency to wide internal growth and the absence of clear boundaries, is difficult to treat, since it is difficult and resection of the affected bowel. Mucocellular cancer quickly metastasizes, spreading through the tissues of the rectum and adjacent organs.
- Squamous cancer.
- by the glandular squamous cancer. This type of malignant neoplasm is rarely diagnosed.
Clinical manifestations
Clinical symptoms of the initial stages of rectal adenocarcinoma are characterized by blurred manifestations.
The presence of the disease can be indicated only by the solid consistency of feces, the difficulty of emptying the intestine and a slight decrease in body weight.
The growth of a cancerous tumor causes increased secretion of mucus, the accumulations of which provoke agonizing tenesms - frequent( up to twenty times a day) urge to defecate.
Some time later, ulceration and disintegration of malignant neoplasm occurs, in connection with which tumor tissues, blood and pus, which publish an unusually fetid smell, enter the feces.
Due to the adenocarcinoma of the rectum, intestinal( partial or complete) obstruction and irregular stool develop in patients. Some have constipation alternating with diarrhea, others have either prolonged constipation or persistent diarrhea. Patients suffering from constipation, feel a swelling, pain and heaviness in the lower abdomen.
At this stage of the oncological process, the patients are characterized by increased fatigue, physical weakness, deterioration in overall well-being, sleep disorders, pale skin, complete lack of appetite. Some patients develop fountain-like vomiting.
Because of severe dehydration( caused by indomitable vomiting) and severe cancer intoxication, patients develop cachexia - a state of extreme exhaustion. Constant loss of blood leads to an increase in anemic syndrome. Chorious discharge from the rectum and tenesmus further aggravate the painful condition of the patients.
Highly differentiated rectum adenocarcinoma
Highly differentiated ferruginous rectal cancer, which accounts for about 6% of the total structure of all cancers, is an extremely widespread oncological pathology on the scale of our planet.
Since the highly differentiated malignant neoplasm has structures that are markedly different from healthy rectal tissues, this contributes to the early detection of the disease and increases the chance of successful healing of the diseased person.
According to medical statistics, the disease recurs after 12-18 months after the end of treatment. Treatment of inoperable cancer tumors, aimed at improving the quality of life of patients, allows for some time to prolong their life.
Moderate
Moderately differentiated rectal adenocarcinoma takes the fourth position in the total mass of oncological pathologies.
Developing from the tissues of glandular epithelium and metastasizing lymphogenically, this type of malignant tumor lends itself to successful treatment only at the early stages of its development.
The problem is that with moderately differentiated adenocarcinoma, the structure of atypical and healthy cells has minimal differences, and this greatly complicates the early diagnosis of the disease and the choice of treatment tactics.
For a fairly long time, cancer cells masquerade as healthy, and pronounced differences in their structure appear only in the last stages of the disease.
Since the selection of effective chemotherapeutic drugs is not possible, moderately differentiated glandular cancer of the rectum is quite difficult to treat.
Therapy for moderately differentiated rectal adenocarcinoma is performed by surgical treatment and point-based radiotherapy.
The prognosis of the disease identified at the I-II stage is relatively favorable. Treatment of moderately differentiated adenocarcinoma of the III-IV stage is associated with the need for excision of the cancerous tumor and the establishment of colostomy.
Low-differentiated
A low-grade adenocarcinoma of the rectum is often called mucosal adenocarcinoma or colloidal( mucosal) cancer. A characteristic sign of a cancerous tumor of this species is the increased secretion of extracellular mucus and the presence of its clusters in the form of "lakes" of different sizes.
Low-grade adenocarcinoma of the rectum has the highest degree of malignancy, because it can give an unfavorable prognosis for the life of a sick person, even at the earliest stages of its development. It is characterized by an aggressive course and extremely rapid growth of cancer cells.
The averaged five-year survival rates for colloid cancer are as follows:
- in the 1st stage survives half of the patients;
- II stage is characterized by 40% survival of patients;
- at Stage III, only 20% of the diseased remain alive;
- at Stage IV only 5% of patients survive.
Undifferentiated
Undifferentiated adenocarcinoma of the rectum, referred to as anaplastic cancer, consists of atypical cells that do not possess the characteristic features allowing them to be attributed to at least one of the existing histological forms.
Anaplastic cancer cells are characterized by infiltrative growth and extremely early metastasis in the regional lymph nodes. This explains the extremely disappointing prognosis for the life of patients( which is the worst of all kinds of adenocarcinomas) and the very low probability of successful treatment.
Stages of
- For adenocarcinoma of the 1st stage, the mucosal and submucosal layer of the intestinal wall is affected. Because of the absence of any specific manifestations, detection of the tumor is extremely difficult.
- Malignant neoplasm of stage IIA germinates in the muscular tissue of the affected rectum and extends 1 cm into the intestinal lumen. The surrounding tissues and lymph nodes remain intact. Adenocarcinoma of stage IIB protrudes into the intestinal lumen more than one centimeter. It is during this stage that patients begin to suffer from constipation, and mucus, blood and other pathological discharges appear in their stool.
- Cancer of stage IIIA is introduced into the intestinal lumen more than 1 cm, through the entire thickness of the intestinal wall, leaving the lymph nodes untouched. For stage IIIB adenocarcinoma, the size ceases to have any significance, since the tumor gives multiple metastases to the nearest lymph nodes. During this period, the patients develop a severe pain syndrome caused by the growth of the tumor in the tissue of the external serous membrane, permeated with nerve fibers.
- Malignant neoplasm of the IV stage has a significant size, it grows into the tissues of adjacent organs and gives a lot of distant metastases to the lymph nodes and internal organs.
Metastases and other complications
Rectal adenocarcinoma primarily produces metastases in a number of proximal lymph nodes( metastasis of the cancer is through the venous plexus of the rectum).
After this, the uterus, bladder, liver, kidneys and bone tissue are affected. Lastly, metastasis enters the lungs and the brain.
Ironic cancer gives a number of severe complications, it can lead to:
- bleeding;
- anemia;
- deterioration of intestinal patency( from relative to complete obstructive obstruction);
- inflammation of the peritoneum followed by the development of peritonitis;
- perforation( rupture) of the wall of the affected bowel due to tumor growth, fraught with the formation of fistulas or the occurrence of peritonitis.
Inspection
Rectum adenocarcinoma requires comprehensive diagnosis, which involves a number of endoscopic and laboratory studies. The patient is subjected to a thorough physical examination, including an anamnesis and a finger examination of the rectum.
After that, he must undergo the following procedures:
- Recto-manoscopy, which allows not only visual examination of the rectal mucosa, but also a biopsy of tumor tissues with the help of electric loops.
- Irrigoscopy - X-ray study, produced using a contrast agent - barium sulfate, administered to the patient's body orally or with enema.
- Colonoscopy is the most informative method that allows you to assess the condition of the entire large intestine.
- ultrasound( endorectal and sometimes transabdominal) of the abdominal cavity. This minimally invasive and completely painless method can provide information about the features of the oncological process, the condition of the internal organs, and the presence or absence of metastases.
- Computed tomography( CT), magnetic resonance imaging( MRI), scintigraphy, positron emission tomography( PET) - modern diagnostic techniques that allow us to clarify the features of the histological structure and localization of the tumor, as well as to reveal signs of the appearance of metastases.
In addition to passing an endoscopic examination, the patient must pass:
- blood tests( general, biochemical, test for oncomarkers);
- feces( on the latent blood).
Treatment of adenocarcinoma of the rectum
Given the tendency of adenocarcinoma of the rectum to early metastasis, the timeliness of treatment is of great importance for the treatment of the patient.
Medical care must be qualified and tailor-made for each patient individually.
The exact therapeutic scheme is chosen taking into account the prevalence of the oncological process and the general condition of the patient. Of great importance is the degree of differentiation of cancer cells.
Undifferentiated, low-grade and moderately differentiated adenocarcinomas, which are the most aggressive neoplasms, require higher doses of radioactive irradiation and more toxic chemical preparations.
- The leading therapeutic method in the treatment of rectal adenocarcinoma is the operative effect of , aimed at the radical removal of malignant neoplasm and all tissues into which metastases penetrated, with subsequent evacuation of the feces from the patient's body.
The most favorable type of surgery is excision of the affected part of the rectum along with the tumor tissues, providing intestinal continuity. Unfortunately, such operations are not always possible.
If the adenocarcinoma is located in the immediate vicinity of the anus, the affected part of the rectum must be removed together with the sphincter apparatus. With this option, it is inevitable to create a colostomy - an artificial outlet for feces, to which the kalospriemnik is attached.
Cancerous tumors are not always operable. Approximately one-third of patients are unable to tolerate surgical treatment because of advanced age or a weakened condition.
In such cases, resort to palliative treatment( one of such methods is electrocoagulation of the tumor), designed to reduce pain, improve the quality and life expectancy of the patient.
- Chemotherapy - the use of cytotoxic drugs for the control of colorectal cancer - is most often used as an auxiliary therapeutic method that improves the result of surgical treatment. In the course of chemotherapy, only one drug( 5-fluorouracil or irinotecan) and a whole complex of medicines can be used( a patient can be assigned a combination of fluoroufur, raltitreksida and capecitabine).Chemotherapy, prescribed before surgery, allows you to suspend the process of dividing cancer cells;its appointment after surgery reduces the risk of cancer recurrence. The use of cytotoxic drugs in relation to inoperable patients plays the role of palliative treatment.
- The use of radiotherapy in relation to the rectum is promoted by the features of its anatomical location: rigid fixation of this organ allows you to specify the exact parameters of the device and to irradiate a strictly defined area. Radiation therapy can be used both before the operation and after it.
The use of radiation exposure as a preoperative preparation can reduce the size of a malignant tumor, inhibit the rate of division of cancer cells, and also prevent the occurrence of metastases.
Too large a tumor that has spread to adjacent tissues and is found to be inoperable, after a course of radiotherapy, may significantly decrease in size and become available for surgical removal. After the operation, radiotherapy is prescribed to affect the tumor tissue that has passed beyond the intestinal wall.
Radiation irradiation can prevent a relapse of colorectal cancer at the site of a remote site of the affected rectum.
Prognosis and prophylaxis of
When compiling an individual prognosis for patients with rectal adenocarcinoma, the physician takes into account a variety of individual factors: the stage of the tumor process, the age of the patient, the characteristics of his psychoemotional state and the immune system.
Average values are as follows:
- Rectal adenocarcinoma, revealed in the first stage, results in a five-year survival rate of 95% of patients.
- Iron carcinoma, identified in the second stage, reduces survival rates to 70%.
- Malignant neoplasm of the third stage, which involves lymph nodes in the tumor process, leaves only half of the diseased chances of survival.
- With adenocarcinoma of the fourth stage, no more than 10% of patients survive.
This video shows a laparoscopic resection for rectum adenocarcinoma: