rectal cancer

Rectal Carcinoma: Description

In many colorectal cancer patients, the tumor is located in the rectum or rectum. This is the last part of the intestine before the anus. He is about 16 inches long.

Rectal cancer (rectal cancer, rectal cancer) is almost always a so-called adenocarcinoma. This is a malignant tumor that develops from the mucous gland tissue. Such adenocarcinoma of the rectum accounts for about 30 to 40 percent of all cases of colorectal cancer (colorectal carcinoma) in Germany.

Rectal cancer: causes and risk factors

Rectal carcinoma usually develops from benign growths of the intestinal mucosa, so-called polyps, Such polyps are found in intestines of many people. Mostly they stay harmless. But they can also degenerate over the years and develop into cancer – a rectal cancer develops.

The cancer tumor grows fast and uncontrolled. It penetrates into surrounding healthy tissue and destroys it. In addition, individual cancer cells can spread through the blood and lymph channels in the body and form secondary tumors (metastases) elsewhere, for example in the lymph nodes, lungs and liver.

Sometimes the rectal cancer occurs familial. This suggests that there is one in such families genetic predisposition for cancer of the rectum indicates: Those affected have an increased risk of developing rectal carcinoma from benign intestinal polyps in the rectum.

There are also some hereditary diseaseswhich promote the development of colon cancer (and other cancerous tumors). These include, for example, Lynch syndrome (hereditary non-polypous colorectal carcinoma, HNPCC) and familial adenomatous polyposis (FAP).

Chronic inflammatory bowel disease also increase the risk of rectal cancer (and other malignant colon tumors). This is especially true for ulcerative colitis.

Very often enters unhealthy lifestyle on the development of colorectal cancer (such as rectal cancer) in: Little movement, overweight and an unhealthy diet increase the risk of cancer. Especially one Nutrition with a lot of (red) meat, processed sausages and low fiber is considered a risk factor for rectal cancer and other forms of colorectal cancer. The same applies Nicotine and alcohol to.

Tips: Regular consumption of vegetables and fruits as well as a low-fat and low-meat diet reduces the risk of colorectal cancer (including rectal cancer)!

Another common risk factor for all forms of colon cancer is this ageWith age, the risk of disease increases. Thus, the mean age of onset at the time of diagnosis is 73 years (men) and 75 years (women).

Rectal Carcinoma: Symptoms

In the early stage, the rectal carcinoma usually causes no symptoms. In the further course, however, signs are noticeable, such as blood in the stool, pain during bowel movements and altered bowel habits (diarrhea and / or constipation). The tumor can even pass the passage through the rectum completely. Then it comes to intestinal obstruction (ileus).

Caution: Not every change in bowel habits equals cancer. From the age of 40, however, it is recommended to have the complaints cleared up by a doctor.

Rectal cancer can also cause general symptoms. This is how many patients feel less efficient and tired, Some patients also report one unwanted weight loss or fever.

Often symptoms of Anemia on. These include, for example, paleness, reduced resilience and palpitations even at low load. The anemia is caused by the fact that the rectal carcinoma bleeds easily and often.

Rectal cancer: examination and diagnosis

If rectal cancer is suspected, the doctor will first talk extensively to you To raise medical history (Anamnese). For example, he gives a detailed account of the symptoms that occur, asks about possible pre-existing and underlying illnesses as well as about your lifestyle. In addition, the doctor will inquire if there are already cases of colon cancer in your family.

The next step is followed by one physical examination, On the one hand, the doctor can better assess your general condition. On the other hand, he is looking for possible signs of the cancer. This includes one digital rectal examination: The doctor scans with one finger over the anus your rectum. In some patients, rectal cancer can be palpated.

Closer digestion brings one colonoscopy (Colonoscopy). It is the best way to detect bowel cancer: The doctor inserts a tubular instrument (endoscope) over the anus. It has a light source and a small camera installed at its tip. The doctor gently pushes the endoscope through the entire colon. On the basis of the camera images on the monitor, the person on the way to inspect the inside of the intestine accurately.

In addition, the doctor can introduce fine instruments via the endoscope. With their help can be Remove intestinal polyps as well as small ones tissue samples (Biopsies) from suspicious mucosal sites. They are examined in the laboratory for cancer cells.

In some patients, colonoscopy is not possible for a variety of reasons (perhaps because the tumor narrows the intestinal passage). Then the doctor can also only a reflection of the rectum (rectoscopy) carry out. Another alternative is the sigmoidoscopy a reflection of the rectum and the preceding S-shaped Grimmdarmschlinge. The disadvantage of both methods is that a large part of the large intestine is not excluded from the investigation.

A third possibility, if a colonoscopy is not feasible, offers the virtual colonoscopy: The intestine is displayed in three dimensions and in detail by computed tomography (CT). If it is found that polyps must be removed or tissue samples must be removed, but then a surgical intervention is necessary.

Further investigations

Exact examination of the intestine and the analysis of tissue samples taken is usually sufficient to reliably diagnose a rectal carcinoma. After that, the doctor will order further examinations. They serve to determine the exact location and size of the tumor as well as its spread in the body.

Possible investigations are, for example, computed tomography (CT), magnetic resonance tomography (MRI) and ultrasound examinations of the abdomen. If women suspect that rectal cancer has spread to the vagina or uterus, a gynecological examination is necessary. An X-ray examination of the chest (chest X-ray) can show whether metastases have settled in the lungs.

Rectal Carcinoma: Treatment

The exact treatment for rectal cancer will be adapted to each patient. A role is played by the tumor stage, the age and the general condition of the patient as well as possible comorbidities.

surgery

The only way to cure rectal cancer is currently one surgery, The surgeon cuts out the tumor as completely as possible, with a certain safety margin. In other words, it cuts into the surrounding healthy tissue in order to actually “catch” all cancer cells.

If there is a high risk of relapse (for larger tumors, for example), the surgeon, together with the tumor, must also excise the surrounding fatty and connective tissue (called mesorectum). If parts of the anal sphincter muscle also have to be removed, this is one artificial intestinal exit (Anus praeter or stoma) necessary.

Radiation and / or chemotherapy

For rectal cancer in the early stages surgery as a treatment is usually sufficient. If the tumor has progressed a bit further, patients will receive it before the operation a radiotherapy or a combined radiotherapy and chemotherapy (chemoradiotherapy). It can shrink the tumor and sometimes prevent the anal sphincter from having to be removed.

Also after the operation Chemotherapy or chemoradiotherapy may be useful: any remaining cancer cells in the body can be killed.

Further treatments

Often, an advanced rectal cancer causes metastases in other parts of the body, such as the liver and lungs. If possible, these – like the primary tumor in the rectum – surgically removed.

In cases of advanced rectal cancer, the metastases are often too large to remove completely surgically. Then you try to downsize them first. This is combined with chemotherapy targeted drugs, Such drugs work specifically against certain features of the patient’s cancerous cells.

An example is bevacizumab: It is a so-called monoclonal antibody. It prevents a certain growth factor (VEGF) from docking on the cancer cells and stimulating the formation of new blood vessels in the direction of the tumor. The tumor is therefore not so well supplied with blood (and thus oxygen and nutrients). This sometimes succeeds in reducing large metastases to such an extent that they become operable.

Rectal Carcinoma: Course and Prognosis

The more advanced the rectal carcinoma is, the worse the prognosis is: With the size and spread of the tumor, the chance of recovery decreases and the risk of relapse increases. This can be concluded from the observed survival rates: Five years after the diagnosis of stage I rectal cancer, 95 percent of the treated patients still live. In stage IV carcinoma, this 5-year survival rate is only 5 percent.

That’s why all patients should be with rectal cancer even after completed, successful treatment go regularly to follow-up visits. A possible relapse can be detected and treated as early as possible.