Rectal cancer: symptoms, stages of development and course

Unfortunately, such a dangerous disease as colon cancer does not have any specific signs by which one could accurately determine malignant pathology. However, the general symptoms of rectal cancer are known, and they cannot go unnoticed. If they appear, it is recommended to immediately consult a doctor who can use more accurate diagnostic methods to confirm or refute the diagnosis.

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First signs

In most cases, the growth of a malignant tumor in the rectum begins with the formation of small benign cellular structures - polyps. Over time, such polyps degenerate into cancer. During this entire period, as a rule, there are no symptoms of the disease, despite the fact that the process has already started.

Clinical signs may appear either at the stage when there are already quite a lot of polyps in the intestine, or when the tumor becomes malignant. There are quite a lot of such signs, but they are not specific to this disease, so they can be ignored:

• constant feeling of fatigue and weakness (due to anemia caused by the tumor);
• disturbances in the functional capacity of the intestine (constipation, flatulence);
• after defecation, a feeling of incomplete bowel movement (mechanical obstruction due to tumor growth into the intestinal lumen).

The larger the tumor becomes, the more pronounced the symptoms become, and the clinical picture becomes more and more intense and clear.

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Course of rectal cancer

The course of a malignant process can be accompanied by typical and atypical symptoms.

Atypical symptoms: feeling of weakness, loss of appetite and weight loss, changes in taste and smell, periodic slight increase in temperature.

Typical signs:

• pathological discharge during stool passage (for example, mucus, pus, blood, tissue elements, mixed discharge);
• pain radiating to the lower back, genitals, coccyx;
• the stool becomes "ribbon-shaped";
• the urge to defecate becomes more frequent and painful;
• there is a sensation of a “foreign body” in the rectum;
• difficulty with defecation, prolonged constipation, heaviness in the lower abdomen, flatulence, lethargy or lack of peristalsis;
• in severe cases – incontinence of feces, urine and gas;
• in advanced cases – the release of feces from the urethra, vagina through the formed fistula, as well as associated cystitis, pyelonephritis, inflammation of the genitals.

Rectal cancer in children

Rectal cancer in childhood can be extremely rare. At the initial stages of the disease, pain in the lower abdomen, discharge of blood, mucus and purulent plugs from the anus are sometimes observed. However, the listed symptoms are not sharply expressed and are often ignored.

As the disease progresses, the symptoms intensify: signs of intestinal obstruction appear, such as constipation, pain, and dyspeptic disorders. Often, when examining the rectum, it is already possible to palpate the neoplasm. General clinical symptoms also become clear: apathy, weakness, and sudden weight loss. Temperature readings often rise to subfebrile levels.

Complete blood count shows elevated ESR. Fecal occult blood test is positive.

Like the vast majority of patients with symptoms of rectal cancer, children get to an oncologist when the pathology has already gone too far. First of all, this happens because in pediatrics, cancerous tumor-like formations of the intestine are very rare, and specialists cannot suspect the disease in a timely manner. As a rule, doctors sound the alarm only in cases where mechanical intestinal obstruction develops, or the child's condition deteriorates sharply.

Stages of colorectal cancer development

In addition to the main classification positions, cancer tumors are usually divided by growth stages. In our country, two such division options are used - global and domestic. We will present both options to your attention.

The generally accepted world classifier for Dukes:

• A – growth of the neoplasm to the level of the submucosal layer.
• B – penetration into all layers of the intestine.
• C – a cancerous tumor of any size with metastases in nearby lymph nodes.
• D – tumor with distant metastases.

According to the domestic classification, the following stages of cancer development are distinguished:

• I – the tumor grows into the mucous and submucous layers.
• IIa – the formation affects less than ½ the diameter of the intestine, does not extend beyond the walls, the nearest lymph nodes are normal.
• IIb – the formation affects more than ½ the diameter of the intestine, does not extend beyond the walls, the nearest lymph nodes are normal.
• IIIa – the neoplasm affects more than ½ the diameter of the intestine, spreads to all layers of the wall, but without metastasis.
• IIIb – the formation is of any size with damage to the nearest lymph nodes.
• IV – a formation of significant size, with growth into nearby organs, with damage to nearby lymph nodes or with distant metastasis.

Classification

A cancerous tumor has quite a lot of different characteristics and parameters, so the disease can be classified in different ways.

In the modern list of diseases, tumors are primarily divided by the form of development:

• exophytic rectal cancer is a form of tumor that grows into the intestinal cavity;
• endophytic form - growing inside the intestinal wall;
• saucer-shaped - growing both into the walls and inside the intestine.

Based on histological characteristics, rectal cancers are classified according to international classification standards:

1. Adenocarcinoma (can be highly differentiated, moderately differentiated and poorly differentiated).
2. Mucinous form of adenocarcinoma (in the form of mucoid, colloid or mucinous cancer).
3. Signet ring cell (mucocellular) cancer.
4. Undifferentiated cancerous tumor.
5. Tumor that cannot be classified.
6. Squamous cell carcinoma.
7. Glandular squamous cell carcinoma.
8. Basal cell (basaloid) form of cancer, as one of the types of cloacogenic tumor.

In order to be able to predict the outcome of the disease in the future, tumors are differentiated by degree, by the depth of growth in the tissue, by the severity of the edges of the neoplasm, by the presence and distance of metastasis.

The more differentiated the tumor, the more optimistic the prognosis.

Formations with low differentiation include:

• mucous rectal cancer (also known as colloid or mucous adenocarcinoma) – occurs with pronounced production and secretion of mucous secretion, with its accumulation in the form of “lacunae” of various sizes;
• signet ring cell (mucocellular) cancer - occurs in young patients, is characterized by rapid intramural growth, does not have distinct outlines (which complicates the assessment of the scope of the operation). Such a tumor more often and quickly gives metastases, spreading not only through the intestines, but also to nearby tissues;
• Squamous cell carcinoma usually develops in the lower 1/3 of the rectum, but can also be found in areas of the large intestine;
• Glandular cancer of the rectum is considered to be quite rare and affects the tubuloalveolar glands located in the submucosa and subepithelial tissues of the perineal part of the rectum.

The tumor is also classified depending on which part of the rectum it is located in. Clinically, the rectum is divided into five sections:

• supraampullary (rectosigmoid);
• upper ampullar (10-15 cm);
• medium-ampullary (5-10 cm);
• lower ampullar (5 cm);
• perineal.

Upper ampullary rectal cancer occurs in approximately 25% of cases, mid-ampullary rectal cancer occurs in 40% of cases, and rectosigmoid rectal cancer occurs in 30% of cases.

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Complications

The consequences of not receiving the necessary treatment for rectal cancer may be as follows:

• intestinal obstruction, obstruction of the intestinal lumen by a neoplasm, difficulty in passing feces;
• over time – complete blockage of defecation and gas removal, up to rupture of the intestinal wall, peritonitis and death;
• tumor bleeding, bleeding, anemia and massive blood loss;
• malignant intoxication with the decay products of a neoplasm.

All complicated cases must be treated without fail. In some cases, urgent or emergency surgery is prescribed when the patient's life and death are at stake. For example, this may occur with the development of diffuse bleeding, intestinal obstruction or perforation.

In advanced forms, the above-mentioned symptoms can be combined, which naturally increases the danger and worsens the prognosis of the pathology.

However, there are still some adverse effects of cancer that we would like to discuss in more detail - these are metastasis, recurrence of cancer, formation of fistula and ascites.

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Metastases

Metastatic spread is the transfer of cancer particles with blood or lymphatic fluid to other organs or tissues of the body, as well as the direct growth of the tumor into nearby organs.

Most often, cancer spreads through the lymphatic vessels to the lymphatic system of the abdominal cavity and the retroperitoneal space, or to the pararectal and inguinofemoral lymph nodes.

Through the circulatory system, cancer spreads via the portal vein to the liver, or through the inferior vena cava system to the lungs, kidneys, skeletal system, and brain.

Rectal cancer with metastases to the liver can manifest itself with the following symptoms:

• discomfort in the right hypochondrium, a feeling of heaviness and constriction (pain in the liver area usually appears only at later stages, when the liver tissue is stretched);
• yellowing of the skin, dilated vessels in the abdomen, ascites;
• skin itching in the absence of allergic or other skin diseases.

Rectal cancer with metastases to the lungs manifests itself as follows:

• regular cough, shortness of breath, and heavy breathing appear;
• there is pain in the chest, a feeling of internal pressure;
• hemoptysis may occur.

Recurrence of rectal cancer

Relapse – the repeated development of a cancerous tumor – occurs only after surgery to remove a stage II or III tumor. This condition is detected in approximately 20% of cases. The use of additional treatment methods simultaneously with surgery significantly reduces the risk of tumor recurrence.

In most cases, relapses occur in the first few years after radical treatment of the primary cancer. Therefore, the patient must undergo regular examinations by an oncologist for the first 2 years in order to notice dangerous symptoms in time. As a rule, the signs of a relapse are no different from the main symptoms of the tumor, or the process is latent.

Fistula in rectal cancer

A fistula may appear in the perianal area as a small wound – a fistula tract, with constant discharge of bloody fluid and pus. The discharge causes itching and skin irritation.

With good discharge of secretions, the pain may be mild. The pain syndrome increases with the development of an inflammatory process in the skin layer, or during defecation, with prolonged sitting, walking, or a coughing fit. The condition may also worsen with blockage of the passage by granulation or a purulent-necrotic plug.

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Ascites in rectal cancer

Ascites is the accumulation of fluid in the abdominal cavity. This complication occurs when the metastasis compresses the venous vessels of the liver, which leads to an increase in hydrostatic pressure and the appearance of ascites.

Symptoms of this condition include:

• frequent heartburn, sour belching;
• poor digestion of food due to increased pressure on the stomach;
• periodic nausea, loss of appetite, increase in abdominal circumference;
• shortness of breath due to upward pressure on the diaphragm.

As a rule, ascites causes severe discomfort in patients and can lead to functional disorders in the body.

Symptoms of rectal cancer are varied, but not always characteristic. It is very important for the doctor to correctly compare all the available signs in order to correctly determine the required diagnostic measures and suspect a dangerous disease. But we should not forget that cancer often proceeds without obvious symptoms, which once again indicates the need for periodic scheduled examination.

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