Cancer of the rectum: symptoms, stages of development and course

Unfortunately, this dangerous disease, like intestinal cancer, does not have any specific signs, according to which it would be possible to accurately identify a malignant pathology. However, the general symptoms of colorectal cancer are known, and they can not go unnoticed. If they occur, it is recommended that you immediately consult a doctor who can use more accurate diagnostic methods to confirm or deny the diagnosis.

[1], [2], [3]

First signs

In most cases, the growth of malignant formation in the rectum begins with the formation of small benign cellular structures - polyps. Over time, such polyps degenerate into cancer. During this period, as a rule, the symptomatology of the disease is absent, in spite of the fact that the process is already started.

Clinical signs can appear either at the stage when the polyps in the gut are already quite large, or when the tumor passes into the malignant course. There are a lot of such signs, but they are nonspecific for this disease, therefore they can be ignored:

• a constant sense of fatigue and weakness (due to anemia caused by a tumor);
• impaired functional capacity of the intestine (constipation, flatulence);
• after defecation a feeling of incomplete liberation of the intestine (mechanical obstruction due to the growth of the tumor inside the lumen of the intestine).

The more the tumor becomes, the more pronounced the symptoms, and in the future the clinical picture becomes more and more saturated and clear.

[4], [5]

Rectal cancer course

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

Atypical signs: a sense of weakness, lack of appetite and emaciation, a change in taste and olfactory sensations, a periodic slight rise in temperature.

Typical signs:

• pathological discharge during feces (eg, mucus, pus, blood, tissue elements, mixed secretions);
• soreness with irradiation in the lower back, genitals, coccyx;
• the feces become "ribbon-like";
• the urge to defecate becomes more frequent, becomes painful;
• There are sensations of the "foreign body" in the rectal area;
• difficulties 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 neglected cases - allocation of feces from the urethra, vagina through the formed fistula, as well as associated cystitis, pyelonephritis, inflammation of the genital organs.

Rectal cancer in children

Cancer of the rectum in childhood can be extremely rare. At the initial stages of the disease, pains in the lower abdomen, discharge from the anus of blood, mucous and purulent plugs are sometimes observed. However, the listed symptoms are not pronounced and are often ignored.

With the progression of the disease, symptoms intensify: signs of intestinal obstruction appear, such as constipation, pain, dyspeptic disorders. Often, when examining the rectum, one can already feel the neoplasm. Clearly there are general clinical symptoms: apathy, weakness, sharp weight loss. Temperature indicators often increase to low-grade figures.

A general blood test demonstrates an accelerated ESR. The analysis of feces for latent blood is positive.

Like the vast majority of patients with symptoms of colorectal cancer, children go to the oncologist already when the pathology goes too far. In the first place, this happens due to the fact that in pediatrics cancerous tumorous formations of the intestine are very rare, and specialists can not suspect the disease in a timely manner. As a rule, doctors sound alarm only in cases when mechanical intestinal obstruction develops, or the child's condition deteriorates sharply.

Stages of development of colorectal cancer

In addition to the main classification positions, the cancer tumor is divided into stages of growth. In our country, two such options are used - world and domestic. Let's present to your attention both options.

A common world classifier for Dukes:

• A - germination of the neoplasm to the level of the submucosa.
• B - germination in all layers of the intestine.
• C - a cancer tumor of any size with the presence of metastases in the nearest lymph nodes.
• D - tumor with distant metastases.

According to the national division, such degrees of cancer development are distinguished:

• I - the tumor grows inside the mucous and submucosal layer.
• IIa - the formation affects less than ½ the diameter of the intestine, then the walls do not spread, the nearest lymph nodes are normal.
• IIb - the formation affects more than ½ the diameter of the intestine, the legs do not extend beyond the walls, the nearest lymph nodes are normal.
• IIIa - the neoplasm affects more than ½ the diameter of the intestine, extends to all layers of the wall, but without metastasis.
• IIIb - the formation is of any size with the damage of the nearest lymph nodes.
• IV - formation of considerable size, with germination in the nearest organs, with damage to the nearest lymph nodes or with distant metastasis.

Classification

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

In the modern list of diseases, the tumor is primarily subdivided according to the form of development:

• Exophytic rectal cancer is a form of a tumor that grows inside the intestinal cavity;
• endophytic form - germinating inside the intestinal wall;
• saucer-shaped - germinating, both in the walls and inside the intestine.

According to histological characteristics, cancers of the rectum are classified according to international classification standards:

1. Adenocarcinoma (can be highly differentiated, moderate and low-grade).
2. Mucosal form of adenocarcinoma (in the form of mucoid, colloidal or mucous cancer).
3. Ring-celled (mucocellular) cancerous tumor.
4. Undifferentiated cancer.
5. A tumor that can not be classified.
6. Squamous cell carcinoma.
7. The glandular squamous cell carcinoma.
8. Basal cell (basaloid) form of cancer, as one of the types of cloacogenic tumor.

In order to later be able to predict the outcome of the disease, the tumors are differentiated in terms of the depth of growth in the tissue, the severity of the edges of the neoplasm, the presence and range of metastasis.

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

To the formations with low differentiation it is possible to carry:

• mucous cancer of the rectum (aka colloidal, or mucosal form of adenocarcinoma) - proceeds with pronounced excretion and secretion of mucous secretion, with the accumulation of it in the form of "lacunae" of various sizes;
• cyst-cell carcinoma (mucocellular) cancer - occurs in young patients, is characterized by turbulent intra-wall growth, has no pronounced outlines (which complicates the assessment of the scope of the operation). Such a tumor more often and quickly gives metastasis, spreading not only through the intestines, but also into the nearest tissues;
• squamous cell carcinoma usually develops in the lower 1/3 part of the rectum, but can also be found in the areas of the large intestine;
• ferruginous cancer of the rectum is considered quite rare and affects the tubular-alveolar glands located in the submucous and subepithelial tissues of the crotch of the rectum.

Also, the tumor is classified according to what part of the rectum it is in. Clinically, the rectum is divided into five sections:

• nameless (rectosigmoid);
• Upper ampullar (10-15 cm);
• medium-most popular (5-10 cm);
• lower ampullar (5 cm);
• perineal.

Cancer of the upper ampulla of the rectum can be found in about 25% of the cases, the middle-most popular cancer in 40% of cases, and cancer of the rectosigmoid part of the rectum - in 30% of cases of pathology.

[6], [7]

Complications

The consequences in the absence of necessary therapy for colorectal cancer may be as follows:

• obstruction of the intestine, obstruction of the neoplasm of the intestinal lumen, difficulties in excreting stool;
• over time - a complete blockage of defecation and gassing, until the rupture of the intestinal wall, peritonitis and death;
• bleeding of the tumor, bleeding, anemia and massive hemorrhage;
• malignant intoxication products of neoplasm decomposition.

All variants of complicated course should be treated without fail. In some cases, urgent or emergency surgery is prescribed, when the question is between the life and death of the patient. For example, this can occur with the development of diffuse bleeding, intestinal obstruction or perforation.

With neglected forms, the above signs can be combined, which naturally increases the risk and worsens the pathology prognosis.

However, there are still some unfavorable consequences of a cancerous tumor, which I would like to dwell in more detail-metastasis, the re-emergence of cancer, the formation of fistula and ascites.

[8], [9], [10], [11]

Metastases

Metastatic spreading is the transfer of particles of a cancerous tumor with blood or lymph fluid to other organs or tissues of the body, as well as the direct germination of the tumor to nearby organs.

Most often, the cancer of the lymphatic vessels passes into the lymphatic system of the abdominal cavity and into the retroperitoneal space, or into the pararectal and inguinal-femoral lymph nodes.

According to the circulatory system, the cancer spreads through the portal vein into the liver, or through the system of the inferior vena cava into the lungs, kidneys, bone system, brain.

Cancer of the rectum with metastases to the liver can reveal itself following symptoms:

• discomfort in the hypochondrium to the right, a feeling of heaviness and constriction (pain in the liver usually appears only at later stages, with stretching of the liver tissue);
• yellowness of the skin, dilated vessels on the abdomen, ascites;
• skin itching in the absence of allergic and other skin diseases.

Cancer of the rectum with metastases to the lungs is manifested as follows:

• there is a regular cough, shortness of breath, heavy breathing;
• there is pain in the chest, a feeling of internal pressure;
• can be observed hemoptysis.

Recurrent colon cancer

Relapse - the re-development of a cancerous tumor - occurs only after surgery to remove a tumor of stage II or III. This condition is found in about 20% of cases. Use simultaneously with the operation of additional treatment methods significantly reduces the risk of recurrence of the tumor.

In most cases, relapses are formed in the first few years after radical treatment of the main cancers. Therefore, for the first 2 years the patient is obliged to regularly be examined by an oncologist, in order to notice dangerous symptoms in time. As a rule, the signs of relapse do not differ from the main symptoms of the tumor, or the latent course of the process predominates.

Fistula with colorectal cancer

The fistula can appear in the perianal region in the form of a small wound-the fistula's passage, with a constant presence of excretions from the saccharic fluid and pus. Allocations provoke sensations of itching and skin irritation.

With good excretion of excretions, the pain may be not pronounced. Pain syndrome increases with the development of the inflammatory process in the skin layer, or during defecation, with prolonged sitting, walking, and coughing. Also, the condition may worsen when the stroke is blocked by granulation or a purulent necrotic plug.

[12], [13], [14],

Ascites in colorectal cancer

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

Symptoms of this condition are:

• frequent heartburn, sour belch;
• poor digestion of food due to increased pressure on the stomach;
• periodic nausea, lack of appetite, increased abdominal circumference;
• Shortness of breath due to ascending pressure on the diaphragm.

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

Symptoms of colorectal cancer are manifold, 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 to suspect a dangerous disease. But we should not forget that cancer often occurs without obvious symptoms, which again indicates the need for periodic routine examination.

[15], [16], [17], [18], [19]