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2.1
Adenocarcinoma of the Rectum
Rectum Adenocarcinoma

Presentation

The authors present the case of a 17-year-old girl with tuberous sclerosis (TS) who presented with symptoms of intussusception. [ncbi.nlm.nih.gov]

Here, we present a case of synchronous rectal SCC and adenocarcinoma. CASE REPORT A 45-year-old man presented with a 1-week history of haematochezia. His medical history was unremarkable, except a 4-kg weight loss in the past 3 months. [academic.oup.com]

SRCC presented extensive lymphatic spread, more frequently with multiple metastatic sites and high risk of peritoneal metastases 12. [nature.com]

Tonsillar metastasis from a renal cell carcinoma presenting as a quinsy. J Laryngol Otol 1997; 111: 379-80. [3] Vasilevsky CA, Abou-Khalil S, Rochon L, Frenkiel S, Black MJ. Carcinoma of the colon presenting as tonsillar metastasis. [em-consulte.com]

Entire Body System

  • Weight Loss

    We describe a 13-year-old girl with short stature and delayed puberty who presented with hematochezia and recurrent abdominal pain for 1 year, and progressive weight loss for 6 months. Per rectal examination was suggestive of a rectal mass. [ncbi.nlm.nih.gov]

    Pancreas : Unintended weight loss, back and stomach pain, oily or light-colored stools, and itchy skin. Colon : A sensation that the bowels are full, bloody stool, rectal bleeding, stomach pain, and unexplained weight loss. [medicalnewstoday.com]

    As the cancer grows, it may spread, producing systemic symptoms that affect your whole body, such as fatigue and weight loss. [cancercenter.com]

    This was associated with a loss of appetite and a marked weight loss. She had no significant medical illnesses or family history of malignancies. [liebertpub.com]

  • Fatigue

    If the lungs are affected, symptoms may include shortness of breath, difficulty breathing, coughing, pain and/or fatigue. [cancercenter.com]

    There were significant differences in favor of SC for grade 3 AE: radiation dermatitis (0% vs 5.6%, P = 0.003), proctitis (0% vs 3.7% P = 0.016), nausea (0% vs 3.1%, P = 0.029), fatigue (0% vs 3.7%, P = 0.016) and grade 3/4 diarrhea rates (1.3% vs 14.2% [ncbi.nlm.nih.gov]

    Generalized fatigue: You feel more tired than usual, even if you're sleeping well. [verywellhealth.com]

    […] does not go away A change in size or shape of your stool Discomfort or urge to have a bowel movement when there is no need Abdominal pain or a cramping pain in your lower stomach Bloating or full feeling Change in appetite Weight loss without dieting Fatigue [mdanderson.org]

    Anemia, fatigue, and at times loss of breath. Incomplete secretion of stool. Unexplained weight loss. Causes No cancer grows overnight. Carcinoma rectum is also a slow process. In its initial stage or the precancerous stage, it is known as polyps. [medanta.org]

  • Pallor

    Symptoms and Types In addition to the black, tarry appearance of the feces, ferrets with melena may demonstrate some of the following: Anorexia Dehydration Weight loss Hypersalivation Vomiting Regurgitation Pallor of the mucous membranes Poor haircoat [petmd.com]

    She had marked pallor and she was obese. On per-abdomen examination, the abdomen was soft and a Pfannenstiel scar of previous surgery was seen. On per vaginal examination (PV), a fixed mass on the posterior portion of the vault was noted. [ispub.com]

    Signs Pallor Abdominal mass PR mass Jaundice Nodular liver Ascites Rectal metastasis travel along portal drainage to liver via superior rectal vein as well as systemic drainage to lung via middle inferior rectal veins. 12. [de.slideshare.net]

    The hydration status of the patient was adequate, she had mild pallor and abdominal examination was essentially normal. [wjso.biomedcentral.com]

    <ul><li>Signs </li></ul><ul><ul><li>Pallor </li></ul></ul><ul><ul><li>Abdominal mass </li></ul></ul><ul><ul><li>PR mass </li></ul></ul><ul><ul><li>Jaundice </li></ul></ul><ul><ul><li>Nodular liver </li></ul></ul><ul><ul><li>Ascites </li></ul></ul><ul> [slideshare.net]

Gastrointestinal

  • Constipation

    A 36-year-old female presented with a 1-year history of constipation and bleeding per rectum. Colonoscopy revealed an ulcerated mass 2 cm above the anal verge. After multiple biopsies an abdomino-perineal resection was performed for the rectal mass. [ncbi.nlm.nih.gov]

    Common local symptoms include: Constipation Diarrhea Alternating diarrhea and constipation, or other changes in bowel habits Rectal bleeding or blood in the stool Abdominal bloating, cramps or discomfort A feeling that the bowel doesn't empty completely [cancercenter.com]

    Her complaints on application were epigastric pain, burning, and constipation. [hindawi.com]

    The symptoms of rectal cancer to watch out for include any change in bowel habits such as constipation, narrowing of the stools or diarrhea and any blood in the stools. [annapoliscolon.com]

  • Hematochezia

    We describe a 13-year-old girl with short stature and delayed puberty who presented with hematochezia and recurrent abdominal pain for 1 year, and progressive weight loss for 6 months. Per rectal examination was suggestive of a rectal mass. [ncbi.nlm.nih.gov]

    Clinical signs consist of tenesmus, hematochezia, dyschezia, rectal bleeding unassociated with defecation, and polyp prolapse. Also vomiting, diarrhea and weight loss can occur. Leiomyoma is the second most common benign tumor. [vin.com]

    Herein, we report a case of an 82-year-old female who presented with a 2-month history of worsening abdominal pain, hematochezia, and bilateral inguinal lymphadenopathy with right-sided purulent discharge. [karger.com]

    The presence of hematochezia is six-times greater in a LGIB than with a UGIB.[5] Occasionally, a person with a LGIB will not present with any signs of internal bleeding, especially if there is a chronic bleed with ongoing low levels of blood loss. [en.wikipedia.org]

    The patient applied because of rectal prolapsus and hematochezia to our hospital’s emergency unit and as the examination revealed a prolapsed rectal tumor, an urgent Computerized Tomography (CT) was performed. [digestive-diseases.imedpub.com]

  • Blood in Stool

    Some changes in bowels habits that may be considered colon cancer signs include: Change in frequency of bowel movements Constipation Change in consistency of stool (loose or watery stools) Blood in stools (either as bright red spots or dark tar-like stools [cancercenter.com]

    Blood in the stool, even blood that cannot be seen by the naked eye (occult blood—see Stool Occult Blood Tests ), can be a sign of cancer. Usually, the stool is tested every year. [msdmanuals.com]

    Mayo Clinic's approach to rectal cancer care Symptoms Common symptoms include: A change in your bowel habits, such as diarrhea, constipation or more-frequent bowel movements Dark or red blood in stool Mucus in stool Narrow stool Abdominal pain Painful [mayoclinic.org]

    Fecal occult blood test: A fecal occult blood test (FOBT) finds blood in your stool that you may not see with the naked eye or confirms that it is actually blood in the stool that you may have seen. [verywellhealth.com]

    stools Colicky abdominal pain due to obstruction Rectum (50%) and sigmoid (30%) Hematochezia ↓ Stool caliber (pencil-shaped stool) Rectal pain Tenesmus Flatulence with involuntary stool loss Symptoms according to stage of disease Colorectal cancer must [amboss.com]

  • Rectal Pain

    At age 44, he presented to his primary care physician with a few-week history of intermittent rectal pain. He had no change in his bowel habits. [omicsonline.org]

    […] due to obstruction Rectum (50%) and sigmoid (30%) Hematochezia ↓ Stool caliber (pencil-shaped stool) Rectal pain Tenesmus Flatulence with involuntary stool loss Symptoms according to stage of disease Colorectal cancer must be ruled out in a patient presenting [amboss.com]

    The symptomatology is very similar to the other colon tumors, and is characterized by hematochezia, abdominal or rectal pain, occurrence of complete rectum prolapse etc.[ 49 ]. [intechopen.com]

  • Fecal Incontinence

    A study on 74 dogs documented a 78% complication rate: permanent fecal incontinence (55%), diarrhea (43%), tenesmus (31%), stricture (22%) and rectal bleeding (11%) were the most common. [vin.com]

    WHAT IS FECAL INCONTINENCE? Fecal incontinence (also called anal or bowel incontinence) is the impaired ability to control the passage of gas or stool. This is a common problem, but often not discussed due to embarrassment. [fascrs.org]

Eyes

  • Lacrimation

    The history, examination and investigations were suggestive of a benign lacrimal gland tumor. The tumor and lacrimal gland were resected. [ijo.in]

Psychiatrical

  • Aggressive Behavior

    Due to its aggressive behavior, early suspicion is crucial to avoid delayed diagnosis and treatment. [elsevier.es]

  • Euphoria

    The result is what is usually referred to as a "high" that ranges between the mild stimulus caused by nicotine to the intense euphoria caused by heroin, cocaine and methamphetamines. [68] Inhaling smoke into the lungs, no matter the substance, has adverse [en.wikipedia.org]

Urogenital

  • Urinary Retention

    In two of the three cases reported the presenting symptom was urinary retention caused by obstruction of the urethra. In the third case the presenting symptom was priapism. [jamanetwork.com]

    Anastomotic leaks after AR occurred in 5% (16 of 291) and overall transient urinary retention in 15%. Eleven percent of patients had a wound infection (abdominal and perineal wound, 30-day, purulence, or cellulitis). [ncbi.nlm.nih.gov]

Workup

Following pathology confirmation of colorectal cancer as biopsied endoscopically, a metastatic workup is undertaken. [bccancer.bc.ca]

CT scan Part of routine workup of patients Useful in identifying enlarged pelvic lymph-nodes and metastasis outside the pelvis than the extent or stage of primary tumor Limited utility in small primary cancer Sensitivity 50-80% Specificity 30-80% Ability [de.slideshare.net]

Patients with biopsy proven rectal cancer were included in this study after a workup consisting of sigmoidoscopy/colonoscopy and a contrast enhanced computed tomography (CT) of the abdomen and pelvis. [jgo.amegroups.com]

The image below depicts the staging and workup of rectal cancer. Diagnostics. Staging and workup of rectal cancer patients. Signs and symptoms Bleeding is the most common symptom of rectal cancer, occurring in 60% of patients. [emedicine.medscape.com]

Proctoscopy

  • Rectal Ulcer

    Lisa KJ, Lin YJ, Orkun BA (1997) The best operation for rectal prolapse. Surg Clin North Am 77: 49-70. Karanjia ND, Rutter KRP (1994) Solitary rectal ulcer and rectal prolapse. Curr Pract Surg 6: 59-64. [digestive-diseases.imedpub.com]

Treatment

If the pathologist confirms that a rectal cancer is in the early stages, surgery may be all that is required for optimal treatment of the cancer. [annapoliscolon.com]

Radical resection is the more definitive surgical treatment of T1 rectal cancers. [ncbi.nlm.nih.gov]

The following are treatment options for stage 1 rectal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. Surgery Surgery is the main treatment for stage 1 rectal cancer. [cancer.ca]

Prognosis

If you have colorectal cancer, you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. [cancer.ca]

In conclusion, SRCC was an independent predictor of poor prognosis in stage III RC patients, but not in stage II. In the PRT setting of locally advanced RC, SRCC patients had significantly worse prognosis. [nature.com]

The prognosis of IIIA approaches that of IIB etc. This is not yet in widespread use). The advent of the newer chemotherapy agents has made a significant impact on rectal cancer prognosis. [healthengine.com.au]

Etiology

[…] the anal canal (not rectal adenocarcinomas with downward spread) Terminology Also known as perianal adenocarcinoma or perianal gland adenocarcinoma Epidemiology 5% of anorectal malignancies Usually diagnosed in the seventh decade; more common in men Etiology [pathologyoutlines.com]

[…] and chronic cough may also play a role in the etiology [2]. [digestive-diseases.imedpub.com]

This article describes a patient with a large squamous carcinoma of the anus along with a large adenocarcinoma of the rectum, and also discusses a current review of the etiology and treatment of squamous carcinoma of the anus. [ncbi.nlm.nih.gov]

Though its etiology and pathogenesis remains unclear, it has been associated with chronic inflammation and infections. [karger.com]

Etiology Predisposing factors Colorectal adenomas (see colonic polyps) Family history Hereditary syndromes Familial adenomatous polyposis: 100% risk by age 40 Hereditary nonpolyposis colorectal cancer (HNPCC): 80% progress to CRC. [amboss.com]

Epidemiology

LIMITATIONS: The study was limited by its retrospective nature and the information available in the Surveillance, Epidemiology, and End Results database. [ncbi.nlm.nih.gov]

Službeni glasnik RS, br. 1106914 Abreu, M.H., Matos, E., Pocas, F.C., Rocha, R., Pinto, J. (2011) Rectal Cancer Epidemiology. u: [ur.] Rectal Cancer - A Multidisciplinary Approach to Management. Dr. [scindeks.ceon.rs]

5][6] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Definition / general Rare adenocarcinoma that primarily involves the anal canal (not rectal adenocarcinomas with downward spread) Terminology Also known as perianal adenocarcinoma or perianal gland adenocarcinoma Epidemiology 5% of anorectal malignancies [pathologyoutlines.com]

J Natl Cancer Inst 100: 1184-7 31 Pera M, Manterola C, Vidal O, Grande L (2005) Epidemiology of esophageal adenocarcinoma. J Surg Oncol 92: 151-9. [codes.iarc.fr]

Pathophysiology

Collision tumors have an idiopathic pathophysiology and in fact "accidental meeting" is accepted by many authors. [ncbi.nlm.nih.gov]

The kidney: Physiology and pathophysiology, New York: Ravan Press, 1491-1525 [ PM ] [ EČ ][ GS ] Kraut, J.A., Madias, N.E. (2010) Metabolic acidosis: pathophysiology, diagnosis and management. Nature reviews. [scindeks.ceon.rs]

Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 126. National Cancer Institute website. [owensborohealthse3.adam.com]

Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 126. Lawler M, Johnston B, Van Schaeybroeck S, et al. Colorectal cancer. [pennstatehershey.adam.com]

Prevention

The goal is to identify the potential for disease or the condition early when it is easier to prevent or cure. [annapoliscolon.com]

[…] undergoing colorectal surgery despite routine efforts to prevent them. [centerwatch.com]

CAN RECTAL CANCER BE PREVENTED? Rectal cancer is preventable. Nearly all rectal cancer develops from rectal polyps, which are benign growths on the rectal wall. [fascrs.org]

Prevention If there is a family history of developing such cancer, one should get regular screening tests to protect themselves from the disease. Other prevention measures include: Quitting smoking. Limiting alcohol consumption. [medanta.org]

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