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Adenocarcinoma of the Rectum

Rectum Adenocarcinoma


Presentation

  • We present the case of a 32-year-old woman who, 10 months after abdominoperineal resection and total mesorectal excision for a locally advanced mucinous adenocarcinoma of the rectum, presented with local recurrence and metastases to the breast, spine,[ncbi.nlm.nih.gov]
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]
  • As the cancer grows, it may spread, producing systemic symptoms that affect your whole body, such as fatigue and weight loss.[cancercenter.com]
  • 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]
  • If there are symptoms, the following may indicate colon cancer: Abdominal pain and tenderness in the lower abdomen Blood in the stool Diarrhea, constipation, or other change in bowel habits Narrow stools Weight loss with no known reason Exams and Tests[owensborohealthse3.adam.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% P 0.001[ncbi.nlm.nih.gov]
  • 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]
  • The rectal cancer symptoms that may require attention are fatigue from anaemia and the feeling of tenesmus (wanting to open the bowels when there is no stool there can be particularly distressing, especially when it is painful).[myvmc.com]
Ascitic Fluid
  • This type of seeding produces small nodules throughout the abdomen which irritates tissues and causes the production of large amounts of ascites (fluid). Direct spread from the rectum may attach the tumour to the bladder in males and cause fistulas.[myvmc.com]
Pallor
  • 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]
Short Stature
  • 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]
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]
  • 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]
  • When symptoms do appear, they may include: A change in bowel habits Blood, either bright red, or black and tarry, in the stool Stools that are narrower than usual Diarrhea, constipation, or feeling that the bowel does not empty completely General abdominal[uvahealth.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]
  • 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]
  • She had a three month history of pelvic pain, hematochezia and difficulty defecating. A CT scan revealed a necrotic colorectal mass most consistent with malignancy, which was seen eroding into a large teratoma within the pelvis.[jgo.amegroups.com]
  • She was studied because of abdominal pain located in lower hemiabdomen, as well as hematochezia and diarrhea, these symptoms accompanied by weight loss during the last month.[scielo.isciii.es]
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]
  • Some new stool tests look for genetic material from a cancer rather than for blood. Genetic stool tests are done every 3 years.[msdmanuals.com]
  • […] in stools, /-abdominal mass, /-rectal mass, /-signs of bowel obstruction (nausea, vomiting), /-narrow caliber stools Symptoms /-constipation Prevalence common Blood work /- anemia (microcytic), /-CEA elevated Radiology /-"apple core" lesion (classic)[librepathology.org]
  • Many of these relate to bowel habit changes and include: Constipation, diarrhea, or bowel incontinence Blood in stool or bowel movements, or stools are narrower than usual Feeling that bowel movements do not completely empty the bowel Constipation or[pamf.org]
  • Fecal occult blood test (FOBT): This take-home test looks for blood in stool. A stool sample is examined for traces of blood not visible to the naked eye. Fecal immunochemical test (FIT): This take-home test detects blood proteins in stool.[mdanderson.org]
Dyschezia
  • 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]
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]
Liver Dysfunction
  • For patients with cirrhosis and for those treated with systemic chemotherapy because of the underlying liver dysfunction, a larger future liver remnant size is recommended (40% for cirrhosis, 30% after systemic chemotherapy). 15 Portal Vein Embolization[ascopubs.org]
Neglect
  • This difference is not surprising given that local excision neglects the substantial risk of spread to regional lymph nodes by T1 rectal cancers.[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]
  • 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]
Multiple Colonic Polyps
  • Although endoscopically diagnosed with multiple colonic polyps, presumed to be hamartomas, and an invasive rectal adenocarcinoma, postoperative pathology findings confirmed the rectal cancer and showed multiple colonic adenomas.[ncbi.nlm.nih.gov]
Lymphocytic Infiltrate
  • All available slides were reviewed by a single pathologist, who assessed the depth of invasion; the presence or absence of vascular invasion, lymphatic invasion, perineural invasion, and lymphocytic infiltrate; the mucinous status; and the degree of differentiation[ncbi.nlm.nih.gov]

Treatment

  • The increased use of multimodal therapy for the treatment of Stage II and III disease continues.[ncbi.nlm.nih.gov]
  • Dukes B tumours may also benefit from adjuvant treatment. This decision is made on an individual basis.[myvmc.com]

Prognosis

  • 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.[myvmc.com]
  • Adenocarcinoma of the colon is a virulent disease in children and has a poor prognosis. The reasons for this are explored, and a literature review is included.[ncbi.nlm.nih.gov]

Etiology

  • 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]
  • […] 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]
  • Etiological agents Environmental & dietary factors Chemical carcinogenesis.[de.slideshare.net]
  • The incidence and epidemiology, etiology, pathogenesis, and screening recommendations are common to both colon cancer and rectal cancer. The image below depicts the staging and workup of rectal cancer. Diagnostics.[emedicine.medscape.com]
  • Multiple etiological factors are thought to increase the risk of colorectal cancer. 9 Some investigators have implicated lifestyle changes as the cause for increased incidence of rectal cancer, while others think of genetic factors.[jpma.org.pk]

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]
  • 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]
  • Increasing incidence of rectal cancer in patients aged younger than 40 years: an analysis of the surveillance, epidemiology, and end results database. Cancer 2010; 116: 4354-9. 4.[jpma.org.pk]
  • 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]
  • The incidence and epidemiology, etiology, pathogenesis, and screening recommendations are common to both colon cancer and rectal cancer. The image below depicts the staging and workup of rectal cancer. Diagnostics.[emedicine.medscape.com]
Sex distribution
Age distribution

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]
  • "The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies". CMAJ. 174 (9): 1293–9. doi : 10.1503/cmaj.051299. PMC 1435949. PMID 16636330.[en.wikipedia.org]

Prevention

  • The mucin, in turn, creates a barrier that may, in fact, prevent chemotherapy medications from effectively penetrating cancer cells. In short, the chemo may not be able to get where it needs to be.[verywellhealth.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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