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Carcinoma of the Rectum

Rectal Carcinoma


Presentation

  • Abstract The early and precise diagnosis of linitis plastica-type tumours of the rectum and anal canal is difficult because of their insidious presentation and anaplastic nature.[ncbi.nlm.nih.gov]
Fatigue
  • If the lungs are affected, symptoms may include shortness of breath, difficulty breathing, coughing, pain and/or fatigue.[cancercenter.com]
  • 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]
  • Diarrhea or constipation A feeling that your bowel does not empty completely Blood (either bright red or very dark) in your stool Stools that are narrower than usual Frequent gas pains or cramps, or feeling full or bloated Weight loss with no known reason Fatigue[medlineplus.gov]
Perineal Pain
  • Severe pelvic and perineal pain may be improved by a variety of nerve block procedures. Locally advanced colorectal carcinoma En bloc resection of the cancer with adherent viscera and portions of the abdominal wall is performed.[surgwiki.com]
Hyperthermia
  • PURPOSE: The aim of this study is to evaluate long-term results of preoperative hyperthermia combined with chemotherapy and irradiation (HCR therapy) in patients with carcinoma of the rectum.[ncbi.nlm.nih.gov]
Candidiasis
  • His subsequent course included esophageal candidiasis, Pneumocystis carinii pneumonia, and severe T-lymphocyte abnormalities on immunologic testing, consistent with the acquired immunodeficiency syndrome (AIDS).[ncbi.nlm.nih.gov]
Lymphedema of the Lower Extremity
  • We report a case of a patient with adenocarcinoma of the rectum with inflammatory metastases to the skin who was treated with radiation therapy and subsequently developed lymphatic obstruction with resultant extensive lymphedema of the lower extremities[ncbi.nlm.nih.gov]
Abdominal Pain
  • Herein, we report a 15-year-old boy who presented with rectal bleeding, lower abdominal pain, and diarrhea. His physical examination revealed tender abdomen with hepatomegaly. A hard mass was palpated by digital rectal examination.[ncbi.nlm.nih.gov]
  • 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 main clinical manifestations of disease include changes in bowel habits (diarrhea or constipation), abdominal pain, blood in the stool, anemia and weight loss.[www2.keelpno.gr]
  • pain Unexplained weight loss Although these symptoms may be caused by other, less serious conditions, such as hemorrhoids, ulcers and Crohn's disease, they should be discussed with a doctor.[cancercenter.com]
  • pain or a cramping pain in your lower stomach Bloating or full feeling Change in appetite Weight loss without dieting Fatigue These symptoms do not always mean you have rectal cancer.[mdanderson.org]
Rectal Bleeding
  • This case highlights the need for awareness of colorectal carcinomas and their invasive nature in the differential diagnosis of rectal bleeding and diarrhea in adolescents.[ncbi.nlm.nih.gov]
  • It is moreover one of the varieties to which a great deal of attention has been devoted in an attempt to control cancer, since a change in bowel habit and rectal bleeding have been emphasized repeatedly in the past decade as the prime warning symptoms[nejm.org]
  • If early-stage colorectal cancer does cause symptoms, they most often include: Rectal bleeding, either bright or dark red in color Narrow stools Tenesmus, which is the feeling that you have to empty your bowel but nothing passes Anemia caused by iron[cancercenter.com]
  • Clinical manifestations of SCC of the rectum are similar to those of adenocarcinoma: change in bowel habits, pain, tenesmus and rectal bleeding, anorexia and weight loss.[wjso.biomedcentral.com]
Rectal Mass
  • The lesions appeared as indurated, ulcerated rectal masses that resembled carcinoma on endoscopic examination. Deep mucosal biopsy results demonstrated no malignancy and barium sulfate crystals in tissue macrophages.[ncbi.nlm.nih.gov]
  • Figure 1 Rectal contrast was extravasating outside the bowel lumen and filling the teratoma consistent with a fistulous communication Figure 2 Colonoscopy view of the rectal mass eroding into the lumen Figure 3 Colonoscopy view of the rectal mass eroding[jgo.amegroups.com]
  • Abdominal CT scan showed an irregular rectal mass with bulky pelvic and retroperitoneal adenopathy. Colonoscopy revealed one large circumferential nonobstructing lesion in the rectum.[karger.com]
Nausea
  • Symptoms of bowel obstruction - nausea, vomiting. Weight loss. Pathogenesis - see pathogenesis of colorectal carcinoma. Clinical - serum: CEA elevated. [1] CA19-9 elevated.[librepathology.org]
  • If the liver is affected, symptoms may include nausea, fatigue, swelling of the feet and hands, increased abdominal girth and/or jaundice.[cancercenter.com]
  • […] constipation A feeling that your bowel does not empty completely Blood (either bright red or very dark) in your stool Stools that are narrower than usual Frequent gas pains or cramps, or feeling full or bloated Weight loss with no known reason Fatigue Nausea[medlineplus.gov]
Hematochezia
  • A 40-year-old woman with hematochezia and change in bowel habits was studied. The main laboratory finding was a mild anemia. A barium enema and a proctoscopy revealed a rectal neoplasm at eight cm from the anal verge.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
Tongue Ulcer
  • Other asymptomatic metastatic lesions were discovered only after the histology report suggested that the tongue ulcer biopsy was metastatic in origin.[ncbi.nlm.nih.gov]
Decrease in Height
  • Major LARS increased significantly with decreasing tumour height from one fifth in sigmoid carcinoma to 90% in low rectum carcinoma.[ncbi.nlm.nih.gov]
Withdrawn
  • SUBJECTS: 186 consecutive patients (between January 1983 and August 1990): 21 were withdrawn because of protocol violation leaving 165 for analysis.[ncbi.nlm.nih.gov]
Meningism
  • The case is described of a middle-aged man whose rectal carcinoma presented with meningitis, due to a fistula into the spinal theca.[ncbi.nlm.nih.gov]

Workup

  • 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[slideshare.net]
  • Eleven patients had no further workup aside from the routine evaluation. Fifty-six patients were treated with curative intent.[jamanetwork.com]
  • Classically the patients will have similar workup (i.e., Pelvic MRI, CT scan of the chest, abdomen and pelvis) to other rectal cancers until the histology is confirmed. Some authors suggest routine bronchoscopy to rule out a primary SmCC.[colorectal-cancer.imedpub.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]

Treatment

Prognosis

  • However, no significant differences were observed in the postoperative prognosis for cases with no lymph node metastasis and/or with tumors limited to the muscularis propria between these two groups.[ncbi.nlm.nih.gov]
  • 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]

Etiology

  • Though its etiology and pathogenesis remains unclear, it has been associated with chronic inflammation and infections.[karger.com]
  • Etiological agents Environmental & dietary factors Chemical carcinogenesis.[slideshare.net]
  • Discussion The etiology of extrapulmonary small cell carcinoma remains unknown.[spandidos-publications.com]
  • 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]

Epidemiology

  • A weaker association between S japonicum infection and colorectal neoplasia has been proposed, although reports are limited to case reports, a case series, and epidemiologic studies.[ncbi.nlm.nih.gov]
  • The data extrapolated from Survey of Epidemiology and End Results (SEER) reported several patient characteristics associated with colorectal NEC (1367 patients) as compared to colorectal adenocarcinoma.[colorectal-cancer.imedpub.com]
  • References Giovannucci E, Wu K: Cancers of the colon and rectum; in Schottenfeld D, Fraumeni JF Jr (eds): Cancer Epidemiology and Prevention, 3rd ed. New York, Oxford University Press, 2006. Dyson T, Draganov PV: Squamous cell cancer of the rectum.[karger.com]
Sex distribution
Age distribution

Pathophysiology

  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 126. National Cancer Institute website.[mountsinai.org]
  • Univariate sub-group analyses showed that the treatment effect for surgery alone vs preoperative radiotherapy plus surgery was not significant in patients whose cancer (TNM stage I to IV) was located between 10.1 cm and 15 cm from the anal verge. [5] Pathophysiology[emedicine.medscape.com]
  • Pathophysiology The transformation of normal rectal or colonic epithelium to a precancerous lesion (adenomas) and ultimately to invasive carcinoma requires an accumulation of genetic mutations either somatic (acquired) and/or germline (inherited).[ncbi.nlm.nih.gov]
  • To bear in mind that the emergency surgeon should have a strong oncologic background or that the specialised colorectal surgeon should have a strong background of surgical pathophysiology, emergency surgery and damage control philosophy.[wjes.biomedcentral.com]

Prevention

  • CONCLUSION: The present results suggested that pre-operative intermediate-dose radiotherapy is effective in preventing pelvic recurrence in rectal cancer patients with acceptable toxicities.[ncbi.nlm.nih.gov]
  • We believe that more multicentric studies are needed to develop a screening tool for the prevention of SCC of the colon. Statement of Ethics The authors have no ethical disclosures. Disclosure Statement There are no conflicts of interest.[karger.com]
  • Prevention The guidelines for the prevention and early detection of the disease in the general population include colonoscopy from the age of 50 years and thereafter every 10 years, or sigmoidoscopy every 5 years.[www2.keelpno.gr]

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