Malignant neoplasm in the rectum and its prevention. The first symptoms of rectal cancer Wed rectum microbial 10

It starts at the level of the 3rd sacral vertebra and ends with the anus in the perineum. Its length is 14-18 cm, the diameter varies from 4 cm at the beginning to 7.5 cm in its widest part, located in the middle of the intestine, then the rectum again narrows to the size of a gap at the level anus. Around the anus subcutaneous tissue there is a muscle - external sphincter of the anus, blocking the anus. At the same level, there is an internal anal sphincter. Both sphincters close the intestinal lumen and hold stool in it.

Incidence

Rectal cancer occupies the 3rd place in the structure of the incidence of malignant neoplasms of the gastrointestinal tract, accounting for 45% of intestinal neoplasms and 4-6% in the structure of malignant neoplasms of all localizations.

Risk factors

The factors contributing to the occurrence of rectal cancer, many authors include a long stay of feces in the rectal ampulla, chronic constipation, bedsores and ulcers. Obligate precancerous diseases of the rectum include polyps (adenomatous, villous) with a high probability of transformation into cancer. Certain factors increase the risk of developing the disease. These include:

Histological picture

In rectal cancer, the following histological forms are observed: glandular cancer (adenocarcinoma, solid cancer, cricoid, mixed, scirr) is more often observed in the ampullar region of the rectum; Rarely in the rectum (and not in the anus) may be squamous cell carcinoma or melanoma, which is likely due to the presence of ectopic transitional epithelium or melanocytes.

staging

Russian classification:

• Stage I - a small, clearly delimited movable tumor or ulcer up to 2 cm in greatest dimension, affects the mucous membrane and submucosal layer of the intestine. There are no regional metastases.
• Stage II - a tumor or ulcer up to 5 cm in size, does not extend beyond the intestine, occupies no more than half the circumference of the intestine. There are no metastases or with the presence of single metastases in regional lymph nodes located in the pararectal tissue.
• Stage III - a tumor or ulcer more than 5 cm in greatest dimension, occupies more than a semicircle of the intestine, germinates all layers of the intestinal wall. Multiple metastases in regional lymph nodes.
• Stage IV - an extensive, decaying, immobile tumor that grows into the surrounding organs and tissues. Numerous metastases to regional lymph nodes. Distant (hematogenous) metastases.

International classification of rectal cancer according to the TNM system :

The symbol T contains the following gradations:

• TX - insufficient data to evaluate the primary tumor;
• Tis - preinvasive carcinoma;
• T1 - the tumor infiltrates the mucous membrane and submucosal layer of the rectum;
• T2 - the tumor infiltrates the muscle layer, without limiting the mobility of the wall of the intestinal wall;
• T3 - a tumor that grows through all layers of the intestinal wall with or without infiltration of adrectal tissue, but does not spread to neighboring organs and tissues.
• T4 - a tumor that grows into the surrounding organs and tissues.

The symbol N indicates the presence or absence of regional metastases.

• NX - insufficient data to evaluate regional lymph nodes
• N0 - no involvement of regional lymph nodes
• N1 - metastases in 1ן regional lymph nodes
• N2 - metastases in 4 or more regional lymph nodes

The symbol M indicates the presence or absence of distant metastases.

• M0 - no distant metastases
• M1 - with the presence of distant metastases.

Clinical picture

The most common and constant symptom of rectal cancer is bleeding. It occurs both in the early and later stages and is observed in 75-90% of patients. The intensity of intestinal bleeding is insignificant, and most often they occur in the form of impurities or blood in the feces, or dark clots, are not constant. Unlike bleeding hemorrhoids, in cancer, the blood precedes the stool or is mixed with the stool. As a rule, profuse bleeding does not occur, and anemia in patients is more often detected in the later stages of the disease.

With rectal cancer, mucus and pus are secreted from the anus along with blood. This symptom usually appears in the later stages of the disease and is due to the presence of concomitant perifocal inflammation.

The second most common symptom of cancer is different kinds disorders of bowel function: changes in the rhythm of defecation, the shape of feces, diarrhea, constipation and incontinence of feces and gases. The most painful for patients are frequent false urges to defecate (tenesmus), accompanied by secretions not a large number blood, mucus and pus. After defecation, patients do not feel satisfaction, they have a feeling foreign body in the rectum. False urges can be observed from 3-5 to 10-15 times a day. As the tumor grows, especially with stenosing cancer of the upper rectum, constipation becomes more persistent, bloating is determined, especially in the left abdomen. Initially, these symptoms are intermittent, then they become permanent.

Due to the further growth of the tumor and the addition of inflammatory changes, partial or complete low intestinal obstruction occurs. At the same time, patients experience cramping abdominal pain, accompanied by gas and stool retention, vomiting occurs periodically. Pain in patients with rectal cancer, they appear with local spread of the tumor, especially when it moves to surrounding organs and tissues. Only in cancer of anorectal localization, due to the involvement of the rectal sphincter zone in the tumor process, pain is the first symptom of the disease at an early stage. At the same time, patients tend to sit on only one half of the buttocks - a “symptom of a stool”.

Violation general condition patients (general weakness, fatigue, anemia, weight loss, pallor of the integument) is due to daily blood loss, as well as tumor intoxication in the later stages of the disease. Of decisive importance in the diagnosis are a full examination by a specialist doctor and the results of a study of biopsy and cytological material.

Diagnostics

Rectal cancer refers to neoplasms of external localization, but, nevertheless, the percentage of errors and neglect in this form of cancer does not tend to decrease. Diagnosis of rectal cancer should be comprehensive and include:

• digital examination of the rectum,
• endoscopic methods - sigmoidoscopy with biopsy, fibrocolonoscopy (to exclude concomitant polyps or primary multiple lesions of the overlying colon),
• radiological methods - irrigography, plain radiography of the abdominal cavity, chest,
• Ultrasound and computed tomography - for diagnosing the spread of a tumor to neighboring organs, determining metastases in organs abdominal cavity(liver) and lymph nodes
• laboratory methods - general and biochemical blood tests, blood tests for oncomarkers (to determine the prognosis of treatment and further monitoring).

Treatment

The surgical method is leading in the treatment of rectal cancer. AT last years actively apply complex treatment: irradiation in the form of preoperative exposure, after which the surgical removal of the intestine with the tumor is performed. If necessary, in postoperative period prescribe chemotherapy.

The question of choosing the type of surgery for rectal cancer is very complex and depends on many factors: the level of the location of the tumor, its histological structure, the degree of spread of the tumor process and the general condition of the patient. The final volume and type of surgical intervention are determined in the operating room after laparotomy and a thorough revision of the abdominal organs.

The widespread point of view that the most radical operation for rectal cancer is abdominoperineal extirpation is currently hardly acceptable both from an oncological standpoint and from the point of view of possible subsequent social and labor rehabilitation.

The main types of operations on the rectum:

• anterior resection of the rectum with restoration of its continuity by applying an anastomosis ( partial removal rectum when the tumor is located in its upper section);
• low anterior resection of the rectum with anastomosis (almost complete removal of the rectum with preservation of the anal sphincter when the tumor is located above 6 cm from the anus).
• abdominal-perineal extirpation of the rectum (complete removal of the rectum and obturator apparatus with the imposition of a single-barrel colostomy in the left iliac region);

Low anterior resection (coloproctology) of the rectum is performed with the imposition of an anastomosis (fistula) using a mechanical suture, open or laparoscopically. It is used in case of cancer of the rectum, with localization of the tumor in the lower parts of the rectum, at a distance of 4-8 cm from the anal canal. Advantages this method: no lifelong colostomy. Currently, patients with low-grade rectal cancers rarely undergo anastomoses, operations end without anastomosis formation. Patients get a colostomy they live with. The presence of a colostomy prevents patients from leading a socially active life, limits their daily activities, a colostomy causes great moral harm, patients live in constant stress. Performing low anterior resections with a mechanical suture will allow patients to ordinary life, will save them from all the problems associated with the stoma. It requires modern electrosurgical equipment: an ultrasonic scalpel, a modern bipolar coagulator, as well as the availability of modern staplers in the departments of coloproctology (circular).

Forecast

The prognosis for rectal cancer depends on the stage of the disease, the form of growth, the histological structure of the tumor, the presence or absence of distant metastases, the radicalism of the intervention performed. According to the generalized data of domestic and foreign authors, the overall 5-year survival rate after radical surgical treatment rectal cancer ranges from 34 to 70%. The presence of metastases in regional lymph nodes reduces the 5-year survival to 40% versus 70% without metastases. Five-year survival rate after surgical treatment of rectal cancer, depending on the stage of the tumor process, is: at stage I - up to 80%, at stage II - 75%, at stage IIIa - 50%, and at stage IIIb - 40%.

Notes

see also

Links

Wikimedia Foundation. 2010 .

AT modern system health care, it is customary to use the unified international classification of diseases (abbreviated name - ICD). The classification is designed to systematize and analyze data on all known diseases worldwide. The international classification provides a standardized approach in the field of diagnostics and is used for international comparability of data. The classification is based on statistical data, which are periodically reviewed at the international level. At this stage, the classification of diseases of the 10th revision (ICD-10 or ICD-10) is used in medicine.

Principles of classification

The ICD is an international document in which various diseases are coded in letters and numbers. Thus, each diagnosis has its own specific standard code. Data on diseases in the ICD-10 are grouped according to the following principle:

1. epidemic type;
2. general;
3. local;
4. related to developmental disorders;
5. injuries caused by external factors.

ICD-10 has 21 systematized classes that include certain health problems. Each class is subdivided into specific three-character headings, which in turn may include additional subheadings. Four-digit subcategories, which are used to specify data for one disease, are formed by adding a fourth digit to the already existing three-digit code.

Oncology of the anorectal region

Today, oncological diseases are the most important problem of mankind.

Rectal cancer occupies one of the leading places among oncological diseases in terms of the prevalence and severity of the course, especially among the elderly.

Every year, cases of detection of malignant neoplasms in the rectum are becoming more frequent, during the diagnosis of which specialists also use the ICD-10.

Colon cancer in this international system belongs to the 2nd class called “Class II. Neoplasms". It is customary to classify all diseases associated with neoplasms of a malignant and benign type, which are grouped according to the principle of localization.

The second class code corresponds to the designation C00-D48. The diagnosis of "rectal cancer" also has its own code, located under the heading "Malignant neoplasms of the digestive system". One of its subcategories is "Malignant neoplasm of the rectum", code C20.

When classifying cancerous tumors in the anorectal zone, code C21 is used. normative document ICD-10, which systematizes all malignant tumors in the anus at their location:

• C21.0 - cancerous tumors in the anus with unspecified localization;
• C21.1 - malignant tumors in the cavity of the anal canal;
• C21.2 - malignant formations of the cloacogenic region;
• C21.8 - extensive lesion malignant tumor rectum, beyond the above areas.

It is this classification that is used in the process of diagnosing tumor neoplasms, when cancer is associated with damage to the wall of the rectum and the anus.

Symptoms of the disease

To assign an appropriate code to a disease, it is necessary to complex diagnostics taking into account characteristic features. Cancer in the rectal cavity is quite difficult to detect at the initial stage - it does not have pronounced symptoms. With the growth of the tumor, the symptoms gradually increase, and the cancer begins to spread throughout the body by metastasis, which is typical for the later stages of the disease.

For rectal cancer, the following symptoms are characteristic:

• pain in the abdomen;
• sensation of the presence of a foreign body in the intestinal cavity;
• discomfort during emptying;
• increased constipation;
• fecal incontinence and increased gas formation;
• false urge to defecate;
• discharge from the anus in the form of blood or mucus.

Symptoms that provoke cancer in the anorectal region may be similar to manifestations of other diseases associated with disorders in the bowel or diseases in the field of proctology. Therefore, only after the necessary tests and studies can confirm the presence of rectal cancer. If you notice similar symptoms, you should immediately undergo an examination for the presence of neoplasms in the intestine, because early diagnosis improves the effectiveness of subsequent treatment.

Diagnosis of the disease

To confirm suspicions of a cancerous tumor in the rectum and make an appropriate diagnosis, designated as an ICD-10 code, a number of necessary studies and analyzes are carried out.

The necessary tests to detect cancer even at an early stage include biochemical analysis blood. Blood is examined for the content of a tumor marker - a substance produced by cancer cells. For patients with a malignant tumor in the anorectal zone, the presence of an increased content of the cancer-embryonic antigen in the blood is characteristic. The detection of such a marker increases the likelihood of a tumor in the rectal cavity. But to confirm the diagnosis and determine the location of its localization, it is necessary to use other methods of studying the problem area.

To the main modern methods, allowing you to carefully examine the rectum from the inside and determine the condition of the mucous membrane of its wall, include:

1. . Introduction through the anus of a special tube with a camera located at the end and allowing you to visually detect possible deviations;
2. irrigoscopy. Finding the tumor and determining its exact localization. It is carried out by X-ray examination of the intestine using a special contrast;
3. ultrasound procedure. Ultrasound is also used to detect neoplasms and possible metastases in the lymph nodes.

If the tumor is not deep, it can be detected with a digital examination of the rectum through the anus. In this case, the disease code will refer to the three-digit ICD-10 rubric with the designation C21, which includes tumors of the anus and anal canal.

Oncology confirmation

In order to finally diagnose cancer and classify the tumor as a malignant neoplasm according to ICD-10, it is necessary to analyze the tissues of the detected neoplasm for the presence of cancer cells. Such a study is carried out using a biopsy.

This is a procedure during which suspicious neoplasm tissues are taken for further analysis under a microscope. A biopsy allows you to accurately confirm cancer and is divided into the following types of methods:

• excisional biopsy. This type of procedure involves harvesting the entire tumor;
• incisional biopsy. It implies the collection of only a small part of a suspicious neoplasm.

In addition to the above studies, an MRI is often performed. Tomographic analysis of tumor-affected areas makes it possible not only to confirm cancer, but also to assess the dynamics of its spread. MRI also monitors the effectiveness cancer therapy by tracking the shrinkage of the tumor. If the tumor continues to grow, then it is necessary to change the prescribed course of therapy.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

Malignant formation in the rectum and its prevention

Posted By: admin May 05, 2016

The digestive organs are often subject to dysfunctional processes in the human body. This is due to a violation of the regimen and quality of the substances supplied to the digestive system, as well as due to the influence of external negative factors on the body. As a result, a person may experience serious illness which has a high mortality rate. We are talking about a malignant process that occurs in any organ.

The rectum (rectum) is the final section of the digestive tract, which originates from the sigmoid colon and is located before the anus. If we take into account the oncology of the large intestine as a whole, then rectal cancer (Cancerrectum) occurs in up to 80% of cases. Cancer rectum, according to statistics, affects the female half of the population, although the difference with this pathology in men is small. AT international classification diseases (mcb) 10 views, rectal cancer occupies codemcb -10 C 20, colon kodommkb -10 C 18 and codemkb -10 C 18.0 - caecum. Kodymkb -10, intestinal oncological pathologies are taken from mkb - O (oncology) in accordance with:

• The primary and localization of the tumor;
• Recognizability (the neoplasm may be of an indefinite and unknown nature D37-D48);
• Near morphological groups;

Rectal cancer (mcb -10 C 20) often develops in adulthood, that is, after 60 years, but often, the oncoprocess affects people in the reproductive period life cycle. In most cases, the pathology is observed in the ampulla of the rectum, but there is a localization of the neoplasm above the ampulla of the intestine, in the anus-perineal part and in the sigmoid rectum.

Causes (Cancerrectum)

Cancer of the rectum (µb -10 C 20) occurs mainly after long-term precancerous pathologies. There is a version of a hereditary predisposition to the oncology of the rectum. The remaining scars after injuries and operations can also degenerate into a malignant formation. The consequences of congenital anomalies of the large intestine is one of the causes of rectal cancer. People suffering from chronic hemorrhoids, anal fissures, are more likely to be at risk for the occurrence of an oncological process in the rectum. Infectious diseases, such as dysentery, as well as chronic constipation and inflammatory processes in the organ (proctitis, sigmoiditis) with the formation of an ulcer or bedsore, may be factors that cause rectal cancer.

Precancerous conditions of the rectum

Polyposis(adenomatous, villous polyps). Such formations are observed in both children and adults. Polyps, both in a single form and in multiple, develop from epithelial tissue in the form of oval formations, which may have a wide base or a thin stalk. Male patients often suffer from polyposis and this pathology has a hereditary factor. Microscopic examination of the affected area reveals hyperplasia of the intestinal mucosa, which is expressed by a colorful picture. With the act of defecation, polyps can bleed and mucous discharge is noted in the feces. Patients with polyposis feel frequent tenesmus (the urge to empty the rectum) and pulling pains after defecation. The course of such a process often develops into oncology, in about 70% of cases, while the degeneration can affect some of the many existing polyps. Treatment of polyposis is carried out only with the help of surgery.

Chronic proctosigmoiditis. Such an inflammatory process is usually accompanied by the formation of cracks and ulcerations, against which hyperplasia of the intestinal mucosa develops. In the feces of the patient after defecation, mucus and blood are found. Such a pathology is considered an obligate precancer, therefore, patients with proctosigmoiditis are put on a dispensary with an examination every six months.

A variety of oncology of the rectum (microbial -10 C 20)

The form of the malignant process in the rectum can be determined by the diagnosis of rectal cancer, which consists in a digital examination and a rectoscopic examination of the organ. Determine the endophytic and exophytic form. The first, is characterized by the defeat of the cancerous formation of the inner mucous layer of the intestine, and the second, with germination into the lumen of the organ wall.

The exophytic form of a tumor of the rectum looks like a cauliflower or a mushroom, from the surface of which, after touching, bloody serous discharge is released. This form of education appears from the polyp and is called polyposis. Diagnosis of rectal cancer is often made by biopsy and subsequent histological analysis biomaterial.

Saucer-shaped cancer looks like an ulcer with dense bumpy and granular edges. The bottom of such a tumor is dark with necrotic plaque.

The endophytic form is represented by a strong growth of the tumor, which thickens the intestinal wall and makes it immobile. This is how diffuse-infiltrative cancer of the rectum develops.

The appearance of a deep flat ulcer with an infiltrate that bleeds and grows rapidly indicates an ulcerative-infiltrative form of cancer. The tumor is characterized by a rapid course, metastasis and germination in nearby tissues.

Cancer of the rectum spreads through the bloodstream, locally and lymphatically. With local development, the tumor grows in all directions, gradually affecting all layers of the intestinal mucosa in depth. With a complete lesion of the rectum by a tumor, significant infiltrates are formed outside it, which pass to bladder, prostate in men, vagina and uterus in women. Depending on the histological examination, determine cancer of the colloidal type, mucous and solid. Metastases, the tumor directs to the bones, lungs, liver tissue, and rarely to the kidneys and brain.

Clinic of rectal tumor

The initial malignancy of the rectum may not signal specific symptoms other than minor local sensations. Consider how rectal cancer manifests itself during the development of the tumor and its decay:

• Constant and aggravated during emptying, pain in the anus is one of the primary sensations in the presence of a tumor. Appearance severe pain may accompany the process of germination of cancer outside the rectum;
• Tenesmus - frequent urge to empty, in which there is a partial discharge of mucous and bloody stool;
• Frequent diarrhea - may indicate both a dysbacteriosis of the digestive tract, and the presence of a tumor in the rectum. In this condition, the patient may observe "ribbon-like feces", a small amount of feces with a lot of mucus and bloody discharge. A complication of this symptom is atony of the sphincter of the anus, which is accompanied by incontinence of gases and stools;
• Mucous and spotting is a manifestation of the inflammatory process of the intestinal mucosa. Such symptoms may be a harbinger of the oncological process or its neglect. The appearance of mucus can be before emptying or during it, as well as instead of stool. Blood appears in small quantities on early stages cancer, and in a larger volume it is observed with the rapid growth of the tumor. Bloody issues come out before defecation or together with feces, in the form of a scarlet or dark mass with clots.
• In the late stage of the neoplasm, during its decay, purulent, fetid discharges are noted;
• General clinic: sallow complexion, weakness, rapid weight loss, anemia.

Help in the malignant process of the rectum

The most important help in such a pathology is the prevention of the onset of the disease. Prevention of rectal cancer is characterized by a careful attitude to your body, that is, it is necessary to control the diet, exercise and psychological condition, and also consult a doctor in time if you experience inflammatory processes intestines. Eating foods and drinks containing flavor substitutes, emulsifiers, stabilizers, preservatives and harmful dyes, as well as the abuse of smoked meats, fatty foods, alcohol, carbonated water, etc., can provoke cell mutation and the occurrence of a malignant process in the upper and lower sections of the digestive tract.

Nutrition for rectal cancer should completely exclude the above foods and sweets with a sparing diet that should not irritate the intestines and have a laxative effect. The diet for rectal cancer is based on the increased use of selenium (a chemical element), which stops the proliferation of atypical cells and is found in seafood, liver, eggs, nuts, beans, seeds, greens (dill, parsley, cabbage, broccoli), cereals (not peeled wheat and rice).

The postoperative diet for rectal cancer in the first two weeks excludes: milk, broths, fruits and vegetables, honey and cereals from wheat.

Prevention of rectal cancer is timely treatment hemorrhoids, colitis, anal fissures, personal hygiene, control over the act of defecation (systematic bowel movements, the absence of a difficult act of defecation, as well as the presence of blood and mucus in the feces), passing test analyzes to check for the presence of atypical cells.

Rectum cancer treatment

The treatment for this type of cancer is surgical intervention and combined treatment. Carry out radical, palliative operations in combination with chemotherapy and radiation sessions. The most commonly used surgery with a radical approach (the Quenu-Miles operation) and the removal of the rectum according to Kirchner. Depending on the degree of damage and the stage of the tumor, resection of the malignant site is sometimes performed.

Radiation therapy for rectal cancer is used in doubtful cases radical operations and with the imposition of an unnatural anus, as a result, the growth of the tumor is delayed and the viability of the cancer patient is prolonged, since the prognosis for the survival of such patients is often unfavorable.

Rectal cancer

ICD-10 code

Related diseases

Symptoms

Bleeding (the intensity of intestinal bleeding is usually insignificant, and most often they occur in the form of a small admixture of scarlet blood in the feces);

Constipation, incontinence of feces and gases, bloating, frequent false urge to defecate);

Soreness in the rectum;

weight loss, pallor of the skin);

Violation of the well-being of patients (general weakness, fatigue);

Anemia (a decrease in the level of hemoglobin in the blood, which is usually caused by intestinal bleeding in rectal cancer).

In later stages of the disease, patients may experience intestinal obstruction, manifested by cramping pains in the abdomen, gas and stool retention, vomiting.

The reasons

Polyps of the rectum belong to the group of obligate precancerous diseases with a high probability of transformation into cancer.

Treatment

* anterior resection of the rectum with the restoration of its continuity by applying an anastomosis (partial removal of the rectum when the tumor is located in its upper section);

* low anterior resection of the rectum with anastomosis (almost complete removal of the rectum with preservation of the anal sphincter when the tumor is located above 6 cm from the anus).

* abdominal-perineal extirpation of the rectum (complete removal of the rectum and obturator apparatus with the imposition of a single-barrel colostomy in the left iliac region);

Low anterior resection (coloproctology) of the rectum is performed with the imposition of an anastomosis (fistula) using a mechanical suture, open or laparoscopically. It is used in case of cancer of the rectum, with localization of the tumor in the lower parts of the rectum, at a distance of 4-8 cm from the anal canal. Advantages of this method: no lifelong colostomy. Currently, patients with low-grade rectal cancers rarely undergo anastomoses, operations end without anastomosis formation. Patients get a colostomy they live with. The presence of a colostomy prevents patients from leading a socially active life, limits their daily activities, a colostomy causes great moral harm, patients live in constant stress. Performing low anterior resections with a mechanical suture will allow patients to lead a normal life, relieve them of all the problems associated with the stoma. It requires modern electrosurgical equipment: an ultrasonic scalpel, a modern bipolar coagulator, as well as the availability of modern staplers in the departments of coloproctology (circular).

ICD 10 - C20 - Cancer of the rectum

Rectal cancer is a malignant disease of the end part of colon cancer. It is the latter area that is often exposed to a cancerous tumor, bringing the patient quite a lot of problems. Like any other disease, rectal cancer has a code according to the International Classification of Diseases 10 revision, or ICD 10. So let's consider this tumor from the standpoint of classification.

ICD code 10

C20 - colorectal cancer code according to ICD 10.

Structure

First, let's analyze overall structure according to ICD 10 to rectal cancer.

• Neoplasms - C00-D48
• Malignant - C00-C97
• Digestive organs - C15-C26
• Rectum - C20

Neighboring diseases

In the neighborhood in the digestive organs, according to the ICD, diseases of neighboring departments are hidden. We list them here while we can. So to speak, note.

• C15 - esophagus.
• C16 - stomach.
• C17 - small intestine.
• C18 - colon.
• C19 - rectosigmoid junction.
• C20 - straight.
• C21 - anus and anal canal.
• C22 - liver and intrahepatic bile ducts.
• C23 - gallbladder.
• C24 Other unspecified parts of the biliary tract.
• C25 - pancreas.
• C26 Other and ill-defined digestive organs.

As you can see, any oncological problem has a clear place in the classifier of diseases.

General information about cancer

We will not dwell here in detail on this disease - we have a separate full article devoted to rectal cancer. Here only short information and classifier.

The main causes of the disease are smoking, alcohol, nutritional problems, and a sedentary lifestyle.

Outside of any international classifications, already within the structure, according to the location of carcinoma, the following types are distinguished for treatment:

1. rectosigmoid
2. Upper ampullar
3. Medium ampoule
4. Lower ampullar
5. anus

According to the aggressiveness of the manifestation:

• highly differentiated
• Poorly differentiated
• Average differentiated

Symptoms

Intestinal cancer in general is a disease that manifests itself only in the later stages, patients turn to 3 or 4.

Highlights in the later stages:

• Blood in the stool
• Fatigue
• Feeling of stomach fullness
• Pain during defecation
• constipation
• Itching anus with discharge
• Incontinence
• Intestinal obstruction
• Diarrhea
• In women, fecal discharge from the vagina through fistulas is possible.

stages

Stage 1 - a small size of the tumor, up to 2 centimeters, does not extend beyond the organ.

Stage 2 - the tumor grows up to 5 cm, the first metastases appear in the lymphatic system.

Stage 3 - metastases appear in nearby organs - the bladder, uterus, prostate.

Stage 4 - widespread, distant metastases appear. Possible new classification- in colon cancer.

Forecast

According to five-year survival, the prognosis is divided into stages:

Diagnostics

The main methods of diagnosing the disease:

• Inspection.
• Palpation.
• Analyzes: urine, feces occult blood, blood.
• Endoscopy, Colonoscopy.
• X-ray.
• Tumor markers.
• Magnetic resonance imaging, CT scan, Ultrasound.

Treatment

We highlight the main methods of treatment of this oncology:

Surgical intervention - from the point removal of the tumor to the removal of part of the rectum or its complete resection.

Chemotherapy. The introduction of chemicals that destroy malignant cells. Possible side effects. It is mainly used as an additional treatment before and after surgery.

Radiation therapy. Another method additional treatment, is to irradiate the tumor with radioactive irradiation.

FAQ

Is it necessary to have an operation?

As a rule, yes. Surgery gives the maximum effect of treatment, radiation and chemotherapy only get the affected cells. The operation is not done only at the last stage, when the treatment itself already becomes meaningless. So - if they offer to do an operation, then everything is not lost yet.

How long do people live with this cancer?

Let's be straight. The disease is not the best. But the survival rate is high. When detected in the first stages, patients live quietly for more than 5 years. But on the latter in different ways, on average up to six months.

Prevention

In order to prevent the occurrence of cancer, we follow the following recommendations:

• We do not start the treatment of intestinal diseases - hemorrhoids, fistulas, anal fissures.
• We fight constipation.
• Proper nutrition - emphasis on plant foods.
• We throw out bad habits - smoking and alcohol.
• More physical activity.
• Regular medical checkups.

Rectal cancer

• 1 Rectum
• 2 Incidence
• 3 Risk factors
• 4 Histological picture
• 5 Staged
• 6 Clinical picture
• 7 Diagnostics
• 8 Treatment
• 9 Forecast
• 10 Notes
• 11 See

Rectum

The rectum is the end section of the large intestine from top to bottom. sigmoid colon to the anus (lat. anus), being the end of the digestive tract. The rectum is located in the pelvic cavity, begins at the level of the 3rd sacral vertebra and ends with the anus in the perineum. Its length is 14-18 cm, the diameter varies from 4 cm at the beginning to 7.5 cm in its widest part, located in the middle of the intestine, then the rectum narrows again to the size of a gap at the level of the anus. Around the anus in the subcutaneous tissue is a muscle - the external sphincter of the anus, which covers the anus. At the same level there is an internal anal sphincter. Both sphincters close the intestinal lumen and hold stool in it.

Incidence

Rectal cancer occupies the 3rd place in the structure of the incidence of malignant neoplasms of the gastrointestinal tract, accounting for 45% of intestinal neoplasms and 4-6% in the structure of malignant neoplasms of all localizations.

Risk factors

The factors contributing to the occurrence of rectal cancer, many authors include a long stay of feces in the ampoule of the rectum, chronic constipation, bedsores and ulcers. Obligate precancerous diseases of the rectum include polyps (adenomatous, villous) with a high probability of transformation into cancer. Certain factors increase the risk of developing the disease. These include:

• Age. The risk of developing rectal cancer increases with age. Most cases of the disease are observed in the age group, while the disease in the age<50 лет без семейного анамнеза встречаются гораздо реже.
• Cancer history. Patients who have previously been diagnosed with colon cancer and treated appropriately are at increased risk for developing colon and rectal cancer in the future. Women who have had ovarian, uterine, or breast cancer are also at increased risk of developing colorectal cancer.
• Heredity. The presence of colon and rectal cancer in blood relatives, especially aged<55 лет, или у нескольких родственников, значительно увеличивает риск развития заболевания. . Семейный полипоз толстой кишки в случае отсутствия соответствующего лечения почти в 100 % случаев приводит к возрасту 40 лет к раку толстой кишки.
• Smoking. The risk of dying from rectal or colon cancer is higher in smokers than in non-smokers. Received by the American Cancer Society American Cancer Society) evidence suggests that women who smoke have a 40% greater risk of dying from colorectal cancer than women who have never smoked. Among male smokers, this figure is 30%.
• Diet. Studies show that a high red meat diet and a low intake of fresh fruits, vegetables, poultry, and fish increase the risk of colorectal cancer. At the same time, people who often eat fish have a lower risk.
• Physical activity. Physically active people have a lower risk of developing colorectal cancer.
• Virus. Carrying some viruses (such as some strains of human papillomavirus) may be associated with colon and rectal cancer and is an obligate precancerous condition for anal cancer.
• Alcohol. Drinking alcohol, especially in large quantities, may be a risk factor.
• Vitamin B6 intake inversely associated with the risk of colorectal cancer.

Histological picture

In rectal cancer, the following histological forms are observed: glandular cancer (adenocarcinoma, solid cancer, cricoid, mixed, scirr) is more often observed in the ampullar region of the rectum; Rarely, there may be squamous cell carcinoma or melanoma in the rectum (rather than the anal canal), probably due to the presence of ectopic transitional epithelium or melanocytes.

staging

• Stage I - a small, clearly delimited movable tumor or ulcer up to 2 cm in greatest dimension, affects the mucous membrane and submucosal layer of the intestine. There are no regional metastases.
• Stage II - a tumor or ulcer up to 5 cm in size, does not extend beyond the intestine, occupies no more than half the circumference of the intestine. There are no metastases or with the presence of single metastases in regional lymph nodes located in the pararectal tissue.
• Stage III - a tumor or ulcer more than 5 cm in greatest dimension, occupies more than a semicircle of the intestine, germinates all layers of the intestinal wall. Multiple metastases in regional lymph nodes.
• Stage IV - an extensive, decaying, immobile tumor that grows into the surrounding organs and tissues. Numerous metastases to regional lymph nodes. Distant (hematogenous) metastases.

International classification of rectal cancer according to the TNM system :

The symbol T contains the following gradations:

• TX - insufficient data to evaluate the primary tumor;
• Tis - preinvasive carcinoma;
• T1 - the tumor infiltrates the mucous membrane and submucosal layer of the rectum;
• T2 - the tumor infiltrates the muscle layer, without limiting the mobility of the wall of the intestinal wall;
• T3 - a tumor that grows through all layers of the intestinal wall with or without infiltration of adrectal tissue, but does not spread to neighboring organs and tissues.
• T4 - a tumor that grows into the surrounding organs and tissues.

The symbol N indicates the presence or absence of regional metastases.

• NX - insufficient data to evaluate regional lymph nodes
• N0 - no involvement of regional lymph nodes
• N1 - metastases in 1ן regional lymph nodes
• N2 - metastases in 4 or more regional lymph nodes

The symbol M indicates the presence or absence of distant metastases.

• M0 - no distant metastases
• M1 - with the presence of distant metastases.

Clinical picture

The most common and constant symptom of rectal cancer is bleeding. It occurs both in the early and later stages and is observed in 75-90% of patients. The intensity of intestinal bleeding is insignificant, and most often they occur in the form of impurities or blood in the feces, or dark clots, are not constant. Unlike bleeding hemorrhoids, in cancer, the blood precedes the stool or is mixed with the stool. As a rule, profuse bleeding does not occur, and anemia in patients is more often detected in the later stages of the disease.

In rectal cancer, mucus and pus are secreted from the anus along with blood. This symptom usually appears in the later stages of the disease and is due to the presence of concomitant perifocal inflammation.

The second most common symptom of cancer are various types of intestinal disorders: changes in the rhythm of defecation, fecal shape, diarrhea, constipation and incontinence of feces and gases. The most painful for patients are frequent false urges to defecate (tenesmus), accompanied by secretions of a small amount of blood, mucus and pus. After defecation, patients do not feel satisfaction, they still have a feeling of a foreign body in the rectum. False urges can be observed from 3-5 times a day. As the tumor grows, especially with stenosing cancer of the upper rectum, constipation becomes more persistent, bloating is determined, especially in the left abdomen. Initially, these symptoms are intermittent, then they become permanent.

Due to the further growth of the tumor and the addition of inflammatory changes, partial or complete low intestinal obstruction occurs. At the same time, patients experience cramping abdominal pain, accompanied by gas and stool retention, vomiting occurs periodically. Pain sensations in patients with rectal cancer appear when the tumor spreads locally, especially when it moves to surrounding organs and tissues. Only in cancer of anorectal localization, due to the involvement of the rectal sphincter zone in the tumor process, pain is the first symptom of the disease at an early stage. At the same time, patients tend to sit on only one half of the buttocks - a “symptom of a stool”.

Violation of the general condition of patients (general weakness, fatigue, anemia, weight loss, pallor of the integument) is due to daily blood loss, as well as tumor intoxication in the later stages of the disease. Of decisive importance in the diagnosis are a full examination by a specialist doctor and the results of a study of biopsy and cytological material.

Diagnostics

Rectal cancer refers to neoplasms of external localization, but, nevertheless, the percentage of errors and neglect in this form of cancer does not tend to decrease. Diagnosis of rectal cancer should be comprehensive and include:

• digital examination of the rectum,
• endoscopic methods - sigmoidoscopy with biopsy, fibrocolonoscopy (to exclude concomitant polyps or primary multiple lesions of the overlying colon),
• X-ray methods - irrigography, plain radiography of the abdominal cavity, chest,
• Ultrasound and computed tomography - to diagnose the spread of the tumor to neighboring organs, to determine metastases in the abdominal organs (liver) and in the lymph nodes,
• laboratory methods - general and biochemical blood tests, blood tests for tumor markers (to determine the prognosis of treatment and further monitoring).

Treatment

The surgical method is leading in the treatment of rectal cancer. In recent years, complex treatment has been actively used: irradiation in the form of preoperative exposure, after which surgical removal of the intestine with the tumor is performed. If necessary, chemotherapy is prescribed in the postoperative period.

The question of choosing the type of surgery for rectal cancer is very complex and depends on many factors: the level of the location of the tumor, its histological structure, the degree of spread of the tumor process and the general condition of the patient. The final volume and type of surgical intervention are determined in the operating room after laparotomy and a thorough revision of the abdominal organs.

The widespread point of view that the most radical operation for rectal cancer is abdominoperineal extirpation is currently hardly acceptable both from an oncological standpoint and from the point of view of possible subsequent social and labor rehabilitation.

The main types of operations on the rectum:

• anterior resection of the rectum with restoration of its continuity by applying an anastomosis (partial removal of the rectum when the tumor is located in its upper section);
• low anterior resection of the rectum with anastomosis (almost complete removal of the rectum with preservation of the anal sphincter when the tumor is located above 6 cm from the anus).
• abdominal-perineal extirpation of the rectum (complete removal of the rectum and obturator apparatus with the imposition of a single-barrel colostomy in the left iliac region);

Low anterior resection (coloproctology) of the rectum is performed with the imposition of an anastomosis (fistula) using a mechanical suture, open or laparoscopically. It is used in case of cancer of the rectum, with localization of the tumor in the lower parts of the rectum, at a distance of 4-8 cm from the anal canal. Advantages of this method: no lifelong colostomy. Currently, patients with low-grade rectal cancers rarely undergo anastomoses, operations end without anastomosis formation. Patients get a colostomy they live with. The presence of a colostomy prevents patients from leading a socially active life, limits their daily activities, a colostomy causes great moral harm, patients live in constant stress. Performing low anterior resections with a mechanical suture will allow patients to lead a normal life, relieve them of all the problems associated with the stoma. It requires modern electrosurgical equipment: an ultrasonic scalpel, a modern bipolar coagulator, as well as the availability of modern staplers in the departments of coloproctology (circular).

Forecast

The prognosis for rectal cancer depends on the stage of the disease, the form of growth, the histological structure of the tumor, the presence or absence of distant metastases, the radicalism of the intervention performed. According to the generalized data of domestic and foreign authors, the overall 5-year survival after radical surgical treatment of rectal cancer ranges from 34 to 70%. The presence of metastases in regional lymph nodes reduces the 5-year survival to 40% versus 70% without metastases. Five-year survival rate after surgical treatment of rectal cancer, depending on the stage of the tumor process, is: at stage I - up to 80%, at stage II - 75%, at stage IIIa - 50%, and at stage IIIb - 40%.

Notes

1. Levin K.E., Dozois R.R. (1991). "Epidemiology of large bowel cancer". World J Surg 15(5): 562-7. doi:10.1007/BF
2. Penn State University
3. Strate LL, Syngal S (April 2005). "Hereditary colorectal cancer syndromes". Cancer Causes Control 16(3):. doi:10.1007/s8-4
4. American Cancer Society Smoking Linked to Increased Colorectal Cancer Risk - New Study Links Smoking to Increased Colorectal Cancer Risk 6 December 2000
5. ‘Smoking Ups Colon Cancer Risk’ at Medline Plus
6. Chao A, Thun MJ, Connell CJ, et al. (January 2005). "Meat consumption and risk of colorectal cancer". JAMA 293(2):. doi:10.1001/jama.293.2.172
7. "Red meat 'linked to cancer risk'". BBC News: Health. 15 June 2005. http://news.bbc.co.uk/2/hi/health/.stm
8. National Institute on Alcohol Abuse and Alcoholism Alcohol and Cancer - Alcohol Alert No.
9. Larson, S.; Orsini, N.; Wolk, A. (2010). "Vitamin B6 and risk of colorectal cancer: a meta-analysis of prospective studies". JAMA: the journal of the American Medical Association 303(11): 1077-1083. doi:10.1001/jama.2010.263
10. AJCC Cancer Staging Manual (Sixth ed.). Springer-Verlag New York, Inc. 2002.

see also

Links

papilloma adenoma, fibroadenoma, cystadenoma, adenomatous polyp non-invasive carcinoma basal cell carcinoma squamous cell carcinoma adenocarcinoma colloidal carcinoma solid carcinoma small cell carcinoma fibrous carcinoma medullary carcinoma

fibroma (desmoid) histiocytoma lipoma hibernoma leiomyoma rhabdomyoma granular cell tumor hemangioma glomus tumor lymphangioma synovioma mesothelioma osteoblastoma chondroma chondroblastoma giant cell tumor fibrosarcoma liposarcoma leiomyosarcoma rhabdomyosarcoma angiosarcoma osteogenic lymphangiosarcoma

and membranes of the brain

astrocytoma astroblastoma oligodendroglioma oligodendroglioblastoma pinealoma ependymoma ependymoblastoma choroid papilloma choroidcarcinoma ganglioneuroma ganglioneuroblastoma neuroblastoma medulloblastoma glioblastoma meningioma meningeal sarcoma sympathoblastoma ganglioneuroblastoma chemofibrosarinoma neurofibromatomas neurocomatoma

Tumor suppressor genes Oncogene Staging Grading Carcinogenesis Metastasis Carcinogen Research Paraneoplastic phenomena ICD-O List of oncological terms

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See what "Rectal Cancer" is in other dictionaries:

Hereditary nonpolyposis colorectal cancer or HNPCC is an autosomal dominant hereditary disease that may be accompanied by carcinoma of the endometritis, ovaries, stomach, pelvic organs and ... ... Genetics. encyclopedic Dictionary

PROLOPS OF THE RECTUM - (prolapsus recti;, temporary or permanent location of the rectum (or part of it) outside the anus. The presence of the rectum in its natural, normal position depends on the balance of the apparatus fixing it and the intra-abdominal ... ... Big Medical Encyclopedia

CANCER - CANCER, or in Latin terminology cancer (cancer), and in Greek carcinoma (carcinoma), a concept denoting in our USSR, as well as in Germany and the Baltic countries, a malignant epithelial tumor. In contrast, in some ... ... Big Medical Encyclopedia

Anal cancer is a disease in which malignant cells form in the tissues of the anus. The anus is the end of the large intestine, the lower part of the rectum, through which feces leave the body. Two ring-like muscles called the sphincter open and ... ... Disease Guide

Cancer of the vagina - ICD 10 C52.52. DiseasesDB93 MedlinePlus ... Wikipedia

COLON AND RECTAL CANCER - honey. Frequency Cancer of the colon and rectum is one of the most common forms of human malignant tumors. In most European countries and in Russia, these carcinomas in total take 6th place after cancer of the stomach, lung, breast, women's ... ... Disease Guide

Cancer is a group of diseases caused by the uncontrolled reproduction of one or more cells, which, multiplying in number, occupy more and more space and form a tumor. These diseases are also called oncological, since by studying them ... ... Collier's Encyclopedia

COLON CANCER - Colon and rectal (colon) cancer is the second leading cause of death from cancer in Western countries. Approx. deaths from colon cancer are recorded annually in the USA; big ... ... Collier's Encyclopedia

Cancer (Disease) - Redirected here from Cancer (Disease). According to the generally accepted medical terminology in Russian, cancer means only malignant neoplasms from epithelial tissue. If you are looking for information about ... ... Wikipedia

Books

• Cancer of the rectum, V. B. Alexandrov. The monograph formulates the current state of the problems that are of the greatest interest in the study of such severe suffering as rectal cancer. Special attention… Read moreBuy for 631 RUB
• Oncology, Sh. Kh. Gantsev. In accordance with the curriculum, the textbook consists of two parts. Part one, "General Oncology", contains information about the history, modern problems of oncology, the organization of oncology ... Read moreBuy for 465 rubles
• Rectal cancer, . The monograph provides an analysis of the most common precancerous diseases, the frequency and prevalence of cancer of this localization, provides data on the pathological anatomy and classification of cancer of the rectum ... MoreBuy for 210 rubles

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In order to clearly understand what rectal cancer is, it is necessary to have information about the anatomy, physiology and mechanism of development of such a disease. This article contains the main points characterizing this malignant pathology.

Code according to ICD 10 (according to the international list of diseases):

• C 00-D 48 - various neoplasms inside the body.
• C 00-C 97 - neoplasms with a malignant course.
• C 15-C 26 - neoplasms with a malignant course, localized in the digestive system.
• C 20 - a neoplasm of a malignant nature in the rectum (lymphoma, cancer, etc.).

To begin with, let's figure out what the rectum is - this is the final section of the large intestine, so to speak, the transition from the large intestine to the anus. Why is this area singled out as a separate category? The main function of the rectum is to hold and store the formed fecal matter, which is already ready for a bowel movement.

The gut is made up of three layers:

• mucous layer - covers the rectal cavity, serves to secrete special mucus, which ensures easy movement of feces;
• muscle layer - the middle tissue, consisting of muscle fibers that hold the shape of the intestine and, contracting, progressively move the stool outward;
• peritoneal layer - is a shock-absorbing adipose tissue that literally envelops the rectum.

Also, when describing rectal cancer, be sure to pay attention and lymph nodes, which are present in sufficient quantities around this organ. Lymph nodes retain not only pathogenic microorganisms (bacteria and viruses), but also cancer cells.

ICD-10 code

C20 Malignant neoplasm of rectum

colorectal cancer statistics

According to statistics, malignant neoplasms are considered the leading in the number of deaths in world medicine. Every year from this disease dies from 7 to 8 million inhabitants of the planet. Of these, rectal cancer ranks third.

Most cancer cases are registered in developed regions and large cities. To be more precise, more than one million patients are diagnosed with colorectal cancer each year, accounting for more than half of the deaths. The disease mainly occurs in people over 40 years of age. Average age illness - 55-65 years. However, young patients from 20 to 25 years old are no exception. It is no secret that cancer is getting younger every year, and the incidence of it is increasing. And the further forecast of the World Health Organization is not optimistic: in the future, scientists predict an increase in mortality from cancer.

After surgery to remove a cancerous growth in the rectum, the so-called "five-year survival rate" is approximately 35-75%. Such a large range is explained by the fact that the degree of survival of patients can directly depend on the type of oncology, the location of the tumor relative to the intestine, the quality and volume of surgical intervention, as well as the literacy and experience of the operating surgeon.

If the patient has regional metastases, then such a sign lowers the value of the estimated survival by 30-40%.

Even though cancer treatment methods are constantly improving, the effectiveness of therapy still remains relatively unchanged. It's all about relapses that occur in operated patients in about 10-40% of cases.

Certainly in different countries and regions, patient survival can vary significantly. Therefore, do not blindly trust the statistics. The average coefficient is based on the vast majority of reported cases, but the degree of risk for any particular patient may be completely different. It is impossible and wrong to tell a cancer patient about how much he has left to live. This is not so much a question of statistical data as the level of care provided to the patient, the quality of clinical examination, as well as the general state of human health.

Causes of colorectal cancer

The causes of the formation of a malignant disease of the rectum are currently under study. So far, there are only assumptions and hypotheses that a cancerous tumor may appear as a result of some chronic pathologies, for example, as a result of anal fissures, ulcerative inflammation of the intestine or proctitis.

In the appearance of a cancerous tumor great importance has a hereditary-genetic factor. That is, for any person, the risk of developing intestinal oncology may be higher if someone in his family had diffuse polyposis or malignant diseases of the intestines. Diffuse polyposis is a disease that is characterized by the occurrence of a large number of polyps (benign tumors) in the lumen of the large intestine or rectum. Such multiple polyps can be genetically transmitted from an older family member to a younger one, and besides, they carry a great risk of cancerous degeneration.

The emergence of a cancerous tumor is also promoted by individual principles of nutrition. Nutritional risk factors include:

• insufficient consumption of vegetables, as well as cereals, cereals, various cereals;
• excessive consumption of animal fats, meat food.

Defecation disorders such as constipation (especially chronic ones) cause stagnant feces to decompose in the intestines, causing irritation of the mucous membrane with decay products.

Also, factors such as overweight, physical inactivity, and overeating make their negative contribution to the appearance of cancer. Established involvement bad habits to the development of malignant diseases of the rectum. So, smoking and alcohol irritate not only the stomach, but also the entire intestinal mucosa, which can cause inflammatory reactions and even oncology.

It is impossible to discount and harmful professional activity– work related to toxic and radioactive waste, with chemicals etc.

In addition, rectal cancer is not a rare event among patients with the human papillomavirus, as well as among homosexuals who practice anal sex.

Pathogenesis

Inflammatory reaction in the tissues of the rectum, mechanical damage to the mucosa provoke stimulation of regenerative processes. But with prolonged and frequent inflammation and violations of tissue integrity, recovery processes may be disrupted. So there are, for example, polyps. With a genetic predisposition to polyposis, the intestinal mucosa from birth tends to pathological overgrowth of polyps. The development of these small tumors is slow and often unnoticeable.

Over time, polyps can malignantly degenerate, tumor cells change structure and cancer occurs.

Cancer long time exists and grows without leaving the rectum. Only years later, the tumor can grow into nearby tissues and organs. For example, germination and spread of cancer in the posterior vaginal wall, prostate, bladder, urethra are often observed. As with any oncopathology, sooner or later metastasis begins - the separation of tumor cells and their spread throughout the body. The lymphatics are primarily affected circulatory system, with the help of which malignant cells are transferred to the liver, lungs, brain, kidneys and other organs.

The growth of rectal cancer is a rather long process in time, if we compare it with any other localization of tumors. So, cancer cells slowly develop in the tissues of the intestine, without penetrating into their depth. A malignant process can be hidden behind local inflammation: it is convenient for degenerate cells to develop inside the inflammatory infiltrate, where entire cancerous colonies can form.

Often, it is precisely because of the slow and hidden growth that the symptoms of rectal cancer are detected at rather late stages of development, when the tumor already has a fairly significant size and distant metastases. And even then, patients apply for medical care not always, mistaking the true signs of malignancy for anal fissures or manifestations of hemorrhoids.

Indeed, the diagnosis this disease difficult for many reasons. First, as we have already said, the early stages of the disease often do not manifest themselves in any way. Secondly, often patients are embarrassed to seek help, considering the symptoms they have are not so serious. And this, despite the fact that in our country it is recommended that all people over 40 years of age periodically examine the intestines for malignant diseases.

Treatment of rectal cancer is mainly surgical. The extent and type of surgery, and additional methods Treatments are selected depending on the location of the tumor, the degree of its germination in the tissues and nearby organs, the presence of metastases, the condition of the patient, etc.

Unfortunately, rectal cancer is not a rare and rather serious pathology that requires long and complex treatment. Therefore, in order to avoid the disease, or at least to start treatment in a timely manner, it is important to follow all recommended prevention methods.

The digestive organs are often subject to dysfunctional processes in the human body. This is due to a violation of the regimen and quality of the substances supplied to the digestive system, as well as due to the influence of external negative factors on the body. As a result, a person may face a severe disease that has a high mortality rate. We are talking about a malignant process that occurs in any organ.

The rectum (rectum) is the final section of the digestive tract, which originates from the sigmoid colon and is located before the anus. If we take into account the oncology of the large intestine as a whole, then rectal cancer (Cancerrectum) occurs in up to 80% of cases. Cancer rectum, according to statistics, affects the female half of the population, although the difference with this pathology in men is small. In the International Classification of Diseases (ICB) 10 views, colorectal cancer occupies codemcb -10 C 20, colon cancer -10 C 18 and codemcb -10 C 18.0 - caecum. Kodymkb -10, intestinal oncological pathologies are taken from mkb - O (oncology) in accordance with:

• The primary and localization of the tumor;
• Recognizability (the neoplasm may be of an indefinite and unknown nature D37-D48);
• Near morphological groups;

functional activity;

• A malignant lesion that is noted outside the localization of the tumor;
• Classifications;
• Benign neoplasms D10-D

Cancer of the rectum (mcb -10 C 20) often develops in adulthood, that is, after 60 years, but often, the oncoprocess affects people in the reproductive period of the life cycle. In most cases, the pathology is observed in the ampulla of the rectum, but there is a localization of the neoplasm above the ampulla of the intestine, in the anus-perineal part and in the sigmoid rectum.

Causes (Cancerrectum)

Cancer of the rectum (µb -10 C 20) occurs mainly after long-term precancerous pathologies. There is a version of a hereditary predisposition to the oncology of the rectum. The remaining scars after injuries and operations can also degenerate into a malignant formation. The consequences of congenital anomalies of the large intestine is one of the causes of rectal cancer. People suffering from chronic hemorrhoids, anal fissures, are more likely to be at risk for the occurrence of an oncological process in the rectum. Infectious diseases, such as dysentery, as well as chronic constipation and inflammatory processes in the organ (proctitis, sigmoiditis) with the formation of an ulcer or bedsore, may be factors that cause rectal cancer.

Precancerous conditions of the rectum

Polyposis (adenomatous, villous polyps). Such formations are observed in both children and adults. Polyps, both in a single form and in multiple, develop from epithelial tissue in the form of oval formations, which may have a wide base or a thin stalk. Male patients often suffer from polyposis and this pathology has a hereditary factor. Microscopic examination of the affected area reveals hyperplasia of the intestinal mucosa, which is expressed by a colorful picture. With the act of defecation, polyps can bleed and mucous discharge is noted in the feces. Patients with polyposis feel frequent tenesmus (the urge to empty the rectum) and pulling pains after defecation. The course of such a process often develops into oncology, in about 70% of cases, while the degeneration can affect some of the many existing polyps. Treatment of polyposis is carried out only with the help of surgery.

Chronic proctosigmoiditis . Such an inflammatory process is usually accompanied by the formation of cracks and ulcerations, against which hyperplasia of the intestinal mucosa develops. In the feces of the patient after defecation, mucus and blood are found. Such a pathology is considered an obligate precancer, therefore, patients with proctosigmoiditis are put on a dispensary with an examination every six months.

A variety of oncology of the rectum (microbial -10 C 20)

The form of the malignant process in the rectum can be determined by the diagnosis of rectal cancer, which consists in a digital examination and a rectoscopic examination of the organ. Determine the endophytic and exophytic form. The first, is characterized by the defeat of the cancerous formation of the inner mucous layer of the intestine, and the second, with germination into the lumen of the organ wall.

The exophytic form of a tumor of the rectum looks like a cauliflower or a mushroom, from the surface of which, after touching, bloody serous discharge is released. This form of education appears from the polyp and is called polyposis. Diagnosis of rectal cancer is often carried out using the biopsy method and subsequent histological analysis of the biomaterial.

saucer-shaped cancer looks like an ulcer with dense bumpy and granular edges. The bottom of such a tumor is dark with necrotic plaque.

The endophytic form is represented by a strong growth of the tumor, which thickens the intestinal wall and makes it immobile. This is how diffuse-infiltrative cancer of the rectum develops.

The appearance of a deep flat ulcer with infiltrate, which bleeds and grows rapidly, speaks of ulcerative infiltrative form of cancer. The tumor is characterized by a rapid course, metastasis and germination in nearby tissues.

Cancer of the rectum spreads through the bloodstream, locally and lymphatically. With local development, the tumor grows in all directions, gradually affecting all layers of the intestinal mucosa up to 10-12 cm in depth. With a complete tumor of the rectum, significant infiltrates are formed outside of it, which pass to the bladder, prostate in men, vagina and uterus in women. Depending on the histological examination, cancer of the colloid type, mucous and solid is determined. Metastases, the tumor directs to the bones, lungs, liver tissue, and rarely to the kidneys and brain.

Clinic of rectal tumor

The initial malignancy of the rectum may not signal specific symptoms other than minor local sensations. Consider how rectal cancer manifests itself during the development of the tumor and its decay:

• Constant and aggravated during emptying, pain in the anus is one of the primary sensations in the presence of a tumor. The appearance of severe pain may accompany the process of germination of cancer outside the rectum;
• Tenesmus - frequent urge to empty, in which there is a partial release of mucous and bloody stools;
• Frequent diarrhea - may indicate both a dysbacteriosis of the digestive tract, and the presence of a tumor in the rectum. In this condition, the patient may observe "ribbon-like feces", a small amount of feces with a lot of mucus and bloody discharge. A complication of this symptom is atony of the sphincter of the anus, which is accompanied by incontinence of gases and stools;
• Mucous and spotting is a manifestation of the inflammatory process of the intestinal mucosa. Such symptoms may be a harbinger of the oncological process or its neglect. The appearance of mucus can be before emptying or during it, as well as instead of stool. Blood appears in a small amount in the early stages of cancer, and in a larger volume it is observed with the rapid growth of the tumor. Bloody discharge comes out before defecation or together with feces, in the form of a scarlet or dark mass with clots.
• In the late stage of the neoplasm, during its decay, purulent, fetid discharges are noted;
• General clinic: sallow complexion, weakness, rapid weight loss, anemia.

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Help in the malignant process of the rectum

The most important help in such a pathology is the prevention of the onset of the disease. Prevention of rectal cancer is characterized by a careful attitude to one's body, that is, it is necessary to control the diet, exercise and psychological state, as well as consult a doctor in time if inflammatory bowel processes occur. Eating foods and drinks containing flavor substitutes, emulsifiers, stabilizers, preservatives and harmful dyes, as well as the abuse of smoked meats, fatty foods, alcohol, carbonated water, etc., can provoke cell mutation and the occurrence of a malignant process in the upper and lower sections of the digestive tract.

Nutrition for rectal cancer should completely exclude the above foods and sweets with a sparing diet that should not irritate the intestines and have a laxative effect. The diet for rectal cancer is based on the increased use of selenium (a chemical element), which stops the proliferation of atypical cells and is found in seafood, liver, eggs, nuts, beans, seeds, greens (dill, parsley, cabbage, broccoli), cereals (not peeled wheat and rice).

The postoperative diet for rectal cancer in the first two weeks excludes: milk, broths, fruits and vegetables, honey and cereals from wheat.

Prevention of rectal cancer, this is the timely treatment of hemorrhoids, colitis, anal fissures, personal hygiene, control over the act of defecation (systematic bowel movements, the absence of a difficult act of defecation, as well as the presence of blood and mucus in the feces), passing test analyzes for verification the presence of abnormal cells.

Rectum cancer treatment

Therapy of this form of oncology consists in surgical intervention and a combined method of treatment. Carry out radical, palliative operations in combination with chemotherapy and radiation sessions. The most commonly used surgery with a radical approach (the Quenu-Miles operation) and the removal of the rectum according to Kirchner. Depending on the degree of damage and the stage of the tumor, resection of the malignant site is sometimes performed.

Radiation therapy for rectal cancer is used in doubtful cases of radical surgery and when an unnatural anus is applied, as a result of which tumor growth is delayed and the viability of the cancer patient is prolonged, since the prognosis for the survival of such patients is often unfavorable.

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