Rectal cancer is one of the more common nauseous tumors in our daily life. Most patients with rectal cancer will have symptoms such as change in stool habit, increase in stool frequency, thin stool, etc. However, due to the low location of rectal cancer, it is often easy to differ from other diseases in terms of symptoms and diagnosis. What are the symptoms of rectal cancer and what are the diseases we need to differentiate from?
The symptoms of rectal cancer are mainly the following five kinds.
Blood in stool: it is the most common symptom of rectal cancer, but it is often ignored by patients or misdiagnosed as hemorrhoids and delayed treatment, which aggravates the condition. Blood in stool is mostly red or dark red, mixed with mucus and blood of stool or pus and blood, sometimes accompanied by blood clots and necrotic tissue. The above symptoms are caused by the obstruction of blood flow after the proliferation of cancer, necrosis and erosion of tissues, ulceration and infection, and the formation of ulcers.
2.Change in ambassadorial habits: Due to the mass and its secretions, it can produce symptoms of intestinal irritation, frequent bowel movements, unpleasant sensation of defecation, urgency, etc. However, the discharge is mostly mucus and pus-like material, and initially these phenomena of “pseudo-diarrhea” occur in the early morning soon after waking up, which is called morning diarrhea. Later, the number of times gradually increases, and even at night can not sleep, changing the usual stool habits.
3.Intestinal stenosis and obstruction: The cancer infiltrates around the circumference of intestinal wall, narrowing the intestinal cavity, especially at the junction of rectum and sigmoid colon, which is mostly hard carcinoma of stenosis, and is very likely to cause obstruction. Recto-pot belly cancer, because it is mostly ulcerated type, recto-pot belly is wider, it is estimated that about 1 to 2 years before it causes narrow obstruction, thin stool formation, defecation difficulty, constipation, abdominal discomfort, gas and pain. Due to the accumulation of feces, in the upper part of the obstructed sigmoid colon area, sometimes in the left lower abdomen, a striated mass can be found.
4.Anal pain and anal incontinence; lower rectal cancer may cause local pain if it infiltrates the anal canal, and if it involves the anal sphincter, it may cause anal incontinence, and pus and blood stool often flows out and pollutes the underwear; cancer infection or metastasis may cause lymph node enlargement in the groin.
Invasion of sacral plexus can cause pain in sacral and perineal area, similar to sciatic nerve pain; invasion of bladder and prostate can cause cystitis, urethritis, vesico-rectal fistula and urethro-rectal fistula in women, and vaginal rectal fistula with fecal matter and mucus-pus-blood discharge from vagina. Liver metastasis may cause hepatomegaly, jaundice, ascites and other symptoms, and systemic symptoms may include anemia and other cachexia, and sometimes acute intestinal obstruction, lower gastrointestinal hemorrhage and perforation may cause diffuse peritonitis.
The symptoms of rectal cancer are very complicated and diverse, and the accompanying symptoms of frequent, urgent and painful urination will become more and more serious, and the painful areas will spread.
If rectal cancer is diagnosed, should we rush to do surgery?
1.Early rectal cancer can be cured by surgery in general
Early rectal cancer refers to tumor invasion to the mucosal layer and submucosal layer, and there is no metastasis, and after surgery to remove the primary lesion, most patients can be cured. Of course, there are many different ways of surgery, in endoscopic resection, laparoscopic resection, transanal laparoscopic resection or open surgery.
If the tumor invades into the muscular layer or outside the muscular layer of the rectum and also has lymph node metastasis, but no liver and lung metastasis, it is in the middle and advanced stage, and the chance of these patients to be cured by surgery will be lower compared to the early stage. Because surgery is a local treatment, it cannot completely remove the tumor everywhere.
2.Low rectal cancer requires stoma surgery
Rectal cancer is different from other tumors in that the tumor is usually located 3-15 cm away from the edge of the anus, and the low rectal cancer is closer to the anus. If direct surgery is performed to remove the tumor lesion, the rectum must be cut off, which will also affect the nerves around the rectum and the function of the sphincter around the anus, resulting in some patients not being able to retain the anus after surgery and needing stoma surgery.
This means that after surgery, an opening is made in the lower left side of the stomach and a fecal bag is hung, through which the bowel is defecated, which has a greater impact on the quality of life. In some patients, even if the anus can be preserved, the ability to control bowel movements will be affected, and bowel incontinence will often occur, which will also affect the patient’s quality of life. Therefore, it is necessary to weigh the pros and cons and choose the method that has less impact on patients’ life and can achieve better treatment effect.
3.For rectal cancer after middle stage, surgery alone may recur
Secondly, for mid-stage rectal cancer, also called locally progressive rectal cancer, the tumor stage is relatively late, and some lymph nodes around the rectum have become enlarged, indicating that there may be lymph node metastasis, and the tumor has invaded into the muscle layer or outside the muscle layer, in this case, it is very difficult to remove the tumor by surgery alone, and it cannot be cut cleanly, and the lymph nodes have to be cleared, and it is likely to recur later.
Previously, it was reported in the literature that for locally progressive rectal cancer, the percentage of local recurrence after surgery alone can reach up to 32%, which means that 1/3 of people have local recurrence after surgery. Local recurrence is equivalent to the re-growth of tumor, which can easily invade the surrounding organs, including bladder, seminal vesicle gland, female vagina, etc.
4. Radiotherapy before surgery can shrink the tumor
The main problem is that the tumor after recurrence is particularly difficult to deal with, because it has been operated once and the normal tissue structure has been changed, so surgery is very, very difficult to do, and the risk of surgery is relatively large. Therefore, for these patients, radiotherapy is used to shrink the tumor, reduce the enlarged lymph nodes and eliminate the residual lesions before surgery.