Rectal cancer is one of the more common malignant 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, its symptoms are similar to many anorectal diseases, so it is easy to be confused with other diseases in diagnosis. How should we treat rectal cancer? Today, we will tell you about rectal cancer.
Symptoms of rectal cancer
1.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 tissue, ulceration and infection, and the consequence of ulcer formation.
2.Change in stool habit
Due to the mass and the secretion produced by it, it can produce symptoms of intestinal irritation, frequent bowel movement, unpleasant feeling of defecation, urgency and heaviness, but the discharge is mostly mucus-pus-blood-like material. 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 the intestinal wall, narrowing the intestinal cavity, especially at the junction of rectum and colon, which is mostly a narrow type of hard cancer and is very likely to cause obstruction. Recto-pot belly cancer, because it is mostly ulcerated type and the recto-pot belly is wider, is estimated to cause narrowing and obstruction only in about 1 to 2 years, with thin stool formation, difficult defecation and constipation, causing 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
If the lower rectal cancer infiltrates the anal canal, it may cause local pain, and if the anal sphincter is involved, it may cause anal incontinence, and pus and blood will often flow out and pollute the underwear; if the cancer is infected or metastasized, it may cause lymph node enlargement in the groin.
5.Other
If rectal cancer infiltrates other organs and tissues in late stage, it may cause symptoms of lesions there. Invasion of sacral plexus may cause pain in sacrum and perineum, similar to sciatic nerve pain; invasion of bladder and prostate may cause cystitis, urethritis, vesico-rectal fistula and urethro-rectal fistula in women, which may cause vaginal rectal fistula and discharge of feces and mucus pus and blood 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.
Which treatment method should be chosen for rectal cancer?
1.Early stage rectal cancer can be cured by surgery in general
Early rectal cancer refers to tumor invasion to 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 of the rectum or outside the muscular layer, 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 on 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%, that is, 1/3 of people have local recurrence after surgery. Local recurrence is equivalent to re-growing the tumor, which can easily invade the surrounding organs, including bladder, seminal vesicle gland, female vagina and so on.
4. Pre-operative radiotherapy can make the tumor smaller
Post-operative recurrence is difficult to deal with even for experienced physicians, because the normal tissue structure has been changed after one operation, so it is difficult to grasp the operation and the operation is risky. Therefore, for these patients, radiotherapy is used before surgery to shrink the tumor, reduce the enlarged lymph nodes, and eliminate the local residual lesions as much as possible, sometimes chemotherapy is added to increase the sensitivity of radiotherapy, and the main purpose is to reduce local recurrence.