Rectal cancer is a common malignant tumor in China, and its incidence has been increasing year by year in recent years, which is a major disease that seriously threatens human life and health, therefore, the diagnosis and treatment of rectal cancer is a very important topic. What are the clinical manifestations of rectal cancer? How to treat rectal cancer?
I. Clinical manifestations
1.Increased number of stools and the feeling of urgency and heaviness (frequency, bloating and incomplete defecation).
2.Blood stool, mucus stool. Blood in the stool, can be seen fresh blood or dark red blood stool (pay attention to distinguish with hemorrhoids), sometimes pus and blood stool or mucus stool (pay attention to distinguish with dysentery and enteritis).
3. The shape of the stool changes, becoming thinner, flatter or with grooves.
4.Lumps in the anus or lower abdomen.
5, abdominal pain, abdominal distension, no stool and anal exhaustion (manifestation of intestinal obstruction).
6.Unexplained weight loss, emaciation, anemia.
7.Other late manifestations: when the tumor invades the bladder and urethra, the symptoms of bladder irritation such as urinary frequency, urinary urgency, urinary pain and difficulty in urination may appear; when the tumor invades the vagina, rectovaginal fistula may appear and fecal fluid may flow from the vagina; when the tumor invades the sacrum and nerves, severe pain in sacrococcygeal area and perineum may appear; when the tumor invades and presses the ureter, swelling and pain in the lumbar area may appear; the tumor may also press the external iliac vessels and lower limb edema may appear.
Examination
1. Rectal examination.
If the above symptoms occur, especially blood in stool, pus and blood stool, cramped stool and thin stool, it is recommended to go to hospital for consultation. About 70% of rectal cancer can be detected by rectal examination. Many patients delay treatment because they treat rectal cancer as hemorrhoids.
2.Proctoscopy or fiberoptic colonoscopy.
It is the main examination and diagnosis means of rectal cancer, and can be diagnosed clearly through biopsy.
3.Barium enema.
Barium enema cannot obtain pathological diagnosis, and colonoscopy should be given priority.
4.Imaging examination.
Such as B-ultrasound, CT, MRI examination, can understand the invasion and metastasis of tumor. PET-CT examination is feasible for those who have economic conditions.
5.Tumor marker examination.
Mainly CEA (carcinoembryonic antigen) and CA19-9, which are important reference indicators of rectal cancer.
6.Other examinations.
Such as stool routine and stool occult blood examination.
Treatment of rectal cancer
Surgery, chemotherapy and radiotherapy are still the three major treatments for rectal cancer and are still irreplaceable.
1.Surgical treatment
Surgery is one of the main treatment means of rectal cancer, mainly applicable to non-advanced rectal cancer (some isolated liver metastases can also be treated by surgery or surgery after chemotherapy).
There are various surgical methods, which should be decided according to the disease and stage. They can be broadly divided into endoscopic mucosal resection or transanal resection (for early stage), anal preservation (tumor more than 5-7CM away from the anus can be considered for this kind of surgery) and non-anal preservation surgery.
2.Chemotherapy
There are preoperative adjuvant chemotherapy, postoperative adjuvant chemotherapy and palliative chemotherapy.
(1) Pre-operative chemotherapy (neoadjuvant chemotherapy): It refers to 2-4 cycles (courses) of chemotherapy before surgery, aiming at shrinking the tumor, facilitating surgical resection and reducing surgical trauma, as well as reducing the staging of the original inoperable cases to the operable ones. A regimen of fluorouracil plus calcium folinate or fluorouracil plus oxaliplatin is generally used.
(2) Postoperative adjuvant chemotherapy: It refers to the killing of possible residual tumor cells after surgery to prevent tumor recurrence and metastasis. It is usually performed for 6-12 cycles (depending on the regimen). Oxaliplatin plus fluorouracil, or fluorouracil plus irinotecan regimens are generally used.
(3) Palliative chemotherapy: advanced inoperable patients or those with recurrent metastases after surgery, with the aim of prolonging the patient’s survival and providing quality of life. The number of courses of treatment depends on the patient’s condition and the effectiveness of chemotherapy. Chemotherapy regimens such as fluorouracil plus oxaliplatin, fluorouracil plus irinotecan, or siroda monotherapy or tegeo monotherapy can be used.
3.Radiotherapy
There are postoperative adjuvant radiotherapy and palliative radiotherapy.
Postoperative adjuvant radiotherapy: the purpose is to prevent postoperative recurrence and specialization and improve the cure rate.
Palliative radiotherapy: the purpose is to relieve symptoms, prolong life and improve the quality of survival.
4.Molecular targeted therapy
Molecular targeted therapy is a new development in the field of tumor treatment in recent years, which is suitable for advanced rectal cancer and postoperative recurrence and metastasis, and can be used alone or in combination with chemotherapy to prolong patients’ survival and improve the quality of survival. There is no evidence that it can be used for postoperative adjuvant therapy. Commonly used drugs include cetuximab (Epiduo) and bevacizumab (Avastin), etc.
5. Other treatments.
Including immunotherapy, herbal treatment, etc., which may have some adjuvant effect on rectal cancer.