The first 12 cm of the large intestine, which is close to the anus, is called the rectum, and malignant tumors arising from this section are called rectal cancer. In general, its frequency begins to increase from the age of 35; It is most common after the age of 50.
What is Rectal Cancer?
It is the third most common type of cancer in the Western world and the second leading cause of death. It mostly arises from adenomatous polyps that occur in the large intestine. Although colon cancer can be seen at any age, more than 90% of patients are over the age of 40. From this age, the risk nearly doubles every decade. Those with a family history of colon cancer or colon polyps and those with ulcerative colitis are at increased risk.
What are the Symptoms of Rectal Cancer?
Unfortunately, the problems are late due to the difficulty of Turkish people in explaining their toilet problems. When it is expressed, the diagnosis is made late. The most important symptom in this regard is the change in the way of defecation and is called “tenesmus”. Tenesmus is the inability to go to the bathroom and relax.
The second most common finding is red fresh blood coming from the anus. This is one of the first signs of the disease. Apart from these two symptoms, there is no significant symptom, but it may take a long time for the person to notice the change in defecation habits.
Fresh blood coming from the rectum is generally considered as "leavened" (hemorrhoids) in our society. Therefore, there is a great delay in the diagnosis stage.
Patients with advanced rectal cancer in our country usually consult a physician in advanced stages of the disease. Around 4 thousand new cases are seen in Turkey every year.
In addition to these symptoms, loss of appetite, weight loss, which shows the general destruction of the body called catabolism due to cancer, can be added to the clinical picture. /p>
How is the Early Diagnosis of Rectal Cancer? Why is it Important?
Early diagnosis saves lives in rectal cancer. When the disease is detected at an early stage, there is no need for preoperative radiotherapy and chemotherapy. This stage is extremely important in early disease.
The disease is at an early stage Colonoscopy and gastroscopy are recommended as standard from the age of 40, as approved by the World Health Organization.
In addition, when rectal bleeding develops, rectoscopy and colonoscopy should be performed. The cure rate for cancers diagnosed at an early stage is between 80-90%. In order to prevent benign polyps, that is, large intestine cancer, which is formed by the cancerization of meat pieces over time, the polyps should be recognized before they become cancerous and surgically removed.
What Problems Can Occur if Rectal Cancer Is Not Treated?
If the disease is not treated In some cases, the spread of the disease to other organs is close to one hundred percent. In addition, emergency surgeries may be required. Emergency surgeries are always more troublesome than normal surgeries and have lower rates in terms of quality. Since emergency surgeries will be more unsuccessful compared to normal surgeries, an unsuccessful surgical intervention shortens the life of the patient. Accordingly, liver involvement (metastasis) is seen in 85% of untreated rectal cancer patients.
Who Makes up the Risk Group in Rectal Cancer?
As in most cancers in colon and rectum cancers, 50 years of age Above the age of 40, the risk begins and the risk is low. The rate of patients under the age of 40 is between 5 percent and 7 percent.
Eating other than the diet recommended by the World Health Organization is thought to cause disease. A diet rich in margarine and industrial-style saturated fats plays an important role in the development of the disease. Not consuming raw fruits and vegetables, which are called antioxidant foods, contributes to the development of the disease. Studies have shown that red meat consumption leads to the development of rectal cancer. However, the method of cooking meat is also important. Especially, excessive consumption of burnt and charred meat increases the susceptibility to rectum and colon cancer.
The second important factor is the use of cigarettes. A factor here is not smoking alone; co-existence of several factors accelerates the development of the disease.
It is known that genetic characteristics are important in rectal cancer, as in all cancers. If the tumor is detected in people under 50 years of age, the patient A third-degree relative should be screened 10 years younger than the normal screening age (from the age of 30).
How to Diagnose in Rectal Cancer?
- With complaints of bleeding and tenesmus As a continuation of the physical examination, rectal finger (digital) examination is performed for each patient who applies. In rectal cancer, most of the tumor structures are located at finger distance. Therefore, rectal finger examination is very important.
- To evaluate the general condition of the patient in detail, complete blood count and biochemistry tests are requested.
- Visual examination of the rectum via a camera with sigmoidoscopy inserted through the anus is added to the physical examination. During sigmoidoscopy, it is possible to take biopsy from tumor tissue and/or suspected areas and to have a definite idea about the location and size of the tumor structure. According to these data, disease staging and treatment planning can be started.
- As a result of the pathological evaluation of biopsy samples, the cancerous cell type and genetic characteristics that can be targeted (mutated) on the tumor tissue are detected. As a result of these determinations, the choice, severity and expected treatment success rate can be determined. The carcinoembryogenic antigen (CEA) used for rectal cancer is not a specific antigen for this cancer. Smoking can also be elevated in the presence of polyps (pieces of flesh growing into the intestinal cavity) and other benign formations in the colon. Therefore, it cannot be used safely.
- Radiological imaging methods: The number and dimensions of the tumor before starting the treatment; proximal and distant organ system involvement; Computed tomography (CT), magnetic resonance imaging (MRI), positive emission tomography (PET) and chest X-ray images are taken to determine the neighborhood relationships such as proximity to vital vascular structures.
What is the Treatment of Rectal Cancer?
Surgery is generally seen as the first choice in treatment. The aim of surgery is to remove the healthy tissue together with the cancerous tissue to provide a tumor-free area. Today, closed method (laparoscopic) rectal surgeries can be performed successfully. The quality of life and rapid recovery of the patients after surgery can be ensured in the first half of the surgery. Chemotherapy and radiotherapy can be performed before the operation by evaluating the condition of the patient and the disease, and by reducing the mass if possible, complete resection can be targeted in the surgical intervention. It was determined that the recurrence rate of the disease was lower (<10%) in preoperative chemotherapy and radiation therapy (radiotherapy). If it is applied after surgery, the recurrence rate is approximately 24-40%.
Is it possible to be protected in rectal cancer?
It is not enough to prevent rectal cancer by shaping nutrition alone. It has been determined that the Mediterranean diet should be made with olive oil as a diet, the correct cooking methods of red meat, and walking 5 km every day reduce the risk of disease. In addition, colonoscopy and gastroscopy every 10 years starting from the age of 40 are very important for early diagnosis and successful treatment.
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