Malignant tumors that arise in the rectum are called rectal cancer or rectal carcinoma. Rectal cancer is one of the colorectal cancers, which are the second most common cancer in both men and women in Germany.
What is rectal cancer?
Rectal cancer is the collective name for all malignant tumors of the rectum. The rectum is a part of the rectum and therefore also part of the colon. It is the approximately 15-18 cm long section of the intestine between the sigmoid colon and the anal canal. It serves to store intestinal contents until the next defecation and is lined with intestinal mucosa, which is clearly different from that of the upstream colon sections. Cancer of the rectum (rectal carcinoma) can be distinguished from cancer of the colon (colon carcinoma), although the two cancers are similar and are therefore often grouped together under the term colorectal carcinoma.
Causes
Rectal cancer usually develops as adenocarcinoma, meaning that the tumor arises from glandular tissue. The tumor cells multiply uncontrollably and without regard for surrounding tissue. As in other cancers, mutations are responsible for the uncontrolled division of tumor cells in rectal cancer. In about 95% of cases, the fatal gene mutations arise sporadically; in only 5% are they hereditary. It is believed that rectal cancer develops into malignant cancer only after passing through several benign precursors. The precursors are called colon adenomas or polyps and may persist for years as benign growths before degenerating.
Symptoms, complaints, and signs
Cancer of the rectum often does not cause clear symptoms at the beginning. As the disease progresses, the tumor may cause stomach cramps and constipation or bowel obstruction. The constant pain is usually accompanied by reduced performance and fatigue. Sufferers generally feel very exhausted, with fatigue increasing as the disease progresses. In most cases, a loss of appetite also sets in, which can lead to weight loss. Rectal cancer is manifested by visible bleeding from the anus and pain during bowel movements. Bowel habits may change for seemingly no reason. These signs are accompanied by general symptoms such as fever and an increasing feeling of malaise. Symptoms of rectal cancer develop insidiously, often over the course of several years, and become more severe over time. In the advanced stages, chronic stomach pain sets in. Patients also develop intolerances to certain foods, especially meat, spicy foods, alcohol and coffee. If the cancer is not treated, it progresses and causes serious complications. Untreated cancer is usually fatal. Initially, the physical condition decreases sharply and the affected person becomes bedridden, causing further health problems.
Diagnosis and progression
Colorectal carcinoma is one of the most common cancers in Germany. The annual number of new cases is 20 to 40 per 100,000 population, with the peak of disease in the 6th and 7th decades of life. For early detection, older insured persons are entitled to colonoscopies and stool tests at regular intervals. In addition, symptoms such as blood in the stool, a noticeable change in bowel movements, pain, weight loss and fatigue can lead the patient to the doctor. The patient’s medical history and current complaints are used for diagnosis. The diagnosis is confirmed by a colonoscopy, during which biopsies are also taken. A pathologist then examines the tissue sample to differentiate between benign and malignant growths. Further instrumental examinations may include X-ray contrast enema, computer tomography or ultrasound examinations. If the diagnosis of rectal cancer is confirmed, the tumor stage must be determined. This involves checking how deeply the tumor cells have penetrated the intestinal wall and whether they have already metastasized to neighboring organs or lymph nodes or even affected distant structures such as the liver or lungs.
Complications
Rectal cancer initially causes digestive discomfort and severe pain. Typical complications also include bowel obstruction due to the tumor and, subsequently, perforation of the bowel wall. This can lead to peritonitis with life-threatening sepsis.Sometimes the cancer spreads to neighboring organs (bladder, vagina, liver) or squeezes off vital blood vessels. This can lead to tissue necrosis, i.e. infarction and death of the intestine or surrounding organs. Very advanced rectal cancer often forms metastases. These can affect the liver and cause clotting disorders, edema and inflammation. The final consequence is liver failure, leading to the death of the patient. After colorectal cancer surgery, wound infections, bleeding and pain may occur. Temporary intestinal failure can lead to intestinal paralysis and subsequently to digestive problems. In addition, a condition called anastomotic insufficiency can occur, in which the suture between two ends of the bowel leaks. Occasionally, complications such as digestive problems, incontinence, and bladder and sexual dysfunction remain permanent. In contrast, complications triggered by prescribed medications (e.g., side effects, allergic reactions, drug interactions) are usually not long-lasting.
When should you see a doctor?
Persistent or increasing digestive discomfort should be clarified by a doctor. If discomfort occurs repeatedly during bowel movements, this should be discussed with a doctor. If there is fatigue, a loss of appetite or lassitude, a doctor should be consulted. Rapid exhaustion while performing everyday and light physical tasks is a cause for concern. If this condition occurs despite a restful night’s sleep, a doctor is needed. If there is unwanted weight loss, deterioration in general performance or stomach problems, a doctor should be consulted. Pain in the upper abdomen or intestines, a general feeling of illness, and malaise should be examined and treated by a physician. Discomfort when going to the toilet, leakage of blood from the bowel and pain at the anus are also signs of an existing irregularity. A visit to the doctor is necessary so that an explanation of the cause can take place. Fever, a social withdrawal, irritability and a decrease in well-being indicate an impairment of health. Since rectal cancer can lead to a fatal course of the disease if left untreated, a visit to the doctor should be made at the first signs of disagreement. If the complaints increase in scope and intensity, consultation with a doctor is urgently recommended. In case of emerging intolerances to food, spicy food, caffeinated beverages as well as alcohol, a doctor should be consulted.
Treatment and therapy
Treatment planning for rectal cancer depends on several considerations, including the size and spread of the tumor, the degree of metastasis, and the patient’s general condition. In most cases, treatment begins with surgical excision of the tumor tissue from the bowel. In this process, natural stool passage can often be preserved nowadays. If the sphincter has to be removed, an artificial colonic outlet (so-called colostomy) is created. In order to kill remaining tumor cells and prevent recurrences, chemotherapy or radiation therapy is applied after surgery. These may also be indicated as palliative therapy when a cure is no longer possible, but the patient’s life expectancy and/or quality of life can still be improved. Even in patients with a good prognosis, careful tumor follow-up is essential: Regular follow-up should be performed up to 5 years after successful tumor resection. The 5-year survival rate for rectal cancer is 40% to 60%.
Outlook and prognosis
The stage of disease at diagnosis is crucial for the prospects of cure and survival. If metastases have not yet formed, there is a good chance of cure. Five years after initiation of therapy, about three-quarters of such patients are still alive. The prospects are considerably worse if metastases have formed in the lungs or liver. Such forms can no longer be successfully treated. Like many tumor diseases, rectal cancer carries a high risk of recurrence. If you want to live free of symptoms for the rest of your life, you will need regular follow-up care. The life-threatening tumors develop when the original tumor has not been completely removed. The experience and skill of the surgeon therefore have a decisive influence on the prognosis. The risk of developing the disease increases significantly with advanced age. Most patients are 60 and older at the time of diagnosis.Long-time smokers are conspicuously often found among them. People with an intensive alcohol history are also sometimes found. In total, about 30 out of every 100,000 people develop rectal cancer each year. Not seeking treatment proves to be a serious mistake. This is because the disease progresses continuously. The infestation of vital organs can no longer be stopped if the diagnosis is made late.
Prevention
Advanced age is a major risk factor for rectal cancer. However, risk factors that can be influenced also exist: smoking for many years significantly increases the risk of disease. A high consumption of red meat is also suspected of increasing the risk of colorectal cancer. The consumption of fish and dietary fiber, on the other hand, is thought to have a protective effect, as is an adequate supply of vitamin D, which can be ensured through food or sufficient exposure to sunlight. Preventive examinations also serve the purpose of prevention: Early detection and preventive removal of polyps can help prevent their degeneration as rectal cancer. People with known cases of colon cancer in their family history should especially take advantage of screening examinations.
Follow-up
After the actual treatment of rectal cancer, those affected require ongoing care. In addition to regular medical examinations and the use of further therapies, a change in lifestyle is also part of aftercare. Those affected must now rebuild their quality of life. The support of the responsible doctors as well as acquaintances and friends is also important in coming to terms with the disease. Affected persons can consult cancer counseling centers, psychooncologists, possibly it can help to visit a self-help group to exchange information. Attending a support group is also an important part of aftercare. The aftercare plan is drawn up together with the doctor and is based on the symptoms, the general course of the disease and the prognosis. In the first phase, when patients are still coping with the consequences of the disease and treatment, aftercare is particularly important. It is crucial to support patients until remission is achieved. The risk of relapse decreases each year. The rule of thumb is five years, although the stage of the cancer is also crucial. Medical rehabilitation also includes the use of anti-hormones and other medications, if necessary. In cases of protracted disease, follow-up and follow-up care merge. The details of follow-up care are discussed at the discharge consultation or at a separate appointment. The further course of rectal cancer depends very much on the time of diagnosis, so no general prediction can be made in this regard.
What you can do yourself
In everyday life, dealing with a cancer is particularly challenging. It can be helpful to get in touch with self-help groups. Sufferers can exchange information here in an anonymous setting and give each other tips on how to overcome various challenges. A cure for the disease is very unlikely without medical care. Therefore, cooperation with the treating physician is very important. In individual cases, there are reports that a change in lifestyle has brought relief from the symptoms. However, there is no proven and statistically verifiable method. A healthy lifestyle helps to improve the general well-being. The diet should be balanced and wholesome. Especially important is the intake of plenty of fiber, vitamins and minerals. Despite a loss of appetite or nausea, care should be taken to ensure adequate food intake. The consumption of harmful and toxic substances such as nicotine, alcohol and drugs should be avoided as a matter of principle. For mental support and stabilization of the psyche, relaxation techniques are recommended. Yoga, meditation, autogenic training or Qi Gong are considered to be the methods that are used particularly frequently. As far as health permits, physical activity can be promoted by sufficient exercise. Walks or light exercises to strengthen the muscles promote well-being. At the same time, a heavy load on the organism should be avoided.
