Rectal Carcinoma

RECTAL CARCINOMA


RECTAL CARCINOMA

Spread

  • Local spread occurs circumferentially rather than in a longitudinal direction
  • Lymphatic spread mainly occurs in the upward direction via the superior rectal vessels to the para-aortic nodes
  • Principle sites of blood borne metastasis are liver (34%), lungs (22%) and adrenals (11%)

Symptoms

  • Bleeding is the earliest and most common symptom
  • Tenesmus
  • Sense of incomplete evacuation (very important early symptom)
  •  Spurious diarrhea
  • Alteration in bowel habits
  • Growth in the ampulla of the rectum – Early morning bloody diarrhea
  • Annular carcinoma at the recto sigmoid junction – increasing constipation

Investigations

  • 90% of rectal growths can be felt by per-rectal examination
  • Investigation of choice – rigid sigmoidoscopy and biopsy
  • To assess local spread – TRUS (Endoluminal ultrasound)
  • For local staging and assessment of proposed circumferential resection margin – MRI (CT is not accurate in local staging)
  • CT chest and abdomen or PET – to exclude distant metastasis

Treatment-

Surgeries

  • Pre-operative neo-adjuvant radiotherapy in resectable rectal cancer reduces the incidence of local recurrence
  • Adjuvant chemotherapy improves survival in node-positive cases
  • Anterior(low) resection: sphincter saving procedure, mid rectum
  • Proximal 2/3rdof rectum(lesions 6cms above the dentate line/2 or more cms above anal canal)
  • Well differentiated tumour

size tumour

T1/T2,NO tumours

  • Recto sigmoid tumors and upper third rectal tumors :High anterior resection (rectum and mesorectum are taken to a margin 5cm distal to the tumour and colorectal anastomosis is performed)
  • Tumours in the middle and lower thirds of rectum: complete removal of rectum and mesorectum (TME-total mesorectal excision)
  • Abdomino perineal resection(Mike’s procedure)- Lower rectum
  • Hartmann’s procedure – for elderly and unstable patients who cannot withstand long procedure of APR
  • Colonoscopy is always performed either before (for synchronous tumours) or within a few months (for metachronous tumours) of surgical resection for tumour detection

 Exam Important

Symptoms

  • Bleeding is the earliest and most common symptom
  • Tenesmus
  • Sense of incomplete evacuation (very important early symptom)
  •  Spurious diarrhea
  • Alteration in bowel habits
  • Growth in the ampulla of the rectum – Early morning bloody diarrhea
  • Annular carcinoma at the recto sigmoid junction – increasing constipation

Treatment-

Surgeries

  • Pre-operative neo-adjuvant radiotherapy in resectable rectal cancer reduces the incidence of local recurrence
  • Adjuvant chemotherapy improves survival in node-positive cases
  • Anterior(low) resection: sphincter saving procedure, mid rectum
  • Proximal 2/3rdof rectum(lesions 6cms above the dentate line/2 or more cms above anal canal)
  • Well differentiated tumour

size tumour

T1/T2,NO tumours

  • Recto sigmoid tumors and upper third rectal tumors :High anterior resection (rectum and mesorectum are taken to a margin 5cm distal to the tumour and colorectal anastomosis is performed)
  • Tumours in the middle and lower thirds of rectum: complete removal of rectum and mesorectum (TME-total mesorectal excision)
  • Abdomino perineal resection(Mike’s procedure)- Lower rectum
  • Hartmann’s procedure – for elderly and unstable patients who cannot withstand long procedure of APR
  • Colonoscopy is always performed either before (for synchronous tumours) or within a few months (for metachronous tumours) of surgical resection for tumour detection
Don’t Forget to Solve all the previous Year Question asked on RECTAL CARCINOMA

Module Below Start Quiz

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this:
Malcare WordPress Security