What are the five common early symptoms of rectal cancer? What is the chance of rectal cancer being cured?

Rectal cancer is one of the common malignant tumors in oncology. It is closely related to the digestive system. It occurs between the dentate line and the junction of the rectum and sigmoid colon. The most common population is people over 45 years old. In recent years, it has gradually become younger and appeared in some young patients. Rectal cancer is difficult to cure and is generally treated with surgery. The prognosis is poor, surgical treatment is relatively difficult, and it is not easy to cure, and it is easy to relapse after surgery.

1. Most early rectal cancers are asymptomatic.

2. Patients with advanced cancer (mid- to late-stage) may experience symptoms such as abdominal pain, blood in the stool, thinning of the stool, and diarrhea.

1) When rectal cancer grows to a certain extent, blood in the stool may occur. A small amount of bleeding is not easy to detect with the naked eye, but a large number of red blood cells can be found when examining the stool under a microscope, and the so-called fecal occult blood test is positive. When the amount of bleeding is large, blood in the stool may appear, and the blood may be bright red or dark red. When the surface of the tumor ruptures and forms ulcers, and the tumor tissue becomes necrotic and infected, pus, blood, mucus and blood in the stool may appear.

2) Patients may have varying degrees of feeling of incomplete bowel movements, a feeling of anal prolapse, and sometimes diarrhea.

3) When rectal tumors cause intestinal stenosis, varying degrees of intestinal obstruction symptoms (abdominal pain, bloating, and difficulty defecating) may occur, with abdominal pain and bowel sounds before defecation, and relief after defecation. The stool may become thinner and grooved.

4) When the tumor invades the bladder and urethra, frequent urination, urgent urination, painful urination, and difficulty urinating may occur; when the tumor invades the vagina, rectovaginal fistula and fecal discharge from the vagina may occur; when the tumor invades the sacrum and nerves, severe pain in the sacrum and perineum may occur; when the tumor invades and compresses the ureter, distension and pain in the waist may occur; the tumor may also compress the external iliac blood vessels and cause lower limb edema. The above symptoms all indicate that the tumor is in a relatively late stage.

5) When the tumor metastasizes to distant sites (liver, lungs, etc.), symptoms may occur in the corresponding organs. For example, dry cough and chest pain may occur when the tumor metastasizes to the lungs.

6) Patients may experience varying degrees of fatigue, weight loss and other symptoms.

Patients with the above symptoms (abdominal pain, blood in the stool, thin stool, diarrhea, etc.) are advised to go to a regular hospital anorectal clinic for treatment. Do not attribute the above symptoms to hemorrhoids. Rectal digital examination can detect about 70% of rectal cancers. Many patients delay treatment because they mistake rectal cancer for hemorrhoids.

1. Genetic factors

Many families with colorectal cancer have a family history of cancer and many digestive tract tumors. Because the genes of normal cells change, cancer patients inherit a susceptibility, and with some stimulating factors, tissue cells grow rapidly and develop into cancer. Cell genetic genes mutate and become malignant cells with genetic characteristics, which manifests as a family history of cancer. This cause of colorectal cancer is relatively common.

2. Dietary factors

The so-called Western diet, which is high in fat, protein and low in fiber, is believed to be related to the occurrence of colorectal cancer. In areas with a high incidence of colorectal cancer in Western countries, the incidence of colorectal cancer is high. In contrast, the Banti tribe in South Africa consumes rough food that is low in fat and rich in fiber, and the incidence of colorectal cancer is low. If these residents immigrate to areas with a high incidence of colorectal cancer, the dietary structure will change, and the incidence will increase accordingly. This is because high-fat and high-protein foods can increase the amount of methylcholanthrene in feces, which can cause increased bile acid secretion and be decomposed into unsaturated polyunsaturated hydrocarbons by anaerobic bacteria in the intestines. Both of these substances are carcinogens. The reduction in fiber content slows down the speed of feces passing through the intestines, which increases the contact time between these carcinogens and the intestinal conjunctiva, leading to an increased chance of cancer.

3. Adenoma cancer

Tumor polyps can turn into cancer. Adenomas can be divided into three types: tubular adenomas, villous adenomas, and mixed adenomas. Tubular adenomas have a high incidence rate, and villous adenomas have a high rate of canceration. Among adenomas, there are hereditary familial adenomas, which are considered precancerous lesions. They usually occur after the age of 30, but some people may become cancerous before the age of 20.

4. Inflammatory bowel disease

Ulcerative colitis and Crohn's disease are caused by the destruction of intestinal mucosa, the proliferation of ulcer repair, and the formation of granulation tissue, which leads to cancer. Schistosoma japonicum eggs are deposited in the rectal mucosa, and chronic inflammation stimulates cancer.

Since the cause of rectal cancer is not completely clear, there is no special prevention method. The preventive measures listed below are mainly to reduce the chance of cancer and to detect patients early and treat them early.

1) Actively prevent and treat rectal polyps, anal fistulas, anal fissures, ulcerative colitis and the stimulation of chronic intestinal inflammation; for multiple polyps and papillary polyps, once the diagnosis is clear, early surgical removal should be performed to reduce the chance of canceration.

2) Diversify your diet, develop good eating habits, do not be partial or picky about food, do not consume high-fat, high-protein diets for a long time, and regularly eat fresh vegetables containing vitamins and fiber, which may play an important role in preventing cancer.

3) Prevent constipation and keep bowel movements smooth.

4) Attach great importance to regular cancer prevention surveys, pay attention to self-examination at any time, improve vigilance, and seek timely diagnosis and treatment after discovering "warning signals" to achieve early detection and early treatment to improve the survival rate of rectal cancer.

1. Western medicine treatment of rectal cancer

1. Surgical treatment

Radical and palliative surgery

1. Radical surgery

Although surgery can remove the tumor, there may still be residual cancer, regional lymph node metastasis, or cancer thrombus in the blood vessels, and the chance of recurrence and metastasis is very high. The surgical method depends on the location of the tumor in the rectum. There are two systems in the rectal wall: the submucosal lymph plexus and the intermuscular lymph plexus. It is rare for cancer cells to metastasize to the lymphatic system in the intestinal wall. Once the cancer cells penetrate the intestinal wall, they spread to the lymphatic system outside the intestinal wall. Generally, the paraintestinal lymph nodes at the same level or slightly higher than the tumor are first affected, and then the intermediate lymph node group accompanying the superior hemorrhoidal artery is gradually affected upwards, and finally to the lymph node group beside the inferior mesenteric artery. The above-mentioned lymphatic metastasis upwards is the most common way for rectal cancer to metastasize. If the tumor is located in the lower rectum, cancer cells can also invade the obturator lymph nodes laterally along the lymphatic vessels of the levator ani muscle and the pelvic wall fascia, or flow along the middle hemorrhoidal artery to the internal iliac lymph nodes. Sometimes cancer cells can also pass through the levator ani muscles and drain along the inferior hemorrhoidal artery to the ischiorectal fossa lymph nodes and inguinal lymph nodes. Since the lymphatic metastasis of upper rectal cancer is almost always upward, surgical resection of the lymphatic tissue adjacent to the tumor and above this plane can achieve the purpose of radical cure, and surgery may preserve the anal sphincter. Although the lymphatic metastasis of lower rectal cancer is also mainly upward, it is also possible to metastasize horizontally to the internal iliac lymph nodes and obturator lymph nodes. Radical surgery needs to include the tissues around the rectum and anal canal and the levator ani muscles, so the anal sphincter cannot be preserved.

(1) Abdominal perineal resection (miles surgery)

In principle, it is suitable for rectal cancer below the peritoneal reflection. The resection range includes the distal sigmoid colon, the entire rectum, the inferior mesenteric artery and its regional lymph nodes, the entire mesorectum, the levator ani muscle, the fat in the ischiorectal fossa, the anal canal, and the skin and subcutaneous tissue about 3 to 5 cm around the anus, as well as the entire anal sphincter. A permanent sigmoid colon single-lumen stoma is performed in the left lower abdomen. Some people also use the gracilis or gluteus maximus instead of the sphincter to perform in situ anoplasty during Miles surgery, but the efficacy is yet to be determined. Anal canal cancer is mostly squamous cell carcinoma, which is an absolute indication for Miles surgery.

(2) Transabdominal low resection and extraperitoneal primary anastomosis

Also known as anterior rectal cancer resection (Dixon surgery), it is suitable for rectal cancer that is more than 5 cm away from the dentate line. In principle, it is based on radical resection and requires that the distal resection edge is more than 2 cm away from the lower edge of the tumor. Because the anastomosis is located near the dentate line, the patient will have an increased frequency of bowel movements and poor bowel control function for a period of time after surgery. In recent years, some people have used a J-shaped colon pouch to anastomose the lower rectum or anus, which can improve bowel control function and reduce bowel movement frequency in the near future. Whether to prepare a J-shaped colon pouch is mainly based on the residual rectal length; if the residual rectal length is less than 3 cm, the J-shaped pouch and rectal anastomosis have better bowel control ability within one year after surgery than the rectal anastomosis. This operation is less invasive and can preserve the original anus, which is more ideal. If the tumor is large and has infiltrated the surrounding tissues, it is not suitable. (3) Rectal cancer resection with preservation of the anal sphincter: It is suitable for early rectal cancer that is 7 to 11 cm away from the anal margin. If the tumor is large, poorly differentiated, or the main lymphatic vessels that extend upward are blocked by cancer cells and there is lateral lymphatic metastasis, this surgical method will not completely remove the tumor, and a combined abdominal perineal resection is still preferred. The current methods of anal sphincter-preserving rectal cancer resection include stapler-assisted anastomosis, low-level abdominal resection-transanal eversion anastomosis, free abdominal resection-transanal pull-out resection anastomosis, and abdominal transsacral resection, which can be selected according to specific circumstances.

(4) Hartmann surgery

Transabdominal rectal cancer resection, proximal stoma, and distal closure. It is suitable for rectal cancer patients who cannot tolerate Miles surgery due to poor general condition or are not suitable for Dixon surgery due to acute obstruction.

2. Palliative surgery

If the cancer is severely infiltrated locally or has spread widely and cannot be cured, palliative resection can be performed to relieve obstruction and reduce the patient's pain. The intestinal segment with cancer is resected to a limited extent, the distal end of the rectum is sutured, and the sigmoid colon is taken as a stoma. If this is not possible, only a sigmoid colostomy is performed, especially in patients with intestinal obstruction.

3. Preoperative and postoperative care for rectal cancer

1. Preoperative care

(1) Psychological care: When a permanent artificial anus is required, it will cause inconvenience in life and mental burden to the patient. We should care for the patient and explain the necessity of the operation to him/her so that he/she can accept the operation in the best psychological state.

(2) Improve nutrition, correct anemia, and enhance the body's resistance. Try to give the patient a high-protein, high-calorie, high-vitamin, easy-to-digest, low-residue diet to increase tolerance to surgery.

(3) Adequate intestinal preparation to increase the success rate and safety of the operation.

(4) Give intestinal antibiotics 3 days before surgery to inhibit intestinal bacteria and prevent postoperative infection.

(5) Give liquid food 3 days before surgery and fast 1 day before surgery to reduce stool and facilitate intestinal cleaning.

(6) One day before surgery, whole-bowel lavage should be performed according to the patient's condition, and the effect of the lavage should be observed.

2. Postoperative care

(1) Observe the patient’s vital signs and changes in condition, and observe any bleeding from the wound.

(2) After surgery, fasting is recommended and gastrointestinal decompression is performed until intestinal motility is restored before eating. Diet should be gradually increased.

(3) Keep drainage unobstructed and flush the drainage tube regularly as directed by the doctor.

(4) Those with long-term urinary catheters should clean the urethral opening daily to prevent urinary tract infections.

(5) Keep the skin around the stoma clean and dry. Apply zinc oxide ointment or comfrey oil.

(6) Take good care of the artificial rectum.

(ii) Chemotherapy

About half of patients with rectal cancer experience metastasis and recurrence after surgery. Except for some early-stage patients, patients in the late stage and after surgical resection need chemotherapy. Chemotherapy is another important treatment measure after surgical treatment in the comprehensive treatment of rectal cancer. Chemotherapy will inhibit the bone marrow hematopoietic system, mainly the decrease of white blood cells and platelets, so as to make up for the deficiency of chemotherapy and reduce the damage of chemotherapy to the hematopoietic system.

3. Radiotherapy

The role of radiotherapy in the treatment of rectal cancer has been increasingly recognized. There are two types of treatment: comprehensive treatment combined with surgery and traditional Chinese medicine, and simple radiotherapy.

1. Comprehensive treatment combining surgery, traditional Chinese medicine and radiotherapy

① Preoperative radiotherapy can control the primary lesion, control lymph node metastasis, improve the resection rate and reduce local recurrence. It is suitable for stage III (Dukesc grade) rectal cancer. The radiation dose can reach 40-45Gy (4000-4500rad) by using two fields of pelvic anterior and posterior irradiation. The surgery is performed 3 weeks after radiotherapy.

② Postoperative radiotherapy is suitable for pathological examination to confirm lymph node metastasis, tumor has obviously infiltrated the intestinal wall, and there are residual unresectable lesions in the pelvic cavity. It is usually started 1 to 2 months after surgery when the perineal wound has healed. The pelvic anterior and posterior fields are used for irradiation, and sometimes the perineal field is also used. The radiation dose can reach 45 to 50 gy (4500 to 5000 rad).

Traditional Chinese Medicine Treatment for Rectal Cancer

Syndrome differentiation and treatment

2. TCM Treatment of Rectal Cancer

Differentiation and treatment of rectal cancer

1) Damp-heat accumulation type: Bai Tou Weng Decoction with modifications.

2) Internal obstruction of blood stasis and toxicity: Gexia Zhuyu Decoction with modifications.

3) Spleen deficiency and qi stagnation type: Xiangsha Liujunzi Decoction with modifications.

4) Spleen and kidney yang deficiency type: Lizhong decoction with modifications.

Patients with colorectal cancer should have a diversified diet, not be partial to certain foods, not eat high-fat and high-protein foods for a long time, and often eat fresh vegetables rich in vitamins and anti-cancer foods, such as tomatoes, dark green and cruciferous vegetables (celery, coriander, cabbage, mustard, radish, etc.), soy products, citrus fruits, malt and oatmeal, onions, garlic, ginger, yogurt, etc.

Eat less smoked food, fried food, overly spicy food, food that is too irritating, and food that is difficult to digest.

Eat less or no food rich in saturated fat and cholesterol, including lard, butter, chicken fat, mutton fat, fatty meat, animal offal, fish roe, squid, cuttlefish, egg yolk, palm oil and coconut oil.