Tumore del Retto

Rectal Cancer

is a disease in which malignant (cancer) cells form in the tissues of the rectum, the last part of the large intestine (12-15 cm to the anus).
It typically starts as a benign tumor, often in the form of a polyp, which over time becomes cancerous.
It can be diagnosed in differend stages.

Signs and Symptoms

The classic signs of rectal cancer include: worsening constipation, blood in the stool, rectal bleeding. Other warning symptoms are loss of appetite and weight loss, asthenia caused by chronic anemia. But anemization is rare in rectal cancers, compared to colic cancer. The presence of blood is a warning sign: it is often underestimated because it is generally correlated to the presence of hemorroids. Unfortunately, this cancer can be completely asymptomatic and diagnosed only at a later stage (bowel occlusion, metastases, locally advanced cancer). For this reason, screening is typically recommended at the age of 50 years old, and for those at high risk screening usually begins at the age of 35-40.

Diagnosis

Digital examination of the rectum is an important tool for diagnosis of cancers of the last portion of the rectum.
Colonoscopy is fundamental for diagnosis, allowing the identification and sampling of areas of the colon suspicious for possible tumor development.
Disease extent is usually determined by a CT scan of the chest, abdomen and pelvis. MRI is the most accurate tool for the local staging of rectal cancer and is a powerful tool to select the appropriate treatment. Transrectal endoscopic ultrasound is also very useful.

Management

• Small polyps can be removed during colonoscopy
• Voluminous benign polyps and early stage cancers (selected cases) can be removed according different surgical approaches such as TEM (Transanal Endoscopic Microsurgery). This avoids major surgery complications.
• For people with localized cancer, the preferred treatment is complete surgical removal with adequate margins, with the attempt of achieving a cure (total mesorectal excision)
• In cases, where MRI or endoscopic ultrasound show local invasion of the tumor or to the nearby lymph nodes, patients will be treated with chemotherapy and radiation therapy to shrink the cancer before attempting to remove it. After surgical removal, the colon may then be reconnected or patient may have a colostomy.
• If the cancer has reached nearby organs and the pelvic floor, a more extensive operation known as abdominoperineal resection with a permanent colostomy may be needed.

Surgical approach

The procedure can be performed in open surgery or with a mini-invasive approach. Evidence shows that mini-invasive surgery is a safe as laparotomy in oncological surgery.
Laparoscopic approach allows to perform surgery using smaller incisions, determining a less post operative discomfort, , a quicker recovery time, shorter hospital stay, earlier return to full activities, with a rapid return to their daily activities.