Rectal cancer
WHAT IS RECTAL CANCER AND ITS INCIDENCE
Colorectal tumours affect the final part of the intestine and, in most cases, are due to a malignant transformation of polyps, small excrescences derived from the abnormal reproduction of cells of the intestinal mucosa. Since they can manifest themselves with different frequencies, modalities and characteristics, such as to condition the choice of therapy offered to the patient, they are generally distinguished in colon tumours and rectal tumours.
Colorectal cancer is the first cancer by onset in the Italian population: among women it is in second place, preceded by breast cancer, while in men it is in third place, preceded by prostate and lung. The disease, which is quite rare before the age of 40, is most common in people between the ages of 60 and 75, with few distinctions between men and women. In recent years, there has been an increase in the diagnosis of colorectal cancers, but this has been accompanied by a decrease in mortality, mainly due to screening programs, early diagnosis and increasingly targeted and personalised therapies.
RISK FACTORS FOR RECTAL CANCER
The factors that appear to have the most influence on the formation of rectum tumours are:
- Environmental: in particular related to lifestyle and nutrition. Sedentary, overweight, alcohol intake, smoking, excessive intake of animal fats, red meats and a high-calorie diet with refined sugars and carbohydrates are all factors that have a profound effect.
- Hereditary: it is possible to inherit the risk of colorectal cancer if certain diseases (e.g., familial adenomatous polyposis and Lynch’s syndrome) have occurred in the family of origin, predisposing to the formation of polyps and bowel tumours.
- Age: age is particularly important; the incidence is ten times higher among people 60–64-year-old than among those aged 40-44.
- Intestinal diseases: certain chronic inflammatory bowel diseases (such as ulcerative rectocolitis and Crohn’s disease) are also an increased risk factor for colorectal cancer.
RECTAL CANCER SYMPTOMS
Colorectal cancer occurs in half of the cases in the last part of the colon and rectum. The symptoms can be very variable and are affected by several factors such as the location of the tumour, its extent, and the presence of occlusions or bleeding. This makes the manifestations of cancer often superimposable to those of many other abdominal or intestinal diseases. For this reason, early and occasional symptoms such as tiredness and lack of appetite, and other more serious symptoms, such as anaemia and weight loss, are often neglected by the patient. Sometimes, a stubborn constipation alternating with diarrhoea can be a first signal.
RECTAL CANCER PREVENTION: SCREENING METHODS
Prevention is important in order to detect the disease at an early stage and to remove the polyps themselves with a simple endoscopy, thus allowing the total eradication of the disease. Screening programs are active prevention strategies aimed at men and women between the ages of 50 and 70 years that allow easy identification of adenomatous polyps before they become carcinomas. Screening methods (consisting of active prevention by faecal occult blood test) increase the chances of early detection of carcinomas, resulting in reduced mortality. Reducing each risk factor (e.g., balanced diet and smoking) is also a good way to reduce the chances of contracting the disease.
RECTAL CANCER DIAGNOSIS
Several instrumental investigations allow the tumour to be diagnosed and its extent and consequent severity to be assessed. The most reliable examination is certainly colonoscopy which, by guaranteeing the possibility of performing biopsies, also allows a rapid analysis of the tissue. Other tests suitable for the diagnosis of the disease are ultrasound, CT scans of the abdomen and chest with contrast agent, transrectal ultrasound and magnetic resonance of the abdomen and pelvis with contrast agent, which allow the assessment of the extent of the tumour itself and the presence or absence of distant metastases.
RECTAL CANCER TREATMENT
The first therapeutic approach is surgery and its type varies with the extent and position of the tumour. Surgery may be preceded and/or followed by chemo-radiotherapy treatment, which plays a fundamental role in both the operable and advanced disease. In particular, rectal tumours are often treated by a combined chemo-radiotherapy treatment, which aims to minimise the risk of local relapses and the extent of the tumour in favour of conservative surgery. Radiotherapy – used for rectal tumours – usually does not apply in the treatment of colon tumours, except in rare cases to relieve symptoms. Like chemotherapy, it can be used before or after surgery.
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