Rectal Carcinoma
Diagnostics
The most important sign for a tumor of the rectum is stool covered with slime and blood. A patient displaying such symptoms should undergo an examination of the rectum and a complete examination of the colon, though the most common cause for an admixture of blood in the stool are haemorrhoids.
During a rectoscopy and a complete coloscopy samples will be taken to examine the malignancy of the tumor. Furthermore, a coloscopy serves to exclude the existence of further tumors in the colon (colonic tumors).
To rule out metastatic spread an ultrasonic examination of the liver,and, if need be, a CT of the abdominal cavity and an x-ray examination of the lungs will be performed.
An ultrasonic examination of the straight bowel or a MRT will show the local extent of the tumor. It depends on the result of this examination if a local radiotherapy with a simultaneous chemotherapy is necessary before surgery, or if the operation can be performed immediately.
Surgery
The surgical aim is the resection of the malignant tumor with a sufficient safety-distance, as well as the removal of the lymph nodes, which could be affected by metastatic spread of the cancerous tumor. A sufficient safety-distance is considered to be 5cm from the sphincter. With tumors directly above the sphincter 2cm safety-distance are considered as sufficient.
The operation is ususally performed by an incision in the middle of the abdomen. In some cases minimal invasive surgery can be performed alternatively.
The combination of the two bowel ends is usually done by suture clips and a stapling device.
Surgical Risks
The resection of rectal carcinoma harbors the same risks like a colon operation. With the suturation of the two bowel ends (anastomosis) up to 5cm above the sphincter there is a great danger (based on operational techniques) that the intestinal suture won't heal properly. For that reason, an artificial anus with a will be attached to drain the faeces into a colostomy bag to avoid a life-threatening infection, that would extend your stay in hospital for a very long time. After an uncomlicated healing of the intestinal suture the artificial anus will be removed early in time (6-12 weeks).
Special Questions
- If the ultrasonic examination or the MRT show extended tumors and enlarged lyph nodesd a preoperative treatment will follow, which consists of a chemotherapy and a radiotherapy, whereby chemotherapy increases the sensibility of the radiation on the tumor. This concept of a preoperative treatment improves the prognosis of the tumor.
- The prognosis of a cancerous tumor of the rectum depends on the stage in which it is diagnosed. This stage is determined on the extent of the tumor in the intestinal wall and the affection of the lymph nodes. The result of the examination of the sample will be given by the pathologist 3-4 days after the examination . The results will be discussed with you in detail.
- Your stay in hospital will take 7-12 days. Early nourishment, an early removal of drains from the abdominal cavity or the bladder, a sufficient pain therapy as well as an early mobilisation will shorten your stay in hospital. Therefore, the active participation of the patient is very important. Every patient should – under a sufficient pain therapy- stay out of bed as long as possible, which means sitting on a chair or walking around, to lower his /her risk of thrombosos or danger of embolism.
- Pre-operative care requires a complete evacuation of the bowels, which will be performed on the day of your admission to hospital. It is certainly possible to begin with the pre-operative measure at home.
- The wound will be closed with invisible dermal stitches that make a removal of sutures after surgery obsolete.
- Every cancerous disease harbors the risk of the development of metastasis. The risk of metastatic spread is at its height in the first two years after surgery, and will decrease in the course of time after surgery. Therefore, we have a post-treatment scheme, which detremines the date on which you should show up in our ambulance for a medical check-up.
