RECTAL CARCINOMA

Globally, colorectal cancer is the second most common malignancy, affecting more than 1 million people every year and resulting in around 715,000 deaths. It is the second most common cancer in women and the third most common cancer in men, being the fourth most common cause of cancer death after lung, stomach, and liver cancer. In Western countries the incidence is rising, with an overall 14% increase since the 1970s, but with the largest increase (20%) seen in males. Risk factors include diet, obesity, smoking and lack of physical exercise. Most colorectal cancers are due to old age, with around 60% of cases affecting patients 70 years or older. The rectum is the most frequently involved site, accountingfor approximately one-third of the cancers.

CLINICAL FEATURES: - Carcinoma of the rectum can occur early in life, but the age of presentation is usually above 55 years, when the incidence rises rapidly. Often, the early symptoms are so insignificant that the patient does not seek advice for 6 months or more, and the diagnosis is often delayed in younger patients as the symptoms are attributed to benign causes. Initial rectal examination and a low THRESHOLD FOR INVESTIGATING PERSISTENT SYMPTOMS ARE ESSENTIAL.

BLEEDING: Bleeding is the earliest and most common symptom. Typically, the bleeding is bright red in colour and painless. It can be mixed with the motions or separate in the toilet bowel. It can be indistinguishable from haemorrhoidal bleeding, which is the most common differential diagnosis, particularly in younger patients.

TENESMUS : The patient experiences a sensation of needing to evacuate

the rectum but is unable to pass a motion. This is an important early symptom and is almost invariably present in patients with tumours of the lower half of the rectum. The patient may endeavour to empty the rectum several times a day (spurious diarrhoea), often with the passage of flatus and a little bloodstained mucus (‘bloody slime’).

ALTERATION IN BOWEL HABIT: There is frequently a change in bowel habit, with a tendency to more frequent defaecation and the passage of looser stool. A patient who has to get up early in order to defaecate, or one who passes blood and mucus in addition to faeces (‘earlymorning bloody diarrhoea’), is usually found to be suffering from carcinoma of the rectum. Although a change to looser stools is more common, patients with a stenosing carcinoma at the rectosigmoid junction may complain of increasing constipation.

PAIN : Pain is a late symptom, but pain of a colicky character may accompany advanced tumours of the rectosigmoid, owing to a degree of obstruction. Advanced cancers invading outside the mesorectum may infiltrate the prostate or bladder anteriorly or the sacral plexus posteriorly, giving rise to severe, intractable pain.

WEIGHT LOSS: Weight loss is also a late symptom and is almost always associated with metastatic disease.

INVESTIGATION: -

ABDOMINAL EXAMINATION: Abdominal examination is normal in early cases. Occasionally, in patients with stenosing tumours at the rectosigmoid junction, signs of subacute large bowel obstruction may be present, with abdominal distension. If large-volume liver metastases are present, an enlarged liver may be palpable along with other signs, such as cachexia. Occasionally, it may be possible to elicit ascites if there is widespread peritoneal dissemination.

RECTAL EXAMINATION: In many cases where the neoplasm is situated within 7–8cm of the anal verge it can be felt on digital rectal examination as an elevated, irregular and hard endoluminal mass. When the centre ulcerates, a shallow depression will be felt with raised and everted edges. An attempt should be made to determine whether the neoplasm is mobile, tethered or fixed, and to estimate the distance of the lower margin from the top of the anal sphincter complex: these factors are important in assessing resectablility and methods of reconstruction following excisional surgery. In females, a vaginal examination may be useful if involvement of the posterior vaginal wall is suspected. Digital rectal examination also affords the opportunity to evaluate the anal sphincter complex, which is important in cases where resection and low anastomosis are being considered.

RIGID SIGMOIDOSCOPY: Rigid sigmoidoscopy can be performed in the outpatient clinic and is useful to identify the neoplasm and possibly obtain biopsies. However, it requires the rectum to be empty of faeces and may require a prior rectal enema, which may not be practical in the outpatient setting. As colonoscopy is almost always required to visualise the whole colorectum, it is often easier and safer to obtain biopsies at this time.

Colonoscopy: - A colonoscopy is required in most patients to exclude a synchronous tumour, be it an adenoma or carcinoma. If a proximal adenoma is found, it can be conveniently snared and removed via the colonoscope. If a synchronous carcinoma is present, the operative strategy is likely to change. If a full colonoscopy is not possible, for example where there is a stenosing cancer, a CT colonography or barium enema can be performed.

HOMOEOPATHIC MANAGEMENT OF RECTAL CARCINOMAS

There are some medicines in Homoeopathy which help in management of Rectal cancers.

Carcinosin: - One of the effective Remedies to start with.

Alumina: - Severe Constipation is the marked feature. The stools are hard, dry, knotty, which may remain in the rectum for long periods without the desire to pass stool. Even a soft stool is passed with great difficulty. The patient has to strain a great to pass stool. The evacuation preceded painful urging long before and then straining at stool.

Aloe soc: - Where persistent painful Diarrhea is present. The stool is preceded with cutting pain in rectum after stool. There is a sense of insecurity in rectum. The stool passes without effort almost unnoticed. The stool may contain blood, mucus with burning in anus.

Hydrastis: - Remedy for Colorectal cancer with Constipation. There is sinking feeling in stomach with constipation. There is bleeding from bowel. Raw smarting pain in rectum during stool, remaining long afterwards.

Nitric acid: - Remedy for Colorectal cancer with profuse bleeding of bright red blood during stool. There is violent cutting pain in rectum, which continues many hours after stool. Due to pain the patient walks in agony. The bowels Constipated with fissures in rectum. For passing stool the patient needs to strain much but little stool passes.

Ornithogalum: - When there is great debility. There is a feeling of lump in the abdomen in the affected area with Vomiting of coffee ground looking material. The patient is highly depressed and have great prostration.