“Similar to hemorrhoids… What are the specific symptoms of rectal cancer?”… Colon cancer symptoms and treatment [인터뷰]

The large intestine, which absorbs water from undigested food and stores waste for excretion in the form of faeces, is distributed into the intestine, colon and rectum. The double rectum is the last part of the large intestine, where it collects faeces and waits before excreting. Rectal cancer is a malignant tumor of the rectum. Rectal cancer has few early symptoms, and the symptoms are similar to hemorrhoids, so it is often diagnosed late. Haidak internal medicine counseling physician Park Hyeon-gyeong (Hyeon-gyeong Seoul Internal Medicine Clinic) explained, “Rectal cancer has symptoms similar to hemorrhoids, but there are differences when you examine it closely.” Learn about rectal cancer symptoms, diagnosis and treatment with Dr. Park Hyeon-kyung.

Director Park Hyeon-kyungㅣSource: Seoul Park Hyeon-kyung Internal Medicine Clinic

C. Rectal cancer is sometimes misdiagnosed as hemorrhoids or constipation, and the treatment period is delayed. When you have actually been treated, what symptoms do patients usually have when they visit the hospital and are diagnosed with rectal cancer?
In the early stages, there are usually no symptoms, so by the time symptoms appear, the cancer is often already quite advanced. You may feel some pain, but usually you don’t feel pain until it’s too late.

As rectal cancer progresses, the most common symptom is ‘blood in the stool’. Recently, during September, four patients in our hospital were diagnosed with rectal cancer, and I became alert. Common symptoms for patients are sudden worsening of constipation and changes in bowel habits, such as a feeling of a residual bowel movement after bowel movements.

Q. What are the symptoms of rectal cancer that are different from hemorrhoids?
It can be said that rectal cancer in a fairly advanced state has symptoms similar to hemorrhoids as it shows symptoms such as rectal bleeding, the feeling of residual stools, pain during bowel movements, and changes in the thickness of the stools. However, if you look closely, there are some differences.

First of all, it is a bleeding symptom. Hemorrhoids are a bright red color, and there are many cases where bleeding occurs only after bowel movements, so feces and blood are separated. It is a pattern where only blood drips after defecation and the blood that bleeds is smeared on the toilet paper. However, in the case of rectal cancer, stool comes out and stimulates cancer tissue along with bleeding in the rectum, so blood is buried in the stool, and blood is often mixed with mucus rather than bright red

The type of pain is also slightly different. Among hemorrhoids, thrombotic external hemorrhoids cause severe pain in the anus, and the pain occurs very suddenly because blood clots occur due to capillary bleeding. On the other hand, pain caused by rectal cancer usually complains of pain that gradually worsens due to the nature of the disease, which develops slowly rather than causing sudden pain. In this way, even if the symptoms seem similar, you can roughly estimate the cause of the disease in the process of consulting a specialist. Therefore, it is strongly recommended that you do not hastily judge that it is just a symptom of hemorrhoids and seek treatment from a specialist in digestive disorders.

Q. What is the difference between colon cancer and rectal cancer?
The large intestine can be divided into the colon and rectum, the rectum being the last 15 cm of the large intestine that passes through the cecum, ascending colon, transverse colon, descending colon, and sigmoid colon . Cancer that occurs in the colon is called colon cancer, and cancer that occurs in the rectum is called rectal cancer. Both colon and rectal cancer are malignancies, eventually referred to as colon or rectal cancer.

In terms of treatment, there is no great difference between the lesions in the colon and the rectum, and it can be seen that it depends on the stage of the cancer. Primary surgical resection and additional chemotherapy (chemotherapy, radiation therapy, etc.) are considered. However, in the case of rectal cancer, it may be close to the edge of the anus, so creating a stoma (colostomy) may be included among the surgical resection methods. In cancer surgery, in order to at least prevent recurrence, the distance between the border of the cancer and the surgical resection site must be kept at least 2 cm. You will be placed in a temporary or permanent colostomy for defecation.

Q. What tests are available to diagnose rectal cancer?
First of all, if rectal cancer is suspected, a biopsy must be carried out by colonoscopy or sigmoidoscopy. However, as lesions in the lower rectum, which is the part connected to the anus, are often missed, it is necessary to reverse the endoscope from the lower rectum and observe the anus well before completion’ r endoscopy. If cancer cells are confirmed in a biopsy, CT (computed tomography), MRI (magnetic resonance imaging), and PET (positron emission tomography) are also used to determine the exact size of the cancer, the depth of invasion, and the extent of metastasis.

Occasionally, a blood test for cancer is desired Carcinoembryonic antigen (CEA), a marker for colorectal cancer, is a glycoprotein that is normally produced during the fetal period, and is produced prevent it before birth. If you have high CEA levels in your blood tests, you may have other cancers, such as colorectal or lung cancer. However, blood tests alone are not suitable for diagnosing colorectal cancer, as this level can also increase in patients with cirrhosis of the liver, liver disease, chronic lung disease, and smokers.

Rectal cancer |  Getty Images BankRectal cancer | Getty Images Bank

C. There are reported to be many cases of problems with bowel function after rectal cancer surgery. Is a colostomy necessary?
Appropriate surgical principles for rectal cancer are distal resection of the bowel and close to a sufficient distance from the tumor, with extensive resection of the lymphatics. In the case of early rectal cancer, if the depth of the invasion is not deep, it can be resected through an endoscopic procedure, but basically, the entire rectum is resected leaving only an appropriate distance to the anus. In this process, if the distance between the rectal cancer and the anus is too close, the function of the anus cannot be saved, so a colostomy is placed permanently. However, with the development of surgical techniques, even if the distance from the anus to the rectal cancer is as close as 4 to 5 cm, it is possible to place a temporary colostomy after surgery and perform a recovery operation later .

Q. Rectal cancer is said to be very likely to recur or have complications even after treatment What is the reason?
Rectal cancer recurs in around 30-50% even after radical resection. Among cases of recurrence, not only is local recurrence in the area where the original tumor was located, but also extensive recurrence with distant metastases to other organs is common. The reason is that the rectum is very close to other organs in the pelvis, such as the uterus or the bladder, and there is no peritoneum in the lower part of the rectum, so cancer cells can easily attack the nearby organs. As there are many recurrences that directly attack the surrounding genitourinary system, there are of course many complications, and distant metastases that spread along blood vessels or lymph nodes are common, so liver or lung metastases, bone (bone) metastases, or brain metastases are mainly observed..

Q. What are some lifestyle habits to prevent rectal cancer?
All cancer-related prevention methods will be similar, but in the end, primary prevention to prevent cancer from occurring at all will be nearly impossible. This is because no single cause of cancer can be determined, and among many causes, there are factors we cannot choose or avoid, such as genetic predisposition. However, secondary prevention from early detection and treatment of rectal cancer through regular screening is quite effective. Therefore, even in the low-risk group without symptoms, it is recommended to perform a regular colonoscopy after the age of 40.

In addition, healthy eating habits are very important to prevent colorectal cancer. First, many studies have shown that the higher your total calorie intake, regardless of the type of food you eat, the higher your risk of colorectal cancer. In this regard, controlling your weight to avoid obesity can help. Also, red meat and a high protein, high fat diet can increase the risk of rectal cancer, so it is good to avoid excessive intake.

It has been said that sufficient dietary fiber and calcium intake can reduce the risk of rectal cancer, but more research is still needed on the effective calcium intake.

Support = Hydak Counseling Doctor, Director Park Hyeon-kyung (Seoul Park Hyeon-kyung Internal Medicine Clinic)

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