Rectal Cancer
This is one cancer which doctors can readily diagnose.
The majority of these growths are within easy reach of
the physician's examining finger. Rectal bleeding can be
an important symptom; it should never be passed off
lightly. If the patient promptly sees a physician after the
occurrence of this symptom and if the proper examination
is done, diagnosis can be made early. Adequate medical
attention demands that all patients with blood in or on the
stool be examined to discover its cause. Usually there
is a simple explanation.
What is the survival rate of rectal cancer?
In the collection of statistics relevant to cancer, the
five and ten year results are the ones commonly used
for reference. A five year or ten year cure means that the
patient is alive for that interval without evidence of
cancer. The term "five year survival" is also employed
when the patient is alive but has residual or recurrent
cancer.
Early rectal cancer offers an excellent chance for cure,
with 80 percent alive and free of cancer five years later.
If the tumor is encountered in a more advanced stage,
when the lymph drainage areas are also involved, the
survival figure falls to 25-40 percent. Because the symptoms
may be regarded as trivial and because the examination
requires exposure of the area, time to examine it,
and appropriate instruments, diagnosis and treatment may
be delayed. Sometimes these growths are less bloody than
irritative, and they can produce diarrhea. Any change
in bowel habits in the adult requires proper examination.
How is rectal cancer diagnosed?
A piece of tissue is removed at the time of the internal
rectal examination. This specimen is examined microscopically.
Since this diagnosis is so serious, can this tissue
examination be relied on?
No pathologist will make the diagnosis unless he is
positive. If there is any uncertainty, a second or even a
third representative piece of tissue may be removed for
further microscopic examination. In rare instances a second, a third or even a fourth pathologist is consulted.
The operation is not done unless the diagnosis is unequivocally
made.
What constitutes a favorable case?
It is not possible to know this before the operation is
performed. However, if examination does not suggest
that the tumor has extended to the bone or to other
parts of the lower body lining, if the
X ray of the bladder
area shows this to be normal and if the blood examination
is normal except for some very mild anemia due to
the blood the patient has been losing, there is good reason
to be optimistic.
Must an operation be performed?
This disease won't go away by itself or by any nonsurgical
means. It will get bigger and spread and cause
much misery. If the patient's condition at all permits it,
we should make an effort to cure him.
What does the operation do?
In general terms the cancer area is completely removed.
In some circumstances we can sew the intestinal ends together
again; under other conditions a permanent colostomy
is required. It is hard to tell in advance which procedure
will be possible and which will be the better
method.
What makes it necessary to do a colostomy?
Every effort will be made to save the rectum so that the
bowels will move in a normal fashion. Sometimes the
growth is so far down toward the anus that it is unwise,
in terms of subsequent bowel control or in an effort
to cure the disease, to bring the ends together. It's almost
always possible to join the ends, but this obviously is not
a wise approach if the cancer will probably reappear
in the same area in a few months. The operation that removes all the tissue by the abdominal as well as the
perineal route offers the best opportunity for total extirpation
of the growth. The so called abdominoperineal
procedure is the standard approach to this type of cancer.
Is my father too old to be operated on?
In this regard an individual is not evaluated in terms
of how old he is in years, rather in terms of how the
years have affected his heart, lungs, kidney and brain.
One may be older or younger than his chronological age.
The family and the doctor are concerned not only with
prolonging existence but also with providing a comfortable
life. Thus the quality of survival must be considered.
In broadest terms, an eighty year old bedridden, blind,
senile individual should be managed differently from a
person of the same age who functions completely and
performs responsible daily activities.
Is there any other surgical method besides opening
the abdomen?
Another method is burning the tumor by special freezing
or electrical techniques. This is done through the
rectum without making an incision. It is one of the alternatives
when for some reason the standard operation
cannot be done. There is currently no long term information
available about the cure rate or the salvage rate. It
is viewed as a comparative method.
My father has already been operated on. At that time he
refused a colostomy and the two ends were brought
together. The cancer has recurred. What can
be done now?
If the examination shows that the cancer is still removable,
a second operation should be done to excise it
all. This will probably require a permanent colostomy.
The chances the second time around are never as good as
the first time. However, it is definitely the thing to do in an attempt to cure him. The discomfort and symptoms
of a recurrent uncontrolled tumor are very disabling.
He had a cancer of the large intestine removed four years
ago and appears to be OK from that. Isn't it surprising
now to have a cancer of the rectum?
It is not too common. About 5 percent have two intestinal
cancers at the same time or get one after the
other.
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