Symptoms of rectal cancer recurrence

Written by Gong Chun
Oncology
Updated on September 03, 2024
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The symptoms of rectal cancer recurrence can include changes in bowel habits and stool characteristics, possibly presenting as rectal bleeding, increased frequency of bowel movements, a sensation of heaviness in the anus, and changes in stool shape, such as narrowing. The second symptom may be abdominal pain, particularly persistent and subtle pain. The third symptom involves palpable abdominal lumps or masses, especially with right-sided colon cancer. The fourth symptom is intestinal obstruction, which can occur if the bowel is blocked due to the recurrence of rectal cancer, leading to symptoms of intestinal obstruction. The fifth symptom, if the recurrent rectal cancer has metastasized, may lead to symptoms at the respective metastatic sites.

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How long can one live after rectal cancer surgery?

The specific life expectancy after radical resection for rectal cancer varies among individuals and is dependent on various factors including the patient's general and physical condition, pathological staging post-surgery, and whether there are high-risk factors for recurrence such as lymph node metastasis, vascular tumor thrombus, and nerve invasion. The overall five-year survival rate post-surgery is approximately 50%. If the disease is confined to the submucosa and lacks high-risk factors such as vascular tumor thrombus, nerve invasion, or lymph node metastasis, the five-year survival rate after radical surgery can reach up to 90%. However, if post-surgery pathology reveals lymph node metastasis, vascular tumor thrombus, and nerve invasion, among other high-risk factors, the patient's five-year survival rate will decrease. Thus, survival rates are closely related to many factors.

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What tests are used to check for rectal cancer?

When clinical symptoms such as diarrhea or constipation, changes in bowel habits, bloody stools, and abdominal pain occur, we should be vigilant about the possibility of rectal cancer. The examination for rectal cancer can start with a digital rectal exam, especially for low-lying rectal cancer, which is closer to the anus; these tumors can be detected through this method. Then, a colonoscopy should be performed to take a biopsy to confirm the diagnosis, which is the gold standard for confirmation. Additionally, blood tests for tumor markers can be conducted. Generally, carcinoembryonic antigen (CEA) and CA199 levels may be elevated, but this is not absolute as their specificity and sensitivity are not very high. An enhanced CT scan of the abdomen can also be done. In such scans, we can see thickening of the intestinal wall where the tumor is located, and the enhancement can show the intensified thickening of the intestinal wall. Combining all these methods can confirm the diagnosis of rectal cancer.

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Stage II colorectal cancer

Rectal cancer staging is based on the TNM system. "T" refers to the primary tumor, "N" indicates whether there are lymph node metastases, and "M" indicates the presence of distant metastases. Staging is determined according to these factors. Stage II generally refers to patients with T3, N0, M0, or T4, N0, M0. What does this mean? T3 indicates that the tumor has penetrated the base layer reaching the subserosal layer, or has invaded the tissues adjacent to parts of the colon or rectum that are not covered by peritoneum, which is described as T3. T4 means that the tumor has invaded through the entire bowel wall, perforated the visceral peritoneum, and involved other organs or structures, which is called T4. N0, M0 means there are no lymph node metastases and no distant metastases, such as to the liver or lungs. Such patients are clinically staged as stage II rectal cancer.

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How to detect colorectal cancer early

In clinical practice, to detect colorectal cancer early, screening should be prioritized for individuals with a family history of colorectal cancer. This generally involves tests for tumor markers and colonoscopy examinations. The tumor markers include carcinoembryonic antigen, carbohydrate antigen 724, carbohydrate antigen 199, and carbohydrate antigen 125, among others. Colonoscopy examinations should be conducted annually. Furthermore, for individuals with colorectal polyps, yearly colonoscopy is especially recommended to detect early stages of colon cancer. Similarly, for individuals suffering from chronic inflammatory diseases of the colon and rectum such as ulcerative colitis or Crohn's disease, colonoscopy examinations should also be performed to facilitate early detection of colorectal cancer.

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Can a colonoscopy detect rectal cancer?

Colonoscopy can detect colon and rectal cancer. It is the most important and primary method for examining colonic mucosal lesions. The large intestine includes the cecum, colon, and rectum. Colonoscopy allows direct visual inspection of lesions, including the size and color of the lesions, and whether there are ulcers and erosion, the nature of any attachments, etc. It also allows for direct biopsy. Firstly, it can assess the texture of the lesion, such as whether it is soft, hard, or brittle. Moreover, the biopsied sample can be analyzed histologically to determine the benign or malignant nature, depth of infiltration, etc. Different pathological characteristics have different prognoses and treatment methods, suitable for early cancers treatable under endoscopy, or those that can be removed during the process of the colonoscopy.