Which method is useful in the diagnosis and preoperative staging of tumors of the rectum?
- Endorectal ultrasonography is useful in the diagnosis and preoperative staging of tumours of the rectum.
How most commonly are presented advanced rectal cancers?
- Advanced rectal cancers most commonly are presented with TENESMUS (the continuous urge to defecate).
- Tenesmus may give way to continual sacral pain, sometimes radiating down the perineal and thighs, as the tumor invades the sacrum and the sacral nerve plexus.
What should be the completion of the physical examination in suspicion of rectal cancer?
- The completion of the physical examination should ALWAYS be a digital rectal examination.
- To feel for a mass
- To assess its mobility and position
- To detect enlarged, extra rectal lymph nodes.
Rectal Cancer
Dx: DRE, Lower GI endoscopy, EndoRectal US, Pelvic MRI
Tx: ADvanced: Neoadjuvent Radio therapy →(6W) Surgery
Tumor upper/ Mid 1/3 : Ant. Rectal resection
Lower 1/3 : Abdominoperineal resection - 'rectum + anus' Permenent Colostomy - Perineum is closed
Small Early: Local excision
🔴 Left-Sided Colon Cancer (distal transverse, descending, sigmoid):
- Anatomically:
- The left colon has a narrower lumen
- Stool is more formed and solid
- Tumor growth pattern:
- Tumors grow endophytically → constrict the lumen (called "napkin-ring" or "apple-core" lesions)
- Main complication:
- Bowel obstruction
- Can also cause alternating constipation and diarrhea, abdominal pain, distension
- Typical presentation:
- Changes in bowel habits, visible blood in stool, colicky pain