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These are the most frequent of the digestive cancers at the non-smokers, in France, in Europe of the west and in North America.
..Some numbers: - One tracks down every year 25 000 new cases in France;
- The cancer of the colonist and the rectum touches in Europe 20 to 35 people for 100 000 inhabitants.
.. Reasons and factors of risk
A better knowledge of the predisposing factors to the cancers rectocoliques (constitutional or acquirement), should permit to improve their prevention and to make their tracking more precocious.
A domestic predisposition exists indeed to the colon cancers in some cases. The polyposes rectocoliques was the subject of very advanced studies: in the polypose domestic rectocolique the risks cancerous transformation is of 100% among the subjects of more than 40 years.
The cancer domestic colic without polypose is less known (syndrome of Lynch). He is characterized by the young age of the topic, the strong proportion of colon cancers right, the frequent association to a genital cancer at the woman.
The rectocolite hémorragique encourages the development of the cancers rectocoliques. The illness of Crohn degenerates more rarely.
The epidemiological studies show that a food rich in fibers and in reduced green vegetables the risk to develop a cancer colic. On the contrary, an elevated caloric contribution, a sedentary life and an overweight are factors of risk. The animal fat matters, the fat meats, some hydrates of carbon would encourage these cancers, but these data must be confirmed.
The colon cancers
.. The signs of the illness The revealing signs of the cancer colic are the most often banal:
* Of the pains to type of intermittent intestinal gripes with distending capable to last 1 to 2 days and consistent of a debacle fetid diarrhéique (syndrome of Koenig); * Of the sensations of flatulence, weight, abdominal distending; * The alternation of diarrhea and constipation; * A change of the general state (fatigue, lack of appetite, notably for meats, thinning, small fever); * An anemia hypochrome (translating an occult bleeding); * Of the traces of black blood in the stools (melaena); * Of the broadcasts of red blood or mucus during or after the stools...
The rectal hemorrhage is a very important alert sign. The research of blood in the stools can make itself by means of the Hémoccult. This reactive paper permits to discover minimal quantities of blood in the stools.
Three stools must be examined to be able to pull a conclusion of this exam. One arranges by means of a spatula a cool saddle particle on the disk of paper. The revelation is made some hours or days later with 2 or 3 drops of an alcoholic solution of oxygenated water. A positive reaction entails a blue or aquamarine coloration in less than 30 seconds.
The régime without meat is not necessary considering the doorstep of sensitivity of the test. It is necessary to exclude on the other hand: - The aspirin and the food rich in peroxydases (radish, turnip, sardine, salmon, pineapple, banana) sources of false positives;
- The C vitamin, source of false negatives.
An exam by Hémoccult is recommended among some subjects, and before reminiscent symptoms, or even in the whole population after fifty years according to some opinions.
.. Evolution of the illness
In the half of the cases, cancers gripes are only recognized on the occasion of a complication:
- Sharp intestinal closure by obstruction installed progressively with gripes. It is an accident that occurs in general after several crises of consistent subocclusion of debacles of stools liquids or after one period of prolonged constipation. The closure appears by vomitings, a stop of matters and gases and an abdominal distending;
- Suppuration néoplasique: evolving toward the abscess around the tumor;
- Peritonitis by perforation of the colon;
- Opening (fistulisation) in an adjoining hollow organ: bladder...
..The tumor is going to spread: - First locally: skin, shackles of the spindly intestine, bladder;
- Then in the lymphatic organs;
- Finally from afar: metastases (secondary localizations) hepatic, peritoneal (ascite), pulmonary, cerebral...
.. Exams and complementary analyses
The coloscopie and the rectoscopie with biopsies, the sigmoïdoscopie to flexible optic fibers permits to affirm the diagnosis while visualizing the tumor and while permitting the analysis of withdrawals (biopsy). The radiological exam by enema baryté in double contrast after enemas évacuateurs permits to see the lesions typical of the cancer: pictures of shrinkage or hiatus.
The balance of opérabilité starts with a clinical assessment and paraclinique of the extension of the cancer, while knowing that the last word will come back to the exam open stomach during the surgical intervention.
..Not to confound with... - A fecalome (heap of dry fecal matters);
- A benign tumor;
- An illness of Crohn;
- A sigmoïdite;
- An endometriosis...
..Treatment
The only treatment of the colon cancers is the surgical ablation. Intervention carries away the tumor and the lymphatic ways of drainage. According to the cases, the surgeon practices:
* The ablation of the left colon with his vessels and lymphatic: left hémicolectomie; * The ablation of the right colon: right hémicolectomie; * The ablation of the transverse colon: intermediate colectomie.
The continuity of the digestive journey is assured by immediate anastomose or in a second operative time. If it is in a second time the patient will have during some times an artificial anus.
In other cases, the surgeon practices a segmental colectomie.
The complete chemotherapy sometimes the treatment.
When the exérèse of the tumor is impossible, the surgeon practices an external or internal derivation.
All surgical treatment must start with an intensive and fundamental preparation, so much the colon that of the patient himself.
* Regime without residues; * electrolytic hydro Rééquilibration; * Vitaminothérapie.
The patient must be warned before the operation of the possibility of a temporary or definitive artificial anus. Some post-operative complications are possible dominated by the risk of fistulas.
The régime without residues suppresses all food bringing the cellulose that increases the fecal bowl and form an important ballast. He aims to assure the emptiness of the intestine and the cleanliness of the colon.
..It especially serves to prepare the intestine to undergo:
* Some exams: enema baryté, coloscopie; * A surgical intervention (colectomie); * The régime suppresses all vegetables, all fruits and all complete cereals completely.
..The food is composed solely of:
* Cheese to dough firing, type gruyere, Holland etc.. * skinny Meat of first whole category or chopped if too fibrous (veal, beef, chicken, fish, ham); * Cereals (doughs, rice, semolina, tapioca); * Toasts and cookies; * Compotes homogenized to basis of quince, apple, banana, frozen of fruits, dough of fruits; * Sugar, butter and oil grown without excess; * Drinks non sparkling natural and mineral water, coffee, light tea, brewings, let's boil vegetables and fruits.
This régime must be of short length because it is tiring for the patient and unbalanced (hyperglucidique, carencé in C vitamin and plant fibers) Prognosis
It depends on the extension of the cancer (classification of Dukes), that will be specified by the biopsies: the prognosis is of as much better than the cancer is diagnosed to a localized stage. ..Cancers of the rectum
The adénocarcinome of the rectum is more frequent at the man that at the woman.
The factors of risk are the rectocolite hémorragique (even after colectomie), the simple adenomas. .. The signs of the illness
Although sitting easily in a cavity accessible, the cancer of the rectum is often discovered only to an advanced stage.
The revealing signs can achieve a real rectal syndrome:
* Evacuations of mucuses mucopurulentes sometimes streaky of blood; * Squeezed, rectal ténesme, sensations of "false needs" of exoneration; * red blood Rectorragies coating the stools.
..Other signs can orient the physician toward the small basin:
* A difficulty to urinate (dysurie) at the man; * Of the pelvic pangs making evoke a gynecological pathology at the woman.
..Other symptoms orient toward the intestine:
* A constipation, a diarrhea or the alternation of the two; * Of the pains left iliac gripes; .. A distending...
Sometimes, the symptoms are a lot more waves:
* thinning, anorexia, fever...
Of other times, the cancer is discovered casually by the rectal touch. .. The consultation
It touch it rectal (TR) that permits the diagnosis, he permits to feel the cancer as a prominent pad, hardened, limiting a crater or as a rounded, irregular, granular mass, hardened and crumbly. The bleeding to the contact of the finger is reminiscent.
[?] Exams and complementary analyses
The rectoscopie confirms the diagnosis and permits to practice simple and painless biopsies.
The enema baryté in double contrast permits to see the lesion and especially to search for another localization colic. The coloscopie is preferable if it is possible.
As soon as the diagnosis of the cancer of the rectum is put, the physician must make the balance of the extension of the cancer:
* Local: in relation to the margin of the anus; * Regional: ureter, prostate, bladder (intravenous urographie, cystoscopie, abdomino-pelvic scanning); * General (metastases): liver (scan), peritoneum, lungs (x-ray), node of Troisier (hollow left know-claviculaire).
The dosage of the carcino-embryonic antigen is especially useful in the post-operative surveillance. .. Evolution of the illness
The complications of the cancer of the rectum are rarely revealing: closure intestinal bass, peritonitis by perforation colic upstream... [?] Not to confound with...
Although the cancer is the most frequent rectal affection, all rectal lesions either hardened ulcerous are not cancerous: - The rectal endometriosis at the woman;
- The inflammatory shrinkage of the illness of Nicolas Favre;
- The simple ulcer of the rectum;
- The rectites (microbial, parasitic, Crohn, rectocolite hémorragique)...
Owing rectal bleedings, it is necessary to evoke the cancer of the rectum however always.
..Treatment
The curative treatment of the cancer of the rectum is the large surgical exérèse. Two types of interventions are possible: with or without conservation of the anal sphincter.
Interventions suppressing the sphincter are the amputation of the rectum by way abdomino-périnéale. The consequence is the abdominal artificial anus of it (definitive colostomy). This intervention is practiced when the tumor is low (close to the anus).
In case of high cancer (situated more of 12 cm of the margin of the anus): the surgeon can practice the resection of the rectum and can re-establish the colo-anal continuity.
The radiotherapy of contact gives good results in the small low cancers. The post-operative radiotherapy reduces the local recidivisms.
The chemotherapy is sometimes associated.
.. Evolution of the illness
Intervention on the rectum is often source of hindrance and complications. The artificial anus requires an equipment and the patient's adaptation, it is frequently the seat of small complications.
The exerese of cloths perished rectal generates urinary unrests enough often (retention of urine or incontinence) and genital.
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