Rectal carcinoma, the most early presentation is:
Correct Answer: Bleeding
Description: Ref: Schwartz SurgeryExplanation:The most common symptom of rectal cancer is hematochezia.Unfortunately, this is often attributed to hemorrhoids.Bright red in colour but may be darker, and should be carefully investigated at any age.Other symptoms include mucus discharge, tenesmus, and change in bowel habit.The differential diagnosisUlcerative colitisCrohn's proctocolitisradiation proctitisand procidentia.Occasionally, internal intussusception of the sigmoid into the rectum can produce a solitary rectal ulcer that mimics an ulcerating cancer.Dukes' stagingGrowth is limited to the rectal wall (15%); prognosis excellent.The growth is extended to the extrareetal tissues, but no metastasis to the regional lymph nodes (35%); prognosis reasonable.There is secondary deposits in the regional lymph nodes (50%). These are subdivided into Cl, in which the local pararectal lymph nodes alone are involved, and C2, in which the nodes accompanying the supplying blood vessels are implicated up to the point of division. This does not take into account cases that have metastasized beyond the regional lymph nodes or by way of the venous system: prognosis is poor, a stage D is often included, which was not described by Dukes. This stage signifies the presence of widespread metastases, usually hepatic.Other staging systems have been developed (e.g. Astler--Coller, TNM) to improve prognostic accuracy, but the tumour-node-metastasis (TNM) classification is now recognized internationally as the optimum classification for stagingTNM stagingT represents the extent of local spread and there are four grades:T1 tumour invasion through the muscularis mucosae, but not into the muscularis propria;T2 tumour invasion into but not through the muscularis propria;T3 tumour invasion through the muscularis propria, but not through the serosa (on surfaces covered by peritoneum) or mesorectal fascia;T4 tumour invasion through the serosa or mesorectal fascia. N describes nodal involvement:NO no lymph node involvement;N1 1-3 involved lymph nodes;N2 4 or more involved lymph nodes.M indicates the presence of distant metastases;MO no distant metastases;Ml distant metastases.The prefix 'p' indicates that the staging is based on histopathological analysis, and V that it is the stage after neoadjuvant treatment, which may have resulted in down staging.Histological gradingLow grade = well-differentiated ; 11 % prognosis good;Average grade = 64% prognosis fair;High grade = anaplastic tumours; 25% prognosis poor.
Category:
Surgery
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