{"id":386184,"date":"2024-10-11T14:00:00","date_gmt":"2024-10-11T12:00:00","guid":{"rendered":"https:\/\/medizinonline.com\/?p=386184"},"modified":"2024-10-03T17:54:11","modified_gmt":"2024-10-03T15:54:11","slug":"abdominal-pain-rectal-cancer","status":"publish","type":"post","link":"https:\/\/medizinonline.com\/en\/abdominal-pain-rectal-cancer\/","title":{"rendered":"Abdominal pain – rectal cancer"},"content":{"rendered":"\n

Colorectal carcinomas usually occur as a transformation within adenomatous polyps.\nPercutaneous sonography of the abdomen is usually performed as an exploratory examination of the abdomen (liver, ascites, gallstones) and also provides information on colon carcinomas that are growing beyond the organ.\nX-rays, CT or MRI are also used depending on the problem.\nThe latter is currently the gold standard for local spread diagnostics. <\/strong><\/p>\n\n\n\n\n\n\n\n

Colorectal carcinoma is one of the three most common malignancies in the Western world, and is the second most common malignant tumor in women [1].\nAround a third of these are found in the rectum.\nThis corresponds to around 18,000 new cases per year [4].\n90-95% of the tumors are adenocarcinomas.\nThe peak age is between 50 and 70 years.\nMen and women are affected in equal numbers.\nMany colorectal carcinomas develop from polyps.\nThe symptoms develop relatively late.\nAt the time of initial diagnosis, there is often tumor growth beyond the wall and metastases in around 25% of patients.\nThe average 5-year survival rate is 50%.\nIn stage Dukes A it is around 90%, in Dukes D 10%.\nBlood in the stool, alternating diarrhea and constipation and occasional tenesmus indicate a mass in the colon.\nFever, night sweats, weight loss, reduced performance, fatigue and anemia sometimes occur. <\/p>\n\n\n\n

The primary diagnostic procedure for detecting rectal or colon cancer is endoscopy.\nThis allows precancerous lesions, such as mucosal polyps or adenomas, to be detected and removed at an early stage and manifest tumors to be diagnosed and histologically confirmed [6].\nThe recommendations for screening vary depending on the family history and hereditary risk.\nThe risk factors are listed in Table 1<\/strong>. <\/p>\n\n\n

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Clinical examination allows the mobility of the tumor to be graded, while endoscopy allows the aboral tumor distance to the dentate line or anocutaneous line to be determined [5].\nThe magnetic resonance imaging findings are of great importance for treatment planning.\nIn early carcinoma without risk factors, local excision can be performed, surgical resection with lymphadenectomy, minimally invasive or open surgery, is the standard therapy, combined with neoadjuvant treatment concepts.\nComplex therapy can lead to a post-resection syndrome (low anterior resection syndrome,<\/em> LARS) in over 50% of patients.\nThis includes limited continence, urge to defecate and frequent bowel movements. <\/p>\n\n\n\n

X-rays <\/em>of the thorax are part of the staging and clarification of pulmonary metastases [4].<\/p>\n\n\n\n

Sonographically, <\/em>endosonography is superior to abdominal ultrasonography, but should always be correlated with the findings of magnetic resonance imaging [5]. <\/p>\n\n\n\n

Computed tomography<\/em> should be used for additional cross-sectional imaging in the case of unclear pulmonary or abdominal findings [4].\nThe local findings of rectal carcinoma may be conspicuous due to segmental wall thickening or polypous intraluminal masses [2].\nEnlarged local lymph nodes, liver metastases and mesenteric and omental filiae can be detected.\nInflammatory processes, such as diverticulitis or appendicitis, can simulate a malignancy [6]. <\/p>\n\n\n\n

CT colonography<\/em> has become relatively quiet in recent years.\nFDG-PET-CT is a valuable diagnostic tool as a complementary imaging procedure for verifying metastasis-specific lesions. <\/p>\n\n\n\n

Magnetic resonance imaging examinations<\/em> are very well suited to differentiate carcinomas of the rectum.\nThey have established themselves as the gold standard for local spread diagnostics.\nPolypous masses or wall thickening are suspicious, especially if there is a low signal in T1w and an intermediate signal in T2w [3,4].\nAfter intravenous administration of Gd-DTPA, a clear increase in tumor signal is detectable.\nThe size of the periproctal lymph nodes correlates with the degree of malignancy.\nContrast enhancement of the mass is low. <\/p>\n\n\n

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Case study<\/h3>\n\n\n\n

Case example 1 (Fig. 1A to G) <\/strong>shows the course of a rectal carcinoma with pre- and postoperative imaging in a 70-year-old female patient.\nOriginally there was a large rectal tumor.\nAfter radical tumor removal and creation of an anus praeter, postoperative computed tomography showed no residual or recurrent tumor.\nHowever, a suspicious lymph node was visible on the right iliac side. <\/p>\n\n\n

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Case 2 <\/strong>demonstrates (Fig. 2A, B and C)<\/strong> a circular stenosing carcinoma in the rectosigmoid junction with local fatty tissue infiltration and paracolic lymph nodes in a 61-year-old female patient.\nThere was also extensive hepatic metastasis. <\/p>\n\n\n\n

Take-Home-Messages<\/strong><\/p>\n\n\n\n