ADENOCARCIN OMA

DEFINITION OF ADENOCARCINOMA
Let's break it down. "Adeno-" is a prefix that means "gland." In general, glands secrete things and are classified as endocrine or exocrine. Endocrine glands secrete things into the bloodstream, like hormones. Exocrine glands secrete things that go outside of the body, like mucus and sweat. Acarcinomais amalignant tumorthat starts in epithelial tissue. Put the two words together and you get "adenocarcinoma," which means a malignant tumor in epithelial tissue, specifically in a gland.

CAUSE OF ADENOCARCINOMA

Virtually all adenocarcinomas develop from adenomas. In general, the bigger the adenoma, the more likely it is to become cancerous. For example,polypslarger than two centimeters (about the diameter of a nickel) have a 30-50 percent chance of being cancerous. You can learn more about polyp size and colon cancer risk by viewing the Polyp Size Gallery.

Definition: An adenoma is abenign tumorthat develops from epithelial tissue. Adenomas in the colon are often referred to as adenomatouspolyps. Although adenomas aren't cancerous, they have the potential to become cancerous.

RECTAL CANCER (ADENOCARCINOMA OF THE RECTUM)

What is Rectal Cancer? Rectal cancer may be of the adenocarcinoma type and usually arise from the epithelium (the layer of cells) which lines the large intestine. The colon is part of the large bowel. The large bowel starts at the end of the small bowel (the ileum), at the caecum. The caecum has the appendix running off it. The start of the colon is the ascending colon and where this rises to meet the liver (the hepatic flexure) it becomes the transverse colon. The transverse colon goes across the upper abdomen until it becomes adjacent to the spleen (the splenic flexure) and at this point it becomes the descending colon. The large bowel at this point goes down the abdomen to the pelvis at which point it becomes the sigmoid colon (because it curves in an "S" shape, sigma being the Greek for "S"). The sigmoid colon terminates at the rectum, which acts as a storage pouch for faeces before it is evacuated through the anus.

OVERALL, THE FUNCTION OF THE LARGE BOWEL IS TO ABSORB WATER FROM STOOLS. WHEN THE ILIUM ENTERS ITS CONTENTS INTO THE CAECUM, THEY ARE EXTREMELY LIQUID AND GRADUALLY SOLIDIFY AS THE CONTENTS PROGRESS AROUND THE LARGE BOWEL.

Statistics on Rectal Cancer Rectal cancer is common but occurs very rarely in young adults. Rectal cancer becomes more common as age increases. People in their 50s, 60s and 70s are most at risk with with sex incidence being slightly more common in females. Geographically, the rectal cancer tumour is found worldwide, but rectal cancer si most common in areas which have low fibre diets. Areas of the world with high fat consumption and low fibre consumption such as Europe, USA and Australia.

RISK FACTORS FOR RECTAL CANCER

There are a number of factors which increase the risk of developing rectal cancer: Hereditary Conditions:At particularly high risk of Rectal cancer are people with hereditary conditions such as Familial Adenomatous Polyposis or Hereditary Non Polyposis Colorectal Cancer. In these conditions, it can occur even in young adults, e.g. late teens and early 20s. Family History of Rectal Cancer:First degree relatives of patients with rectal cancer have an increased risk, particularly if the relative develops rectal cancer at a young age. Polyps:Certain types of polyps, notably villous adenomas have a potential to become malignant. Rectal cancer patients who have previously had a polyp in the large bowel should undergo regularcolonoscopy(ask your doctor how often).

Inflammatory Bowel Disease:Patients who suffer fromulcerative colitis, have approximately a ten fold risk of developing the disease and should have a colonoscopy carried out regularly. Diet:A high fat, low fibre diet, especially if high in red meat, is the worst diet that predisposes people to rectal cancer. People who suffer fromobesityare also at an increased risk.

HOW IS RECTAL CANCER DIAGNOSED?

General investigations into rectal cancermay showanaemiaor an abnormal liver function test. The blood albumin level may be low (Albumin is produced mainly in the liver. It helps to keep the blood from leaking out of blood vessels. When albumin levels drop, fluid may collect in the ankles, lungs, or abdomen). If liver involvement is severe the clotting profile will be abnormal with a raised INR.

HOW IS RECTAL CANCER TREATED?

The rectal cancer treatment of choice is clearly surgery for early disease. For Dukes Stage A tumours (that have not reached the muscular layer within the bowel wall) this will usually be curative in approximately 90% of cases. Rectal cancer surgery involves usually 1 of 2 methods: Anterior Resectionis where the rectum is resected from an operation from the front. The Anus is retained, along with anal function. Abdomino-Peroneal Resectionis usually carried out for tumours low down in the rectum and requires the removal of the Anus. A colostomy is then necessary.

Sometimes, a colostomy may be used in a temporary way for any bowel surgery, as a protective method to allow the intended surgery to heal. Rectal cancer surgery is usually carried out to remove the primary tumour for all except Dukes D (Stage IV disease. In some cases of Dukes D disease, if the bowel looks as though it will become obstructed, the primary tumour may be resected. If the rectal cancer has breached the bowel wall, and especially if it is has gone into the local lymph nodes, adjuvantchemotherapywill increase the chance of cure. The same is true if it has spread to regional lymph nodes. There is a clear consensus of opinion that Dukes Stage C should receive adjuvantchemotherapy. Dukes B tumours may also benefit from adjuvant treatment. This decision is made on an individual basis. If the rectal cancer has spread further, such as to the liver, longer term palliation can still be achieved by surgery to the primary tumour to prevent bowel obstruction, followed by specific treatment for the metastases.

PROGRESSION OF RECTAL CANCER

The rectal cancer tumour spreads by invading the bowel wall. Once it crosses through the muscle layer within the bowel wall, it enters the lymphatic vessels, spreading to local and then regional lymph nodes. Sometimes rectal cancer spread via the blood stream to the liver, which is the most common area of metastasis from this tumour. Other organs that may be affected by blood borne spread are the lungs, less often the bones, and even less often the brain. If a lot of tumour cells get through the bowel wall, they tend to float around as a small amount of fluid within the abdomen and can seed the covering of the bowel (peritoneum). This type of seeding produces small nodules throughout the abdomen which irritates tissues and causes the production of large amounts of ascites (fluid). Direct spread from the rectum may attach the tumour to the bladder in males and cause fistulas. In females it may invade the vagina or adjacent pelvic organs.