Dr. Dale Prokupek MD
The Importance of Regular Colonoscopies in ...
Dr. Dale Prokupek MD
Don’t Skip Your Colonoscopy

National Men's Health Month

“It’s time make your health a priority.”
— Dr. Dale

From National Men's Health

Take action to be healthy and safe and encourage men and boys in your life to make their health a priority. Learn about steps men can take each day to improve health.

Celebrate National Men’s Month

Get Good Sleep

Adults need between 7-9 hours of sleep. Insufficient sleep is associated with a number of chronic diseases and conditions, such as diabetes, cardiovascular disease, obesity, and depression. Also, poor sleep is responsible for motor vehicle and machinery-related accidents.

Toss out the Tobacco

It’s never too late to quit. Quitting smoking has immediate and long-term benefits. It improves your health and lowers your risk of heart disease, cancer, lung disease, and other smoking-related illnesses.
Also avoid secondhand smoke. Inhaling other people's smoke causes health problems similar to those that smokers have. Babies and kids are still growing, so the poisons in secondhand smoke hurt them more than adults.

Move More

Adults need at least 2½ hours of moderate-intensity aerobic activity every week, and muscle strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms) on two or more days a week. You don't have to do it all at once. Spread your activity out during the week, and break it into smaller amounts of time during the day.

Eat Healthy

Eat a variety of fruits and vegetables every day. Fruits and vegetables have many vitamins and minerals that may help protect you from chronic diseases. Limit foods and drinks high in calories, sugar, salt, fat, and alcohol.

Tame Stress

Sometimes stress can be good. However, it can be harmful when it is severe enough to make you feel overwhelmed and out of control. Take care of yourself. Avoid drugs and alcohol. Find support. Connect socially. Stay active.

Stay on Top of Your Game

See your doctor or nurse for checkups. Certain diseases and conditions may not have symptoms, so checkups help identify issues early or before they can become a problem.

Pay attention to signs and symptoms such as chest pain, shortness of breath, excessive thirst, and problems with urination. If you have these or symptoms of any kind, be sure to see your doctor or nurse. Don’t wait!

Keep track of your numbers for blood pressure, blood glucose, cholesterol, body mass index (BMI), or any others you may have. If your numbers are high or low, your doctor or nurse can explain what they mean and suggest how you can get them to a healthier range. Be sure to ask him or her what tests you need and how often you need them.

Get vaccinated. Everyone needs immunizations to stay healthy, no matter how old you are. Even if you had vaccines as a child, immunity can fade with time. Vaccine recommendations are based on a variety of factors, including age, overall health, and your medical history.

Rectal Cancer

https://emedicine.medscape.com/article/281237-overview

Rectal cancer is a disease in which cancer cells form in the tissues of the rectum; colorectal cancer occurs in the colon or rectum. Adenocarcinomas comprise the vast majority (98%) of colon and rectal cancers; more rare rectal cancers include lymphoma (1.3%), carcinoid (0.4%), and sarcoma (0.3%).

The incidence and epidemiology, etiology, pathogenesis, and screening recommendations are common to both colon cancer and rectal cancer. The image below depicts the staging and workup of rectal cancer.

Diagnostics. Staging and workup of rectal cancer patients.

 

Signs and symptoms

Bleeding is the most common symptom of rectal cancer, occurring in 60% of patients. However, many rectal cancers produce no symptoms and are discovered during digital or proctoscopic screening examinations.

Other signs and symptoms of rectal cancer may include the following:

  • Change in bowel habits (43%): Often in the form of diarrhea; the caliber of the stool may change; there may be a feeling of incomplete evacuation and tenesmus

  • Occult bleeding (26%): Detected via a fecal occult blood test (FOBT)

  • Abdominal pain (20%): May be colicky and accompanied by bloating

  • Back pain: Usually a late sign caused by a tumor invading or compressing nerve trunks

  • Urinary symptoms: May occur if a tumor invades or compresses the bladder or prostate

  • Malaise (9%)

  • Pelvic pain (5%): Late symptom, usually indicating nerve trunk involvement

  • Emergencies such as peritonitis from perforation (3%) or jaundice, which may occur with liver metastases (< 1%)

See Clinical Presentation for more detail.

Diagnosis

Perform physical examination with specific attention to the size and location of the rectal tumor in addition to possible metastatic lesions, including enlarged lymph nodes or hepatomegaly. In addition, evaluate the remainder of the colon.

Examination includes the use of the following:

  • Digital rectal examination (DRE): The average finger can reach approximately 8 cm above the dentate line; rectal tumors can be assessed for size, ulceration, and presence of any pararectal lymph nodes, as well as fixation to surrounding structures (eg, sphincters, prostate, vagina, coccyx and sacrum); sphincter function can be assessed

  • Rigid proctoscopy: This examination helps to identify the exact location of the tumor in relation to the sphincter mechanism

Laboratory tests

Routine laboratory studies in patients with suspected rectal cancer include the following:

  • Complete blood count

  • Serum chemistries

  • Liver and renal function tests

  • Carcinoembryonic antigen (CEA) test

  • Histologic examination of tissue specimens

Screening tests may include the following:

  • Guaiac-based FOBT

  • Stool DNA screening (SDNA)

  • Fecal immunochemical test (FIT)

  • Rigid proctoscopy

  • Flexible sigmoidoscopy (FSIG)

  • Combined glucose-based FOBT and flexible sigmoidoscopy

  • Double-contrast barium enema (DCBE)

  • Computed tomography (CT) colonography

  • Fiberoptic flexible colonoscopy (FFC)

Imaging studies

If metastatic (local or systemic) rectal cancer is suspected, the following radiologic studies may be obtained:

  • CT scanning of the chest, abdomen, and pelvis

  • Endorectal ultrasonography

  • Endorectal or pelvic magnetic resonance imaging (MRI)

  • Positron emission tomography (PET) scanning: Not routinely indicated

See Workup for more detail.

Management

A multidisciplinary approach that includes colorectal surgery/surgical oncology, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer. Surgical technique, use of radiotherapy, and method of administering chemotherapy are important factors. 

Strong considerations should be given to the intent of surgery, possible functional outcome, and preservation of anal continence and genitourinary functions. The first step involves achievement of cure, because the risk of pelvic recurrence is high in patients with rectal cancer, and locally recurrent rectal cancer has a poor prognosis.

Surgery

Radical resection of the rectum is the mainstay of therapy. The timing of surgical resection is dependent on the size, location, extent, and grade of the rectal carcinoma. Operative management of rectal cancer may include the following:

  • Transanal excision: For early-stage cancers in a select group of patients

  • Transanal endoscopic microsurgery: Form of local excision that uses a special operating proctoscope that distends the rectum with insufflated carbon dioxide and allows the passage of dissecting instruments

  • Endocavity radiotherapy: Delivered under sedation via a special proctoscope in the operating room

  • Sphincter-sparing procedures: Low anterior resection, coloanal anastomosis, abdominal perineal resection

Adjuvant medical management

Adjuvant medical therapy may include the following:

  • Adjuvant radiation therapy

  • Intraoperative radiation therapy

  • Adjuvant chemotherapy

  • Adjuvant chemoradiation therapy

  • Radioembolization

Pharmacotherapy

The National Comprehensive Cancer Network guidelines recommend the use of as many chemotherapy drugs as possible to maximize the effect of adjuvant therapies for colon and rectal cancer.

The following agents may be used in the management of rectal cancer:

  • Antineoplastic agents (eg, fluorouracil, vincristine, leucovorin, irinotecan, oxaliplatin, cetuximab, bevacizumab, panitumumab)

  • Vaccines (eg, quadrivalent human papillomavirus [HPV] vaccine)