Cáncer de Recto

CÁNCER DE RECTO

El cáncer rectal surge del revestimiento del recto. El recto es la parte inferior 6 pulgadas de su colon (intestino grueso). Al igual que el cáncer de colon, el cáncer rectal es altamente curable si se detecta en etapas tempranas. En comparación, el cáncer colorrectal se refiere a cualquier cáncer que pueda ocurrir en el colon o el recto.

HECHOS Y ESTADÍSTICAS

  • En 2017, se estima que cerca de 40.000 nuevos casos de cáncer de recto serán diagnosticados en los Estados Unidos en comparación con más de 95.000 nuevos casos de cáncer de colon.
  • Aproximadamente uno de cada 22 (4,5%) de estadounidenses desarrollará cáncer colorrectal durante su vida.
  • Los pólipos colorrectales (crecimientos anormales benignos) afectan aproximadamente del 20% al 30% de los adultos estadounidenses.
Diagrama tomado del folleto existente de ASCRS "Polyps"

FACTORES DE RIESGO

Se desconoce la causa exacta del cáncer de recto. Los siguientes factores pueden aumentar el riesgo de cáncer rectal.
  • Edad: Más del 90% de las personas son diagnosticadas con cáncer de colon después de los 50 años
  • Antecedentes familiares de cáncer colorrectal (especialmente padres o hermanos)
  • Antecedentes personales de enfermedad de Crohn o colitis ulcerosa por 8 años o más
  • Pólipos colorrectales
  • Antecedentes personales de cáncer de mama, útero u ovario

PREVENCIÓN

El cáncer rectal es prevenible. Casi todos los casos de cáncer de recto se desarrollan a partir de pólipos. Estos pólipos son crecimientos benignos en el revestimiento interno del recto. La detección y eliminación de pólipos mediante colonoscopia reduce el riesgo de cáncer rectal. Las recomendaciones para la detección del cáncer de recto se basan en antecedentes médicos y familiares. El examen comienza típicamente a los 50 años en pacientes con riesgo promedio. A las personas de mayor riesgo se les aconseja generalmente que reciban su primera prueba a una edad más temprana.
Aunque no es definitivo, hay algunas pruebas de que la dieta puede desempeñar un papel importante en la prevención del cáncer colorrectal. Una dieta rica en fibra (granos enteros, frutas, verduras y nueces) y baja en grasa puede ayudar a prevenir el cáncer colorrectal.
 

SÍNTOMAS

El cáncer de recto a menudo no causa síntomas y se detecta durante las pruebas de rutina. Es importante señalar que otros problemas de salud comunes pueden causar algunos de los mismos síntomas. Por ejemplo, las hemorroides son una causa común de sangrado rectal, pero no causan cáncer de recto. Los síntomas del cáncer rectal incluyen:
  • Un cambio en los hábitos intestinales (por ejemplo, estreñimiento o diarrea)
  • Taburetes de forma estrecha
  • Sangre roja o muy oscura en las heces
  • Dolor abdominal o abdominal continuo (por ejemplo, gases, hinchazón o dolor)
  • Pérdida de peso inexplicable
  • Náuseas o vómitos
  • Sentirse cansado todo el tiempo
El dolor abdominal y la pérdida de peso suelen ser síntomas tardíos, lo que indica posible enfermedad extensa. Cualquier persona que experimente cualquiera de los síntomas anteriores debe consultar a un médico tan pronto como sea posible.

DIAGNÓSTICO

  • Historial médico
  • Examen físico
  • Análisis de sangre
  • Examen rectal digital: Inserción de un dedo con guantes y lubricado en el recto para detectar anormalidades
  • Proctoscopia: Examen de la cavidad anal y recto con un instrumento estrecho llamado proctoscopio
  • Colonoscopía: El examen de todo el colon con un instrumento largo y flexible llamado colonoscopio
  • Biopsia: Tomar muestras de tejidos para que puedan ser vistos bajo un microscopio para detectar signos de cáncer

PRUEBAS DE ESTUDIO DE CÁNCER RECTAL

Escenificación distante
  • Tomografía computarizada (TC): una prueba de rayos X altamente sensible que permite a los médicos ver "dentro" del cuerpo y observar todos los órganos. Esta prueba puede ayudar a detectar la presencia de cáncer que se han extendido fuera del recto.
  • Tomografía por emisión de positrones (PET): una prueba de imagen que utiliza un colorante especial que tiene trazadores radiactivos. Esto permite a los médicos identificar áreas donde el cáncer se puede diseminar fuera del recto.
  • Ensayo CEA: El antígeno carcinoembrionario es una sustancia en la sangre que puede estar elevada cuando el cáncer está presente. Aunque no es completamente concluyente por sí solo, esta prueba se utiliza para ayudar a controlar a los pacientes después de que su cáncer ha sido tratado.
Escenificación local
  • MRI: Una prueba de imagen que utiliza un campo magnético y pulsos de energía de ondas de radio para crear imágenes de órganos y estructuras dentro del cuerpo. Esto ayuda a determinar si el tumor se ha diseminado a través de la pared del recto y ha invadido estructuras cercanas.
  • Ultrasonido endoscópico (UES): procedimiento en el que se inserta un endoscopio en el recto. Un ultrasonido puede entonces ser realizado para determinar hasta qué punto en la pared rectal el cáncer ha crecido.

TRATAMIENTO QUIRÚRGICO

La cirugía para extirpar el cáncer de recto casi siempre se requiere para una cura completa. Dependiendo de la ubicación y el estadio, esto puede realizarse a través del ano (apertura del recto) o a través del abdomen. El tumor y los ganglios linfáticos se eliminan, junto con una porción de recto normal a cada lado del tumor. Una colostomía es una abertura quirúrgicamente creada que conecta una parte del colon con la piel de la pared abdominal. Este procedimiento normalmente sólo se hace en un número muy pequeño de pacientes con cáncer de recto.
Técnicas quirúrgicas mínimamente invasivas pueden ser utilizadas por cirujanos entrenados basados ​​en el caso individual. Su cirujano discutirá esto con usted antes de la cirugía y decidirá sobre el enfoque más óptimo.


TRATAMIENTO MÉDICO

La quimioterapia o radioterapia se puede ofrecer antes o después de la cirugía, dependiendo de la etapa del cáncer.

FACTORES PROGNOSTICOS (RESULTADOS)

La detección temprana mediante métodos de detección como la colonoscopia es crucial. El resultado del paciente está fuertemente asociado con la etapa del cáncer rectal en el momento del diagnóstico. Los factores pronósticos incluyen:
  • Etapa de cáncer (cuánto avanzado es el cáncer)
  • Ubicación del cáncer en el recto
  • Si el intestino está bloqueado o tiene un agujero
  • Si todo el tumor se puede extirpar quirúrgicamente
  • Salud general del paciente y capacidad para tolerar tratamientos diferentes
  • Si el cáncer se ha diagnosticado recientemente o ha vuelto a aparecer (regresar)

 
SEGUIMIENTO POST-TRATAMIENTO

El cuidado de seguimiento después del tratamiento para el cáncer rectal es importante. Incluso cuando el cáncer parece haber sido completamente eliminado o destruido, la enfermedad puede repetirse. Las células cancerosas no detectadas pueden permanecer en el cuerpo después del tratamiento. Su cirujano de colon y rectal monitoreará su recuperación y verificará la recurrencia del cáncer en intervalos específicos. Los exámenes de sangre, los exámenes clínicos y las pruebas de imagen se pueden realizar sobre la base de la etapa del cáncer.



¿QUÉ ES UN CIRUJANO DE COLON Y RECTO?

Cirujanos de colon y recto son expertos en el tratamiento quirúrgico y no quirúrgico de las enfermedades del colon, recto y ano. Han completado el entrenamiento quirúrgico avanzado en el tratamiento de estas enfermedades, así como la formación en cirugía general completa. Cirujanos certificados por la junta de colon y recto completan residencias en cirugía general y cirugía de colon y recto, y pasan los exámenes intensivos llevados a cabo por la Junta Americana de Cirugía y la Junta Americana de Cirugía de Colon y Recto. Ellos están bien versados en el tratamiento de enfermedades tanto benignas como malignas del colon, recto y ano. Ellos son capaces de realizar exámenes de detección rutinas y de tratar quirúrgicamente condiciones, si está indicado para hacerlo.

AVISO LEGAL

La Asociación Americana de Cirujanos de Colon y Recto está dedicada a asegurar la atención al paciente de alta calidad, al avance de la ciencia, la prevención y el tratamiento de los trastornos y enfermedades del colon, recto y ano.  El propósito de estos folletos es proporcionar información sobre los procesos de enfermedades, y no la de indicar una forma específica de tratamiento. Están diseñados para el uso de  los médicos, trabajadores sanitarios y pacientes que deseen información sobre la gestión de las condiciones tratadas. Estos folletos no incluyen o excluyen otros métodos apropiados de atención médica de estas enfermedades. La última palabra sobre el tratamiento a seguir le corresponde al médico basándose en las circunstancias  de cada paciente.



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