Problemy proktologiczne u pacjenta leczonego z powodu raka odbytnicy

*Małgorzata Kołodziejczak, Michał Talarek

Summary
In Poland the colorectal cancer takes the third place amongst all malignant tumours (11%), and the rectal carcinoma is the most frequent localization of the colorectal cancer constituting about 45-50% of cases. Contemporary treatment of the rectal carcinoma is multidisciplinary and involves surgical treatment, including in early stages of disease the minimally invasive method (TEM), radiotherapy (neoadjuvant, supplemental, palliative) and chemotherapy. The combination therapy increases chances for curing the cancer, but also brings higher risk of complications, including proctologic ones. Amongst complications of surgical treatment are: incontinence of gasses and stool, anterior resection syndrome and post-operative anal fistulas. Minimally invasive techniques (operation using operating rectoscope – TEM technique), requiring divulsion of anus, can lead to rupture of fibres of internal sphincter muscle and in consequence to incontinence of gasses and stool. Radiotherapy can result in post-radiation proctitis, ulcerations or strictures. Treatment of radiation proctitis in most cases is conservative. The surgical treatment is reserved for serious complications, including: uncontrollable rectal bleeding, rectal perforations, critical strictures and anal and rectovaginal fistulas. Immunodeficiency in course of chemotherapy can cause infective perineal diseases requiring antibiotic treatment, and frequently surgical treatment. Diarrhoea in course of chemotherapy is treated symptomatically.
Proctologic manifestations caused by rectal carcinoma treatment negatively affect patient’s quality of life. Although main purpose of therapy is to cure the cancer, it is necessary to take proctologic complications into consideration (mainly incontinence of gasses and stool). In patients with poor continence the functional examinations should be considered in planning the surgical treatment.

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