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rectosigmoid junction neoplasm

ICD-10 Codes

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Description

A rectosigmoid junction neoplasm, also known as a rectosigmoid adenoma or carcinoma, is a type of tumor that affects the transition area between the sigmoid colon and rectum.

Types of Neoplasms

  • Benign neoplasms, such as lipomas and leiomyomas, can occur in this region.
  • Malignant neoplasms, including carcinomas, lymphomas, and sarcomas, can also be found here. Rectosigmoid adenomas are considered premalignant neoplasms.

Characteristics

  • The rectosigmoid junction is a transition area between the sigmoid colon and rectum, characterized by a change in tissue structure and muscle function.
  • This region is often affected by conditions such as diverticulitis, colorectal cancer, and inflammatory bowel diseases (IBD).
  • Tumors in this region can be treated as either rectal or sigmoid colon tumors due to their heterogeneous characteristics.

Molecular Profile

  • Studies have shown that rectosigmoid junction cancer has a distinctive molecular profile compared to the molecular profiles of the adjacent bowel segment cancers.
  • The key genes and pathways involved in rectosigmoid junction tumors are still being researched, but understanding these characteristics can guide treatment selection.

Incidence and Mortality

  • Malignant neoplasms of the colon and rectosigmoid junction are diagnosed in approximately 12,500 people per year, with around 8,500 deaths.
  • While there is a continuous increase in morbidity and mortality in men, the increase in mortality has been halted in women.

Symptoms

  • Symptoms of rectosigmoid junction neoplasm can include changes in bowel habits, such as diarrhea or constipation, and a feeling that the bowel doesn't empty completely.

References:

[1] - Rectosigmoid adenomas always exhibit epithelial dysplasia and are considered premalignant neoplasms. [2] [3] - Approximately 10% of colorectal cancers are located at the rectosigmoid junction. [4] - Rectosigmoid junction cancer has a distinctive molecular profile compared to the molecular profiles of the adjacent bowel segment cancers. [5] - Carcinomas of the rectosigmoid junction reveal a deviant behavioral pattern compared to its adjacent bowel segments. [6] - Studies have shown that colorectal cancer is more common in the sigmoid colon, which includes the rectosigmoid junction. [7] - Malignant neoplasms of the colon and rectosigmoid junction are diagnosed in approximately 12,500 people per year.

Additional Characteristics

  • Colorectal cancer
  • Diverticulitis
  • Rectosigmoid adenomas
  • Benign neoplasms (lipomas, leiomyomas)
  • Malignant neoplasms (carcinomas, lymphomas, sarcomas)
  • Rectal or sigmoid colon tumors
  • Inflammatory bowel diseases (IBD)

Signs and Symptoms

Diagnostic Tests

Imaging Tests for Accurate Diagnosis

Rectal cancer diagnosis often begins with an imaging test to look at the rectum, which can help identify any abnormalities or tumors in the rectosigmoid junction. Some common diagnostic tests used to examine the rectosigmoid junction include:

  • Endoscopic ultrasound: This test uses a thin, flexible tube with a camera and ultrasound probe to visualize the tumor's depth of penetration and measure its size [4].
  • Computed tomography colonography (CTC): A non-invasive imaging test that uses X-rays and computer technology to create detailed images of the rectosigmoid junction [7].
  • Magnetic Resonance Imaging (MRI): An advanced imaging technique that can provide detailed images of the rectosigmoid junction, helping doctors diagnose tumors more accurately [3].
  • Digital Rectal Examination (DRE): A physical examination where a doctor inserts a gloved finger into the rectum to feel for any abnormalities or tumors [8].

Other Diagnostic Tests

In addition to imaging tests, other diagnostic methods can be used to confirm rectosigmoid junction neoplasm. These include:

  • Colonoscopy: A procedure that uses a flexible tube with a camera to visualize the inside of the colon and rectum [7].
  • Sigmoidoscopy: A test that examines the sigmoid colon, which is the lower part of the large intestine [5].

Staging System

The American Joint Committee on Cancer (AJCC) TNM staging system is commonly used to stage colorectal cancer, including tumors in the rectosigmoid junction. This system takes into account three key factors: tumor size, lymph node involvement, and distant metastasis [6].

References:

[3] Sep 13, 2024 — Tests that examine the rectum and colon are used to diagnose rectal cancer.

[4] Endoscopic ultrasound: An ultrasound probe at the tip of an endoscope allows a doctor to see how deeply the cancer has penetrated and measure the size of the tumor.

[5] A sigmoidoscopy is a diagnostic test used to check the sigmoid colon, which is the lower part of your colon or large intestine.

[6] Jan 29, 2024 — The staging system most often used for colorectal cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key factors: tumor size, lymph node involvement, and distant metastasis.

[7] by FA Macrae · Cited by 60 — Colonoscopy · Flexible sigmoidoscopy · Computed tomography colonography · - Incomplete colonoscopy · - Initial diagnostic test · PILLCAM 2 ...

[8] Sep 21, 2022 — Digital Rectal Examination (DRE) is a physical examination where a doctor inserts a gloved finger into the rectum to feel for any abnormalities or tumors.

Additional Diagnostic Tests

  • Magnetic Resonance Imaging (MRI)
  • Colonoscopy
  • Sigmoidoscopy
  • Digital Rectal Examination (DRE)
  • Endoscopic ultrasound
  • Computed tomography colonography (CTC)

Treatment

Treatment Options for Rectosigmoid Junction Neoplasm

Rectosigmoid junction neoplasm, also known as colorectal cancer (CRC), is a type of cancer that affects the rectum and sigmoid colon. The treatment options for this condition are similar to those for other types of CRC.

  • Surgery: Surgery is usually the primary treatment option for rectosigmoid junction neoplasm. The goal of surgery is to remove the tumor and affected tissue, followed by chemotherapy and/or radiation therapy if necessary.
  • Chemotherapy: Chemotherapy may be used in combination with surgery or as a standalone treatment. The most commonly used chemotherapeutic agents include fluoropyrimidines (such as 5-FU), irinotecan, oxaliplatin, and capecitabine.
  • Radiation Therapy: Radiation therapy may be used to treat rectosigmoid junction neoplasm, especially in cases where surgery is not possible or has been unsuccessful. This treatment involves the use of high-energy rays to kill cancer cells.

Specific Chemotherapy Regimens

Several chemotherapy regimens have been approved for the treatment of rectosigmoid junction neoplasm:

  • FOLFOX: FOLFOX (folinic acid, 5-FU, and oxaliplatin) is a commonly used regimen that combines three chemotherapeutic agents to target cancer cells.
  • FOLFIRI: FOLFIRI (folinic acid, 5-FU, and irinotecan) is another widely used regimen that targets cancer cells with a combination of three chemotherapeutic agents.

Targeted Therapies

In some cases, targeted therapies may be used to treat rectosigmoid junction neoplasm. These treatments work by targeting specific molecules involved in the growth and spread of cancer cells.

  • Bevacizumab: Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor (VEGF), which plays a key role in tumor angiogenesis.
  • Encorafenib: Encorafenib is a kinase inhibitor that targets the BRAF V600E mutation, which is present in some cases of rectosigmoid junction neoplasm.

References

  1. [8] lists fluoropyrimidines, irinotecan, oxaliplatin, tri-fluridine-tipiracil, capecitabine, and 5-fluorouracil (5-FU) as the most commonly used chemotherapeutic agents for rectosigmoid junction neoplasm.
  2. [9] recommends the use of FOLFOX or FOLFIRI regimens in combination with surgery to treat rectosigmoid junction neoplasm.
  3. [13] reports a case where PD-1 blockade combined with chemotherapy resulted in a partial response in a patient with rectosigmoid-junction SCC.

Note: The information provided is based on the search results and may not be comprehensive or up-to-date.

Recommended Medications

  • Surgery
  • Bevacizumab
  • Radiation Therapy
  • Encorafenib
  • Chemotherapy (5-FU, irinotecan, oxaliplatin, capecitabine)
  • oxaliplatin
  • irinotecan

💊 Drug information is sourced from ChEBI (Chemical Entities of Biological Interest) database. Always consult with a healthcare professional before starting any medication. Click on any medication name for detailed information.

Differential Diagnosis

The differential diagnosis of rectosigmoid junction neoplasms involves considering various benign and malignant tumors that can occur in this region.

Common Differential Diagnoses

  • Benign Neoplasms: Lipoma, leiomyoma, and rectosigmoid adenomas are common benign neoplasms that can be found in the rectosigmoid region [14].
  • Malignant Tumors: Carcinoma, lymphoma, sarcoma, and carcinoid tumors are among the malignant neoplasms that need to be considered in the differential diagnosis of a polypoid mass of the colon [13].

Other Considerations

  • Desmoid Fibromatosis: This is a rare condition characterized by the growth of fibrous tissue in the rectosigmoid region, which can mimic a tumor. The histological diagnosis of desmoid fibromatosis can be challenging, especially when the specimen is small [8].
  • Hemangiomas: These are rare vascular tumors that can occur in the GI tract, including the rectosigmoid region. They may be single or multiple and have syndrome associations [12].

Importance of Accurate Diagnosis

Accurate diagnosis of a neoplasm at the rectosigmoid junction is crucial for determining the appropriate treatment plan. Imaging studies such as CT scans and MRI can provide precise information about the structure and function of this region, aiding in the differential diagnosis [11].

References:

[8] - The histological diagnosis of desmoid fibromatosis is difficult, especially when the specimen is small. [12] - Rectal hemangiomas are also rare, but in the colon the rectosigmoid region is the most common location. [13] - All these malignant tumors need to be considered in the differential diagnosis of a polypoid mass of the colon. [14] - Representative examples of benign neoplasms include lipoma and leiomyoma. Representative examples of malignant neoplasms include carcinoma, lymphoma, and sarcoma. [11] - Accurate Diagnosis: Imaging provides precise and detailed information about the structure and function of the rectosigmoid junction.

Additional Information

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