rectosigmoid junction cancer

Rectosigmoid junction cancer, also known as rectosigmoid carcinoma, is a type of cancer that affects the lower part of the colon (sigmoid) and the upper part of the rectum. The signs and symptoms of this condition can be similar to those of other types of colorectal cancers.

Common Symptoms:

• A change in bowel habits, such as diarrhea or constipation [1]
• Abdominal pain or cramping [10]
• Blood in the stool (bright red or dark) [7]
• A feeling that the bowel doesn't empty completely [1]
• Weight loss without dieting [13]

Other Possible Symptoms:

• Bloating [13]
• Change in appetite [13]
• Discomfort during bowel movements [13]
• Discomfort when sitting [13]
• Excessive fatigue [13]
• Pain or cramping in the lower stomach [13]

It's essential to note that some people may not experience any symptoms at all, especially in the early stages of rectosigmoid junction cancer. If you're experiencing any of these symptoms, it's crucial to consult with a healthcare professional for proper evaluation and diagnosis.

References:

[1] Symptoms. Rectal cancer may not cause symptoms early on. Symptoms of rectal cancer usually happen when the disease is advanced. [7] Signs of rectal cancer include blood in the stool or a change in bowel habits. [10] Result: tumors or masses | constipation | general abdominal pain, cramps, or spasms [13] Rectal cancer symptoms vary person to person.

Rectal cancer diagnosis often begins with an imaging test to look at the rectum, and in some cases, the rectosigmoid junction. A thin, flexible tube with a camera may be passed into the rectum and colon to examine the area.

Imaging Tests

• 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].
• High-sensitivity fecal occult blood test (FOBT): checks for blood in three consecutive stool samples, which can indicate rectosigmoid junction cancer [13].
• Flexible sigmoidoscopy: uses a flexible, lighted tube (sigmoidoscope) to look at the interior walls of the rectum and part of the colon, which can help diagnose rectal cancer [13].

Other Diagnostic Tests

• Colonoscopy: uses a flexible, lighted tube (colonoscope) to look at the entire colon and rectum, including the rectosigmoid junction. This test may be done if rectal cancer is suspected [3].
• Biopsy: a sample of tissue may be taken from the rectum or rectosigmoid junction for lab testing to confirm the presence of cancer [3].

Importance of Imaging

Imaging tests are crucial in diagnosing rectal cancer, especially when it comes to the rectosigmoid junction. A study compared volumetric analysis with conventional unidimensional measurements for follow-up of rectosigmoid cancer before and after radiation therapy, highlighting the importance of accurate imaging [14].

Incidence and Mortality Rates

Rectal cancer incidence in the European Union is approximately 125,000 per year, accounting for about 35% of total colorectal cancer incidence. The mortality rate is around 4-10/100,000 population per year, with a median age at diagnosis of around 70 years [15].

References:

[3] Context result 3 [5] Context result 5 [13] Context result 13 [14] Context result 14 [15] Context result 15

Treatment Options for Rectosigmoid Junction Cancer

The treatment options for rectosigmoid junction cancer, which accounts for around 10% of colorectal cancers [13], include a combination of surgery, chemotherapy, and radiation therapy. For patients with microsatellite stable or proficient mismatch repair locally advanced rectal cancer, total neoadjuvant therapy (TNT) is recommended as initial treatment [15].

Chemotherapy

Chemotherapy plays a crucial role in the treatment of rectosigmoid junction cancer, particularly when combined with other modalities like radiation and surgery. The goal of chemotherapy is to shrink tumors, slow their growth, or eliminate them altogether.

• Chemoradiation (CRT) and chemotherapy are often used as initial treatment for patients with tumors located in the lower rectum and/or those at higher risk for local and/or distant metastases [15].
• Targeted therapy, which involves using medications to specifically target cancer cells, may also be an option for some patients.

Radiation Therapy

Radiation therapy is another essential component of treatment for rectosigmoid junction cancer. It can be used alone or in combination with chemotherapy and surgery to:

• Shrink tumors before surgery
• Eliminate any remaining cancer cells after surgery
• Relieve symptoms and improve quality of life

Surgery

Surgery remains the primary treatment option for rectosigmoid junction cancer, particularly when the tumor is localized. The type of surgery performed depends on various factors, including the location and size of the tumor.

• High anterior resection (HAR) is recommended for tumors located at the upper third of the rectum and the rectosigmoid junction [10].
• Other surgical options include transanal endoscopic microsurgery (TEM) and total mesorectal excision (TME) [8].

Multidisciplinary Approach

The treatment of rectosigmoid junction cancer often requires a multidisciplinary approach, involving a team of healthcare professionals from various specialties. This ensures that patients receive comprehensive care tailored to their individual needs.

• A specialized care team with experience treating rectal cancer should be consulted for optimal management [12].
• Regular follow-up appointments and monitoring are essential to detect any potential recurrence or metastasis early on.

References

[13] Colorectal cancer ranks second among the leading causes of cancer mortality globally. With its rising incidence, not only among the elderly but also in younger populations, it is becoming increasingly important to understand the most effective treatment modalities for these malignancies.

[15] Following assessment with magnetic resonance imaging, for patients with microsatellite stable or proficient mismatch repair locally advanced rectal cancer, total neoadjuvant therapy (TNT; ie chemoradiation [CRT] and chemotherapy) should be offered as initial treatment for patients with tumors located in the lower rectum and/or patients who are at higher risk for local and/or distant metastases.

The differential diagnosis for rectosigmoid junction cancer involves considering various conditions that can present similarly to this type of cancer. Some of the key points to consider are:

• Colonic diverticulitis: This condition can cause symptoms such as abdominal pain, changes in bowel habits, and rectal bleeding, which can be similar to those experienced with rectosigmoid junction cancer [8].
• Colon cancer: As mentioned earlier, colon cancer is a common differential diagnosis for colonic diverticulitis and should be systematically sought by colonoscopy or CT colonography [8].
• Rectal cancer: Rectal cancer is another type of cancer that can present similarly to rectosigmoid junction cancer. It occurs when cancerous cells develop in the rectum, and symptoms may include rectal bleeding or changes in bowel habits [7].
• Colonic stricture: A colonic stricture is a narrowing of the colon that can cause symptoms such as abdominal pain, constipation, and rectal bleeding. The rectosigmoid junction is a common site for stricture formation [10].

It's worth noting that the differential diagnosis for rectosigmoid junction cancer may also include other conditions such as arteriovenous malformation (AVM), carcinoid/neuroendocrine tumors, and rare tumors of the gastrointestinal tract [2]. A thorough evaluation by a healthcare professional is necessary to determine the correct diagnosis.

References:

[7] Rectal cancer happens when cancerous cells develop in your rectum. Symptoms include rectal bleeding or changes in how and when you poop. [8] 12). Colon cancer is the essential differential diagnosis for colonic diverticulitis and should be systematically sought by colonoscopy or CT colonography, at a ... [10] Differential Diagnosis of Colonic Strictures: Pictorial Review With Illustrations from Computed Tomography Colonography ... Conversely, a diagnosis of colon cancer is more likely if pericolonic lymph nodes are identified adjacent to a segment of colonic thickening, ... The commonest site of stricture formation is the rectosigmoid junction [38].