Aims and Objectives

1. To study age distribution of carcinoma rectum.
2. To study sex distribution of carcinoma rectum.
3. To study varied clinical presentation of carcinoma rectum.
4. To study the risks associated with various lifestyle factors.

Etiology of Carcinoma Rectum

The development of colorectal malignancy involves interplay between genetic and environmental influences. Colorectal cancers that develop in individuals without hereditary links are referred to as “sporadic,” and account for 75% of all colorectal cancers. A potential genetic influence is identified in the remaining 25% of patients, including family history (15% to 20%); Lynch syndrome (5%); and FAP (<1%).

The aetiology is multifactorial and includes risk factors such as: increasing age, male sex and previous colorectal cancer. Lifestyle factors may also contribute to a higher risk. Lack of physical activity, low fruit and vegetable intake, low fibre and a high fat diet, overweight and obesity, tobacco use and alcohol consumption have all been associated with a higher risk.¹

Adenoma is the precursor to rectal carcinoma. Approximately 10% of adenomas progress to invasive carcinomas through a well-defined sequence of genetic change called the adenoma-carcinoma sequence. This process may take 10 to15 years.

Inflammatory Bowel Disease

Patients with inflammatory bowel disease (IBD) are at significantly increased risk for developing colorectal cancer; the risk is proportional to the extent and duration of disease. In ulcerative colitis patients, where the risk of cancer appears to begin after 8 to 10 years of disease and increases at a rate of about 0.5% to 1.0% per year. Currently it is believed that the cancer risk is equivalent in Crohn and ulcerative colitis patients who have disease of similar duration and extent. An increased risk is also seen in patients with an onset of Crohn’s disease before the age of 30 years.

Hereditary Rectal Cancer

About 20% of all rectal cancer cases might have a familial component. Most of the known familial syndromes are inherited in an autosomal-dominant pattern, resulting in a 50% risk for a child of an affected individual to bear the predisposition for the cancer form.

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Dr Prashanth Thalluri MS

3rd Year Post Graduate, Department of General Surgery, NRI Academy of Sciences, Chinakakani