Colon and Recta Cancer. El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Rectal Adenocarcinoma. This 73 year-old man was referred to us by his surgeon due to palpable mass on digital rectal examination, colonoscopy confirm a large mass in the rectum.

Video Endoscopic Sequence 1 of 8.

Rectal Adenocarcinoma.

This 73 year-old man was referred to us by his surgeon due to palpable mass on digital rectal examination, colonoscopy confirm a large mass in the rectum.

This endoscopic image is seen at retroflexion

 For more endoscopic details, download the video clip
 by clicking on the endoscopic image. Wait to be
 downloaded
 complete then Press Alt and Enter for full screen.
 All endoscopic images shown in this Atlas contain
 video clips. We recommend seeing the video clips in full
 screen mode.

RectalCaRRR2

Video Endoscopic Sequence 2 of 8.

Rectal Adenocarcinoma

Rectal tumors may be asymptomatic, but the possible symptoms of rectal tumors include the following

  • Palpable mass on digital rectal examination
  • Overt rectal bleeding
  • Microcytic anemia with fatigue, shortness of breath, and
     angina
  • Vague abdominal discomfort
  • Change in bowel habit
  • Large bowel obstruction
  • Pneumaturia
  • Feculent vaginal discharge
  • Perforation (rare)
  • Weight loss
  • Jaundice
  • Ascites
     
RectalCaRRR3

Video Endoscopic Sequence 3 of 8.

Rectal Adenocarcinoma

 Evaluation begins with a history and physical examination, including a digital rectal examination.

  • Inspect the stool and test for occult blood.
  • Order blood tests (ie, complete blood count, liver function tests, and carcinoembryonic antigen levels).
  • Perform complete colonoscopy looking for syncronic adenonocarcinoma or polyps.Colonoscopy, which has been found to be more accurate in detecting synchronous neoplasms, should be included in the evaluation of all patients with colorectal cancers.
  • Perform CT studies to stage the tumor before treatment and to choose the most appropriate treatment. Although magnetic resonance imaging (MRI) is slightly more accurate than CT in staging primary rectal tumors, CT is much more widely available. Most institutions and departments have more extensive experience using CT than MRI and continue to use CT for staging rectal tumors. This may change in the future.
Immediately after the anus the neoplasia is seen.

Video Endoscopic Sequence 4 of 8.

Immediately after the anus the neoplasia is seen.

Many factors increase the risk for rectal cancer, including the following:

  •  High-fat, low-fiber diet
  • Age greater than 50 years
  • Personal history of colorectal adenoma or carcinoma (3-fold greater risk).
  • First-degree relative with colorectal cancer (3-fold greater risk).
  • Familial polyposis coli, Gardner syndrome, and Turcot syndrome (in which all patients without a colectomy develop colorectal carcinoma).
  • Juvenile polyposis syndrome, Peutz-Jeghers syndrome, and Muir syndrome (risk increased slightly).
  • Hereditary nonpolyposis colorectal cancer (as many as 50% of patients are affected).
  • Inflammatory bowel disease.
  • Ulcerative colitis (risk is 30% after 25 y)
  • Crohn disease (4- to 10-fold risk).
The presentation depends on the site of the cancer:

Video Endoscopic Sequence 5 of 8.

 The presentation depends on the site of the cancer:

    • Right colon cancers: weight loss, anemia, occult bleeding, mass in right iliac fossa, disease more likely to be advanced at presentation.
    • Left colon cancers: often colicky pain, rectal bleeding, bowel obstruction, tenesmus, mass in left iliac fossa, early change in bowel habit, less advanced disease at presentation.
  • The most common presenting symptoms and signs of cancer or large polyps are rectal bleeding, persisting change in bowel habit and anemia.
  • All patients with symptoms suspicious of colorectal cancer must have a thorough abdominal and rectal examination.
  • In some patients, symptoms do not become apparent until the cancer is far advanced. Approximately 55% of patients present with advanced colorectal cancer (spread to the lymph nodes, metastasised to other organs, or is so locally invasive that surgery to remove the primary tumour alone is unlikely to be sufficient for cure
  • Jaundice and hepatomegaly indicate advanced disease with extensive liver metastases. Peritoneal metastases with ascites are often also present. 20-25% of patients have clinically detectable liver metastases at the time of the initial diagnosis and a further 40-50% of patients develop liver metastases within three years of primary surgery.
  • Rarer clinical signs include: pneumaturia, gastro-colic fistula, ischiorectal or perineal abscesses, deep vein thrombosis.
Almost all rectal cancers are primary adenocarcinomas. Adenocarcinoma of the rectum is a major cause of mortality and morbidity in North America and Western Europe. Rectal cancers are, after colon cancers, the second most common gastrointestinal (GI) carcinoma, and have the best prognosis. The 5-year survival rate is approximately 50%. Screening for and removing adenomatous polyps may improve survival rates.

Video Endoscopic Sequence 6 of 8.

 Almost all rectal cancers are primary adenocarcinomas.
 Adenocarcinoma of the rectum is a major cause of
 mortality and morbidity in North America and Western
 Europe. Rectal cancers are, after colon cancers, the
 second most common gastrointestinal (GI) carcinoma, and
 have the best prognosis. The 5-year survival rate is
 approximately 50%. Screening for and removing
 adenomatous polyps may improve survival rates.

 
Adenocarcinoma of the rectum arises as an intramucosal epithelial lesion, usually in an adenomatous polyp or gland. As cancers grow, they invade the muscularis mucosa, lymphatic structures, and vascular structures and involve regional lymph nodes, adjacent structures, and distant sites, especially the liver.

Video Endoscopic Sequence 7 of 8.

 Adenocarcinoma of the rectum arises as an intramucosal
 epithelial lesion, usually in an adenomatous polyp or gland.
 As cancers grow, they invade the muscularis mucosa,
 lymphatic structures, and vascular structures and involve
 regional lymph nodes, adjacent structures, and distant
 sites, especially the liver.

 
Enhanced magnification colonoscopy.

Video Endoscopic Sequence 8 of 8.

Enhanced magnification colonoscopy.

 

 
Adenocarcinoma of the splenic flexure with villous component. A 58 year-old male with weigh loss of 20 ponds, and palpable mass in the upper left abdomen.

Video Endoscopic Sequence 1 of 6.

 Villous Adenocarcinoma.

 Adenocarcinoma of the splenic flexure with villous
 component.

 A 58 year-old male with weigh loss of 20 ponds and
 palpable mass in the upper left abdomen.

 
 

 
Endoscopic image with optical magnification. Magnification endoscopy, with or without dye spraying, has been developed for this purpose, allowing fine topographical details to be seen. The structures visible by magnification endoscopy correspond to those seen under a dissecting (stereoscopic) microscope.

Video Endoscopic Sequence 2 of 6.

Endoscopic image with optical magnification.

 Numerous finger like indentations forming a polypoid mass.

 Magnification endoscopy, with or without dye spraying, has
 been developed for this purpose, allowing fine
 topographical details to be seen. The structures visible by
 magnification endoscopy correspond to those seen under a
 dissecting (stereoscopic) microscope.

 
Chromoendoscopy using methylene blue. Chromoendoscopy involves the topical application of stains or dyes to improve mucosal visualization during endoscopy.

Video Endoscopic Sequence 3 of 6.

Chromoendoscopy using methylene blue.

 Chromoendoscopy involves the topical application of stains
 or dyes to improve mucosal visualization during endoscopy.

 
Another image and video clip chromoendoscopy using methylene blue.

Video Endoscopic Sequence 4 of 6.

 Another image and video clip of chromoendoscopy, using
 methylene blue.
Microscopic specimen of the Adenocarcinoma with villous component.

Video Endoscopic Sequence 5 of 6.

 Microscopic specimen of the adenocarcinoma with
 villous componente.
 

 Download the video clip by clicking on the image.

 
Macroscopic specimen of the tumor.

Video Endoscopic Sequence 6 of 6.

Macroscopic specimen of the tumor.
Rectal carcinoma with acanthosis nigrans association. A 73 year-old female, who was referred to us because of rectal blood discharge A constricting, ulcerated, annular rectal carcinoma was found The patient had severe the clinical picture of a severe acanthosis nigrans. In order to appreciate the pictures of this dermatologica associated cancer.

 Rectal carcinoma with acanthosis nigrans association.

 A 73 year-old female, who was referred to us because of
 rectal blood discharge.
 A constricting, ulcerated, annular rectal carcinoma was
 found.
 The patient had severe the clinical picture of a severe
 acanthosis nigrans. In order to appreciate the pictures of
 this dermatologica associated cancer press here.

 
Rectal Carcinoma that emerges in the pectin line.

Video Endoscopic Sequence 1 of 3.

 Rectal Carcinoma that emerges in the pectin line.
The tumor is observed in retroflexed view.

Video Endoscopic Sequence 2 of 3.

 The tumor is observed in retroflexed view.
 
For more endoscopic details download the video clip.

Video Endoscopic Sequence 3 of 3.

             Same case as the one shown above.

 
Rectal Adenocarcinoma that infiltrates the second and the third valve.

Video Endoscopic Sequence 1 of 5.

 Rectal Adenocarcinoma that infiltrates the second and the
 third valve.
 
After the carcinoma, an adenomatous polyp is found. Confirming adenoma-carcinoma theory. In Colorectal Canceres At the time of surgical resection, it is important to ascertain preoperatively whether or not a second lesion exists. If synchronous polyps are present in patients with synchronous colorectal carcinomas, they should be ablated to reduce the risk of metachronous colorectal carcinoma.

Video Endoscopic Sequence 2 of 5.

 After the carcinoma, an adenomatous polyp is found.
 Confirming adenoma-carcinoma theory.

 In Colorectal Canceres At the time of surgical resection, it is
 important to ascertain preoperatively whether or not a second
 lesion exists. If synchronous polyps are present in patients with
 synchronous colorectal carcinomas, they should be ablated to
 reduce the risk of metachronous colorectal carcinoma.
  
Macroscopic specimen of the tumor.

Sequence 3 of 5.

         Macroscopic specimen of the tumor.
Microscopic specimen of the adenocarcinoma.

Sequence 4 of 5.

        Microscopic specimen of the adenocarcinoma.

 

    

Another view of the macroscopic specimen.

Sequence 5 of 5.

        Another view of the macroscopic specimen.
Rectal Carcinoma at the Second Valve. The video clip displays internal hemorrhoids. It is a common situation that the medical history reveals when the patient had been under prior treatment for hemorrhoids, over a long period of time, without having a digital examination.

Rectal Carcinoma at the Second Valve.

 The video clip displays internal hemorrhoids.
 It is a common situation that the medical history reveals
 when the patient had been under prior treatment for
 hemorrhoids, over a long period of time, without having a
 digital examination.
  
 
The sequence polyp-carcinoma. Cancer of the colon is the fourth cause of cancer in the republic of El Salvador and its early detection has become a goal for all gastroenterologist. Adenocarcinomas of the colon and rectum, they all begin in the mucosa, and typically, begin as a polypoid lesion that protrudes into the lumen. Adenoma-carcinoma sequence Most colorectal cancers arise from adenomatous polyps, some of which progress from small <5 mm to large polyps, and then to dysplasia and cancer. This progression probably takes at least 8 years in most people.

Rectal Carcinoma that originates from a rectal polyp.

"The sequence polyp-carcinoma".

 Cancer of the colon is the fourth cause of cancer in the
 republic of El Salvador and its early detection has become
 a goal for all gastroenterologist.
 Adenocarcinomas of the colon and rectum, they all begin in
 the mucosa, and typically, begin as a polypoid lesion that
 protrudes into the lumen.
 Adenoma-carcinoma sequence Most colorectal cancers
 arise from adenomatous polyps, some of which progress
 from small <5 mm to large polyps, and then to dysplasia
 and cancer. This progression probably takes at least 8
 years in most people.

Adenocarcinoma of the rectum. Circumferential neoplasia with an ulcerated center and everted edge.

Adenocarcinoma of the rectum.

 Circumferential neoplasia with an ulcerated center and
 everted edge.

 
Rectum Adenocarcinoma. This sessile lesion in the rectum presented with frank bleeding. The lesion was ulcerated in various places and bled heavily when touched.

Rectum Adenocarcinoma.

 This sessile lesion in the rectum presented with frank
 bleeding. The lesion was ulcerated in various places and
 bled heavily when touched.  
Rectal Carcinoma, A 66 year-old female with rectal adenocarcinoma that infiltrated from the first to the third rectal valve.

Video Endoscopic Sequence 1 of 3.

 A 66 year-old female with rectal adenocarcinoma
 that infiltrated from the first to the third rectal valve.
 
         

Rectal Carcinoma, Retroflexed maneuver was performed to evaluate the extension of the carcinoma.

 Video Endoscopic Sequence 2 of 3.

 Retroflexed maneuver was performed to evaluate
 the extension of the carcinoma.
 

  

             Download the video clip.
Rectal Carcinoma, Same case of above, the rectal tumor is appreciated in retroflexed view.

Video Endoscopic Sequence 3 of 3.

 Same case of above, the rectal tumor is appreciated in
 retroflexed view.
   


   
  
              Download the video clip.