Will chronic proctitis develop into rectal cancer? Can it be completely cured?

Author: Fan Xueshun, Chief Physician of China-Japan Friendship Hospital

Reviewer: Lin Guole, Chief Physician, Peking Union Medical College Hospital

Clinically, proctitis is mainly divided into six types, namely acute proctitis, chronic proctitis, ulcerative proctitis, tuberculous proctitis, radiation proctitis, and venereal proctitis.

1. What are the differences between different types of proctitis?

Acute proctitis is a sudden attack, with increased bowel movements and a noticeable feeling of anal prolapse. Some patients may also experience fever due to infection. This is the acute phase. Generally, after two weeks of treatment in the acute phase, the symptoms improve and can be converted into a chronic phase.

Compared with acute proctitis, chronic proctitis has a relatively reduced frequency of bowel movements and alleviated symptoms, but constipation and diarrhea will alternate, and sometimes pain in the lower left abdomen will occur, but it is not accompanied by fever.

Ulcerative proctitis is usually accompanied by rectal ulcers, secreting a large amount of mucus, followed by purulent and bloody stools, and occasionally blood in the stool. When we examine under colonoscopy, we will find that there are flaky ulcers on the rectal mucosa.

Radiation proctitis generally has a history of pelvic tumors, including gynecological and rectal cancer. Radiotherapy is performed first. Radiotherapy can suppress tumors, but it can also damage normal mucosa, causing mucosal congestion and erosion, and some patients will have ulcers.

There is also a type of venereal proctitis, such as gonorrhea, which can cause proctitis. The main reason is related to anal sex. If protective measures are not in place, gonococcal proctitis and herpetic proctitis may occur. It is mainly diagnosed through bacteriological examination and rectal mucus.

Then there is tuberculous proctitis. Tuberculous proctitis is generally related to tuberculosis. During examination, tuberculosis can usually be seen in the secretions.

Among the above types, chronic proctitis may be the least likely to attract patients' attention due to its mild symptoms.

2. What complications may occur with chronic proctitis?

The first one is rectal stenosis. Due to repeated inflammatory stimulation, the end of the rectum becomes fibrotic due to inflammatory stimulation, and finally stenosis-like changes appear at the end of the rectum.

Second, due to repeated inflammatory stimulation of ulcerative proctitis, polyps will form on the edges of the ulcers. These polyps are called hyperplastic inflammatory polyps. Some people have single polyps, while others have multiple polyps.

The third one is submucosal fistula, which is caused by ulcer infection and occurs in some patients.

The fourth one is canceration, which turns into rectal cancer.

Figure 1 Original copyright image, no permission to reprint

These are the four most common complications in clinical practice.

In addition, because proctitis often manifests as mucus and blood in the stool, especially ulcerative proctitis, exudation often occurs, and some proctitis has flaky ulcers on the mucosa, and the amount of bleeding is also relatively large. Therefore, over time, it will also lead to secondary anemia.

3. Why does chronic proctitis develop into rectal cancer?

Clinically, chronic proctitis sometimes turns into cancer.

Because chronic proctitis, especially ulcerative proctitis, produces hyperplastic polyps. If these polyps are not treated for a long time, especially when they are larger than 1 cm, they are very likely to become cancerous.

Therefore, some patients also develop cancer because their polyps are not treated well. However, there is no need to worry too much, because the cancer rate of this type of hyperplastic polyp is not very high.

What we need to understand is that once proctitis has symptoms, we must treat it in time, there is no doubt about it. This includes diet, medication, sitz baths, enemas, etc. We must stabilize proctitis, so as to reduce the chance of onset and the chance of cancer.

When polyps appear, we should remove them as soon as possible and make a pathological diagnosis at the same time. It is also best to have regular check-ups to detect abnormalities in a timely manner.

4. Can chronic proctitis be completely cured?

Whether it can be completely cured depends on the cause of chronic proctitis.

If it is caused by radiotherapy, it can generally be cured after the radiation factors are removed.

However, if the cause is a decrease in immunity, such as in the case of ulcerative proctitis, it is often difficult to cure completely, and the patient may suffer from recurrent attacks due to factors such as fluctuations in immunity, lack of rest, or emotional stress.

Therefore, for patients with chronic proctitis, it is important to combine work and rest, arrange diet and rest reasonably, and minimize the chance of disease attacks. These are all achievable.

5. What foods are suitable for patients with chronic proctitis?

Generally speaking, patients with chronic proctitis should pay attention to dietary conditioning.

You should reduce the intake of raw, cold, greasy, seafood and spicy food, and try to drink less alcohol. It is recommended to eat more cooked food, such as porridge made from coix seeds, jujubes and yam.

Figure 2 Original copyright image, no permission to reprint

Through careful adjustment of diet, we can achieve the effect of nourishing the kidneys and strengthening the spleen, which is very beneficial for improving bowel movements.