What are Presacral Tumours?
Presacral tumours, also known as retrorectal tumours, are the uncontrolled growth of tissues or cells in the presacral space, the space between the rectum and part of the lower spine called the sacrum, which is usually made up of fatty tissue. Tumours are rare in this region and can exist in benign or malignant forms.
Causes of Presacral Tumours
Causes of presacral tumours include:
- Congenital disease
- Hereditary condition (Curranino syndrome)
- Malignant cancer that has spread from another area
Classification of Presacral Tumours
Based on the tissues they arise from, presacral tumours are classified as:
- Congenital or developmental: These masses develop from remnant embryo tissue.
- Neurogenic: These tumours develop in the pelvic nerves.
- Osseous: These tumours develop in the bone or cartilage.
- Inflammatory: These masses include inflammatory reaction to a foreign body, tuberculosis, abscesses, fistulas.
- Miscellaneous: These include tumours that arise from other tissues such as fat, blood vessels and lymph. It also includes malignant tumours from other areas.
Symptoms of Presacral Tumours
Most presacral tumours, especially benign tumours, are asymptomatic, but symptoms can occur due to compression of the tumour on the rectum and other surrounding structures. Common symptoms include:
- Pelvic pain
- Faecal/urinary incontinence
- Weight loss
- Leg pain
- Heavy feeling in the region
- Erectile dysfunction
- Lower intestinal dysfunction
Diagnosis of Presacral Tumour
Presacral tumours have symptoms similar to other conditions, therefore, making it difficult to diagnose. Your doctor will analyze your symptoms and medical history. A physical examination is performed including a digital rectal examination where your doctor will insert a gloved finger into the anus to feel for lumps or growths. Diagnostic tests that are performed can include:
- Sigmoidoscopy: An illuminated tube with a camera is used to examine the rectum and the end of the colon.
- X-rays: X-rays of the rectum can help detect the tumour.
- MRI scan: Radio waves are used to create detailed images of the tumour.
- CT scan: A specialized x-ray technique that produces clear images of the rectum.
- Biopsy: A small sample of the tissue (biopsy) will be taken from the rectum and observed under the microscope.
- Laboratory tests: This includes blood tests and tests on tissue samples.
Treatment for Presacral Tumors
Treatment for presacral tumours depends on the type and position of the tumour and can include:
- Surgery: This is the first-line treatment and involves removal of the tumour or the affected part of the pelvic region called pelvic excision.
- Radiation therapy: This method uses high beam radiation to shrink the tumour and destroy cancer cells. This is performed after surgery to destroy the remaining cancerous cells. Radiation may be administered internally or externally. Internal radiation involves using needles, catheters, or wires containing radioactive substances which are placed in contact with the tumour. In external radiation therapy, radiation is administered through devices present outside the body.
- Chemotherapy: A combination of anti-cancer drugs is used to destroy cancer cells or inhibit their growth. Chemotherapy is used to shrink tumours and prevent cancer cells from spreading to the surrounding tissues. The drugs enter the bloodstream and reach the cancerous cells to destroy them. Chemotherapy may be administered orally or intravenously.