Rectal Cancer

Rectal cancer is a type of cancer that develops in the rectum. The rectum is the final part of the large intestine, located at the end of the colon, and leading to the anus. Sometimes, rectal cancer and colon cancer are grouped together and called colorectal cancer.

This final section of the large intestine, the rectum, is tucked in a tight space near other organs and structures in the body. This close proximity makes surgery to remove rectal cancer more complex than colon cancer surgery.

While both types of cancer share some similarities, their treatments differ significantly. Removing rectal cancer often requires more intricate surgical procedures because of the rectum's location.

Treatment for rectal cancer usually includes surgery to remove the cancerous growth. Other options might include chemotherapy, radiation therapy, or a combination of both. Doctors may also use targeted therapy or immunotherapy to help fight the cancer.

Rectal cancer can sometimes hide early on. Many people don't notice any problems until the cancer has progressed. As rectal cancer grows, it can cause several changes in your body. These signs and symptoms include:

• Changes in bowel movements: This might mean having diarrhea more often, constipation, or needing to go to the bathroom more frequently than usual. You might also feel like your bowels aren't completely emptying.

• Belly (abdominal) pain: This can be a general ache or a more focused pain in your lower abdomen.

• Blood in your stool: Blood in your stool can appear as dark maroon or bright red. This is a noticeable sign that requires immediate attention.

• Changes in stool shape: Your stool might become narrower than usual.

• Unexplained weight loss: Losing weight without trying to lose it could be a sign of something serious, including cancer.

• Weakness or tiredness: Feeling unusually weak or tired, without a clear reason, can sometimes be linked to a medical issue like cancer.

If you experience any of these symptoms, it's important to see your doctor. Don't hesitate to schedule an appointment if anything feels unusual or concerning. Early detection of rectal cancer is key to successful treatment.

If you're concerned about any health issues, please schedule a visit with your doctor or other medical provider.

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Rectal cancer is a type of cancer that starts in the rectum. Unfortunately, scientists don't fully understand why it happens in most cases.

Rectal cancer happens when the DNA inside the cells of the rectum gets damaged or altered. Think of DNA as the instruction manual for a cell. Healthy cells have instructions that tell them how quickly to grow and divide, and when to die. These instructions are carefully regulated. However, in rectal cancer cells, the DNA instructions are messed up. This means the cells get confused and start growing and dividing much faster than normal, and they don't die when they're supposed to. This uncontrolled growth leads to a buildup of extra cells.

These extra, rapidly growing cells can form a lump called a tumor. This tumor can grow large and push into surrounding healthy tissue, damaging it. In some cases, cancer cells can detach from the main tumor and travel through the bloodstream or lymphatic system to other parts of the body. When cancer spreads in this way, it's called metastatic cancer. This spread can make the cancer more difficult to treat.

Factors that raise the chance of getting colon or rectal cancer are similar. Here are some things that can increase your risk:

• Past colorectal problems: If you've had colon or rectal cancer, or non-cancerous growths called polyps, in the past, you have a higher chance of getting it again. This is important to remember if you have a family history of these problems.

• Race: In the United States, Black people have a higher risk of colorectal cancer compared to other racial groups.

• Diabetes: Having type 2 diabetes might increase your risk of colorectal cancer.

• Alcohol use: Drinking too much alcohol can raise your risk of colorectal cancer. This means more than a certain amount, which your doctor can tell you more about.

• Diet: Eating a diet low in fruits and vegetables and high in red meat might be connected to a higher colorectal cancer risk. A healthy diet that includes plenty of fruits, vegetables, and whole grains is important for overall health, and may help lower your risk.

• Family history: If a close family member (parent, sibling, or child) has had colon or rectal cancer, you have a higher chance of getting it yourself. This is why it's important to talk to your doctor about your family history.

• Inflammatory bowel diseases: Conditions like ulcerative colitis and Crohn's disease, which cause long-term inflammation in the colon and rectum, increase the risk of colorectal cancer. If you have these conditions, it's crucial to discuss your risk with your doctor.

• Inherited genes: Sometimes, certain gene changes passed down through families can significantly raise the risk of colorectal cancer. These changes are present in only a small number of cases. Examples include familial adenomatous polyposis (FAP) and Lynch syndrome. Genetic testing can help identify these and other rare inherited cancer risks. If you have a family history of these conditions, you may want to consider talking to a genetic counselor or your doctor.

• Weight: Being overweight or obese increases your colorectal cancer risk. Maintaining a healthy weight through a balanced diet and exercise is important for overall health and may reduce your risk.

• Age: Most people diagnosed with colorectal cancer are over 50. However, the number of cases in younger people is rising, and doctors aren't entirely sure why.

• Previous radiation treatment: Radiation therapy used to treat cancer in the abdomen can slightly increase the risk of colorectal cancer later in life.

• Smoking: Smoking may increase the risk of colorectal cancer. Quitting smoking can lower your risk of many health problems, including cancer.

• Lack of exercise: A lack of physical activity can increase your risk of colorectal cancer. Regular exercise is important for overall health and may help lower your risk.

It's important to remember that these are factors that can increase your risk, but they don't guarantee you'll get colorectal cancer. Talk to your doctor about your personal risk factors and what steps you can take to lower your chance of developing this disease.

Rectal cancer can cause several problems. Here are some common complications:

• Rectal bleeding: Rectal cancer frequently leads to bleeding from the rectum. Sometimes, the amount of blood is significant enough to be a concern, and immediate treatment may be necessary to stop the bleeding. This bleeding can range from a small amount of blood on the toilet paper to a more substantial amount of blood in the stool.

• Blockage of the intestines (intestinal obstruction): As rectal cancer grows, it can block the passageway for stool to leave the body. This blockage prevents waste from moving through the intestines normally. Surgery to remove the cancer is often the best way to fix this obstruction. If surgery isn't possible right away, other treatments can help ease the blockage, such as medication or temporary procedures to open up the blocked area.

• A hole in the intestines (intestinal perforation): Rectal cancer can sometimes cause a tear or hole in the intestines. This is known as a perforation. A perforation usually needs immediate surgery to repair the damage and prevent serious infection.

Preventing rectal cancer isn't guaranteed, but you can lower your chances.

One key way to reduce risk is getting screened for colorectal cancer. This involves checking for precancerous growths called polyps in your colon and rectum. These polyps can sometimes turn into cancer. Talk to your doctor about when you should start getting screened. Most doctors suggest starting around age 45, but you might need to start earlier if you have risk factors for colorectal cancer, such as a family history of the disease.

There are different ways to get screened. Discuss your options with your doctor. They can help you decide which tests are best for you.

If you drink alcohol, do so in moderation. For healthy adults, this means no more than one drink per day for women and no more than two drinks per day for men. A "drink" is usually a standard glass of wine, a 12-ounce beer, or a shot of liquor.

Eating a healthy diet is important. Focus on plenty of fruits and vegetables. Getting your vitamins and nutrients from whole foods is always better than taking large doses of vitamins in pill form. These large doses can sometimes be harmful.

Aim for at least 30 minutes of exercise most days of the week. If you haven't been active recently, check with your doctor first before starting an exercise routine. Start slow and gradually increase the intensity and duration of your workouts.

Maintaining a healthy weight is also crucial. If you are overweight or obese, talk to your doctor about healthy ways to lose weight safely. This often involves eating fewer calories and gradually increasing physical activity. Losing weight slowly and steadily is more likely to be successful and less harmful to your body.

Diagnosing and Treating Rectal Cancer

Rectal cancer is a type of cancer that starts in the rectum, the last part of the large intestine. A doctor often first suspects rectal cancer through an imaging test, such as a colonoscopy.

What is a Colonoscopy?

A colonoscopy is a procedure where a long, thin, flexible tube with a camera (a colonoscope) is inserted into the rectum. This allows the doctor to see the entire colon and rectum, looking for signs of cancer or other problems. Before and during the procedure, medication is given to help you relax and feel comfortable.

Taking Tissue Samples (Biopsy):

Sometimes, a small tissue sample (biopsy) needs to be taken. A doctor uses special tools passed through the colonoscope to gently remove a tiny piece of tissue from the rectum. This sample is sent to a lab for examination to check for cancer cells. The lab results, along with other tests, help the medical team create a treatment plan.

Checking for Spread of Cancer:

If rectal cancer is diagnosed, the next step is to determine how far it has spread (the "stage"). This is done through various tests:

• Complete Blood Count (CBC): This blood test counts different types of blood cells. A low red blood cell count (anemia) might suggest the cancer is causing blood loss. A high white blood cell count could indicate infection, which is a possible complication if the cancer has grown through the rectal wall.

• Blood Tests for Organ Function (Chemistry Panel): This blood test measures different chemicals in the blood. Unusual levels of some chemicals might indicate that the cancer has spread to the liver or other organs, such as the kidneys.

• Carcinoembryonic Antigen (CEA): Some cancers produce substances called tumor markers that can be detected in the blood. CEA is one such marker. Higher-than-normal CEA levels are sometimes seen in people with colorectal cancer and can be helpful to track how a patient responds to treatment.

• Imaging Tests: Different imaging techniques provide detailed views of the body.

  • CT scan (Computed Tomography): This scan looks at the chest, abdomen, and pelvis to see if the cancer has spread to other organs like the liver or lungs.
  • MRI (Magnetic Resonance Imaging): This scan provides detailed images of the muscles, organs, and tissues around the rectum, including the lymph nodes, and different layers of rectal tissue, offering better detail than a CT scan.

Understanding Cancer Stages:

Rectal cancer stages range from 0 to 4. Stage 0 cancer is small and only affects the surface lining. Stages 1 to 4 indicate increasing size and depth of the cancer. Stage 4 means the cancer has spread to other parts of the body.

Treatment and Care:

Mayo Clinic's team of experts provides comprehensive care for rectal cancer patients. They use the results from these tests to create a personalized treatment plan.

Rectal Cancer Treatment Options

Rectal cancer treatment often starts with surgery to remove the tumor. However, if the cancer is large or has spread, doctors might begin with medicine (chemotherapy) and/or radiation instead. The best course of action depends on several factors, including your overall health, the type and stage of cancer, and what you prefer.

Surgery can be used alone or combined with other treatments. Different surgical procedures are used depending on the size and location of the cancer:

1. Removing Small Cancers:

Doctors might use a thin, flexible tube (a colonoscope) to remove very small cancers directly from inside the rectum. This is called transanal local excision. Surgical tools passed through the scope cut away the cancer and some surrounding healthy tissue. This is a good option for small cancers that are not likely to spread to nearby lymph nodes. If lab tests show the cancer might spread, more surgery may be needed.

2. Removing Part or All of the Rectum:

For larger cancers further from the anus, surgeons might remove part or all of the rectum. This is called a low anterior resection. They also remove nearby tissue and lymph nodes. The goal of this surgery is to preserve the anus, so you can use the bathroom normally.

• The procedure varies based on where the cancer is located. If the cancer is higher up in the rectum, the affected portion is removed, and the colon is connected to the remaining rectum (colorectal anastomosis).
• If the cancer is lower in the rectum, the entire rectum is removed, and the colon is reshaped into a pouch and connected to the anus (coloanal anastomosis).

3. Removing the Rectum and Anus:

If the cancer is very close to the anus, it might not be possible to remove it completely without damaging the muscles that control bowel movements. In these cases, an abdominoperineal resection (APR) might be recommended. This surgery removes the rectum, anus, some of the colon, and nearby lymph nodes. A colostomy is created where a small opening is made in the abdomen to allow waste to exit the body into a bag attached to the skin.

Other Treatments:

• Chemotherapy: This uses strong medicines to kill cancer cells. It's often used before or after surgery, or alone for advanced cancer that has spread. Chemotherapy might be used before surgery to shrink a large tumor, making it easier to remove.

• Radiation Therapy: This uses powerful energy beams (like X-rays) to kill cancer cells. External beam radiation is a common approach. Radiation is often used in combination with chemotherapy, either before or after surgery, or to relieve symptoms like bleeding or pain in cases where surgery isn't possible.

• Targeted Therapy: This uses medicines to attack specific parts of cancer cells. This can be combined with chemotherapy for advanced cancers that can't be removed or that return after treatment. Lab tests may be needed to see if targeted therapy is appropriate.

• Immunotherapy: This helps the body's immune system fight the cancer. It's sometimes used before or after surgery, or for advanced cancers. Special tests are needed to see if immunotherapy is a good option.

• Palliative Care: This focuses on relieving symptoms and improving quality of life, even if a cure isn't possible. It's provided by a team of doctors, nurses, and other specialists, and can be used alongside other cancer treatments.

Coping with Rectal Cancer:

Learning about your cancer, treatment options, and prognosis can help you feel more in control. Strong relationships with friends and family can provide practical and emotional support. Talking to a counselor, support group, or clergy member can also be helpful. Don't hesitate to ask your healthcare team about support groups in your area. The National Cancer Institute and the American Cancer Society also offer valuable information.

Dealing with a rectal cancer diagnosis can be tough, but you'll find ways to cope over time. In the meantime, here are some things that might help:

Understanding Your Cancer: Learning about rectal cancer is key to making informed decisions about your care. Talk to your doctor's team about everything, including your test results, different treatment options, and what your outlook might be (your prognosis). The more you understand, the more confident you'll feel about the choices you make.

Strong Support System: Keeping your close friends and family involved is really important. They can offer practical help, like taking care of your home if you're in the hospital, and emotional support when you need it most. Feeling overwhelmed by a cancer diagnosis is normal, so having someone to talk to is crucial.

Finding a Listener: Having someone to talk to about your hopes and fears is essential. This could be a friend, a family member, or someone else you trust. A counselor, medical social worker, member of the clergy, or a cancer support group can also provide valuable support and understanding. Your healthcare team can tell you about support groups in your area.

Reliable Resources: The National Cancer Institute and the American Cancer Society are great sources of information about rectal cancer. They offer facts, resources, and support that can be extremely helpful.