Rectal Cancer

WHAT IS RECTAL CANCER?

The rectum is the last six inches of the large intestine which is composed of the colon and rectum. Colon and rectal cancers both arise from the inner lining. Despite the similarities, colon and rectal cancers are treated differently due to differences in anatomy as well as potential pathways of spread.
 
Colon and rectal cancers are the fourth most common form of cancer in the United States.  It is estimated that there will be 151,030 newly diagnosed cases in 2022 with an estimated 52,580 deaths.  The lifetime risk of developing colon or rectal cancer is 4.1%.  When diagnosed in early stages, cure rates can be high.

 

Diagram taken from existing ASCRS brochure "Polyps"

WHO IS AT RISK FOR RECTAL CANCER?

Though rectal cancer risk increases with age, there has been a noticeable trend towards earlier age at diagnosis. Recently, the recommended age when screening should start was lowered to 45.  Risk factors include a family history of colon or rectal cancer, especially involving a parent or sibling, a history of inflammatory bowel disease, colon or rectal polyps, as well as a history of certain other types of cancer or familial cancer syndromes. These risk factors will start the screening process at a younger age.
 

PREVENTION OF RECTAL CANCER

Most colon and rectal cancers start as polyps, which are growths of abnormal tissue inside the colon and rectum. Rectal cancers can be prevented by discovering and removing these polyps with colonoscopy.  It usually takes years for a polyp to become a cancer, so routine detection and removal of these polyps will greatly decrease the development of colon and rectal cancers.  All patients should discuss recommendations for colon and rectal cancer screening with their health care providers.  Screening for the average risk patient should begin at age 45.  This may be different for individuals depending on personal and family health history.

Evidence also suggests that a high fiber, low fat diet may decrease the risk of developing colon or rectal cancer.
 

WHAT ARE THE SYMPTOMS OF RECTAL CANCER?

Colon and rectal cancer may have no symptoms.  When symptoms are present, they are often mistaken for other problems such as hemorrhoids.  Common symptoms can include a change in bowel habits, a change in the size or shape of the stools, or blood in or with the stool.  Abdominal pain, unexplained weight loss, and fatigue may also occur, though they may be associated with other common health problems as well.  These symptoms should always be discussed with your healthcare provider or colon and rectal surgeon.
 

WHAT TESTS ARE PERFORMED TO DIAGNOSE RECTAL CANCER?

WHAT DETERMINES THE OUTCOME OF RECTAL CANCER?

HOW IS RECTAL CANCER TREATED?

Rectal cancer treatment is determined by the results of the staging. When the cancer is completely contained within the walls of the colon and rectum, and no suspicious lymph nodes are found, surgery is usually the primary method of treatment.  When there is any evidence of penetration of the tumor through the wall of the rectum, or suspicious lymph nodes are found, initial treatment may include one of several combinations of chemotherapy and radiation therapy.  This is usually then followed by surgical removal of the involved portion of rectum.  Treatment of rectal cancers is tailored to the individual patient and involves a team of doctors and healthcare workers who specialize in the treatment of this disease. 
 
Surgery is often performed by specially trained colon and rectal surgeons. Minimally invasive techniques such as laparoscopic and robotic surgery are often utilized to help to minimize the impact of surgery and assist in a speedy recovery.  Depending on the individual patient and multiple technical factors, a stoma (colostomy or ileostomy) may be needed.  This could be permanent or temporary, though permanent is less frequent. Sometimes if the rectal cancer is diagnosed at early stages, before the cancer penetrates deep into the rectal wall, the treatment might involve local excision of the cancer through the anus (transanal excision). The final stage in pathology might be more advanced than initially diagnosed and additional treatment with surgery or radiation and chemotherapy may be required.

WHAT FOLLOW-UP IS NEEDED AFTER TREATMENT?

After surgery, blood testing (CEA level), regular examinations and imaging studies such as CT scans are used to monitor a patient in case there is return of the cancer, or distant spread. Regular colonoscopy is essential to prevent or diagnose recurrence or a separate cancer, and to remove any polyps that grow.

WHAT IS A COLON AND RECTAL SURGEON?

Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum and anus. They have completed advanced surgical training in the treatment of these diseases as well as full general surgical training. Board-certified colon and rectal surgeons complete residencies in general surgery and colon and rectal surgery, and pass intensive examinations conducted by the American board of Surgery and the American Board of Colon and Rectal Surgery. They are well-versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions if indicated to do so.

DISCLAIMER

The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention and management of disorders and diseases of the colon, rectum and anus. These brochures are inclusive but not prescriptive. Their purpose is to provide information on diseases and processes, rather than dictate a specific form of treatment. They are intended for the use of all practitioners, health care workers and patients who desire information about the management of the conditions addressed. It should be recognized that these brochures should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtain the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient.

ASCRS committee members review and update information for accuracy.  We believe content is medically accurate at the time it was produced. The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention and management of disorders and diseases of the colon, rectum and anus. These brochures are inclusive but not prescriptive. Their purpose is to provide information on diseases and processes, rather than dictate a specific form of treatment. They are intended for the use of all practitioners, health care workers and patients who desire information about the management of the conditions addressed. It should be recognized that these brochures should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtain the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient.

ASCRS committee members review and update information for accuracy.  We believe content is medically accurate at the time it was produced.