Rectal Cancer

Rectal cancer often causes no symptoms and is detected during routine screenings. It is important to note that other common health problems can cause some of the same symptoms. For example, hemorrhoids are a common cause of rectal bleeding but do not cause rectal cancer. As a result, it is important for your physician to examine you when you have rectal bleeding. Remember that not all rectal bleeding is caused by hemorrhoids.

Rectal cancer symptoms include:

• A change in bowel habits (e.g., constipation or diarrhea)
• Narrow shaped stools
• Bright red or very dark blood in the stool
• Ongoing pelvic or lower abdominal pain (e.g., gas, bloating or pain)
• Unexplained weight loss
• Nausea or vomiting
• Feeling tired all the time

Abdominal pain and weight loss are typically late symptoms, indicating possible extensive disease. Anyone experiencing any of the above symptoms should see a physician as soon as possible.

The following are used to offer a diagnosis and treatment plan:

• Medical history
• Physical exam
• Blood tests
• Digital rectal exam (DRE) Insertion of a gloved, lubricated finger into the rectum to check for abnormalities
• Proctoscopy Examination of the anal cavity and rectum using a narrow instrument called a proctoscope
• Colonoscopy Examination of the entire colon with a long, flexible instrument called a colonoscope
• Biopsy Taking samples of tissues to view under a microscope for signs of cancer

Rectal cancer is preventable. Nearly all cases of rectal cancer develop from polyps, benign growths on the inner lining of the rectum. Detection and removal of polyps through colonoscopy reduces the risk of rectal cancer. Rectal cancer screening recommendations are based on medical and family history. Screening typically starts at age 45 in patients with average risk. Those at higher risk are advised to receive their first screening at a younger age.

While it is not definitive, there is some evidence that diet may play a significant role in preventing colorectal cancer. A diet high in fiber (whole grains, fruits, vegetables and nuts) and low in fat may help prevent colorectal cancer.

While the exact cause of rectal cancer is unknown, the following factors can increase the risk of rectal cancer.

• Nearly 90 percent of rectal cancer is detected in patients 50 and older
• Family history of colorectal cancer (especially parents or siblings)
• Personal history of Crohn's Disease or ulcerative colitis for eight years or longer
• Colorectal polyps
• Personal history of breast, uterine or ovarian cancer

Because there is no way to predict whether a colorectal polyp will become a cancer, we recommend removal of polyps. The vast majority of polyps can be removed or destroyed by our specialists during a colonoscopy. Large polyps may require more than one treatment and some patients may require surgery for complete polyp removal.

Once a colorectal polyp is completely removed, recurrence is unusual. However, new polyps may develop in at least 30 percent of patients after polyp removal. To minimize the risk for future polyps, our experienced team will recommend follow-up procedures at specific intervals to watch for new polyps, usually within three to five years following polyp removal.

Surgery to remove rectal cancer is almost always required for a complete cure. Depending on the location and stage, this may be performed through the anus (opening of the rectum) or through the abdomen. The tumor and lymph nodes are removed, along with a portion of normal rectum on either side of the tumor. Minimally invasive surgical techniques such as laparoscopy and robotic surgery may be used by trained surgeons based on the individual case. Your surgeon will discuss this with you prior to surgery and decide on the best approach.

An ostomy may be necessary in some surgeries to treat rectal cancer. An ostomy, or stoma, is a surgically created opening between the intestines and the abdominal wall. The most common types of ostomies connect either the small intestines (ileostomy or jejunostomy) or the large intestine (colostomy) to the abdominal wall. After an ostomy is created, bowel movements pass through the opening in the abdominal wall or stoma and into the ostomy appliance. Ostomies can be temporary or permanent.  Your surgeon can advise you about this possibility and how to prepare for it.

Chemotherapy or radiation therapy may be offered either before or after surgery, depending on the stage of the cancer.

Early detection through screening methods (like colonoscopy) is crucial. Patient outcome is strongly associated with the rectal cancer stage at the time of diagnosis, including:

• Cancer stage (how advanced the cancer is)
• Cancer location in the rectum
• Whether the bowel is blocked or has a hole in it
• Whether all of the tumor can be removed surgically
• Patient's general health and ability to tolerate different treatments
• Whether the cancer is newly diagnosed or has recurred (come back)

Follow-up care after treatment for rectal cancer is important. Even when the cancer appears to have been completely removed or destroyed, the disease may recur.