Rectal Cancer


General Information

What is rectal cancer?

Rectal cancer is a disease in which malignant (cancer) cells form in the tissues of the rectum. The rectum is part of the body's digestive system. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The digestive system is made up of the esophagus, stomach, and the small and large intestines. The first 6 feet of the large intestine are called the large bowel or colon. The last 6 inches are the rectum and the anal canal. The anal canal ends at the anus (the opening of the large intestine to the outside of the body). Age and family history can affect the risk of developing rectal cancer.

The following are possible risk factors for rectal cancer:

-Age 50 years or older.
-A family history of cancer of the colon or rectum.
-A personal history of cancer of the colon, rectum, ovary, endometrium, or breast.
-A history of ulcerative colitis (ulcers in the lining of the large intestine).
-Certain hereditary conditions, such as familial adenomatous polyposis and hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome).

Possible signs of rectal cancer include a change in bowel habits or blood in the stool.

These and other symptoms may be caused by rectal cancer or other conditions. A doctor should be consulted if any of the following problems occur:

-A change in bowel habits.
-Blood (either bright red or very dark) in the stool.
-Diarrhea, constipation, or feeling that the bowel does not empty completely.
-Stools that are narrower than usual.
-General abdominal discomfort (frequent gas pains, bloating, fullness, or cramps).
-Weight loss with no known reason.
-Constant tiredness.
-Vomiting.

Tests that examine the rectum and colon are used to detect (find) and diagnose rectal cancer. Tests used in diagnosing rectal cancer include the following:

Fecal occult blood test: This test examines a patient's stool (solid waste) for occult (hidden) blood. A small stool sample is placed on a special card and returned to the doctor or laboratory.

Digital rectal examination: The doctor or nurse inserts a lubricated gloved finger into the rectum and feels for lumps or abnormal areas and tests any stool for blood.

Barium enema: A procedure in which a liquid containing barium is put into the rectum by way of the anus. Barium is a silver-white metallic compound that helps to show the image of the lower gastrointestinal tract on an x-ray.

Sigmoidoscopy: An examination in which a doctor uses a sigmoidoscope (a thin, lighted tube) to view the inside of the rectum for polyps, tumors, or abnormal areas. If the doctor sees a polyp or other abnormal tissue during the procedure, it can be removed and further examined under a microscope.

Colonoscopy: An examination of the inside of the colon and rectum using a colonoscope (a thin, lighted tube) inserted into the rectum. If the doctor sees a polyp or other abnormal tissue during the procedure, it can be removed and further examined under a microscope.

Biopsy: The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire tumor or lesion is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fine-needle aspiration.

Certain factors affect treatment options and prognosis (chance of recovery). The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether it affects the inner lining of the rectum only, involves the whole rectum, or has spread to other places in the body), the type of cancer, the size of the tumor, and the patient's general health.

Stages of Rectal Cancer

After rectal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the rectum or to other parts of the body. The process used to find out whether cancer has spread within the rectum or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. The following tests and procedures may be used in the staging process:

Digital rectal examination: The doctor or nurse inserts a lubricated gloved finger into the rectum and feels for lumps or abnormal areas and tests any stool for blood.

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography.

MRI (magnetic resonance imaging): A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. This test is also called nuclear magnetic resonance imaging (NMRI).

Sigmoidoscopy or colonoscopy and biopsy: A sigmoidoscope or colonoscope (a thin, lighted tube) is used to examine the inside of the rectum. If abnormal tissue is found, a small piece of the tissue is cut out and looked at under a microscope to see if cancer cells are present.

Endoscopic ultrasound (EUS): An endoscope (a thin, lighted tube used to look at tissues inside the body) is used to bounce high-energy sound waves off internal tissues and organs and change the echoes into pictures called sonograms. This procedure is also called endosonography. EUS may be used to produce pictures of the inside of the rectum.

The following stages are used for rectal cancer:

Stage 0 (carcinoma in situ)
In stage 0, cancer is found in the innermost lining of the rectum only. Stage 0 cancer is also called carcinoma in situ.

Stage I
In stage I, cancer has spread beyond the innermost lining of the rectum to the second and third layers and involves the inside wall of the rectum, but it has not spread to the outer wall of the rectum or outside the rectum. Stage I rectal cancer is sometimes called Dukes' A rectal cancer.

Stage II
In stage II, cancer has spread outside the rectum to nearby tissue, but it has not gone into the lymph nodes (small, bean-shaped structures found throughout the body that filter substances in a fluid called lymph and help fight infection and disease). Stage II rectal cancer is sometimes called Dukes' B rectal cancer.

Stage III
In stage III, cancer has spread to nearby lymph nodes, but it has not spread to other parts of the body. Stage III rectal cancer is sometimes called Dukes' C rectal cancer.

Stage IV
In stage IV, cancer has spread to other parts of the body, such as the liver, lungs, or ovaries. Stage IV rectal cancer is sometimes called Dukes' D rectal cancer.

Recurrent Rectal Cancer
Recurrent rectal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the rectum or in other parts of the body, such as the colon, pelvis, liver, or lungs.

Treatment Option Overview

There are different types of treatment for patients with rectal cancer. Different types of treatment are available for patients with rectal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment

Clinical trials are taking place in many parts of the country. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used:

Surgery
Surgery is the most common treatment for all stages of rectal cancer. A doctor may remove the cancer using one of the following types of surgery:

Local excision: If the cancer is found at a very early stage, the doctor may remove it without cutting into the abdomen. If the cancer is found in a polyp (a growth that protrudes from the rectal mucous membrane), the operation is called a polypectomy.

Resection: If the cancer is larger, the doctor will perform a resection of the rectum (removing the cancer and a small amount of healthy tissue around it). The doctor will then perform an anastomosis (sewing the healthy parts of the rectum together, sewing the remaining rectum to the colon, or sewing the colon to the anus). The doctor will also take out lymph nodes near the rectum and examine them under a microscope to see if they contain cancer.

Resection and colostomy: If the doctor is not able to sew the rectum back together, a stoma (an opening) is made on the outside of the body for waste to pass through. This procedure is called a colostomy. Sometimes the colostomy is needed only until the rectum has healed, and then it can be reversed. If the doctor needs to remove the entire rectum, however, the colostomy may be permanent.

Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be offered chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after surgery to increase the chances of a cure is called adjuvant therapy.

Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

After treatment, a blood test to measure amounts of carcinoembryonic antigen (a substance in the blood that may be increased when cancer is present) may be done to see if the cancer has come back.

Other types of treatment are being tested in clinical trials.

Chemotherapy and biological therapy
Biological therapy is treatment to stimulate the ability of the immune system to fight cancer. Materials made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against disease. Biological treatment is sometimes called biological response modifier (BRM) therapy or immunotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options by Stage

Stage 0 Rectal Cancer
Treatment of stage 0 (carcinoma in situ) rectal cancer may include the following:

1.Local excision (surgery to remove the tumor without cutting into the abdomen) or simple polypectomy (surgery to remove a growth that protrudes from the rectal mucous membrane).
2.Resection (surgery to remove the cancer). This is done when the cancerous tissue is too large to remove by local excision.
3.Internal or external radiation therapy.

Stage I Rectal Cancer
Treatment of stage I rectal cancer may include the following:

1.Surgery to remove the tumor with or without anastomosis (joining the cut ends of the rectum).
2.Surgery to remove the tumor with or without radiation therapy and chemotherapy.
3.Internal and/or external radiation therapy.

Stage II Rectal Cancer
Treatment of stage II rectal cancer may include the following:

1.Resection with or without anastomosis (joining the cut ends of the rectum and colon, or the colon and anus) followed by chemotherapy and radiation therapy.
2.Partial or total pelvic exenteration (surgery to remove the organs and nearby structures of the pelvis), depending on where the cancer has spread. Surgery is followed by radiation therapy and chemotherapy.
3.Radiation therapy with or without chemotherapy followed by surgery and chemotherapy.
4.Radiation therapy during surgery followed by external-beam radiation therapy and chemotherapy.
5.A clinical trial evaluating new treatment options.

Stage III Rectal Cancer
Treatment of stage III rectal cancer may include the following:

1.Resection with or without anastomosis (joining the cut ends of the rectum and colon, or the colon and anus) followed by chemotherapy and radiation therapy.
2.Partial or total pelvic exenteration (surgery to remove the organs and nearby structures of the pelvis), depending on where the cancer has spread. Surgery is followed by radiation therapy and chemotherapy.
3.Radiation therapy with or without chemotherapy followed by surgery and chemotherapy.
4.Radiation therapy during surgery followed by external-beam radiation therapy and chemotherapy.
5.Chemotherapy and radiation therapy to relieve symptoms caused by advanced cancer.
6.A clinical trial evaluating new treatment options.

Stage IV Rectal Cancer
Treatment of stage IV rectal cancer may include the following:

1.Resection/anastomosis (surgery to remove the cancer and join the cut ends of the rectum and colon, or colon and anus) to relieve symptoms caused by advanced cancer.
2.Surgery to remove parts of other organs, such as the liver, lung, and ovaries, where the cancer may have spread.
3.Chemotherapy and radiation therapy to relieve symptoms caused by advanced cancer.
4.Chemotherapy following surgery.
5.Clinical trials of chemotherapy and biological therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options for Recurrent Rectal Cancer
Treatment of recurrent rectal cancer may include the following:

1.Surgery to remove the tumor or as palliative therapy to relieve symptoms caused by advanced cancer.
2.Surgery to remove parts of other organs, such as the liver, lungs, and ovaries, where the cancer may have spread.
3.Radiation therapy and/or chemotherapy as palliative therapy to reduce the size of the tumor and relieve symptoms caused by advanced cancer.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.





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