Rectal Cancer

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Rectal Cancer 

1. What is Rectal Cancer?

Rectal Cancer is cancer is a tumor arising from the lowest 15 centimeters of the large intestines, lying within the pelvis and connecting the colon to anus. Rectal cancer, unlike colon cancer, has a tendency to recur locally within the pelvis in the other organs near the colon and has a worse outcome. Local recurrence of rectal cancer is common (15-45%) after standard surgery and is often catastrophic. It is difficult to cure, and the associated symptoms are debilitating. Accordingly, preventing local recurrence is one of the main treatment goals with rectal cancer. Roughly one third of all colorectal cases involve the rectum.

2. How does one know if one has rectal cancer?

Rectal cancer can cause many symptoms that require a person to seek medical care. However, rectal cancer may also be present without any symptoms, hence it is important to have routine health screening check up. Symptoms, to be aware of include the following:

* Bleeding

- Seeing blood mixed with stool is an urgent sign. Although many people bleed due to hemorrhoids, a doctor should be notified in the event of any rectal bleeding. It is a sad fact that many patients with rectal cancer attribute their symptoms to hemorrhoid, causing them to delay consultation.

-  Prolonged rectal bleeding (perhaps in small quantities not seen in the stool) may lead to anemia, causing fatigue, shortness of breath, light-headedness, or a fast heartbeat.

* Obstruction

-  A rectal mass may grow so large that it prevents the normal

passage of stool. This blockage may lead to the feeling of severe constipation or pain when having a bowel movement. In addition, abdominal pain  and cramping may occur due to the blockage.

- The stool should pass around the rectal mass. Therefore,

pencil-thin stool maybe another sign of an obstruction from rectal cancer.

-  A person with rectal cancer may have a sensation that the stool cannot be completely evacuated after a bowel movement, requiring frequent trips to the bathroom.

* Weight loss, usually unexplained

3. Who are at risks/what are the risk factors?

The actual cause of rectal cancer is unclear. However, the following are risks factors for developing rectal cancer:

* Increasing age

* Smoking

* High-fat diet and/or diet mostly from animal sources

* Personal or family history of colorectal cancer or polyps in the colon

 * Lack of screening for colorectal cancer

 4. What happens if you have rectal cancer?

Rectal cancer usually develops over several years, first growing as a benign precancerous growth called a polyp. Some of these polyps will eventually turn into cancer and begin to grow and penetrate the wall of the rectum, after which they spread into the lymph nodes and reach other organs like the liver and the lungs.

 5. How is rectal cancer diagnosed?

Screening for rectal cancer is the only way to prevent this disease. Screening test  for rectal cancer include the following:

* Fecal Occult Blood Test  (FOBT)

* Endoscopy, wherein a doctor inserts a scope through the anus. The scope  maybe rigid, as in proctosigmoidoscope or flexible and connected to a video camera, as in colonoscopy (which views the entire colon) or flexible sigmoidoscopy (which views the lower part of the colon). If a rectal tumor is found on endoscopy, a biopsy is performed. If biopsy confirms that it is rectal cancer, the next important phase in management is accurate staging of the disease, which will determine the appropriate treatment. Stage I patients can be treated by surgery alone, while stage II and III patients will require radiochemotherapy  prior to surgery. The treatment for stage IV patients is best individualized. The test to stage rectal cancer include:

* Endorectal Ultrasound is a test where a special ultrasound probe is inserted into the anus, with a unique ability to determine how deep the tumor has grown into the rectal wall; whether there is a spread to the lymph nodes around the area; and whether there is invasion into the anal muscles.

* CT scan and MRI to evaluate the tumor in relation to the pelvis, as well as check for spread to the liver.

* Chest x-ray or CT scan of the lungs

* CEA blood test

6. What are the available treatment options?

 The standard surgical procedure is called wide or total mesorectal excision. Preoperative chemoradiotherapy  has been found to reduce the risk of local recurrence and to cause fewer long-term toxic effects than if the chemoradiotherapy  is given postoperatively. At five years, the overall survival among patients with locally advanced rectal

cancer, irrespective of whether they have had preoperative or postoperative chemoradiotherapy is about 75%.

A common concern among patients with rectal cancer is possibility of permanent colostomy, where the anus is removed and feces is made to come out of an opening in the abdominal wall. Thankfully, with the appropriate use of preoperative chemoradiotherapy and the surgical

Technique of total mesorectal excision, surgeons are now more able to preserve the anus during rectal cancer surgery. However,  this highly complex operations usually will necessitate the creation of a temporary colostomy in order to prevent the passage of feces  into the freshly reconstructed anus. This temporary colostomy is then closed in a separate operation later, when the anus is completely healed.

 At present, a permanent removal of the anus with the creation of  a colostomy , is only performed if there is evidence on endorectal  ultrasound that the anal muscles are involved. This situation is uncommon, and occurs in less than 20% of the cases.

 7. What are the outcomes of rectal cancer?

 The outlook for recovery from rectal cancer is unique for each individual. Many factors are involved when considering the chance of survival after rectal cancer treatment.Treatment of rectal cancer depends on the stage or extent of disease.

 According to stage, the following approximations of the likelihood of survival 5 years after treatment are as follows:

Stage I - The cancer is in the inner layers of the rectum, and the probability of being alive in 5 years is approximately 70-80%.

 Stage II -  The cancer has spread through the muscle wall of the rectum, sometimes invading adjacent organs like urinary bladder, vagina or prostate. The probability of being alive in 5 years is approximately 50-60%.

 Stage III - the cancer has spread to the lymph nodes. The probability of being alive in 5 years is approximately 30-40%.

Stage IV - the cancer has spread to other organs far from the rectum, like the liver and lungs. The probability of being alive in 5 years is less than 10%.

Services Available:

Sreening

1) Fecal Occult Blood Test  (FOBT) yearly with flexible sigmoidoscopy every 3 years

2) Colonoscopy every 5 to 10 years

3) Virtual CT colonography every 3 to 5 years.

Prevention

1) Colonoscopic Polypectomy

Comprehensive Rectal Cancer Treatment Program

* State-of-the-art Staging Modalities

1) Endorectal Ultrasound

2) Triphasic CT scan

3) MRI

* Multidisciplinary Treatment planning

* Neo-adjuvant (Preoperative) Chemoradiotherapy

* State-of-the-art Surgery

1) Total Mesorectal Excision

2) Sphincter-preservation, avoiding permanent colostomies

3) Pelvic Nerve Preservation

4) Minimally-invasive surgery

* Note: This information is not intended as a substitute for professional medical advice. For any inquiries please visit or call your specialists.

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