Rectal Cancer

Overview

Rectal cancer is a type of cancer that originates in the rectum, which is the last several inches of the large intestine. It often occurs in the mucosa, the innermost lining of the rectum, and can spread to other organs and structures in the tight space surrounding the rectum. Rectal cancer can cause various symptoms, such as changes in bowel habits, blood in stool, abdominal pain, unexplained weight loss, and weakness or fatigue. Treatment options may include surgery, chemotherapy, and targeted therapy, depending on the specific case and stage of the cancer. While the exact causes of rectal cancer are not entirely clear, it is believed to result from DNA mutations in healthy rectal cells. Over the past few decades, advances in treatment have led to a significant improvement in rectal cancer survival rates.

Understanding the disease

Symptoms

The symptoms of rectal cancer include a change in bowel habits, such as diarrhea, constipation, or more-frequent bowel movements, dark maroon or bright red blood in stool, narrow stool, a feeling that your bowel doesn't empty completely, abdominal pain, unexplained weight loss, weakness or fatigue. If you have any persistent symptoms that worry you, make an appointment with your doctor.

Risk Factors

The risk factors for developing rectal cancer include:

1. A personal history of colorectal cancer or polyps.
2. Inflammatory bowel disease.
3. Inherited syndromes that increase rectal cancer risk, such as FAP and Lynch syndrome.
4. Family history of colorectal cancer.
5. Eating a diet low in vegetables and high in red meat, particularly when the meat is charred or well done.
6. Older age.
7. African-American descent.
8. Too little exercise.
9. Diabetes.
10. Obesity.
11. Smoking.
12. Drinking alcohol.
13. Radiation therapy for previous cancer. Remember that these risk factors do not guarantee the development of rectal cancer, and some people without any risk factors may still develop the disease. Regular screenings and discussions with your doctor can help assess and manage your risk factors.

Development

The development of rectal cancer typically begins with mutations in the DNA of healthy rectal cells. These mutations cause the cells to grow uncontrollably and continue living when they should die. The accumulating cells can form a tumor, which can then invade and destroy nearby healthy tissue. Over time, cancerous cells can spread (metastasize) to other parts of the body. In most cases, the exact cause of these mutations is not clear. However, some inherited gene mutations can increase the risk of rectal cancer, such as Lynch syndrome and familial adenomatous polyposis (FAP). These genetic disorders are passed down through families and increase the likelihood of developing colorectal cancer. Additionally, other factors like a personal history of colorectal cancer or polyps, inflammatory bowel disease, family history of colorectal cancer, and certain lifestyle factors, such as a low vegetable intake and high red meat consumption, may also contribute to the development of rectal cancer.

Assessment and Diagnosis

Triage

You should see a doctor if you experience any persistent symptoms of rectal cancer or if you have risk factors for the condition. Symptoms of rectal cancer can include changes in bowel habits, blood in the stool, abdominal pain, unexplained weight loss, and weakness or fatigue. Risk factors for rectal cancer include a family history of colon cancer, being over 50 years old, and having a personal history of polyps. If you have any concerns about rectal cancer, it's important to make an appointment with your healthcare provider.

Diagnosis

To diagnose rectal cancer, doctors may perform the following tests and procedures:

1. Colonoscopy: Using a scope to examine the inside of your colon and rectum.
2. Biopsy: Removing a sample of tissue for testing to determine if the cells are cancerous. It is also recommended to find someone to talk with about your hopes and fears and consider joining support groups or speaking with medical professionals for further guidance. Additionally, preparing for your appointment with specialists, such as gastroenterologists, oncologists, colorectal surgeons, and radiation oncologists, can help you better understand your prognosis and treatment options.

Management and Treatment

Complications

Potential complications of rectal cancer can include:

1. Local complications: Rectal cancer can cause blockages in the colon or rectum, leading to bowel obstruction. This can cause severe constipation or difficulty passing stool.
2. Invasion of surrounding organs: As rectal cancer grows, it can invade nearby organs such as the bladder, urethra, or vagina. This can cause a range of symptoms, including urinary or sexual dysfunction.
3. Spread of cancer (metastasis): Rectal cancer can spread to other parts of the body, most commonly to the lymph nodes or liver. Metastasis can reduce the effectiveness of treatment and decrease the chances of a successful outcome.
4. Incontinence: As rectal cancer or its treatment damages the muscles and nerves surrounding the rectum, fecal incontinence can occur. This means the inability to control bowel movements, leading to accidental leakage of stool.
5. Impaired sexual function: Radiation therapy, surgery, or other treatments for rectal cancer can damage the nerves and blood vessels responsible for sexual function, leading to erectile dysfunction in men and vaginal dryness or loss of sensation in women.
6. Emotional and psychological complications: A diagnosis of rectal cancer can cause significant emotional distress, anxiety, and depression. The fear of recurrence, body image concerns, and changes in daily activities due to treatment can also impact mental health. It is essential to discuss potential complications with your healthcare provider to better understand the risks and benefits of various treatment options.

Home Remedies

It is important to note that home remedies are not a substitute for professional medical advice and treatment. If you have concerns about rectal cancer or any other health issues, it is best to consult a healthcare professional for proper evaluation and guidance.

Treatment

Treatments for rectal cancer often involve a combination of surgery, chemotherapy, and radiation therapy. The specific treatment plan depends on the stage of the cancer, the patient's overall health, and other factors. Some common treatments for rectal cancer include:

1. Surgery: The most common treatment for rectal cancer is surgery to remove the cancerous tumor. The surgery may involve removing the tumor and some surrounding healthy tissue, as well as a segment of the colon or rectum. In some cases, a permanent colostomy (an opening in the abdomen to pass stool) may be necessary.
2. Chemotherapy: Chemotherapy uses drugs to kill cancer cells or slow their growth. This treatment is often used in combination with surgery to increase the chances of a cure and to help reduce the risk of the cancer returning. Chemotherapy can also be used before surgery to shrink the tumor and make it easier to remove.
3. Radiation therapy: Radiation therapy uses high-energy rays or particles to destroy cancer cells. External beam radiation therapy is often used to treat rectal cancer, and it involves aiming the radiation at the tumor from outside the body. In some cases, internal radiation therapy may be used, where a radioactive substance is placed inside the body near the tumor.
4. Targeted therapy: Targeted therapy uses drugs that target specific molecules on the surface of cancer cells or inside the cells. These targeted drugs can help slow the growth of cancer cells and may be used in combination with chemotherapy or radiation therapy.
5. Immunotherapy: Immunotherapy uses the body's own immune system to fight cancer cells. This treatment is still being researched for its effectiveness in treating rectal cancer. It is important to note that the choice of treatment and its success depend on various factors, including the stage of the cancer, the patient's overall health, and other individual considerations. It is essential to consult with a healthcare professional to determine the most appropriate treatment plan for each individual case.

Preparing for medical consultation

To prepare for an appointment for rectal cancer, you should:

1. Find a good listener, such as a friend, family member, counselor, medical social worker, clergy member, or cancer support group to talk with about your hopes and fears.
2. Ask your doctor about support groups in your area or check with local and national cancer organizations, such as the National Cancer Institute or the American Cancer Society.
3. Before meeting with specialists, including a gastroenterologist, oncologist, and colorectal surgeon, find out if there are any pre-appointment instructions, such as avoiding certain foods or medications.
4. Make a list of all your medications, including vitamins or supplements.
5. Bring a family member or friend to take notes during the appointment, so you can focus on listening.
6. Write down a list of questions to ask your doctor, such as:
   • In what part of the rectum is my cancer located?
   • What is the stage of my rectal cancer?
   • Has my rectal cancer spread to other parts of my body?
   • Will I need more tests?
   • What are the treatment options?
   • How much does each treatment increase my chances of a cure?
   • What are the potential side effects of each treatment?
   • How will each treatment affect my daily life?
   • Is there one treatment that you feel is best for me? Remember to be well-prepared for the appointment, and don't hesitate to ask questions or discuss any concerns you may have.