What is Rectal Cancer?

Rectal cancer, also known as colorectal cancer, occurs when abnormal cells grow together and form masses called tumors in the rectum. The rectum is at the end of the digestive tract, between the colon and the anus. In the rectum, cancer most often develops as noncancerous clumps of cells called adenomatous polyps. These polyps become cancerous over time. 

Rectal cancer can spread through the bloodstream and lymphatic system to other parts of the body. Rectal cancer and colon cancer are both called colorectal cancer because they are similar, but rectal cancer starts in the rectum and colon cancer starts in the colon.

Baptist Health is known for advanced, superior care for patients with cancer and the diagnosis, treatment and management of rectal cancer. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost excellent care to those who trust us with their health.

Types of Rectal Cancer

There are different types of rectal cancer:

• Adenocarcinoma. The most common form of rectal cancer, this type of rectal cancer forms in the glands that line the inside of the rectum.
• Gastrointestinal stromal tumors. This type is also called a GIST. It usually forms in the stomach or small intestines.
• Lymphoma. This type grows in the lymphatic system, which includes your lymph nodes (lymph glands), bone marrow, spleen, and thymus gland.
• Carcinoid tumors. This type grows slowly over time, displaying few symptoms in the beginning. Usually, it grows first in the lungs or digestive tract.

Signs and Symptoms

There may be no discernable signs of rectal cancer in the early stage of the disease. As the condition progresses, you may experience unexplained weight loss, diarrhea, and fatigue. The signs and symptoms of rectal cancer may go unnoticed for some time. Both early and advanced signs can include:

• A change in bowel habits that lasts more than a month, including constipation or diarrhea or narrow stools 
• A feeling the bowel does not empty completely
• Constant abdominal pain
• Blood in stools
• Fatigue
• Nausea or vomiting
• Rectal bleeding
• Weakness
• Unexplained weight loss

If you experience any of these signs of rectal cancer, contact your provider and schedule an appointment.

Causes

In most cases, the cause of rectal cancer is unknown. But many lifestyle factors can lead to the development of rectal cancer, including: 

• Regular, heavy use of alcohol 
• Having diabetes or being insulin-resistant 
• Eating high-fat, low-fiber foods and also eating a lot of red meat 
• Having a body mass index of 30 or higher
• A lack of exercise 
• Tobacco use

Genetic Factors That Can Cause Rectal Cancer

Genetic factors that can increase the risk for rectal cancer include:

• Familial adenomatous polyposis (FAP). When certain genes mutate, they result in an abundance of polyps. Left untreated, these polyps can lead to cancer.
• Lynch syndrome. This syndrome is also known as hereditary non-polyposis colon cancer or HNPCC). Defective genes leave damaged DNA unrepaired. Damaged DNA causes polyps to form that might be cancerous.
• Inflammatory bowel disease. Also called IBD, this risk factor is an inflamed colon.
• Other rarer syndromes. In some cases, someone might inherit a rare condition from their parents. Rare syndromes include Peutz-Jeghers syndrome (PJS) and MUTYH-associated polyposis (MAP).
• Type 2 Diabetes. People with non-insulin-dependent diabetes are at greater risk for rectal cancer.
• Race and ethnic background. African Americans and individuals from Eastern Europe have higher incidents of rectal cancer.

Diagnosis

To diagnose rectal cancer, a physician performs a physical exam, including a rectal exam, and asks about symptoms and medical and family history. We also use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures can include:

Blood tests: Test results for red blood cell count, liver function and certain substances produced by tumors may indicate a tumor is present.

Fecal tests: In this test, a stool sample is examined for blood or proteins that could indicate cancer.

Endoscopic tests: In these tests, a thin tube with a small camera on the end is inserted into the rectum to allow the doctor to look for tissue or polyps that could be cancerous. Sometimes, suspicious tissue is removed during the procedure for biopsy.

Risk Factors

Risk factors that can contribute to rectal cancer include:

Age: People older than age 45 are at greater risk for developing rectal cancer.

Genetics: In a small number of families prone to rectal cancer, a gene mutation has been identified that raises the risk for rectal cancer.

History of polyps or rectal, breast or ovarian cancer: Previously having any of these conditions raises the risk of getting rectal cancer.

Intestinal conditions: Diseases of the colon that are inflammatory and chronic, including Crohn’s disease and ulcerative colitis, can increase the risk of developing rectal cancer.

Race and ethnicity: African-Americans and Ashkenazi Jews face a higher risk of developing rectal cancer.

Prevention

While some risk factors like age and heredity cannot be controlled, there are ways you can lower the chance of getting rectal cancer:

Don’t smoke: Avoid tobacco because it is linked to cancers.

Get screenings: People over 45, and people with a high-risk family history, should get regular screenings to detect rectal cancer early. Screenings can include a colonoscopy, virtual colonoscopy with a CT scan and fecal occult blood test.

Limit alcohol: Reduce the risk of getting rectal cancer by having only one alcoholic drink a day.

Maintain a healthy weight or lose weight: Aim for a body mass index no higher than 25 to avoid the development of rectal cancer. 

Practice good health: Eat a healthy low-fat, lower-calorie diet that includes plenty of fruit and vegetables, and exercise daily.

Prognosis

The prognosis for rectal cancer depends upon how early the cancer is diagnosed, how far it has progressed and the size of the rectal carcinoma or tumor. The highest survival rate for rectal cancer occurs in people diagnosed and treated early. Screenings can detect polyps and rectal cancer in the early stages, which increases the chance of a good outcome.

Treatment and Recovery

Rectal cancer treatment depends upon how far the condition has progressed and the location of the tumor. It may be treated with surgery, chemotherapy, radiation or a combination of treatments. 

Surgery

Surgery is the main treatment for rectal cancer. The type of surgery for rectal cancer can depend on the location and stage of the tumor. Options include:

• Excision: During this procedure, small tumors are removed through the anus.
• Pelvic exenteration: This extensive procedure is used if cancer has spread to nearby organs. The rectum and organs, such as the bladder, uterus or prostate are removed. An opening in the abdomen is made to allow for the elimination of waste into a bag. If the bladder is removed, an opening in the abdomen will be made for an urostomy to allow urine to exit the body into a small bag.
• Polypectomy: During this procedure, a long tube with a video camera attached is inserted through the anus to view the colon. A tiny tool is used to remove polyps.  
• Resection: During this type of procedure, some or all of the rectum with the tumor is removed. If all of the rectum is removed, a small opening will be made to allow for the elimination of waste into a colostomy bag.

Chemotherapy

Chemotherapy uses special drugs designed to kill cancer cells. The treatments can be given as a pill or injected into the bloodstream. Chemotherapy can be administered before surgery to make the tumor smaller or after surgery to keep cancer from reoccurring. 

Radiation Therapy

This therapy uses small doses of high-energy radiation to kill cancer cells. Treatments can be given before surgery to shrink tumors or after surgery to reduce the risk of cancer returning. Most often radiation treatments are given five days a week for several weeks. 

Complications

Rectal cancer can return after treatment or spread to other areas of the body. Rectal cancer treatment can cause these complications:

• Intestinal obstruction 
• Nausea, vomiting or diarrhea