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Rectal Cancer Treatment (PDQ®)
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General Information About Rectal Cancer
Key Points:
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).
Gastrointestinal (digestive) system anatomy; shows esophagus, liver, stomach, colon, small intestine, rectum, and anus
Age and family history can affect the risk of developing rectal
cancer.
The following are possible risk
factors for rectal cancer:
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. Other conditions may cause the same symptoms. 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 for no known reason.
- Feeling very tired.
-
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: A test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.
Fecal Occult Blood Test (FOBT) kit; shows card, applicator, and return envelope.
-
Digital rectal exam: An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual.
-
Barium
enema: A series of x-rays of the lower gastrointestinal tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.
Barium enema procedure; shows barium liquid being put into the rectum and flowing through the colon. Inset shows person on table having a barium enema.
-
Sigmoidoscopy: A procedure to look inside the rectum and sigmoid (lower) colon for polyps, abnormal areas, or cancer. A sigmoidoscope (a thin, lighted tube) is inserted through the rectum into the sigmoid colon. Polyps or tissue samples may be taken for biopsy.
Sigmoidoscopy; shows sigmoidoscope inserted through the anus and rectum and into the sigmoid colon. Inset shows patient on table having a sigmoidoscopy.
-
Colonoscopy: A procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer. A colonoscope (a thin, lighted tube) is inserted through the rectum into the colon. Polyps or tissue samples may be taken for biopsy.
Colonoscopy; shows colonoscope inserted through the anus and rectum and into the colon. Inset shows patient on table having a colonoscopy.
-
Biopsy: The removal
of cells or tissues so they can be viewed under a microscope to check for signs of cancer.
Certain factors affect prognosis
(chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- 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 patient’s general health.
- Whether the cancer has just been diagnosed or has recurred (come back).
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Stages of Rectal Cancer
Key Points:
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 treatment. The following tests and
procedures may be used in the staging process:
-
Digital rectal exam: An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual.
-
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 made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
-
MRI (magnetic
resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
-
Sigmoidoscopy or
colonoscopy and
biopsy: A procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer. A sigmoidoscope or colonoscope is inserted through the rectum into the colon. Polyps or tissue samples may be taken for biopsy.
-
Endoscopic ultrasound (EUS):
A procedure in which an endoscope (a thin, lighted tube) is inserted into the body. The endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
The following stages are used for rectal cancer:
Colon cancer staging; shows tumors growing through layers of the colon wall for Stage 0, Stage I, Stage II, Stage III, and Stage IV colon cancer. Inset shows serosa, muscle, submucosa and mucosa layers of the colon wall, and lymph nodes and blood vessels.
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the innermost lining of the rectum. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in
situ.
Stage I
In stage I, cancer has
formed and 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.
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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.
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Treatment Option Overview
Key Points:
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.
Information about ongoing clinical trials is available from the
NCI Web site. 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.
Three panel drawing showing rectal cancer surgery with anastomosis; first panel shows area of rectum with cancer, middle panel shows cancer and nearby tissue removed, last panel shows the colon and anus joined.
- 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. A bag is placed around the stoma to collect the waste. 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 given 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 a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
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.
New types of treatment are being tested in clinical
trials. These include the following:
Biologic therapy
Biologic therapy is a treatment that uses the patient’s immune
system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
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Treatment Options by Stage
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Stage 0 (Carcinoma in Situ)
Treatment of stage 0 may include the following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage 0 rectal cancer.
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Stage I Rectal Cancer
Treatment of stage I rectal
cancer may include the following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I rectal cancer.
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Stage II Rectal Cancer
Treatment of stage II rectal
cancer may include the following:
Information about ongoing clinical trials is available from the
NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II rectal cancer.
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Stage III Rectal Cancer
Treatment of stage III rectal
cancer may include the following:
Information about ongoing clinical trials is available from the
NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III rectal cancer.
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Stage IV Rectal Cancer
Treatment of stage IV rectal
cancer may include the following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV rectal cancer.
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Treatment Options for Recurrent Rectal Cancer
Treatment of recurrent
rectal cancer may include the following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent rectal cancer.
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Changes to This Summary (09/20/2007)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
This information is provided from the PDQ® database in collaboration with the NCI.
