Rectal Cancer Treatment in Mumbai, India

Rectal cancer is a type of cancer that develops when cancer cells form in the rectum, a continuation part of the colon located just above the anus. The rectum and colon together make up your large intestine, a part of your digestive system.

Associated Anatomy

Rectal cancer is the cancer of the chamber called the rectum, located between the sigmoid colon and anus.

Alternate Names of Rectal Cancer

Bowel cancer, colon cancer, and colorectal cancer are other names for rectal cancer.

Rectal Cancer Symptoms

Although rectal cancers usually don't show any symptoms, some warning signs noticed in people include:

• Rectal bleeding or blood in your stools
• Sudden change in bowel habits
• Pain while passing stools
• Narrow stool
• Persistent diarrhoea or constipation
• Change in appetite
• Frequent abdominal discomfort, gas
• Unexplained weight loss
• Frequent tiredness and weakness
• Consistent abdominal pain, cramps
• Iron deficiency anaemia

Rectal Cancer Causes

Mutations in DNA result in abnormal growth of cells, which usually pile up and develop into tumors. These cells often penetrate and harm the healthy tissues causing unwanted symptoms.

Some inherited genetic mutations like hereditary nonpolyposis colorectal cancer (Lynch syndrome) can enhance the risk of colon and other cancers, especially in the elderly population.

Another similar syndrome is familial adenomatous polyposis, a rare condition associated with polyps in the lining of the colon and rectum. If left untreated, it can cause rectal or colon cancer, in the younger population, below 40 years of age.

Rectal Cancer Stages

Depending on the size of the rectal cancer tumor and its spread in your body, it can be categorized into five different stages.:

• Stage 0: The surface of the rectal lining shows the presence of cancer cells.
• Stage 1: The tumor has extended from below the rectal lining into the rectal wall.
• Stage 2: If the tumor has spread into the tissues around the rectum, besides involving the rectal wall. 
• Stage 3: If the tumor has invaded the lymph nodes surrounding the rectum and tissues outside the rectal wall.
• Stage 4: If the tumor has already spread to distant lymph nodes or organs.
  
  

Typical Tests for Diagnosing Rectal Cancer

If doctors suspect rectal cancer, they may advise you of tests that include

• Physical exam
• Digital rectal exam (DRE)
• Imaging tests like MRI and CT scan
• Proctoscopy (Office exam which uses proctoscope to examine rectum)
• Colonoscopy (Used to check inside the rectum for polyps or cancer)
• Biopsy (Involves removal of tissues or cells and getting them checked under a microscope for signs of cancer)

Rectal Cancer Additional Types

Often the cancer of the colon and rectum are grouped together as they share several characteristics and have similar treatment plans. Cancer of the rectum and colon together is called colorectal cancer and is one of the most common cancers.

Rectal cancers have several types; common ones include:

• Adenocarcinomas (98%)
• Gastrointestinal stromal tumors (GISTs)
• Lymphoma (1.3%)
• Carcinoid tumors (0.4%)
• Sarcoma (0.3%)

Rectal Cancer Treatment

Depending on the stage of rectal cancer and the extent to which it has progressed, the treatment options include:

• Surgery: Usually recommended for initial stage rectal cancer, where a suspicious tissue is removed by surgery.
• Chemotherapy: A combination of drugs is given orally or iv to shrink or kill the cancer cells.
• Immunotherapy: Assists your body's immune system to fight cancer cells.
• Radiation Therapy: Uses radioactive seeds or high-energy rays to shrink or kill cancer cells.
• Targeted Therapy: Uses monoclonal antibodies or angiogenesis inhibitors.

Rectal Cancer Prevention

It is possible to prevent rectal cancer or its recurrence in some instances by:

• Regular screening: It is recommended in those with a family history of rectal cancer or aged persons or have a history of Crohn's disease.
• Nutrition: Eating plenty of fruits, vegetables, and fiber; and limiting the quantity of processed meat.
• Indulge in regular exercise and maintain a healthy weight
• Avoid smoking and drinking alcohol.
  
  

Rectal Cancer Diagnosis

The differential diagnosis of rectal cancer are:

• Diverticular disease
• Inflammatory bowel diseases like Crohn's disease or ulcerative colitis
• Irritable bowel syndrome
• Piles or hemorrhoids
• Ischemic colitis
• Pneumatosis coli

Rectal Cancer Risk Factors

The cause of rectal cancer is yet unknown, but some of its risk factors include:

• Age: Usually, rectal cancer is noted in people above 50 years of age.
• Gender: Men are relatively more likely to develop rectal cancer when compared to women.
• Family History: You are almost doubly likely to get rectal cancer if your family member has been diagnosed with the same.
• Specific Diseases: Some health conditions like ovarian cancer, polyps, inflammatory bowel disease, Crohn's disease, and diabetes may enhance your chance of getting rectal cancer.
• Smoking and excessive consumption of alcohol
• Sedentary lifestyle
• Obesity
• History of radiation therapy
• Unhealthy eating habits
  
  

Rectal Cancer Complications

Early diagnosis can best help cure rectal cancer. However, treatment may not help much if cancer has spread to other parts of the body. Some complications of rectal cancer include

• Bowel obstruction resulting due to blockage of the colon
• In the case of stage-4 metastatic rectal cancer, it can spread to other vital tissues or organs like the liver, lungs, brain, or abdomen.
• If left untreated or detected in later stages, rectal cancer may cause death.

Epidemiology

The risk of rectal cancer increases as you age and is usually observed in those above 65 years.

Men are more prone to rectal cancer than women.

Worldwide, colorectal cancer is the third most common cancer in males and the second most common cancer in females.

Rectal Cancer Prognosis

Expected Prognosis

The prognosis of rectal cancer depends on several factors like the stage of rectal cancer, where it is located in the rectum, if the entire tumor can be removed by surgery, the patient's overall health, and if cancer has recurred.

Thanks to the advances in treatment, several cases of rectal cancer can be cured, with an overall five-year survival rate of 63%. And, among all those with rectal cancer, the five-year survival rate increases to 91% if the cancer is localized and has not extended to other areas.

Natural Prognosis

In most cases, rectal cancer is a slowly progressing condition. It often begins in the lower part of the digestive tract by forming a collection of noncancerous or benign cells, known as polyps. Although these polyps may not necessarily become malignant, some may become cancerous over the course of ten to fifteen years. However, once they become cancerous, the progression varies with the cellular makeup of the tumor, overall health, and age of the patient.

Pathophysiology

Rectal cancer usually results when the cells in the rectum mutate and grow in abnormal proportions. It is also caused by rectal growths called polyps forming on the inner wall of the rectum, which eventually develop and become cancerous. Once the cancer forms in a polyp, it can eventually extend into the wall of the colon or rectum, which is made of several layers. Usually, rectal cancer starts in the innermost mucosa layer and grows outward through other layers. Cancer cells in the wall can further develop into the blood or lymph vessels and the lymph nodes or distant body parts.

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