Why Choose Cedars-Sinai Marina del Rey Hospital for Rectal Cancer Treatment?
Our oncologists and colorectal surgeons work together in order to evaluate patients with rectal cancer and derive a treatment plan, most suitable to the patient’s health condition. Various treatment options - both nonsurgical and surgical treatments are available. The option that best suits your individual needs will be considered.
Rectal cancer is a disease in which there is abnormal growth of cells in the tissues of the rectum. Bloody stools along with a change in bowel habits are a sign of rectal cancer. Most of the rectal cancers comprise of adenocarcinomas, which are tumors that form in the cells that make mucus. Rectal cancer often starts as an unusual growth called polyp in the inner lining of the rectum. Over a period of time, some of these polyps may become cancerous. Therefore, timely identification and removal of rectal polyps can prevent rectal cancer.
Rectal cancer ranks third among the cancer incidences in the United States. Modern diagnostic methods such as colonoscopy and fecal occult blood tests have greatly reduced the mortality rates of rectal cancer.
Rectal Cancer Surgical Procedures Performed at Cedars-Sinai Marina del Rey Hospital
Surgery is the treatment of choice for rectal cancer of all stages, even though radiation therapy and chemotherapy are given just before or after the surgical removal. Depending upon the extent of your rectal cancer, its location, and surgical goal, one of these surgical techniques are chosen:
Polypectomy and local excision: These surgical procedures are performed with specialized instruments that are inserted through your anal canal, without the need to make an incision in your abdomen. These surgeries are done to remove polyps and superficial cancers.
- Polypectomy: This is usually done during colonoscopy by inserting a wire loop through the colonoscope to cut away the polyp from the rectal wall using electric current.
- Local excision: This is done when cancer lies on the inner surface of the rectum, without being spread into the rectal wall. This is a more extensive procedure in which superficial cancer along with a small amount of surrounding healthy tissue from the wall of the rectum is removed.
Local transanal resection or full thickness resection: This procedure is also called transanal excision, and is performed with tools inserted through your anal opening, without making any cuts on your abdomen. Your surgeon will dissect through all the layers of the rectal wall in order to remove cancer along with a small amount of healthy rectal tissue around cancer. Then, the hole that is created in the rectal wall is closed. This type of surgery is indicated in the early stage when rectal tumors are very small, located near the anus. This procedure is performed under local anesthesia, which means that you will be awake during the surgery.
Transanal endoscopic microsurgery (TEM): This surgical technique is followed to remove early stage I rectal cancer that is located higher up in the rectum. A unique magnifying scope is passed up through the anus to reach the rectum, which assists your surgeon to perform a transanal resection more precisely, with greater accuracy.
Low anterior resection (LAR): This technique is used in the removal of some stage I and most stage II and III cancers located at the upper portion of the rectum. In this procedure, the portion of the rectum having the tumor is removed, and the colon is then reattached to the remaining portion of the rectum. This allows normal bowel movements.
General anesthesia will be administered during the procedure. You will need to stay in the hospital for a few days, and complete recovery takes 3-6 weeks at home.
Proctectomy with colo-anal anastomosis: Proctectomy involves the removal of the entire rectum, and is indicated in some of stage I and the majority of stage II and III rectal cancers located in the middle and lower third part of the rectum.
After the rectum has been removed, the colon is reattached to the anus, which is called colo-anal anastomosis. This allows you to pass stools in a normal way.
Abdominoperineal resection (APR): This procedure is done to treat a few stage I and most of stage II and III cancers that occur at the lower portion of the rectum, nearest to the anus, particularly if it is involving the sphincter muscles. Your surgeon makes one or more small incisions in your abdomen and another cut in the perineal area around your anus. This facilitates the removal of the anus and tissue around it, including the sphincter muscle. As the anus is removed in this procedure, the end of the colon is attached to a hole made in the abdominal wall so that feces can be passed through this opening.
Pelvic exenteration: This procedure will be needed if the rectal cancer is invading nearby organs. This operation is very extensive as your surgeon removes the rectum along with the surrounding organs (the bladder, prostate in men and uterus in women) if cancer has spread. A colostomy procedure, in which stoma or artificial openings are made to excrete stools, will be performed after pelvic exenteration.
Diverting colostomy: This is performed in patients with tumors causing a blocked rectum. Surgery aims at relieving the obstruction without excising the portion of the rectum that contains the tumor. The colon is cut just above the tumor and reattached to an opening made in the abdomen to allow the passage of feces.
Drugs and Other Treatment Needed for Rectal Cancer
Chemotherapy and/or radiation therapy can be advised before the surgery to reduce the size of the tumor so that it becomes easy to remove during the surgery. After surgery, these therapies may help with bowel control problems. The treatment given prior to surgery is called neoadjuvant therapy. Chemotherapy or radiation therapy is given after the surgery and kills any remaining cancer cells and decreases your risk of cancer recurrence. This treatment is called adjuvant therapy.
Radiation therapy »
Targeted therapy »
The characteristics of the five types of rectal cancers are described below:
stromal tumors »
Carcinoid tumors »
Symptoms of Rectal Cancer
The major signs and symptoms of rectal cancer include blood-stained stools and an unusual change in bowel movements.
- Bright red or very dark colored stools
- Change in bowel habits may include:
- Discomfort in the abdomen, which may include:
- Loss or changes in your appetite
- Unexpected weight loss
Diagnosis of Rectal Cancer
Rectal cancer can be diagnosed through these tests:
- Physical examination and medical history: Your doctor will perform a careful physical examination during which the presence of unusual lumps is checked. Medical history taking involves a discussion with your doctor regarding your health issues in the past and treatments undertaken.
- Digital rectal examination: Your doctor will pass a gloved as well as a lubricated finger into the lower part of your rectum to feel for unusual lumps.
- Colonoscopy: In this procedure, an instrument called colonoscope, which is a thin, flexible tube attached with a light and a lens at its end is passed through your anus and rectum to reach the colon. This allows visualizing the internal portion of your rectum and checking for the presence of abnormal growths, polyps or tumors. A colonoscope may also have a special tool that can obtain abnormal tissue sample that may be examined under a microscope for cancer signs.
- Biopsy: This involves the removal of suspected tissues or cells that are examined under a microscope to find out if there are signs of cancer. These tissues may also be tested for the presence of gene mutation as it helps in planning the treatment. The tests include:
- Reverse-transcription polymerase chain reaction (RT-PCR) test: In this test, abnormal cells present in a tissue sample are examined with chemicals to check for structural and functional changes in the genes.
- Immunohistochemistry: This test involves the use of antibodies to check for the presence of specific antigens in a tissue sample. This test helps you differentiate between the various types of cancer. The antibody that is used in this test is linked to a radioactive material or a dye that makes the tissue sample appear illuminated under a microscope.
- Carcinoembryonic antigen (CEA) assay: This test finds out the level of CEA in your blood. Higher levels of CEA can be a sign of rectal cancer or other conditions.
Risk Factors for Rectal Cancer
Several risk factors have been identified to possibly increase your chance of developing rectal cancer, which include two major types:
Risk factors that can be modified:
- Obesity: Your risk of developing rectal cancer is high if you are overweight or obese.
- Sedentary lifestyle: Being physically inactive increases your risk of developing rectal cancer.
- Diet: A diet that includes large amounts of red meat and processed meat increases your risk of developing rectal cancer.
- Smoking and heavy alcohol consumption: Chronic cigarette smoking habit and heavy alcohol use have been linked to a greater risk of rectal cancer.
Risk factors that cannot be modified:
- Age: Your risk of developing rectal cancer increases greatly after the age of 50.
- Personal history of conditions such as colorectal polyps or cancer, inflammatory bowel disease, and cancer of the breast, ovaries or endometrium.
- The family history of adenomatous polyps: People with their first-degree relatives (parent, child or siblings) diagnosed with colorectal cancer or adenomatous polyps are at a greater risk of developing rectal cancer.
- Certain inherited genetic mutations: The common inherited syndromes related to increased risk of rectal cancer include familial adenomatous polyposis (FAP) and hereditary nonpolyposis colon cancer (HNPCC or Lynch syndrome).
- Racial background: In the US, the incidence and mortality rates due to rectal cancer is higher among African Americans than people belonging to other races. Worldwide, the Jews of East European descents are at a higher risk of rectal cancer than any other ethnic group.
- Type 2 diabetes: People with type 2 diabetes mellitus have a greater risk of developing rectal cancer.
Causes of Rectal Cancer
Although research has suggested several factors to be involved in increasing a person’s risk of developing rectal cancer, the exact cause of this cancer is not clearly understood. Generally, cancer results from changes that occur in the DNA of your cells. The DNA comprises of your genes that control the functions of your cells. The genes that direct the cell growth, division, and keep the cells alive and functioning are called oncogenes. The genes that control the abnormal division of cells, ensuring cell death at the right time are called tumor suppressor genes. Any defect in the DNA that causes activation of oncogenes and inhibition of tumor suppressor genes can cause cancer.
Different types of gene mutations may cause rectal cancer. These include:
- Inherited genetic mutations: These mutated genes are passed from a generation to the next generation, and are detected in all body cells. Inherited defects in the APC gene, which is a tumor suppressor gene, can cause polyps in the colon. Cancer may gradually develop in these polyps as a result of a new genetic mutation occurring in the polyp cells.
- Acquired gene mutations: Most cases of rectal cancer occur due to mutations that develop during an individual’s life, and are not inherited. Only the cells that are derived from the original mutated cell are affected. The first mutation usually takes place in the APC gene, which causes increased growth and uncontrollable spread of rectal cells.
Your oncologist may recommend various alternative medicines and treatment during the course of your treatment for rectal cancer. These alternative treatment methods help manage a few symptoms such as nausea, acid reflux, bloating sensation, and diarrhea. One or more of the following alternative therapies may be useful to support your immune system during the treatment for rectal cancer:
Acupuncture: This ancient form of Chinese medicine that involves the pricking of fine needles into specifically identified points in your body can be included in your treatment plan.
Hydrotherapy: This treatment includes water-based therapies such as hot and cold wraps.
Physical therapy: This includes massage and other techniques directed towards your deep muscles and joints for therapeutic purpose.
Herbal remedies and dietary supplements: Intake of certain herbal extracts or teas may be recommended. Dietary supplements may include vitamins, amino acids, and minerals.
Homeopathic medicines: Certain plant extracts and minerals may be prescribed in very minimal doses to strengthen your body’s healing capacity and immune system.
Preventive actions may be taken to reduce your chances of developing rectal cancer. These measures hopefully, can lower the mortality rates of rectal cancer. Awareness of the risk factors, as well as protective factors, is essential to prevent rectal cancer from developing. A risk factor is anything that enhances your chance of getting cancer, and a cancer protective factor is anything that reduces your chance of developing cancer. Most of the risk factors cannot be avoided or modified, whereas a few risk factors can be changed. For instance, genetic inheritance is something out of our control whereas smoking is a modifiable risk factor for cancer.
Lifestyle modifications such as eating a healthy, well- balanced diet and exercising regularly can be considered as protective factors. Adoption of these protective factors and avoidance of risk factors helps in decreasing the risk of developing rectal cancer to some extent. The preventive measures that may help in avoiding cancer progression include:
- Modifying eating habits and lifestyle: avoid foods that are known to cause cancer.
- Avoid exposure to substances known to cause cancer (carcinogenic substances)
- Take the medicines that have been prescribed as a treatment for a precancerous condition or as a preventive medication to avoid cancer.
For any questions, information or guidance related to rectal cancer, consult our specialty-trained, skilled colorectal surgeons at Cedars-Sinai Marina del Rey Hospital.