Rectal Cancer
General Information About Rectal Cancer
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).
 |
| Anatomy of the lower digestive system, showing the colon and other organs. |
Age and family history can affect the risk of developing rectal cancer.
The following are possible risk factors for rectalcancer:
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 to check for blood in stool. |
-
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. The patient lies on an x-ray table. Barium liquid is put into the rectum and flows through the colon. X-rays are taken to look for abnormal areas. |
-
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. A thin, lighted tube is inserted through the anus and rectum and into the lower part of the colon to look for abnormal areas. |
-
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. A thin, lighted tube is inserted through the anus and rectum and into the colon to look for abnormal areas. |
-
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).
Stages of Rectal Cancer
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:
 |
| As rectal cancer progresses from Stage 0 to Stage IV, the cancer cells grow through the layers of the rectum wall and spread to lymph nodes and other organs. |
Stage 0 (carcinoma in situ)
In stage 0, cancer is found only in the innermost lining of the rectum. Stage 0 cancer is also called carcinoma in situ.
Stage I
In stage I, cancer has 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.
Recurrent Rectal Cancer
Recurrentrectalcancer 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.
Treatment Option Overview
There are different types of treatment for patients with rectal cancer.
Different types of treatment are available for patients with rectalcancer. 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 rectalcancer. A doctor may remove the cancer using one of the following types of surgery:
-
Localexcision: 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.
 |
| Rectal cancer surgery with anastomosis. The rectum and part of the colon are removed, and then the colon and anus are 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.
Treatment Options by Stage
Stage 0 Rectal Cancer
Treatment of stage 0 (carcinoma in situ) rectalcancer may include the following:
Stage I Rectal Cancer
Treatment of stage I rectal cancer may include the following:
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.
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.
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.
Treatment Options for Recurrent Rectal Cancer
Treatment of recurrentrectalcancer may include the following:
Changes to This Summary (07/12/2007)
The PDQcancer 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.
To Learn More
Call
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Web sites and Organizations
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
LiveHelp
The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write
For more information from the NCI, please write to this address:
About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.