Rectal Cancer

Rectal cancer is a disease in which malignant (cancer) cells form in the tissues of the rectum, the final straight portion of the large intestine.

Risk Factors

• Having a family history of colon or rectal cancer in a first degree relative (parent, sibling, or child)
• Having a personal history of cancer of the colon, rectum, or ovary
• Having a personal history of high risk adenomas (colorectal polyps that are 1 centimeter or larger in size or that have cells that look abnormal under a microscope)
• Having inherited changes in certain genes that increase the risk of familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary nonpolyposis colorectal cancer)
• Having a personal history of chronic ulcerative colitis or Crohn' s disease for 8 years or more
• Having three or more alcoholic drinks per day
• Smoking cigarettes
• Being obese

Signs and Symptoms

• Blood (either bright red or very dark) in the stool
• A change in bowel habits
• Diarrhea, constipation, or feeling that the bowel does not empty all the way
• Stools that are narrower or have a different shape than usual
• Frequent gas pains, bloating, fullness, or cramps
• Change in appetite
• Weight loss for no known reason
• Feeling very tired

Testing

The following tests and procedures may be used:

• Physical exam and health history
• Digital rectal examination (DRE)
• Colonoscopy
• Biopsy
• Carcinoembryonic antigen (CEA) assay

Prognosis Factors

The prognosis and treatment options depend on the following:

• The stage of the cancer, whether the cancer is in the inner lining of the rectum, involves the whole rectum, or has spread to lymph nodes, nearby organs, or other places in the body.
• Whether the tumor has spread into or through the bowel wall.
• Where the cancer is found in the rectum.
• Whether the bowel is blocked or has a hole in it.
• Whether all of the tumor can be removed by surgery.
• Whether the cancer has just been diagnosed or has recurred.
• The patient's general health.

Treatment Options

Six types of standard treatments are used:

• Surgery - Removing the cancer in an operation is the most common treatment for all stages of rectal cancer.
• Radiation therapy - Using high-energy X rays or other types of radiation to kill cancer cells or keep them from growing.
• Chemotherapy- Using drugs to stop the growth of cancer cells either by killing the cells or by stopping the cells from dividing.
• Active surveillance - Closely following a patient's condition without giving any treatment unless there are changes in test results. Targeted therapy
• Targeted Therapy - Uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.
• Immunotherapy - uses the patient's immune system to fight cancer.

Clinical Trials

• Providers are testing other types of treatments in clinical trials, which patients may want to consider. Patients can enter clinical trials before, during, or after starting their cancer treatment.

This content was last medically reviewed in May 2022 by Sharlotte Manley, MSN, FNP, Erlanger Gastroenterology.