The rectum is the last several inches of the large intestine, starting at the end of the final segment of the colon and ending at the narrow passage leading to the anus. Cancer inside the rectum and cancer inside the colon are often referred to together as “colorectal cancer.” However, their treatments differ, mainly due to the rectum location. The rectum is in a tight space and is barely separated from other organs, which complicates surgery to remove rectal cancer. Our surgeons specialize in minimally invasive techniques, including robotic surgery and laparoscopy, to reduce complications.
For most rectal cancers, it is unclear what causes the cancer to form. Inherited gene mutations such as Lynch Syndrome and Familial Adenomatous Polyposis (FAP) can increase risk of rectal cancer but do not make it inevitable. Genetic testing can detect these and other inherited syndromes.
Factors that may increase risk are the same as those for colon cancer:
- Alcohol use
- Diet high in fat and refined carbohydrates
- Sedentary lifestyle
- Older age, although rates are increasing among those under 50
- History of inflammatory bowel disease
- History of cancerous or noncancerous colon polyps
- Inflammatory intestinal conditions, e.g., ulcerative colitis, Crohn’s disease
- Family history of colon cancer or related conditions
- African-American race
Symptoms of rectal cancer include:
- Change in bowel habits, e.g., diarrhea, constipation, frequency
- Dark maroon or bright red blood in stool
- Narrow stool
- Feeling that bowel doesn’t empty completely
- Abdominal pain
- Weakness or fatigue
- Unexplained weight loss
Rectal cancer can be found during a screening test for colorectal cancer, e.g., colonoscopy. If any suspicious areas are present, tissue samples are taken for further analysis.
Treatment options include targeted therapy, immunotherapy, radiation therapy, surgery to remove the rectum and nearby lymph nodes, or a combination of these options depending on the type of cancer and how far it has advanced.
If rectal cancer is detected early, a transanal local excision can be performed through the anus and without an incision to the abdomen.
Rectal resection surgery can also be performed in which our surgeons remove the diseased section of the rectum, plus nearby lymph nodes. This is called a low anterior resection. After removing the diseased section, the two healthy parts of the intestine are reattached. We utilize a minimally invasive approach to speed recovery and minimize complications versus traditional open surgery performed through an abdominal incision. There are two surgery options:
- Robotic-assisted surgery – Made possible with da Vinci® technology, fewer, smaller incisions are made for insertion of surgical equipment and a camera for viewing to complete the procedure.
- Laparoscopic – Again, using small incisions, long-handled tools are inserted to perform surgery while viewing magnified images from the laparoscope (camera) on a video screen.
Following surgery, these subsequent treatments may also be prescribed: chemotherapy, radiation therapy, targeted drug therapy.