Rectal cancer begins in the cells lining the inside of the rectum, the final part of the large intestine. It represents approximately one third of all colorectal cancer cases.
The rectum is the part of the large intestine that is located just before the anus, the opening through which feces leave the body. Rectal cancer develops when the cells of this organ begin to grow uncontrollably, forming a tumor. This process can occur slowly over several years. Rectal cancer can have a significant impact on a patient’s quality of life, causing pain, bleeding, and difficulty with bowel movements. Furthermore, if left untreated, it can spread to other parts of the body (metastasis).
Symptoms of rectal cancer
The symptoms of rectal cancer can be subtle at first and are often mistaken for other benign conditions, such as hemorrhoids or anal fissures. It is important to remember that the symptoms can vary considerably from person to person, and some people may not experience any symptoms in the early stages. Therefore, it is crucial to consult a doctor if you experience any of these symptoms in order to obtain an accurate diagnosis and rule out the presence of cancer. The most common rectal cancer symptoms include:
Rectal bleeding:
it is one of the most common rectal cancer symptoms. The blood may be bright red or darker, and may be mixed with the stool or appear separately.
Changes in bowel habits:
changes in bowel habits, such as constipation, diarrhea, or thin stools, can be a sign of rectal cancer. These changes can be persistent or intermittent.
Pain or pressure in the rectum:
rectal cancer can cause pain or pressure in the rectum, which may be constant or intermittent. The pain may worsen when defecating.
Feeling of incomplete evacuation:
you may feel that you cannot completely empty your rectum after defecating, which is known as rectal tenesmus.
Weakness or fatigue:
anemia caused by blood loss can lead to weakness and fatigue. These symptoms can be general and not specific to rectal cancer.
Classification of rectal cancer
Rectal cancer is classified according to the type of cell in which it originates and the extent of cancer spread. The most common type is adenocarcinoma, which originates in the glandular cells that produce mucus in the lining of the rectum. Other less common types include squamous cell carcinoma, which originates in the squamous cells lining the anal canal, neuroendocrine carcinoma, which originates in neuroendocrine cells, and other rare types such as sarcoma and lymphoma.
The staging of rectal cancer is generally based on the TNM system, where T describes the size and extent of the primary tumor, N indicates whether the cancer has spread to nearby lymph nodes, and M indicates whether there is distant metastasis. This classification helps doctors understand the extent of the cancer and predict the patient’s prognosis.
Causes of rectal cancer
Rectal cancer, like other types of cancer, originates from genetic mutations in the cells that line the inside of the rectum. These mutations alter the DNA of the cells, causing them to grow and divide uncontrollably, forming a tumor. Although the exact causes of these mutations are not fully known, it is known that certain factors can increase the risk of developing rectal cancer.
There are various risk factors that can increase the likelihood of developing rectal cancer. Some of these factors are modifiable, such as diet and lifestyle, while others, such as age and family history, cannot be changed. Knowing these risk factors is important for taking preventive measures and for the early detection of the disease. These include:
Age: the risk of rectal cancer increases with age, being more common after age 50. This is due to the accumulation of genetic mutations over time.
Family history: having a close relative with rectal cancer increases the risk. This suggests that genetics may play a role in the development of the disease.
Polyps in the rectum: polyps are abnormal growths in the lining of the rectum. Some types of polyps, such as adenomas, can become cancerous over time.
Inflammatory bowel disease: ulcerative colitis and Crohn’s disease are chronic inflammatory bowel diseases that increase the risk of rectal cancer. Chronic inflammation can damage cells in the rectum and increase the risk of mutations.
Diet: a diet high in fat and low in fiber is associated with a higher risk of rectal cancer. A healthy diet, rich in fruits, vegetables, and whole grains, can help reduce the risk.
Obesity and sedentary lifestyle: lack of physical activity and excess weight increase the risk of rectal cancer.
Smoking: smoking increases the risk of several types of cancer, including rectal cancer.
Excessive alcohol consumption: excessive alcohol consumption has been linked to an increased risk of rectal cancer.
Complications of rectal cancer
Rectal cancer can cause various complications that affect a patient’s health and quality of life. These complications can arise as a result of tumor growth, the spread of cancer to other organs, or the side effects of treatment. It is essential to seek medical attention if rectal cancer is suspected in order to obtain an accurate diagnosis and an appropriate treatment plan, which can help prevent or minimize these complications.
Intestinal obstruction: the tumor can grow and partially or completely block the passage of stool through the rectum, causing abdominal pain, bloating, nausea, and vomiting.
Metastasis: rectal cancer can spread to other organs, such as the liver, lungs, bones, and brain. Metastases can cause a variety of symptoms, depending on the organ affected.
Fecal incontinence: rectal cancer can damage the anal sphincter muscles, which can lead to fecal incontinence, that is, difficulty controlling bowel movements.
Chronic pain: rectal cancer and its treatment can cause chronic pain in the pelvis, abdomen, or back.
Diagnosis of rectal cancer
Rectal cancer is diagnosed through a series of tests and procedures that allow the doctor to assess the presence, location, and extent of the cancer. These tests may include a physical exam, imaging tests, and laboratory analyses. An early diagnosis is essential for successful treatment.
Digital rectal examination: the doctor inserts a gloved and lubricated finger into the rectum to palpate the area and detect any lumps, masses, or abnormalities. This test is quick and painless and can provide initial information about the presence of a tumor.
Colonoscopy: during a colonoscopy, a flexible tube with a camera (colonoscope) is inserted into the rectum and colon. This allows the doctor to visualize the inner lining of the rectum and colon and take tissue samples (biopsies) if suspicious areas are found. Colonoscopy is the most accurate method for detecting polyps and rectal cancer.
Biopsy: it is the extraction of a small tissue sample of the suspicious area for examination under a microscope. Microscopic analysis of the tissue sample taken during the colonoscopy is essential to confirm the diagnosis of rectal cancer. A pathologist examines the sample to determine whether cancer cells are present.
Imaging tests: imaging tests, such as magnetic resonance imaging (MRI) and computed tomography (CT), provide detailed images of the rectum, pelvis, and surrounding organs. These tests help determine the extent of the tumor, possible lymph node involvement, and the presence of metastases. Endorectal ultrasound, which uses sound waves to create images of the rectum, can also be helpful in diagnosis.
Blood tests: although not specific to rectal cancer, blood tests can provide information about a patient’s overall health and detect tumor markers, which are substances produced by cancer cells.
Treatment for rectal cancer is individualized according to the specific characteristics of each patient and the stage of the disease. The goal of treatment is to eliminate the cancer, prevent recurrence, and improve the patient’s quality of life. Treatment options may include surgery, chemotherapy, radiotherapy, and targeted therapy, and are often combined for the best results.
Lifestyle changes: adopting a healthy lifestyle is fundamental to overall well-being and can be beneficial during treatment for rectal cancer. This includes a balanced diet, rich in fiber and low in fat, regular exercise, and quitting smoking. These changes can help strengthen the immune system, improve tolerance to treatment, and reduce the risk of complications.
Chemotherapy: it uses medications to destroy cancer cells or stop their growth. It can be given before surgery (neoadjuvant) to shrink the tumor and make it easier to remove, after surgery (adjuvant) to eliminate remaining cancer cells and reduce the risk of recurrence, or to treat metastatic cancer that has spread to other organs.
Radiotherapy: it uses radiation to destroy cancer cells. It is administered externally, directing rays towards the tumor from a machine outside the body. Radiotherapy can be used in combination with chemotherapy or surgery.
Local resection: it is a surgical procedure in which the tumor and a small portion of surrounding healthy tissue are removed. This option is considered for early-stage cancers located in the lower part of the rectum, where they can be accessed through the anus.
Low anterior resection: it is a surgical procedure in which the affected part of the rectum is removed, and the intestine is reconnected. This surgery is performed for cancers located in the upper or middle part of the rectum.
Abdominoperineal amputation: it is a more extensive surgery in which the rectum and anus are removed, creating a permanent colostomy. This surgery is performed for cancers located near the anus or involving the anal sphincter muscles.
Rectal cancer treatment often requires a multidisciplinary approach involving medical oncologists, surgeons, radiation oncologists, gastroenterologists, and other healthcare professionals. This approach ensures that the patient receives the most comprehensive and personalized care possible, considering all aspects of the disease and the patient’s individual needs.
At HM Hospitales, we are committed to providing the most advanced and least invasive treatment options for rectal cancer. Our experience in Robotic Surgery, using the da Vinci system, allows for more precise and controlled complex procedures, minimizing pain and postoperative complications. https://www.hmhospitales.com/cirugia-robotica/In addition, our comprehensive Proctology program offers specialized care for the diagnosis and treatment of diseases of the rectum and anus, including rectal cancer, with a team of experts dedicated to providing the best possible care to our patients.
Remember that this article is for informational purposes only and does not replace professional medical advice. If you suspect you have rectal cancer, consult a specialist to obtain an accurate diagnosis and a treatment plan tailored to your needs.
Our doctors
Contact and make an appointment with the professionals in this area