Rectal cancer

Overview

Rectal cancer forms in the tissues of the rectum, the lower part of the large intestine where stool is stored. Rectal cancer, along with colon cancer (which occurs in the large intestine), are known as colorectal cancers.

Our approach

At Northwell Health, the goal is to diagnose and treat the symptoms of rectal cancer while allowing patients to maintain their normal life activities.

Highlights of the rectal cancer treatments and services include:

  • A focus on treating the rectal cancer while preserving normal life functions
  • Advanced rectal cancer treatments, such as immunotherapy and chemotherapy
  • Therapies to boost the immune system, reduce pain and improve quality of life
  • Minimally invasive and nerve-sparing procedures, including laparoscopic and robotic surgery, that grant patients quicker recovery, less pain and scarring, and a sooner return to a normal diet

Multidisciplinary Rectal Cancer Treatment

Within the first several days of a visit, the team will conduct a complete array of tests and develop a personalized rectal cancer treatment program. Each rectal cancer diagnosis is unique, so the team meets regularly to discuss the individual treatment approach for each specific situation during weekly multidisciplinary conferences which allow the physicians to share ideas and best practices for delivering highly specific and fully explored collaborative patient care. Each phase of a patient’s treatment is reviewed by the team, to ensure that treatment milestones are reached.

Diagnosis

The first step to diagnosing any cancer, including rectal cancer, is usually a physical.

  • The doctor will check overall physical health while considering medical history, rectal cancer risk factors and any related medical or precancerous conditions.
  • The exam will likely include a digital rectal examination (DRE), during which a doctor or nurse will insert a gloved, lubricated finger to feel for anything abnormal or unusual. In women, the vagina might also be examined.
  • The patient will likely receive a fecal occult blood test where they will be sent home with a chemically treated card, onto which they will place a very small stool sample for three successive days. The card is returned to the doctor’s office or a lab to test for the presence of hidden blood (occult) in the stool.

If a doctor suspects that a patient might be experiencing rectal cancer symptoms, they will be given additional tests. A number of procedures and tests are used to deliver an accurate rectal cancer diagnosis. 

  • Colonoscopy — To view the entire length of the large intestine, a long, flexible, lighted tube called a colonoscope is inserted into the rectum up into the colon. If any abnormal growths (polyps) are found, they can be usually removed (see biopsy, below) and sent for examination by a pathologist.
  • Virtual colonoscopy (CT colonography) — A virtual colonoscopy also examines the intestine, but instead of using a colonoscope, a series of X-rays taken from outside the body are used to develop a 3D picture of the colon.
  • Sigmoidoscopy — Similar to a colonoscopy, a tool called a sigmoidoscope examines the part of the colon closest to the rectum and anus, known as the sigmoid colon. 
  • Biospy — During a biopsy, tissue or cell samples are removed for further analysis by a laboratory to check for signs of rectal cancer.
  • Barium enema with air contrast (also called a double-contrast barium enema) — In order for internal organs to be visible on an X-ray, sometimes a barium enema is required. Barium, a metallic chemical, is delivered into the rectum and coats the areas of the colon so any problems can turn up on X-rays.
  • Imaging tests — A number of imaging tests are used to diagnose and determine the staging of each rectal cancer case (see the section on staging, below).

Staging

Once signs of rectal cancer are discovered, doctors will determine whether the cancer has spread to the colon or to other parts of the body. This process is called staging. Some of the tests used for staging, which can also be involved in rectal cancer diagnosis, include

  • Computed tomography (CT) — A set of X-rays that develops a detailed picture of the chest, abdomen and pelvis.
  • Magnetic resonance imaging (MRI) — Magnetic fields produce detailed images to determine whether the cancer has spread.
  • PET/CT — A single machine can perform both positron emission tomography (PET), and CT. PET is able to trace the molecular qualities of possible abnormalities, while CT can locate visible, physical changes. A PET/CT machine allows a patient to be scanned both ways at the same time.
  • Endoscopic ultrasound (EUS) — Sound waves produce detailed images of internal organs.

The stages for rectal cancer are:

  • Stage 0 — Also known as carcinoma in situ, this stage means that abnormal cells are found in the inner lining of the rectum.
  • Stage 1 — Cancer has spread to additional walls of the rectum but not beyond the outer wall of the rectum or outside the rectum.
  • Stage 2 — Cancer has spread outside the rectum to other tissues but not into the lymph nodes.
  • Stage 3 — Cancer has spread to lymph nodes but not other parts of the body.
  • Stage 4 — Cancer has spread to other organs, such as the liver and lungs.

Once staging is determined, specialists can develop the best possible treatment plan. 

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