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Rectal Cancer Treatment in NJ, CT, MD, and the Washington, D.C., Area
Rectal cancer develops in the rectum, the lower portion of the large intestine that stores fecal matter until it passes out of the body through the anus during a bowel movement, Rectal cancer is distinct from colon cancer, but the two conditions often are referred to together as colorectal cancer. According to the American Cancer Society, colorectal cancer is the third most common cancer in the United States, excluding skin cancers. While risk factors differ from case to case, the overall lifetime risk of developing colorectal cancer is about 1 in 26 for women and 1 in 23 for men.
The medical oncologists of Regional Cancer Care Associates (RCCA) have extensive experience treating various types of cancer, including rectal cancer. Our compassionate team of physicians, nurses, and other healthcare professionals uses state-of-the-art procedures and spends time getting to know each patient’s unique circumstances and needs to develop highly individualized cancer treatment plans. Patients can find treatment for colorectal cancer at RCCA’s community-based care centers throughout New Jersey, Connecticut, Maryland, and the Washington, D.C., area.
What Is Rectal Cancer?
Rectal cancer occurs when malignant cells develop in the tissues of the rectum. The rectum and colon make up the large intestine of the digestive system.
The rectum is the lower portion of the large intestine and represents the final 5 to 6 inches of the digestive system. As noted above, it stores solid waste until that waste passes through the anus during a bowel movement. The rectum is S-shaped and features two bends — the sacral flexure at the top that adheres to the spine’s curve and the anorectal flexure where the rectum meets the anus. These bends are essential for continence (holding in bowel movements).
Causes and Risk Factors of Rectal Cancer
Like other cancers, rectal cancer begins with changes to cell DNA. These genetic mutations can lead to diseases such as rectal cancer. While scientists have not identified all of the causes of these mutations, some patients have a genetic predisposition to rectal cancer because they inherited mutations that increase their risk of developing the disease.
However, only a minority of rectal cancer cases occur because of inherited gene mutations. The following are some known genetic causes of colorectal cancer:
Familial Adenomatous Polyposis (FAP)/Attenuated FAP (AFAP)
This mutation disrupts the APC gene, which helps regulate cell growth in the colon and rectum. It causes hundreds of polyps to form. The likelihood of cancer is increased by this high volume of polyps.
Hereditary Non-Polyposis Colon Cancer (HNPCC)
Also called Lynch syndrome, HNPCC occurs when genes that typically help repair damaged DNA are altered, allowing problems with DNA to go unfixed. These errors can impact genes that regulate growth, potentially leading to cancer.
Peutz-Jeghers Syndrome
This syndrome is caused by mutations in the STK11 (LKB1) gene. It forms a type of polyp called a hamartoma in the digestive tract, putting a person at a significantly higher risk for colorectal cancer.
MUTYH-Associated Polyposis (MAP)
Brought on by mutations in the MUTYH gene, this syndrome causes a person to develop numerous polyps. Individuals with this mutation require regular colonoscopies to detect signs of rectal cancer, as well as other cancers of the gastrointestinal tract.
In addition to inherited gene mutations, several other risk factors can increase the chances a person will develop rectal cancer. These include:
Age and Gender
Women are more likely to develop colorectal cancer than men. The risk of colorectal cancer also increases with age, although research has indicated that instances of colorectal cancer in younger adults are rising for unknown reasons.
Lifestyle Factors
Being overweight or obese, lack of physical activity, moderate to heavy alcohol consumption, and smoking can increase the risk of colorectal cancer. Diets high in red and processed meats and cooking meats at high temperatures also can compound risk.
Family History
Family history plays a role in many cases of colorectal cancer. Individuals with a first-degree relative, such as a parent or sibling, who developed colorectal cancer are at elevated risk for the disease themselves. This risk increases if the relative was younger than 50 when diagnosed, or if more than one first-degree relative had colorectal cancer.
Inflammatory Bowel Disease
Having inflammatory bowel disease (IBD) can increase the risk of colorectal cancer. This can include Crohn’s disease and ulcerative colitis. Patients with IBD may need to begin screening for colorectal cancer at a younger age and screen more frequently than others.
It is important to note that IBD is different than irritable bowel syndrome (IBS). Research does not support a link between IBS and increased risk of colorectal cancer.
Types of Rectal Cancer
Like cancer that develops in many other parts of the body, most rectal cancers are adenocarcinomas. These cancers form in the cells of glandular tissue, which lines internal organs and generates and releases mucus, digestive juices, and similar substances. Less common types of rectal cancer include squamous cell carcinomas and neuroendocrine tumors.
Staging of Rectal Cancer
When staging rectal cancer, physicians typically use the TNM staging system. It is the most widely used staging system globally. TNM stands for the three elements used in staging — the size of the tumor (T), the extent of the spread to the lymph nodes (N), and the occurrence of metastasis (M).
Each letter corresponds with different values. Once physicians determine these values, they combine them and classify them into a numerical stage. These stages may be subdivided into further categories using letters. The stages of rectal cancer include:
- Stage 0: In the earliest stage, the cancer has not grown beyond the innermost lining of the rectum or bowel. Doctors also may call it in situ or intramucosal carcinoma.
- Stage I: The cancer has spread past the innermost lining but not past the main muscle layer of the rectal or bowel wall to nearby lymph nodes or distant areas.
- Stage II: The cancer has spread to the outermost layers of the rectum and may be affecting surrounding structures. It has not reached distant lymph nodes or organs. Stage II is subdivided into IIA, IIB, and IIC.
- Stage III: The cancer has spread to nearby lymph nodes. Stage III includes IIIA, IIIB, and IIIC.
- Stage IV: In the most advanced stage, the cancer has reached distant organs. Stage IV is subdivided into IVA, IVB, and IVC.
Doctors also may use the terms localized, regional, and distant when discussing staging and survival rates. The standard approach for describing cancer prognoses is the 5-year relative survival rate. It helps patients understand the likelihood of successful treatment, though it does not provide certainty about how long they will live following their diagnosis.
Localized means that cancer has not spread outside its site of origin. Regional means it has spread only to surrounding lymph nodes and structures, and distant means it has reached further parts of the body. According to the American Cancer Society, the 5-year relative survival rate for rectal cancer is as follows:
- Localized: 90%
- Regional: 74%
- Distant: 17%
Signs and Symptoms of Rectal Cancer
Patients with rectal cancers may not notice any signs at first. However, some symptoms can suggest rectal cancer in its early stages. These signs include:
- Changes in bowel habits (constipation, diarrhea, and having bowel movements more often than normal)
- Blood in the stool (can appear bright red or a very dark maroon)
- Abdominal discomfort or pain
As rectal cancer progresses, signs change and become more noticeable. These advanced-stage symptoms include:
- Unexplained weight loss
- Fatigue and weakness
- Bowel obstruction (resulting in narrow stool)
Treatment Options for Rectal Cancer
After patients have been diagnosed with rectal cancer, their doctor will refer them to a medical oncologist for treatment, such as the team at RCCA. Treatment options differ depending on the cancer type and its stage, as well as the patient’s age and overall health. Treatment options include:
Surgery
The main treatment for rectal cancer is surgery. To select the right procedure, surgeon consider the cancer’s location and extent and how close it is to the anus. Options include:
- Local excision: During a colonoscopy, the surgeon uses tools to remove small cancers and polyps from the inside lining of the rectum. This technique often is used for early rectal cancers.
- Transanal resection: The surgeon accesses the rectum through the anus to remove all layers of the rectal wall and eliminate the cancer. This procedure leaves a hole in the rectal wall, which the surgeon closes. It is intended for small, early-stage I rectal cancers close to the anus.
- Radical resection: Radical resection is a more extensive procedure to treat stage II and III rectal cancers and some stage I rectal cancers. Types of radical resection for rectal cancer include:
- Low anterior resection for cancers in the upper part of the rectum where the organ connects to the colon
- Abdominoperineal resection for cancers in the lower part of the rectum near the anus
Radiation Therapy
Radiation therapy is used more often for rectal cancer than for colon cancer. It uses beams from high-energy rays, such as X-rays, to attack and destroy cancer cells or slow their growth. Oncologists may administer radiation with chemotherapy before or after surgery to prevent recurrence. Types of radiation therapy include:
- External beam radiation therapy (EBRT): EBRT involves receiving radiation from an external machine, like having an X-ray but with more intense radiation. The frequency and duration of EBRT differ from patient to patient.
- Brachytherapy: Also called internal radiation therapy, brachytherapy involves placing a radioactive source inside the rectum near or in the tumor. Brachytherapy allows radiation to circumvent the skin and tissues in the abdomen, minimizing the risk of damage.
Chemotherapy
Chemotherapy uses powerful anti-cancer drugs to kill malignant cells. Medical oncologists administer chemotherapy through intravenous infusion or with pills taken orally. Chemotherapy can be used in different ways, including:
- Neoadjuvant chemotherapy: Patients receive chemotherapy before surgery. The goal is to shrink the cancer to make removing it easier. This may be done in conjunction with radiation therapy.
- Adjuvant chemotherapy: Patients receive chemotherapy after surgery. Adjuvant chemotherapy reduces the chances of cancer coming back by killing malignant cells that are too small to see with imaging modalities.
Other Treatment Options
Other methods for treating rectal cancer include:
- Targeted therapy: Like chemotherapy, targeted therapy uses drugs to target and kill cancer cells and prevent them from growing. Unlike chemotherapy, however, targeted therapy acts specifically on proteins or other substances found on the surface of cancerous cells, and s does not affect nearby healthy cells.
- Immunotherapy: Immunotherapy strengthens a patient’s immune system, enabling it to better identify and destroy cancer cells. It may be recommended for individuals with advanced forms of rectal cancer.
Managing Rectal Cancer Treatment Side Effects
In addition to the various symptoms of rectal cancer, patients may experience side effects during or after treatment. Common short-term side effects include fatigue, hair loss, nausea, and vomiting. Bowel dysfunction and sexual or fertility concerns are potential long-term side effects. Patients can consult with their physicians about managing these side effects.
Patients also should be aware of the emotional and psychological impact of cancer. To cope with these side effects, patients may consider reaching out to family and friends for support. Medical oncologists also ease concerns by educating patients about their treatments and connecting them with community support groups.
Prevention and Lifestyle Measures
While some risk factors for rectal cancer are outside a person’s control, such as genetic mutations and family history, patients can mitigate others by altering lifestyle habits. Some strategies for reducing the risk of rectal cancer include:
- Eating a diet high in fruits, vegetables, and whole grains and low in red and processed meats
- Exercising regularly, particularly vigorous activity, to maintain a healthier weight
- Ceasing smoking and limiting alcohol intake
- Managing chronic conditions that increase the risk of rectal cancer, such as IBD
Frequently Asked Questions About Rectal Cancer
What Are Polyps?
Polyps are growths, often resembling tiny mushrooms, that form when cells lining the colon grow and divide in an uncontrolled manner.
Can Rectal Cancer Spread Quickly?
Most often, colorectal cancer grows slowly, over the course of several years.
What Is the Most Common Site of Metastasis Associated With Rectal Cancer?
The most common site of metastases for colon cancer or rectal cancer is the liver. Colorectal cancer cells also may spread to the lungs, bones, brain or spinal cord.
Seek Rectal Cancer Care at RCCA
Rectal cancer is a life-threatening disease. It also causes a host of symptoms that can diminish a person’s quality of life. Various treatment options are available for patients with different stages of rectal cancer. At Regional Cancer Care Associates, compassionate medical oncologists and hematologists have extensive experience treating rectal cancer and offer multiple treatments to tailor care to a patient’s unique needs.
Contact RCCA to learn more about treatment for rectal cancer. Patients can find care at more than 20 community-based locations across New Jersey, Connecticut, Maryland, and the Washington, D.C., area
Regional Cancer Care Associates — Leading the way in cancer care
The doctors at Regional Cancer Care Associates (RCCA) are trained at the world’s leading medical institutions. They are experts who have proven their leadership as professors, clinicians and researchers. At RCCA, you’ll get high-quality, advanced treatment close to home. We’ll work with you and your family to make sure your care is second to none.
To get more information, to schedule an appointment, or just to discuss your situation, please call (844) 346-7222. You can also contact the RCCA location nearest you.
Physicians SPECIALIZED IN Rectal cancer
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