American Mayo Clinic experts talk about the treatment of rectal cancer

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Rectal cancer is cancer that occurs in the last few inches of the colon. This area is called the rectum. The main treatment for rectal cancer is surgery. Depending on the progress of the cancer, radiation therapy and chemotherapy may also be accepted. If rectal cancer occurs early, the long-term survival rate is about 85% to 90%. If rectal cancer spreads to the lymph nodes, the number of generation rates will drop sharply.

Most rectal cancers start with small cells called polyps, which are the growth of non-cancerous cells. After polyps are removed, rectal cancer can be prevented. This is why timely colon cancer screening for colonoscopy is very important. Rectal cancer prevention guidelines generally recommend that colonoscopy screening should start at the age of 50. If you have other risk factors, such as a family history of colorectal cancer, your doctor may recommend more frequent or earlier colon cancer screening.

Many patients with rectal cancer have no signs and symptoms in the early stages of the disease. Signs and symptoms in the later stages may include rectal bleeding (usually bright red), which is mistaken for hemorrhoids bleeding; changes in bowel bowel habits; abdominal discomfort; rectal pain; The feeling of rushing back and forth.

Patients should first assess the cause of rectal bleeding. Many people may attribute rectal bleeding to common diseases such as hemorrhoids, but unless you have a previous diagnosis of hemorrhoids, you should have a medical examination as soon as possible to rule out the presence of polyps or rectal cancer. To do this, the doctor will insert a lubricated, gloved finger into the lower part of the rectum to check for any abnormalities in the rectum.

After the doctor finds the abnormality, in order to confirm the diagnosis and determine the degree of cancer progression, other tests can also be performed. Colonoscopy allows doctors to view the entire colon, and can remove polyps or tissue samples for biopsy. A computed tomography (CT) scan or X-ray can determine whether the cancer has spread. Other tests, such as endoscopic  ultrasonography or magnetic resonance imaging (MRI), can help determine whether the cancer has penetrated beyond the rectum and whether lymph nodes are involved.

There are many factors that affect the treatment plan of patients with rectal cancer. If the tumor does not grow through the rectal wall and the lymph nodes are not affected, then the cancer is considered very early (stage I). A tumor that has invaded or passed slightly through the rectal wall but has not spread to the lymph nodes is stage II. If it involves lymph nodes, it is stage III. Cancer spread to other areas is stage IV.

Surgery is the most common treatment for all stages of rectal cancer. The type of surgery is determined by the location of the tumor and involves the removal of the muscle ring (anal sphincter) at the end of the rectum.

For cancers that grow out of the rectum or penetrate the rectum, the surgeon recommends removing the rectum near the cancer to partially remove the rectal cancer, and removing the edges of healthy rectal tissue near the cancer and removing nearby lymph nodes.

If possible, the doctor reconnects the remaining healthy parts of the rectum and colon. If it cannot be reconnected, it may be necessary to create a permanent opening (ostomy) through the abdominal wall from a portion of the remaining intestine. This is called a colostomy.

In addition to surgery, locally advanced rectal cancer is usually treated with radiation therapy and chemotherapy. When cancer has spread to nearby lymph nodes or grows through the rectal wall, chemotherapy and radiation therapy are often used.

If the cancer has not spread to other parts of the body, chemotherapy and radiation are usually done before surgery to shrink the tumor and increase the likelihood of complete tumor removal. It is generally recommended to combine chemotherapy and radiotherapy for stage II and III rectal cancer before surgery, and more chemotherapy is performed after surgery.

In view of the severity of advanced rectal cancer, patients should consult your doctor when the first symptoms occur, especially rectal bleeding, changes in stool size or traits, or persistent rectal discomfort.

-Robert Cima, MD, colon & Rectal Surgery, Mayo Clinic, Rochester, Minn. 

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