The rectum is the last section of the large intestine and is where the bowel stores waste until it is ready to be passed out of the body through the anus.
Rectal cancer and colon cancer are often referred to as colorectal cancer although treatments can be quite different, mainly because of the position of the rectum, making it more challenging to remove the tumour.
Although rectal cancer is less common than colon cancer, it can be more likely to spread locally. Survival rates have greatly improved in recent years.
Potential signs of rectal cancer include:
- Changes in your bowel habits, which could present as diarrhoea or constipation
- Abdominal pain
- Dark stools due to bleeding in the colon
- Unexplained weight loss
- Weakness or fatigue
- A feeling that your bowel doesn’t empty completely
Who might be at risk?
- Age – most rectal cancers occur after the age of 50
- A family history of the disease
- Some inherited disorders
- Lifestyle factors including obesity, smoking and excessive alcohol consumption
The first step is usually to have an operation to remove the tumours. For 10% of patients that will be a procedure known as an APER, or abdominal perineal resection, which removes the lower part of the colon, the rectum, and the anus.
For most patients, though, Prof Jamie Murphy will perform an anterior resection. The diseased part of the rectum is removed and any surrounding tissue and then the colon is attached to the lowest part of the rectum or the upper part of the anus.
For high-risk patients, we may feel the tumours should be shrunk before surgery. Previously they would be treated with chemoradiotherapy but the new approach is radiotherapy followed by chemotherapy (total neoadjuvant therapy)
After total neoadjuvant therapy, 30% rectal cancers appear to fully respond and disappear, referred to as ‘complete clinical response’. Then it’s typically a case of watching and waiting by scanning and examining periodically. If it does return, then surgery may be necessary.