Rectal Cancer

Preparing for Rectal Cancer Treatment

The doctor develops a rectal cancer treatment plan to fit each person's needs. Treatment for rectal cancer depends mainly on the location of the tumor in the rectum and the stage of the disease. The doctor can describe the treatment options and the expected results.

People do not need to ask all of their questions at once. They will have other chances to ask the doctor to explain things that are not clear and to ask for more information.

Methods of Rectal Cancer Treatment

Rectal cancer treatment may involve surgery, radiation therapy, or chemotherapy. Some people have a combination of treatments.

Colon cancer sometimes is treated differently from rectal cancer. Treatments for colon and rectal cancer are described separately.

At any stage of rectal cancer, treatments are available to control pain and other symptoms, and to relieve the side effects of therapy. This kind of treatment is called supportive care, symptom management, or palliative care.

People with rectal cancer may want to talk to the doctor about taking part in a clinical trial, a research study of new rectal cancer treatment methods. The section on "The Promise of Cancer Research" has more information about clinical trials.

Surgery for Rectal Cancer

Surgery is the most common rectal cancer treatment. It is a type of local therapy. It treats the cancer in the colon or rectum and the area close to the tumor.

A small malignant polyp may be removed from the colon or upper rectum with a colonoscope. Some small tumors in the lower rectum can be removed through the anus without a colonoscope.

For a larger cancer, the surgeon makes an incision into the abdomen to remove the tumor and part of the healthy colon or rectum. Some nearby lymph nodes also may be removed. The surgeon checks the rest of the intestine and the liver to see if the cancer has spread.

When a section of the colon or rectum is removed, the surgeon can usually reconnect the healthy parts. However, sometimes reconnection is not possible. In this case, the surgeon creates a new path for waste to leave the body. The surgeon makes an opening (a stoma) in the wall of the abdomen, connects the upper end of the intestine to the stoma, and closes the other end. The operation to create the stoma is called a colostomy. A flat bag fits over the stoma to collect waste, and a special adhesive holds it in place.

For most people who have a colostomy, it is temporary. It is needed only until the colon or rectum heals from surgery. After healing takes place, the surgeon reconnects the parts of the intestine and closes the stoma. Some people, especially those with a tumor in the lower rectum, need a permanent colostomy.

Rectal Cancer Chemotherapy

Chemotherapy uses anticancer drugs to kill cancer cells. It is called systemic therapy because it enters the bloodstream and can affect cancer cells throughout the body.

The patient may have chemotherapy alone or combined with surgery, radiation therapy, or both. Chemotherapy given before surgery is called neoadjuvant therapy. Chemotherapy before surgery may shrink a large tumor.

Chemotherapy treatment after surgery is called adjuvant therapy. Adjuvant therapy is used to destroy any remaining cancer cells and prevent the cancer from coming back in the colon or rectum, or elsewhere.

Chemotherapy is also used to treat people with advanced disease.

Anticancer drugs are usually given through a vein, but some also may be given by mouth. The patient may be treated in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a hospital stay may be needed.

Radiation Therapy for Rectal Cancer

Radiation therapy (also called radiotherapy) is local therapy. It uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area.

Doctors use two types of radiation therapy to treat cancer. Sometimes people receive both types:

  • External radiation: The radiation comes from a machine. Most patients go to the hospital or clinic for their treatment, generally 5 days a week for several weeks. In some cases, external radiation is given during surgery.

  • Internal radiation (implant radiation): The radiation comes from radioactive material placed in thin tubes put directly into or near the tumor. The patient stays in the hospital, and the implants generally remain in place for several days. Usually they are removed before the patient goes home.

Rectal Cancer Treatment Options

Most patients with rectal cancer are treated with surgery. Some have both surgery and chemotherapy. A colostomy is seldom needed for people with colon cancer.

Although radiation therapy is not commonly used to treat rectal cancer, sometimes it is used to relieve pain and other symptoms.

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