What is a rectal carcinoma?

A rectal carcinoma is a cancer that starts in the last few inches of the large intestine. Treatment for rectal cancer is different than for colon cancer, primarily because of the limited space in the rectum and its close proximity to other organs. This makes surgery to remove the cancer more difficult.

Who gets rectal cancer?

Like colon cancer, rectal cancer can develop at any age but the majority of people who develop rectal carcinomas are older than 50. However, as with colon cancer, the incidences of rectal cancer are increasing in people under 50 years of age.

Diet and family history are also risk factors. High fat diets with an emphasis on red meat put people at increased risk of developing rectal carcinomas, as does a diet low in fiber. Other risk factors include:

• Race. Black people are at greater risk.
• Cancer history. Previous bouts of rectal cancer, colon cancer, or adenomatous polyps increase your risk of developing rectal cancer.
• IBD. Chronic inflammatory diseases such as ulcerative colitis or Crohn’s disease are risk factors.
• Sedentary lifestyle
• Uncontrolled diabetes
• Obesity
• Smoking
• Alcohol. Consuming more than three alcoholic drinks per week increases your risk.
• Radiation therapy. Previous radiation therapy directed at the stomach/abdomen area is also linked to rectal cancer.

Symptoms of rectal cancer

The symptoms of rectal cancer are similar to that of colon cancer. They include:

• Changes in bowel habits, including diarrhea, constipation, or increased need for bowel movements
• Blood in the stool, particularly if it is bright red or maroon in color
• A narrow stool
• Constant feeling that you aren’t emptying your bowels
• Pain in the abdomen
• Unexplained weight loss

Surgical treatment of rectal carcinomas

You may need chemotherapy and/or radiation in addition to your surgery for rectal cancer. The tumor’s proximity to the anus determines the type of surgery being done.

• Polypectomy. In the early stages, the polyp can be removed during a colonoscopy. A wire loop is inserted through the colonoscope, and the polyp is removed with an electric current.
• Local excision. During a local excistion, tools are passed through the colonoscope to surgically remove carcinomas found on the interior lining, along with a margin of healthy tissue.
• Transanal excision. Your surgeon can use transanal excision to excise small cancers close to the anus. Under local anesthesia, the instruments are inserted through the anus, and your surgeon cuts through the layers of the rectal wall to remove the cancer and surrounding tissue.
• Transanal endoscopic microsurgery (TEM). As an alternative to major abdominal surgery, your surgeon uses a special magnifying scope placed through the anus to remove tumors located high in the rectum.
• Low anterior resection. This surgery can be used for some stage I, stage II and stage III cancers in the upper part of the rectum. The section of the rectum with the cancer is removed, and the lower part of the colon is attached to the remaining portion of the rectum.
• Proctectomy with colo-anal anastomosis. For cancers in the middle and lower third of the rectum, removal of the entire rectum is needed. The colon is then attached to the anus.
• Abdominoperineal resection (APR). This type of operation is needed when the cancer has grown into the sphincter muscle or levator muscles. Your surgeon makes an incision or incisions and removes the rectum, anus and the tissue surrounding it, as well as the sphincter. This requires a permanent colostomy.
• Pelvic exenteration. This is required if the cancer has grown into nearby organs. The rectum is removed, as well as the organs the cancer has compromised, such as the bladder, uterus or prostate.
• Diverting colostomy. In some cases, your surgeon may divert the colon by cutting the colon above the cancer and attaching it to an opening in the skin of the abdomen where stool can come out. The cancer is bypassed so you can gain strength in order to start treatment such as chemotherapy.

Colorectal Disease Specialties We Treat