Rectal Cancer

Symptoms and risk factors

Most people don't have symptoms of rectal cancer.

Like colon cancer, most people with early-stage rectal cancer don’t experience any symptoms. By the time signs appear, it’s already progressing to a more advanced stage. And when cancer is advancing, it may be spreading and harder to treat.

Once this cancer has advanced, you may experience symptoms, such as:

• Bloating, cramping, and/or frequent gas pains
• Bloody stool
• Constipation or diarrhea
• Persistent fatigue
• Unexplained, sudden weight loss
• Vomiting

Many of these symptoms could be related to other health conditions, including colon cancer. However, if symptoms continue for more than two weeks, be sure to check in with your doctor to rule out cancer.

Knowing your risk can help you minimize your chances of developing rectal cancer.

Knowing your risk ahead of time can help you take action to stay healthy and minimize the likelihood of a diagnosis.

Risk factors may include:

• Age: Men and women over 45 have a higher risk of developing this type of cancer.

• Race/Ethnicity: If you are African-American or Jewish with an Eastern European background, you are at an increased risk.

• Medical history: Certain health conditions raise your risk, including ulcerative colitis, Crohn’s disease, Type 2 diabetes, or other types of cancer. And, if your doctor found polyps during a colonoscopy, you are also at an elevated risk.

• Family history: If you have family members with this type of cancer, you are at a higher risk. Our genetic counselors can help you determine how much you are at risk and take action to reduce your chances.

• High-fat diet: Lifestyle choices significantly impact your risk. Studies show that you have an increased risk if you eat a diet high in fatty calories, such as those in red meat. You may also have a higher risk if you don’t eat enough food with fiber, such as fruits and vegetables.

• Not enough exercise: If you aren’t active, you may have a higher risk of cancer development.

• Tobacco and alcohol use: Poor lifestyle choices such as smoking cigarettes and drinking too much alcohol can increase your risk.

If one or more risk factors apply to you, that doesn’t mean that you will get this cancer. But, it’s a good idea to talk to your doctor about ways to minimize your risk.

At MedStar Health, you’ll benefit from genetic counselors who are experts in evaluating your family history and risk for inherited cancers. Through our High-Risk Gastrointestinal Cancer Prevention program, we can help you proactively manage your risk through earlier screening and lifestyle changes.

A healthy lifestyle can lower your risk of rectal cancer.

Some studies suggest that a healthy lifestyle helps to prevent this cancer. Consider taking the following steps to lower your risk:

• Get screened every ten years, starting at age 45
• Maintain a healthy weight
• Exercise regularly
• Eat a low-fat diet and less red meat
• Consume more fruits and vegetables
• Avoid smoking and excessive alcohol consumption

If you are considered at a high risk of developing this type of cancer, talk to your doctor about screening guidelines, as you may need to be screened earlier or more frequently. A genetic counselor can also help you manage your risk, if this type of cancer runs in your family.

Diagnosis

An accurate diagnosis leads to more effective treatment.

At MedStar Health, our colorectal specialists are experts in diagnosing and treating because we see a high number of patients every year. Research shows that patients experience better outcomes, like higher survival rates and a lower risk of needing a colostomy when they seek care from a care team who treats a high volume of patients.

We believe an accurate diagnosis is the most important step to getting treatment that will give you the best results and the highest quality of life. There are a variety of tests that your doctor may use to confirm your diagnosis and understand the size and location of your rectal tumor, as well as if it has spread, or metastasized. These may include:

• Physical exam: Your doctor will review your medical history and symptoms. They’ll also examine your body for anything abnormal. This may include a digital rectal exam (DRE), where your doctor will use a gloved finger to feel for anything unusual in the rectum.
• Colonoscopy: A colonoscopy may be used as both a screening and a diagnostic procedure. It allows your doctor to evaluate the inside of your rectum for polyps or other signs that cancer is developing.
• Biopsy: Your doctor will take a small sampling of suspicious tissue from your rectum using a procedure called a biopsy. This is the most definitive way to determine if your tumor is cancerous or not.
• Proctoscopy: If your doctor suspects cancer, they may use a proctoscope to look inside the rectum. During a proctoscopy, your doctor will insert a thin, lighted tube with a camera into the rectum. This allows them to identify the location and size of your tumor.
• Imaging: Your doctor may use a combination of x-ray, computed tomography scans (CT scans), or ultrasound to take pictures of the inside of your body. This allows them to see if the tumor has spread to other parts of the body.
• Blood tests: Your doctor may use various blood tests to:
  • Look for blood in your stool that may not be otherwise visible
  • Measure the types of cells in your blood
  • Identify tumor markers found in blood
  • Check your liver function
  • Inform treatment options

Rectal cancer stages

As part of your diagnosis, your doctors will evaluate the stage of your cancer, or how much it has grown and spread. Your stage will determine what kind of treatment is necessary to remove your cancerous tumor and prevent it from coming back.

The staging system is complex and indicates:

• The tumor size
• How much it is affecting the lymph nodes
• How far it has spread to other parts of the body

Your doctor will consider all three factors to describe your cancer on a scaled stage of zero to four. The higher the number, the more your cancer has progressed and the harder it is to treat.

• Stage 0: There are abnormal cells in the innermost rectum lining. This is the earliest possible sign of cancer and is highly treatable.
• Stage I: The tumor has grown beyond the inner lining of the rectum. However, it’s still contained in the rectum and has not spread to nearby lymph nodes.
• Stage II: Cancer has expanded to the outer layer of the rectum but has not spread to the lymph nodes.
• Stage III: Cancer has grown through the rectum wall and has reached one or more lymph nodes.
• Stage IV: Cancer has spread to other vital organs in the body, such as the lungs. There may also be cancer in the lymph nodes.

Types of cancer

The most common type of rectal cancer is an adenocarcinoma, which develops from a polyp in the lining of the rectum. Other rare types may include:

• Gastrointestinal stromal tumors, which rarely develop in the lining of the gastrointestinal tract and can form in the rectum

• Rectal leiomyosarcoma, in which the tumor begins in the layers of muscle in the rectum
• Colorectal lymphoma, which commonly develop in the lymph nodes but can begin in the rectum
• Familial adenomatous polyposis (FAP), which is an inherited syndrome that can cause hundreds-to-thousands of polyps in the rectum or colon

Why choose us

Studies prove that outcomes are better at high-volume centers like MedStar Health. When you receive rectal cancer treatment here, you can expect the highest quality of care from specialists who have more experience treating this disease than most cancer centers in the region. Because we have extensive experience treating patients with this specific cancer, our surgeries are more successful in:

• Removing cancer
• Preventing cancer from returning
• Preserving the sphincter
• Lowering the risk of a colostomy

Your care team includes several specialists who work together in regular tumor boards. Multidisciplinary care leads to exceptional results because it ensures you receive comprehensive treatment that addresses all of your physical and emotional needs. Here, your team may involve surgical, radiation, and medical oncologists, interventional radiologists, gastrointestinal specialists, therapists, and nurses who collaborate in your care. Your team may also involve genetic counselors, psychologists, dietitians, and others who can help you manage your health throughout your cancer journey.

We translate the latest research into novel therapies and surgeries that help preserve your quality of life. We partner with the only comprehensive cancer center in the region, Georgetown Lombardi Comprehensive Cancer Center, to conduct research paving the way for a cure for gastrointestinal cancers. Because our oncologists and researchers are investigating the latest treatment options, we can quickly put new methods for diagnosing and treating the disease into practice. In addition, our surgeons are experts in complex, minimally invasive, and robotic procedures that result in less pain, fewer risks, and shorter recovery times than traditional surgery. Our goal is to preserve your quality of life while minimizing the chances of your disease returning.