Type of surgery to remove rectal cancer
How long does it take to recover from rectal cancer surgery?
Is rectal cancer curable?
Can rectal cancer be cured with surgery?
Does rectal cancer spread fast?
What are the chances of surviving stage 3 rectal cancer?
Rectal cancer surgery
Surgery is a common treatment for rectal cancer. The type of operation used to remove the rectal cancer depends on the extent and location of the cancer. If the rectal cancer is located well above the anus, a low anterior resection (LAR) can be performed. This operation allows the patient to keep anal function and pass stools in a normal manner. If the rectal cancer is located close to the anus, sometimes the anus must be removed with the cancer in an operation called an abdominoperineal resection (APR). The patient must then use a colostomy bag. A colostomy is an opening where the large intestine is attached to the abdominal wall. A replaceable bag that encloses the colostomy is worn by the patient to collect stool.
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Rectal cancer Symptoms
Common symptoms include:
-A change in your bowel habits, such as diarrhea, constipation or more-frequent bowel movements
-Dark or red blood in stool
-Mucus in stool
-Narrow stool
-Abdominal pain
-Painful bowel movements
-Iron deficiency anemia
-A feeling that your bowel doesn't empty completely
-Unexplained weight loss
-Weakness or fatigue
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Causes
Rectal cancer occurs when healthy cells in the rectum develop errors in their DNA. In most cases, the cause of these errors is unknown.
Healthy cells grow and divide in an orderly way to keep your body functioning normally. But when a cell's DNA is damaged and becomes cancerous, cells continue to divide even when new cells aren't needed. As the cells accumulate, they form a tumor.
With time, the cancer cells can grow to invade and destroy normal tissue nearby. And cancerous cells can travel to other parts of the body.
Inherited gene mutations that increase the risk of colon and rectal cancer
In some families, gene mutations passed from parents to children increase the risk of colorectal cancer. These mutations are involved in only a small percentage of rectal cancers. Some genes linked to rectal cancer increase an individual's risk of developing the disease, but they don't make it inevitable.
Two well-defined genetic colorectal cancer syndromes are:
Hereditary nonpolyposis colorectal cancer (HNPCC). HNPCC, also called Lynch syndrome, increases the risk of colon cancer and other cancers. People with HNPCC tend to develop colon cancer before age 50.
Familial adenomatous polyposis (FAP). FAP is a rare disorder that causes you to develop thousands of polyps in the lining of your colon and rectum. People with untreated FAP have a greatly increased risk of developing colon or rectal cancer before age 40.
FAP, HNPCC and other, rarer inherited colorectal cancer syndromes can be detected through genetic testing. If you're concerned about your family's history of colon cancer, talk to your doctor about whether your family history suggests you have a risk of these conditions.
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Risk factors
The characteristics and lifestyle factors that increase your risk of rectal cancer are the same as those that increase your risk of colon cancer. They include:
Older age. The great majority of people diagnosed with colon and rectal cancer are older than 50. Colorectal cancer can occur in younger people, but it occurs much less frequently.
African-American descent. People of African ancestry born in the United States have a greater risk of colorectal cancer than do people of European ancestry.
A personal history of colorectal cancer or polyps. If you've already had rectal cancer, colon cancer or adenomatous polyps, you have a greater risk of colorectal cancer in the future.
Inflammatory bowel disease. Chronic inflammatory diseases of the colon and rectum, such as ulcerative colitis and Crohn's disease, increase your risk of colorectal cancer.
Inherited syndromes that increase colorectal cancer risk. Genetic syndromes passed through generations of your family can increase your risk of colorectal cancer. These syndromes include FAP and HNPCC.
Family history of colorectal cancer. You're more likely to develop colorectal cancer if you have a parent, sibling or child with the disease. If more than one family member has colon cancer or rectal cancer, your risk is even greater.
Dietary factors. Colorectal cancer may be associated with a diet low in vegetables and high in red meat, particularly when the meat is charred or well-done.
A sedentary lifestyle. If you're inactive, you're more likely to develop colorectal cancer. Getting regular physical activity may reduce your risk of colon cancer.
Diabetes. People with poorly controlled type 2 diabetes and insulin resistance may have an increased risk of colorectal cancer.
Obesity. People who are obese have an increased risk of colorectal cancer and an increased risk of dying of colon or rectal cancer when compared with people considered normal weight.
Smoking. People who smoke may have an increased risk of colon cancer.
Alcohol. Regularly drinking more than three alcoholic beverages a week may increase your risk of colorectal cancer.
Radiation therapy for previous cancer. Radiation therapy directed at the abdomen to treat previous cancers may increase the risk of colorectal cancer.
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Type of surgery to remove rectal cancer
Surgery to remove the cancer is the most common treatment for rectal cancer. Surgery may also be done to treat a blocked bowel or cancer that has spread to other parts of the body.
- Low Anterior Resection Surgery (LAR)
LAR is a common treatment for rectal cancer when the cancer is located well above the anus. During a LAR, the entire rectal cancer, adjacent normal rectal tissue and surrounding lymph nodes are removed through an incision made in the lower abdomen. After the cancer is removed, the cut ends of the rectum are sewn back together. The passage of stool from the large intestine through the anus is therefore preserved. If the cancer is lower in the rectum, the cut end of the large bowel may be attached directly to the anus, a procedure known as Colo-anal anastomosis. When a Colo-anal anastomosis is performed, some surgeons will create a temporary colostomy in order to protect the delicate surgical connection of the large intestine to the anus. After the patient has recovered from the surgery, the temporary colostomy is removed and stool is again passed normally through the large intestine. The colon is resewn to the anus.
Despite undergoing complete surgical removal of rectal cancer, some patients may experience recurrence of their cancer. It is important to realize that some patients with rectal cancer already have small amounts of cancer that have spread outside the rectum and were not removed by surgery. These cancer cells are referred to as micro metastases and cannot be detected with any of the currently available tests. The presence of these microscopic areas of cancer causes the relapses that follow treatment with surgery alone. External beam radiation therapy and chemotherapy can be used to cleanse the body of micrometastases in order to improve the cure rate achieved with surgical removal of the cancer.
Patients undergoing a LAR may experience lower abdominal pain after the operation. Less common complications related to surgery include bleeding, infection and temporary difficulty with emptying the bladder. Some men may experience sexual dysfunction after surgery. In-hospital death occurs after LAR in less than 5% of patients. Patients should ask their surgeon to explain the various surgical complications and their frequency of occurrence at the hospital where the surgery will be performed.
- Abdominoperineal Resection Surgery (APR)
APR is a common treatment for rectal cancer when the cancer is located close to the anus. During an APR, the entire rectal cancer, adjacent normal rectum, rectal sphincter or anus, and surrounding lymph nodes are removed through an incision in the lower abdomen and the perineum (the skin around the anus). Following removal of the cancer, the incision in the perineum is sewn shut. The cut end of the large intestine is attached to an opening in the abdominal wall, called a colostomy. This opening is covered with a bag, which serves to collect stool as it passes through the large intestine and through the colostomy. In contrast to a LAR, the colostomy is permanent.
Many patients would like to avoid a permanent colostomy. When the rectal cancer lies close to the sphincter or anus, an APR is typically recommended. In some instances, a more limited surgery can be used to avoid a colostomy, or radiation therapy can be used to shrink the rectal cancer prior to surgery allowing the patient to maintain control of bowel function. Some small rectal cancers that lie close to the anus can be removed with less extensive surgery called a local excision. Not all patients can undergo a local excision (see Local Excision below).
Patients undergoing an APR may experience lower abdominal pain after the operation. Less common complications related to surgery include bleeding, infection, slow wound healing and temporary difficulty with emptying the bladder. Some men may experience sexual dysfunction after surgery. In-hospital death occurs after APR in less than 5% of patients. Patients should ask the surgeon to explain the various surgical complications and their frequency of occurrence at the hospital where the surgery will be performed.
- Sphincter-Sparing Treatment
The rectal sphincter is the circular muscle that controls defecation. If damaged, patients lose control of bowel function. Sphincter-sparing treatment refers to cancer therapy that avoids removal of the anal sphincter for rectal cancers that lie close to the anus. The standard surgical procedure used to remove rectal cancer that lies close to the anus is an abdominoperineal resection (APR). Following an APR procedure, the anus is removed with the cancer, and the cut end of the large bowel is attached to the abdominal wall to form a colostomy. The colostomy is covered by a bag, which collects stool as it empties from the bowel. Because of the inconvenience of a colostomy, physicians are using sphincter-sparing treatments that allow the patient to preserve function of the anus. Sphincter-sparing treatment for rectal cancer involves limited surgery, often followed by a combination of chemotherapy and radiation therapy. The limited surgery is designed to remove the cancer and a small rim of normal bowel, but not the anus. The surgery may be performed through the anus (transanal excision) or through the coccyx (trans coccygeal) or the tailbone. A transanal excision can be performed for small cancers that lie close (within 2 inches) to the anus. Other small cancers higher in the rectum can be removed with a trans coccygeal excision.
- Local Excision
Limited surgery can be performed to remove the cancer and preserve the anus and prevent the complications that may occur with more extensive LAR or APR surgeries. The limited surgery is designed to remove the cancer and a small rim of normal bowel, but not the anus. The surgery may be performed through the anus (transanal excision) or through the coccyx (trans coccygeal) or the tailbone. A transanal excision can be performed for small cancers that lie close (typically within 2 inches) to the anus. Other small cancers higher in the rectum can be removed with a trans coccygeal excision.
For limited surgery to be effective, the entire cancer with a rim of normal tissue must be removed. Patients with cancers that are larger, more deeply invading, or appear aggressive under the microscope are better treated with traditional surgery. In order to improve the cure rates after limited surgery alone, a combination of chemotherapy and radiation therapy is often administered for cancers that have grown into the muscular wall of the rectum.
Patients undergoing limited surgery may experience pain in the region of the perineum or tailbone. Less common complications related to surgery include bleeding, infection, and difficulty with healing of the rectal wall. In-hospital fatality is very rare after limited surgery.
How long does it take to recover from rectal cancer surgery?
Most patients spend several days in the hospital after surgery, depending on how it was done and their overall health. It could take 3 to 6 weeks to recover at home. Your recovery time will depend on the type of surgery you have had. You’ll want to make sure that you have support at home, a friend or family member, who can help you during this time. Here are a few other things to consider:
Have a pain management plan. Talk to your doctor before the surgery to line up any medications you may need and get tips on other ways to manage it.
Care for your surgery site well. Make sure you’re clear on what you need to do for wound care, and of course, talk to an ostomy nurse if needed!
Showering with gentle soap and water and pat dry is the general rule. NO swimming, hot tubs, or tub baths for at least a month. And do not use ring pillows–they can compromise blood flow to the healing area. Regular pillows are generally okay.
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Is rectal cancer curable?
In general, stages 0, I, II, and III are often curable with surgery. However, many people with stage III colorectal cancer, and some with stage II, receive chemotherapy after surgery to increase the chance of eliminating the disease. People with stage II and III rectal cancer will also receive radiation therapy with chemotherapy either before or after surgery. Stage IV is not often curable, but it is treatable, and the growth of the cancer and the symptoms of the disease can be managed. Clinical trials are also a treatment option for each stage.
Stage 0 colorectal cancer
The usual treatment is a polypectomy, or removal of a polyp, during a colonoscopy. There is no additional surgery unless the polyp cannot be fully removed.
Stage I colorectal cancer
Surgical removal of the tumor and lymph nodes is usually the only treatment needed.
Stage II colorectal cancer
Surgery is often the first treatment. People with stage II colorectal cancer should talk with their doctor about whether more treatment is needed after surgery because some people receive adjuvant chemotherapy. Adjuvant chemotherapy is treatment after surgery with the goal of trying to destroy any remaining cancer cells. However, cure rates for surgery alone are quite good, and there are few benefits of additional treatment for people with this stage of colorectal cancer. Learn more about adjuvant therapy for stage II colorectal cancer. A clinical trial is also an option after surgery.
For stage II rectal cancer, radiation therapy is usually given in combination with chemotherapy, either before or after surgery. Additional chemotherapy may be given after surgery as well.
Stage III colorectal cancer
Treatment usually involves surgical removal of the tumor followed by adjuvant chemotherapy. A clinical trial may also an option. For rectal cancer, radiation therapy may be used with chemotherapy before or after surgery, along with adjuvant chemotherapy.
Metastatic (stage IV) colorectal cancer
If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. Colorectal cancer can spread to distant organs, such as the liver, lungs, the tissue called the peritoneum that lines the abdomen, or a woman’s ovaries. If this happens, it is a good idea to talk with doctors who have experience treating this stage of cancer. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Your treatment plan may include a combination of surgery, radiation therapy, immunotherapy, and chemotherapy, which can be used to slow the spread of the disease and often temporarily shrink a cancerous tumor. Palliative care will also be important to help relieve symptoms and side effects.
At this stage, surgery to remove the portion of the colon where the cancer started usually cannot cure the cancer, but it can help relieve blockage of the colon or other problems related to the cancer. Surgery may also be used to remove parts of other organs that contain cancer, called resection, and can cure some people if a limited amount of cancer spreads to a single organ, such as the liver or a lung.
If the colorectal cancer has spread only to the liver and if surgery is possible either before or after chemotherapy there is a chance of complete cure. Even when curing the cancer is not possible, surgery may add months or even years to a person’s life. Determining who can benefit from surgery for cancer that has spread to the liver is often a complicated process that involves multiple doctors with different specialties working together to plan the best treatment option.
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Can rectal cancer be cured with surgery?
Stage 0 rectal cancers have not grown beyond the inner lining of the rectum. Removing or destroying the cancer is typically all that's needed. You can usually be treated with surgery such as a polypectomy (removing the polyp), local excision, or transanal resection. In rare cases, a more extensive surgery might be needed. The standard surgical procedure used to remove rectal cancer that lies close to the anus is an abdominoperineal resection (APR). Following an APR procedure, the anus is removed with the cancer, and the cut end of the large bowel is attached to the abdominal wall to form a colostomy.
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Does rectal cancer spread fast?
In most cases, colon and rectal cancers grow slowly over many years. The research also suggests that once a colon carcinoma develops, if it is going to spread outside the colon, it will do so in less than two years. We know that most of those cancers start as a growth called a polyp. Rectal cancer most often spreads to the liver. This happens in part because the blood supply from the large intestine, which includes the rectum, is connected to the liver through a large blood vessel.
What are the chances of surviving stage 3 rectal cancer?
Stage I cancers have a survival rate of 80-95 percent. Stage II tumors have survival rates ranging from 55 to 80 percent. A stage III colon cancer has about a 40 percent chance of cure and a patient with a stage IV tumor has only a 10 percent chance of a cure.
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