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National Cancer Institute

PDQ® bullet Treatment  bullet Patients

Rectal cancer


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is cancer of the rectum?
STAGE EXPLANATION
Stages of cancer of the rectum
Stage 0 or carcinoma in situ
Stage I
Stage II
Stage III
Stage IV
Recurrent
TREATMENT OPTION OVERVIEW
How cancer of the rectum is treated
Treatment by stage
STAGE 0 RECTAL CANCER
STAGE I RECTAL CANCER
STAGE II RECTAL CANCER
STAGE III RECTAL CANCER
STAGE IV RECTAL CANCER
RECURRENT RECTAL CANCER
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is cancer of the rectum?

Cancer of the rectum, a common form of cancer, is a disease in which cancer (malignant) cells are found in the tissues of the rectum. The rectum is part of the body's digestive system. The digestive system is made up of the esophagus, stomach, and the small and large intestines. The last 6 feet of intestine is called the large bowel or colon. The last 8 to 10 inches of the colon is the rectum. The purpose of the digestive system is to remove nutrients, such as vitamins and minerals, from food and to store the waste until it passes out of the body.

A doctor should be seen if a person has a change in bowel habits or if there is any bleeding from the rectum.

A doctor will usually begin by giving the patient a rectal examination. In a rectal examination, the doctor places a gloved, greased finger into the rectum and gently feels for lumps. The doctor may then check material collected from the rectum to see if there is any blood in it.

The doctor may want to look inside the rectum and lower colon with a special instrument called a sigmoidoscope or proctosigmoidoscope. This examination, called a proctoscopy or procto examination, finds about half of all colon and rectal cancers. The doctor may also want to look inside the rectum and the entire colon (colonoscopy) with a special tool called a colonoscope. Both examinations are done in a doctor's office. Also, for both tests, patients may feel some pressure usually with no pain.

If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy. Biopsies are usually done during the proctoscopy or colonoscopy in a doctor's office.

The doctor may also perform a test called an endorectal ultrasound. This test uses sound from a probe inserted into the rectum to determine how large the tumor is, and whether it has spread.

Screening tests (such as the rectal examination, proctoscopy, and colonoscopy) may be done regularly in patients who are at higher risk to get cancer. These tests may be done in patients who are over age 50; who have a family history of cancer of the colon, rectum, or of the female organs; or who have a history of ulcerative colitis (ulcers in the lining of the large intestines).

Other tests are being developed. In patients with some forms of rectal and colon cancer, abnormal genes have been found. Genes are markers in cells associated with hereditary traits. Tests are being developed to determine who carries these abnormal genes long before cancer appears.

After treatment, blood tests (to measure amounts of carcinoembryonic antigen or CEA in the blood) and x-ray tests also may be done to see if the cancer has come back.

The prognosis (chance of recovery) and choice of treatment depend on the stage of the cancer (whether it is just in the inner lining of the rectum or if it has spread to other places) and the patient's general state of health.


STAGE EXPLANATION


Stages of cancer of the rectum

Once cancer of the rectum is found (diagnosed), more tests will be done to find out if cancer cells have spread to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the rectum:


Stage 0 or carcinoma in situ

Stage 0 cancer of the rectum is very early cancer. Cancer is found only in the top lining of the rectum.


Stage I

Cancer has spread beyond the top lining of the rectum to the second and third layers and involves the inside wall of the rectum, but has not spread to the outer wall of the rectum or outside the rectum.

Stage I cancer of the rectum is sometimes called Dukes A rectal cancer.


Stage II

Cancer has spread outside the rectum to nearby tissue, but it has not gone into the lymph nodes. (Lymph nodes are small, bean-shaped structures that are found throughout the body. They produce and store cells that fight infection.)

Stage II cancer of the rectum is sometimes called Dukes B rectal cancer.


Stage III

Cancer has spread to nearby lymph nodes, but it has not spread to other parts of the body. (Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store cells that fight infection.)

Stage III cancer of the rectum is sometimes called Dukes C rectal cancer.


Stage IV

Cancer has spread to other parts of the body.

Stage IV cancer of the rectum is sometimes called Dukes D rectal cancer.


Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the rectum or in another part of the body. Recurrent cancer of the rectum is often found in the liver and/or lungs.


TREATMENT OPTION OVERVIEW


How cancer of the rectum is treated

There are treatments for all patients with cancer of the rectum. Three kinds of treatments are available: surgery (taking out the cancer), radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells), chemotherapy (using drugs to kill cancer cells), and biological therapy (using materials made by the body or in the laboratory to kill cancer cells).

Surgery is the most common treatment of all stages of cancer of the rectum.

A doctor may take out the cancer from the rectum using one of the following:

If cancer is found at a very early stage, the doctor may take out the
cancer without cutting into the abdomen. Instead, the doctor may put a
tube into the rectum and cut the cancer out. This is called a local
excision. Sometimes, the doctor may take out the cancer using high-energy
electricity. This is called electrofulguration.

If the cancer is larger, the doctor will take out the cancer and a small
amount of healthy tissue around it. The healthy parts of the rectum are
then sewn together (anastomosis). If only a small amount of tissue is
removed, this is called a wedge resection. If a larger amount of tissue is
removed, this is called a bowel resection. The doctor will also take out the
lymph nodes near the rectum and look at them under the microscope to see if
they contain cancer.

If the doctor is not able to sew the rectum back together, he or she will
make an opening (stoma) on the outside of the body for waste to pass out of
the body. This is called a colostomy. Sometimes, the colostomy is only
needed until the colon has healed, and then it can be reversed. However,
the doctor may have to take out the entire rectum and make the colostomy
permanent. A patient, who has had a colostomy, will need to wear a special
bag to collect body wastes. This special bag, which sticks to the skin
around the stoma with a special glue, can be thrown away after it is used.
This bag does not show under clothing, and most people take care of these
bags themselves.

Radiation therapy is the use of x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that contain radiation through thin plastic tubes (internal radiation therapy) in the intestine area. Radiation can be used alone or in addition to surgery and/or chemotherapy.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by inserting a needle into a vein. A patient may be given chemotherapy through a tube that will be left in the vein while a small pump provides constant treatment over a period of weeks. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the rectum. If cancer has spread to the liver, a patient may be given chemotherapy directly into the artery going to the liver. Chemotherapy or other drugs may be given with radiation therapy to make cancer cells more sensitive to radiation (radiosensitizers).

If the doctor removes all the cancer that can be seen at the time of the operation, a patient may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after an operation to a person who has no cancer cells that can be seen is called adjuvant chemotherapy.

Biological therapy tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy.


Treatment by stage

Treatments of cancer of the rectum depend on the stage of the disease and the patient's overall condition.

Standard treatments, that have been proven effective in past studies, may be received or participation in a clinical trial may be considered. Clinical trials are done to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of cancer of the rectum. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


STAGE 0 RECTAL CANCER

Treatment may be one of the following:

1. Local removal of the tumor.

2. Surgery (bowel resection).

3. Electrofulguration (removal of the tumor using high-energy electricity).

4. Internal radiation therapy.

5. Radiation therapy.


STAGE I RECTAL CANCER

Treatment may be one of the following:

1. Surgery (bowel resection) to remove the tumor.

2. Local removal of the tumor with or without radiation therapy plus chemotherapy.

3. Internal radiation therapy.

4. Electrofulguration (removal of the tumor using high-energy electricity).


STAGE II RECTAL CANCER

Treatment may be one of the following:

1. Surgery (bowel resection) to remove the tumor, followed by radiation therapy and chemotherapy.

2. Surgery (bowel resection) to remove the tumor, as well as the colon, rectum, prostate, or bladder, depending on where the cancer has spread. Surgery is followed by radiation therapy and chemotherapy.

3. Radiation therapy with or without chemotherapy followed by surgery (bowel resection) followed by chemotherapy.

4. Clinical trials evaluating all of the above treatments to find better combinations of chemotherapy drugs and better ways of combining radiation therapy with chemotherapy.

5. Radiation therapy following surgery with chemotherapy or radiation therapy.


STAGE III RECTAL CANCER

Treatment may be one of the following:

1. Surgery (bowel resection) to remove the tumor, followed by radiation therapy and chemotherapy.

2. Surgery (bowel resection) to remove the tumor, as well as the colon, rectum, prostate, or bladder, depending on where the cancer has spread. Surgery is followed by radiation therapy and chemotherapy.

3. Radiation therapy with or without chemotherapy followed by surgery (bowel resection) followed by chemotherapy.

4. Clinical trials evaluating all of the above treatments to find better combinations of chemotherapy drugs and better ways of combining radiation therapy with chemotherapy.

5. Radiation therapy following surgery with chemotherapy or radiation therapy.


STAGE IV RECTAL CANCER

Treatment may be one of the following:

1. Surgery (bowel resection) to remove or go around the tumor or to make the patient more comfortable.

2. If the tumor has spread only to the liver, lungs, or ovaries, surgery to take out the tumor where it has spread.

3. Radiation therapy and chemotherapy to reduce the size of the tumor and make the patient more comfortable.

4. Clinical trials of chemotherapy and biological therapy.


RECURRENT RECTAL CANCER

Treatment may be one of the following:

1. Surgery (bowel resection) to remove or go around the tumor or to make the patient more comfortable.

2. Radiation therapy to reduce the size of the tumor and make the patient more comfortable.

3. Clinical trials of chemotherapy to reduce the size of the tumor and make the patient more comfortable.

4. Radiation therapy and chemotherapy to reduce the size of the tumor and make the patient more comfortable.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about cancer of the rectum, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, you can speak with a trained information specialist who can answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public and can be sent on request. The following booklet about cancer of the rectum may be helpful:

What You Need To Know About Cancer of the Colon and Rectum

The following general booklets on questions related to cancer may also be helpful:

What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again

There are many other places where people can get materials and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 08/1998


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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