Types of Treatment for Rectal Cancer

Types of Treatment for Rectal Cancer

Rectal cancer, a malignant growth originating in the cells of the rectum, is among the most common forms of cancer in the United States. According to the American Cancer Society, new rectal cancer cases as of 2023 are 46,050, affecting men and women.

When dealing with rectal cancer, there are different types of treatment for rectal cancer. The options may vary depending on its size, location, family history, and overall health.

Work with a specialized medical team to find the right combination of treatment plans to combat rectal cancer and regain your health. Read this article to learn what the types of treatment for rectal cancer are.

What is the Diagnosis of Rectal Cancer?

Early detection of rectal cancer increases your chances of successful management and cure. The process starts with a thorough medical history and physical examination, during which your doctor will ask about your symptoms, risk factors, and family history of cancer.

Your healthcare provider will use the following diagnostic methods to identify and assess rectal cancer.

  • Colonoscopy – This procedure involves the insertion of a flexible tube with a camera (endoscope) into your rectum and colon. The camera lets the doctor see your rectal lining and identify abnormal growths or tumors.
  • Digital rectal examination (DRE) – In a DRE, your doctor inserts a gloved finger into your rectum to feel for abnormal masses or growths close to the rectal opening.
  • Endorectal Ultrasound – This imaging method uses sound waves to create images of your rectum’s layers and nearby lymph nodes. It helps detect the tumor’s depth and invasion into surrounding tissues.
  • MRI (Magnetic Resonance Imaging) – MRI provides high-resolution images that comprehensively check the tumor’s size, location, and involvement with nearby structures.
  • CT (Computed Tomography) Scan – CT scans give detailed cross-sectional images of your abdomen and pelvis, helping evaluate the extent of tumor growth and the involvement of nearby organs.
  • Biopsy and pathology – Your doctor may request a biopsy if they identify a suspicious growth during a colonoscopy or imaging study. During a biopsy, your doctor will extract a small tissue sample from the tumor for examination by a pathologist.

With advancements in medical technology and a multidisciplinary approach, doctors are better equipped to accurately diagnose rectal cancer, allowing you to start on a journey toward effective treatment and improved quality of life.

What are the Stages of Rectal Cancer?

Understanding the stages of rectal cancer is crucial for you and your healthcare team as it guides treatment decisions, prognosis assessment, and overall disease management. The staging of rectal cancer is based on the TNM classification system, which evaluates three key aspects of the disease:

  • A tumor (T) – This category assesses the primary tumor’s size and extent of invasion into nearby tissues.
  • Lymph Nodes (N) – The node category indicates whether cancer has spread to nearby lymph nodes.
  • Metastasis (M) – This stage shows if the cancer has spread to distant body parts.

Using the TNM classification, the stages of rectal cancer are defined as follows:

  • Stage 0 (Tis) – Also known as carcinoma in situ, this stage refers to cancer confined to the rectum’s inner lining and has not invaded deeper layers.
  • Stage I (T1 or T2, N0, M0) – At this stage, cancer has grown into the deeper layers of the rectal wall (T1 or T2) but has not spread to nearby lymph nodes.
  • Stage II (T3 or T4, N0, M0) – Cancer has developed into or through the outermost layers of the rectal wall (T3 or T4) but has not spread to nearby lymph nodes.
  • Stage III (Any T, N1 or N2, M0) – Cancer may be any size (T) but has spread to nearby lymph nodes (N1 or N2). The involvement of lymph nodes suggests a more advanced stage and a higher risk of recurrent rectal cancer.
  • Stage IV (Any T, Any N, M1) – Cancer has spread to distant parts of the body (metastasis). Common sites of metastasis include the liver, lungs, and bones.

Localized therapies such as surgery and radiation can successfully treat early-stage cancers (Stages 0 and I). Advanced stages (Stages III and IV) may require a combination of treatments, including surgery, chemotherapy, radiation, and immunotherapy.

Types of Treatment for Rectal Cancer

If you have a positive rectal cancer result, treating it will involve different approaches to effectively target the disease and enhance your outcome. Here are three significant treatment modalities;

1. Surgery

For localized tumors–those that have not spread beyond the rectum, your doctor can successfully treat them with surgery.  Some of the surgical techniques include;

  • Low anterior resection ( LAR) – With this procedure, the cancerous part of the rectum is removed, and the remaining healthy portions are reconnected, allowing normal bowel function.
  • Abdominoperineal Resection (APR) – For more advanced tumors, your doctor will remove the rectum and anus, then create a permanent colostomy–an opening through the abdominal wall for waste elimination in a bag.
  • Transanal Endoscopic Microsurgery (TEM) – This minimally invasive procedure uses specialized tools to remove early-stage tumors through the anus.
  • Local excision – Your doctor will remove the cancer through the rectum, eliminating the need for a large incision.

Surgery will help remove the cancerous growth. Your doctor will remove the cancerous part along with some healthy tissues to ensure complete eradication.

2. Chemotherapy

Chemotherapy uses drugs to destroy cancer cells or stop their growth. Your doctor can administer chemotherapy before or after surgery, individually or combined with other treatments.

Before surgery, you may receive neoadjuvant chemotherapy to shrink the tumor for easy removal. After surgery, your doctor can administer adjuvant chemotherapy to eliminate the remaining cells and reduce the risk of recurrence.

If cancer has spread to the liver–beyond the rectum, your doctor may recommend systemic chemotherapy. It targets cancer cells throughout the body using oral medication or intravenous infusions.

3. Radiation Therapy

This rectal treatment technique uses high-energy rays to target and destroy cancer cells. Your healthcare team can use it before or after surgery to reduce tumor size, improve surgical outcomes, or eliminate remaining cancer cells.

External beam radiation delivers focused radiation from outside the body, while internal radiation(brachytherapy)places a radioactive source close to the tumor.

Are There Other Treatment Options for Rectal Cancer?

The treatment choice depends on your cancer stage, overall health, and preferences. Your oncologists and other multidisciplinary teams may settle on other options like radiofrequency ablation (RFA) and cryotherapy. These are minimally invasive techniques that use extreme temperatures to destroy cancer cells–RFA uses heat, and cryotherapy harnesses cold.

Another option is immunotherapy, where your body’s immune system is enhanced to recognize and attack cancer cells. Also, using monoclonal antibodies to bind specific proteins on cancer cells can disrupt their growth and signaling.

For elderly patients, doctors may consider watchful waiting or active surveillance. The healthcare team assigned to the patient will monitor the cancer without immediate intervention; if the cancer grows, doctors can start treatment later.

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