At HCG, our specialists opt for a comprehensive and multidisciplinary approach while planning treatment for rectal cancer. This helps our specialists have a thorough understanding of the case, which is extremely important for them to devise a personalized treatment plan. The more personalized the cancer care is, the better the health outcome.
There are a myriad of tests available for rectal cancer diagnosis. Initially, when patients present with symptoms, doctors recommend a detailed physical examination and medical history assessment. The physical exam and the medical history evaluation help doctors understand the possible causes of the symptoms and recommend additional rectal cancer tests to arrive at a definitive diagnosis.
The answer to the question, “How to diagnose rectal cancer?” or “How is rectal cancer detected?” lies in the following tests:
A colonoscopy is a non-invasive diagnostic test recommended for rectal cancer diagnosis. This is one of the first tests recommended when an individual is suspected of having rectal cancer.
During this procedure, a long and slender tube (endoscope), which carries a light source, a camera, and specialized instruments, is inserted through the anus to examine the cavities of the colon and rectum. This rectal cancer test helps doctors look for the presence of cancerous polyps and other signs of cancer in the rectum.
Another common test recommended for rectal cancer diagnosis is a biopsy. A biopsy involves the removal of a small piece of tissue from the suspected area and its examination under a microscope for the presence of cancer cells. A biopsy is mostly recommended for the conclusive diagnosis of rectal cancer.
Once the rectal cancer diagnosis is confirmed, further tests are recommended to determine the extent of the disease. These tests help doctors find out if the cancer has spread to other parts of the body.
A complete blood count (CBC) is recommended for various reasons. A CBC helps determine the levels of various blood cells. It could also be recommended to look for infections, which, at times, can present with symptoms similar to those of rectal cancer. A CBC may also be ordered to check for anemia, which is one of the indicators of rectal cancer.
Blood tests may also be recommended to assess the functions of different body parts. If cancer has spread to other organs, such as the kidneys or liver, their functions are hampered, as are the levels of specific chemicals released by them. A blood test can be used to assess the levels of these chemicals and check if rectal cancer has spread to other organs.
Carcinoembryonic antigen (CEA) is a tumor biomarker that is associated with colorectal cancer. A CEA test has multiple applications; it is recommended as a rectal cancer screening tool for high-risk individuals; it may help in monitoring the treatment response; and lastly, it may also help in predicting the risk of recurrence in rectal cancer patients.
That said, the CEA test may report false positives or false negatives, too. Also, having higher levels of CEA does not always confirm a rectal cancer diagnosis. Therefore, it is important not to consider this a stand-alone rectal cancer test.
A CT scan of the chest captures detailed, 360-degree-view images of the chest region using X-rays. This scan is recommended for rectal cancer patients to determine if the cancer has spread to the organs in the chest region.
An MRI scan involves capturing detailed images with the help of powerful magnetic fields and radio waves. An MRI of the pelvis is recommended for rectal cancer patients to check if the cancer has spread to the organs present in the pelvic region.
During a digital rectal exam, the doctor will physically examine the rectum for the presence of a tumor. The doctor will insert a lubricated, gloved finger into the anus to feel the walls of the rectum cavity, the prostate gland (in men), and reproductive structures (in women) for lumps and other signs of rectal cancer.
Microsatellite instability (MSI) is the latest diagnostic test available for rectal cancer diagnosis. MSI is a genetic mutation that can lead to colorectal cancer. This is an important rectal cancer prognostic factor, too. There are MSI-high rectal cancers and MSI-low rectal cancers. MSI-high rectal cancers have a better prognosis than MSI-low rectal cancers.
Significant advancements have happened in the field of rectal cancer management, and therefore, we have multiple rectal cancer treatment options today.
Depending on the stage of the disease, its grade, the patient’s age, and their overall health status, the expert team will devise a personalized treatment plan. Different treatment approaches available for rectal cancer include:
The surgical management of rectal cancer involves the removal of the tumor and a small portion of healthy tissue that surrounds it (the margin). Surgery is often the first line of treatment for rectal cancer. Also, surgery is often recommended in combination with radiation therapy or chemotherapy for better treatment outcomes.
If rectal cancer is in its early stages, the doctor may recommend the removal of the tumor and a small amount of surrounding tissue (the margin), and this procedure is known as local excision. As an effective rectal carcinoma treatment, this procedure helps preserve the organ while treating the disease effectively. Local excision may be followed by other treatments like radiation therapy and chemotherapy to enhance the overall effectiveness of the treatment and reduce the risk of recurrences.
If the tumor size is large or a large portion of the rectum is affected by cancer, the doctor may recommend partial or complete removal of the rectum (proctectomy).
If there is any healthy rectum tissue left, it will be reconnected to the colon through a procedure called anastomosis. Normal bowel movements are possible; however, the frequency and pattern of the bowel movements may vary.
Sphincter-preserving surgery is another form of partial proctectomy where the doctors operate on the tumor and preserve the sphincter muscles, which help in controlling bowel movements.
Total proctectomy involves the complete removal of the rectum.
This procedure may or may not be followed by radiation for rectal cancer or chemotherapy.
If the rectal cancer has advanced significantly, then the removal of the rectum and anus may be recommended. In some cases, a part of the colon may also be removed. This procedure is called an abdominoperineal resection (APR).
This will be followed by a colostomy, wherein the colon is connected to an opening made in the abdomen (stoma) to help the patient pass stools into a bag.
Chemotherapy is a form of systemic therapy that uses powerful drugs to destroy cancer cells throughout the body. Chemotherapy may be recommended before rectal cancer surgery to shrink the tumor size or after rectal cancer surgery to destroy the residual cancer cells and reduce the risk of recurrence.
Chemotherapy is especially recommended in cases where the rectal cancer is aggressive, hard-to-reach, advanced, or has higher chances of recurrence.
In some cases where rectal cancer treatment without surgery is recommended, the doctor may recommend chemotherapy.
Radiation therapy for rectal cancer involves targeting the tumor with powerful radiation beams. These radiation beams kill cancer cells by destroying their DNA structure. Radiation therapy is a localized and non-invasive form of rectal carcinoma treatment that has been found to improve treatment efficacy remarkably.
In some cases, the oncologists recommend combined chemotherapy and radiation therapy for rectal carcinoma treatment. Together, chemotherapy and radiation therapy can kill more cancer cells and help manage the disease more effectively. Chemoradiation is reported to be a highly effective treatment for rectal cancer.
Targeted drug therapy is a new treatment for rectal cancer. This treatment precisely targets the cancer cells while leaving the healthy cells intact. Targeted therapy drugs identify specific molecules on the surface of cancer cells; these molecules are responsible for the growth and spread of cancer cells.
By targeting these molecules, targeted therapy drugs can help in effective rectal cancer management.
Immunotherapy is another new treatment for rectal cancer, wherein the patient’s immune system is re-engineered to recognize and attack the cancer cells. Immunotherapy may not be recommended as a stand-alone treatment; it is often recommended along with other standard treatments to enhance the overall efficacy of the treatment.
Supportive care, or palliative care, is recommended in advanced or terminal stages when there are no chances to treat or manage rectal cancer effectively. Palliative care primarily focuses on easing the symptoms associated with advanced rectal cancer and improving the quality of life for patients.
Rectal cancer management is more than just its treatment. Rectal cancer patients often need assurance, support, and guidance in navigating through their cancer journey. The following are a few things that can help patients during their rectal cancer treatment:
Making informed decisions is important for successful rectal cancer management, and for this to happen, both the patient and their caregivers must have a sufficient level of understanding about rectal cancer. Learning about its risk factors, its symptoms, the treatment options available for rectal cancer, post-treatment care for rectal cancer, etc. can help patients and their families know what to look forward to.
Having a support system goes a long way when dealing with cancer. Keeping in touch with family and friends and seeking emotional support can help patients take their minds off the disease. This can also have a positive impact on the treatment response.
Talking to someone who can understand the situation and respond positively is also imperative. There are multiple online and offline support groups where patients can get in touch with cancer survivors. Interacting with them can help build a sense of understanding and community.
Recurrent rectal cancer, whether locally or in distant areas, demands a comprehensive and personalized treatment approach. Recurrences are managed through multiple treatment approaches, such as surgery, chemotherapy, radiation for rectal cancer, targeted therapy, and immunotherapy.
Local recurrent rectal cancer refers to the reappearance of cancer cells in or close to the original tumor location. Local recurrence is often managed with surgery, radiation for rectal cancer, chemotherapy, or targeted therapy, depending on individual case parameters.
Distant recurrent rectal cancer refers to the reappearance of cancer in distant organs in the body. Distant recurrences are often treated with systemic therapies, like personalized immunotherapy and targeted therapy.
Biofeedback cancer rehabilitation therapy for rectal cancer refers to the patient-centric rehabilitation approach that is focused on enhancing recovery and improving the quality of life. Comprehensive rehabilitation programs often involve biofeedback techniques that help patients regain control over their bodily functions, manage treatment-related side effects, and enhance their overall well-being.
Opting for biofeedback cancer rehabilitation therapy can help cancer patients in multiple ways:
Biofeedback therapy can help rectal cancer patients strengthen their pelvic floor muscles, regain their urinary control, and minimize the incontinence issues that are common after rectal tumor treatment.
Rectal cancer treatment can hamper bowel functions in most cases, and carefully planned biofeedback therapy can help restore bowel functions and improve the quality of life for patients.
Biofeedback rehabilitation therapy also helps patients manage their symptoms and effectively cope with treatment-related challenges.
The following are important things to keep in mind while preparing for a doctor’s appointment:
In some cases, the doctor may ask the patient to refrain from certain foods and medications, and the patient must adhere to these restrictions.
The patient needs to have a comprehensive list of all medications, including dosages, that they are on. This is important as it will help the doctor thoroughly understand the patient’s medical history.
Preparing a list of all the questions and concerns that need to be discussed during the appointment can be time-saving and help the patient make the most of their appointment.
In rectal cancer management, multiple factors affect or decide the disease prognosis. These factors are also taken into account while devising the treatment plan for rectal cancer. The following are the important factors that specialists consider for effective rectal cancer management:
The disease stage is an important factor for treatment planning and disease prognosis. Early-stage cancers have a better prognosis and can be treated more readily than advanced-stage rectal cancers. As the disease advances, its treatment becomes challenging, and it is also associated with a poor prognosis.
The depth of the tumor invasion is one of the most important disease prognostic factors. Those cancers that have spread into and beyond the rectum wall are more likely to metastasize into other body parts, and therefore, these cancers have a poor prognosis. Cancers that have not invaded into the bowel wall, on the other hand, have a better prognosis.
The exact location of the tumor is another important disease-prognostic factor. The tumors that form in the lower rectum are more likely to spread to other body parts than the tumors that form in the upper rectum.
A blocked bowel can cause problems related to bowel movements, and a hole in the bowel can increase the risk of infection. These complications may impact the clinical outcome of rectal cancer treatment. These conditions should be managed effectively before rectal tumor treatment.
At times, the entire tumor cannot be removed with surgery. In such cases, after rectal cancer surgery, other treatments like radiotherapy or chemotherapy may be recommended to treat the disease effectively. Often, early-stage rectal cancers can be treated with surgery alone, but as the disease advances, a more comprehensive treatment approach is required.
The overall health condition of the patient is an imperative prognostic factor. Rectal cancer patients with no underlying medical conditions have more treatment options and a relatively better prognosis than patients with underlying medical conditions.
Cancers occurring for the first time often have a better prognosis, as compared to recurrent cancers. This is also an important factor to consider while planning rectal tumor treatment.
Side effects associated with rectal cancer treatment vary from patient to patient. It may also depend on the type of cancer treatment given.
Most of these side effects go away sometime after the treatment, and the severity may vary from mild to moderate. However, in rare cases, these side effects can be severe, and in such cases, patients must talk to their expert team for appropriate medical attention.
Choosing the right cancer hospital for the diagnosis and treatment of rectal cancer is an important decision. As a leading rectal cancer treatment hospital, HCG uses a multidisciplinary approach, wherein specialists from multiple disciplines come together to study each case thoroughly, understand the diagnosis properly, and devise a treatment plan accordingly.
Our care approach is patient-centric and personalized, through which we put our patient’s comfort and well-being above everything. We employ modern technologies and treatment approaches like robotic surgery, CyberKnife, targeted therapy, immunotherapy, etc., to treat and manage rectal cancer effectively and improve the survival rates and quality of life for rectal cancer patients.