Rectal cancer Information
This is not a substitute for direct care by YOUR doctor. Confirm with your doctor before doing any of the following.
1. What stage am I?
Your stage is determined by how deep the tumor goes into the bowel wall, if the
tumor invades the lymph nodes, and if there is cancer outside of the bowel. This
can be estimated using MRI and CT (computed tomography). Sometimes PET
(position emission tomography) and/or Ultrasound are also needed. If lesions
are found outside of the bowel, the lesions typically have to be biopsied to
confirm if they are cancer.
2. How is rectal cancer treated?
Most patients with rectal cancer start treatment with chemotherapy and
radiation. Approximately two out of every three patients will have a complete
response from this and not be recommended to undergo surgery.
The remaining one third of patients will still have some tumor left, even after
chemotherapy and radiation. These patients will be recommended to undergo
surgery after completing chemotherapy and radiation treatment.
Of the patients that have a complete response to chemotherapy and radiation,
one half of these patients will "regrow" the tumor and then be recommended to
undergo surgery. If "regrowth" happens, it is typically in the first 1-2 years
after completing chemotherapy and radiation. The other half of the patients
that do not have any tumor regrowth, will never need to undergo surgery to
remove the tumor.
How do we know if the tumor regrows or never fully goes away? Patients will
undergo exams in clinic, endoscopic evaluations (a mini - colonoscopy called a
flexible sigmoidoscopy), and MRIs at least every 3-6 months.
3. Who does not need chemotherapy or radiation?
Patients with very early stage tumors can sometimes just undergo surgery and
not need further treatment. This will be determined by the evaluation steps in
question 1. The laboratory findings by the pathologist make the final
determination on cancer stage.
4. Will I need an ostomy (bag)?
If you undergo surgery after chemotherapy and radiation, then yes, you will
need an ostomy for at least 3-6 months. After radiation, the tissues will not heal
very quickly. The ostomy allows the new connection between pieces of bowel to
heal without poop going by it. A special CT scan is done to evaluate the
connection (anastomosis). When the anastomosis is confirmed to be healed on
the CT, then the ostomy can usually be reversed.
5. Why would an ostomy need to be permanent?
In patients where the tumor is very "low" (almost to the anus), and surgery is
required, the muscles that control bowel function must be removed. If these
muscles are removed, you will not be able to control your bowel function at all.
This means that poop will come out without you being able to control it. It also
means that the anus will need to be removed as well. The area will be sutured
closed during something called an Abdominoperineal Resection.
6. What is all of this testing that I am getting?
Before surgery, you need a colonoscopy (which is probably how the cancer was
diagnosed). The CT scan and MRI are explained in question 1. You will also
need a lab test called "CEA." CEA (carcinoembryonic antigen) is something that
we look at after surgery as a marker of worsening cancer. If your CEA goes up,
then we know to be more concerned that the cancer may be back, and we need
to do more testing.
7. Are my children at a higher risk of cancer?
Yes. Any first degree relative (children, siblings, parents) of a person with rectal
cancer should undergo colonoscopy (not Cologuard testing) every five years
instead of every ten years. They should also start at 10 years before your cancer
was diagnosed or at 40 years old (whichever is younger).
8. Will my bowel function ever be “normal” again?
Your function after treatment will likely be different than your baseline. This
difference can be small or large. It can be permanent or temporary. Some
patients develop something called Low Anterior Resection Syndrome (LARS).
This is a group of symptoms such as fecal urgency, frequent bowel movements,
and difficulty emptying your bowels. There are ways to improve things if you
do develop problems, but for some patients, it is a significant problem.
9. Am I going to be okay?
Cancer is a very scary thing. The most important thing in figuring out survival
likelihood is what stage you are at. There are a lot of different factors that go
beyond stage though. These include: the tumor DNA / genetic factors, how
healthy you are to begin with, if you complete treatment, etc.
There are things that you can do to help your health. Treatment makes all of
these things more difficult, so just do your best. Even trying some of these can
help (regardless of how successful you are at them).
Here are some recommendations:
1. If you are a smoker – QUIT NOW
2. Exercise if you can.
3. Try to eat well. This does not mean that you have to be perfect or that all of
your food must be organic or fresh or a special diet. This means that you
should try to eat a good variety of fruits, vegetables, and protein.
4. Friends and family help a great deal. Support groups can offer you
encouragement. Your mental health can make a big difference. Let your medical team know
if we can do something to help you during this stressful time.
10. How is my surgery done?
Most patients undergo minimally invasive surgery. This refers to either
laparoscopic or, more commonly, robotic surgery using small incisions and a
camera. If it is not safe to do surgery through small incisions, a larger incision
will need to be made. This is uncommon but does happen.
11.How long will I be in the hospital?
Usually, 2-4 days, depending on the kind of surgery and how you recover.
Before being discharged from the hospital, you need to have your pain well
controlled, tolerate a diet, and have a bowel movement.
https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1461