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The most common sign and
symptom of rectal cancer is rectal bleeding.
And it's usually painless bleeding.
And it can be either blood that appears on the toilet paper or
in the toilet itself after a bowel movement.
Other signs can be pain,
depending on where the tumor is, diarrhea or constipation.
The scary thing about rectal cancer is, commonly,
there are no signs or symptoms.
And people can have this tumor growing in them for a while and
not even know it.
That's why it's very important to adhere to the screening
guidelines that have been established, to either
prevent colon and rectal cancer by removing precancerous lesions
when they occur in individuals, or detect cancers early.
So that everybody's chance of survival is better.
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Screening for rectal cancer is generally that people should
undergo a regular physical exam with a digital exam,
digital rectal exam, looking for
blood in the stool whilst the digital exam is done.
When people get to the age of 50, if they don't have any
history of colon or rectal cancer in their family, and
if they don't have any history of other colonic diseases,
like inflammatory bowel disease,
they should undergo a screening colonoscopy.
If they're not going to have a colonoscopy,
they can have a sigmoidoscopy, which is looking at less of
the colon in conjunction with radiology tests to look for
either precancerous or cancerous conditions.
Now if people have a history of colon and
rectal cancer in their family, then generally we recommend
the screening start ten years earlier at the age of 40.
And if the family member that has colon or rectal cancer in
your family has had that cancer very early, then we could
potentially recommend screening even earlier than that.
So, screening is very important because often times
these cancers develop from precancerous lesions.
And if they're detected early and
removed then you won't develop the cancer.
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So people should consider genetic testing if
they are what I would consider a young person.
And young we would define as someone under the age of 40, or
people who have a significant family history of rectal cancer.
Those people are individuals who have direct relatives,
either a mother, father, sister, or brother with rectal cancer.
If people have many relatives in their family that have rectal
cancer, so uncles, aunts, cousins, those also are people
who I think should consider some sort of testing.
Nowadays, almost all colorectal cancers undergo some form of
genetic testing.
Those tests that are done are looking at specific
gene defects that we then use to define how we treat
the cancers after surgery with chemotherapy.
So there are some defects that we have that will respond very
well to chemotherapeutic agents.
And so by defining those defects in all individuals,
we know whether or not they should get certain drugs.
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There actually are quite a few minimally invasive treatment
options now for rectal cancer.
There is the, what we call the laparoscopic approach, which
uses a camera and instruments that are placed through small
incisions to free the cancer up from its attachments.
Free the rectum up from its attachments.
Remove the portion of colon and rectum that has the cancer and
put everything back together.
That can be done in conjunction with
new technology that allows us to operate through the anus freeing
up the rectum in difficult places.
That's something called a tamis or a TEM procedure.
Or it can be done with the robot, which currently is
also used to mobilize and remove the portions of the colon and
the rectum, and put things back together.
Technology is advancing at a very rapid pace.
And so, every two or three years,
we have a new piece of equipment that makes it easier for
us to do this without making large incisions.
And I think there are multiple options for treating these
patients with rectal cancer with smaller incisions.
Now, smaller incisions are helpful, and
we think that people recover quicker with them.
But they don't necessarily reduce the complexity,
or the difficulty of the operation.
So that's something to keep in mind.
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I think the advances for
treating recurrent rectal cancers are, again,
multi-factorial and involve multiple different teams.
One of the advances is we just have better techniques of
operating, of maintaining patients' vital signs in
the operating room so that we can do bigger procedures.
If the cancer hasn't spread to other places we can
still perform large resections in the pelvis and
maintain patients' quality of life and
indeed have low mortality rates with these procedures.
A second advancement is in the use of intraoperative
radiation therapy,
which over the last 25 years has really also gone through
tremendous improvement, and has sort of revolutionized the care.
We have the capability here.
And there are certain centers in the United States to deliver
the radiation to the patient during the operation,
when the abdomen is open, thereby reducing the risk of
radiation side effects to other structures.
Finally, the way we reconstruct either the rectum,
colon, or other structures such as the bladder,
have advanced people's quality of life after these procedures.
So all of those things together have improved the likelihood
of being able to remove recurrent rectal cancer, and
have also improved people's survival and
quality of life after the procedure.
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Well, for rectal cancer, there have been dramatic improvements
over the last 10 to 15 years in how we manage these tumors.
And those improvements include advances in chemotherapy and
radiation therapy.
And indeed nowadays many rectal cancers,
before we even think about doing surgery,
are treated with chemotherapy and radiation therapy together.
There are different forms of radiation therapy and
there are different chemotherapeutic agents.
It's really very important to have a team that looks at
the entire picture with respect to the patient and the cancer to
determine what is the best therapy prior to surgery.
What surgery should be done.
And then, how to care for
the patient after the surgery is completed.
We feel that that multidisciplinary approach
really provides the highest quality care that you can
achieve.
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