Rectal Cancer

Rectal cancer begins in the cells in your rectum, which is at the end of your colon (this is why rectal cancer and colon cancer are often referred to under the umbrella term ‘colorectal cancer.’ However, they’re treated differently.)

It tends to start as polyps (small, benign cells) that develop in your rectum. Some of these polyps can become cancerous, causing rectal cancer.

Symptoms of rectal cancer include:

• Rectal bleeding / blood in your stool
• Rectal pain
• A change in bowel habit from your normal pattern
• Abdominal cramps, bloating or gas
• Ongoing diarrhoea or constipation
• Unexplained weight loss
• Fatigue
• Feeling you haven’t fully emptied your bowel
• A mass in your back passage

If you have any of these symptoms, you should see your doctor.

It’s not clear what causes rectal cancer, but there are certain risk factors that make you more likely to get it, such as:

• Having polyps – as mentioned, some polyps can develop into rectal cancer
• Your age – those over 50 are more likely to get it
• Your genes – if you have family member/s with colorectal cancer, this increases your chances, as does having some inherited conditions, such as Lynch syndrome or familial adenomatous polyposis
• Smoking
• A high intake of red meat
• Having certain other conditions – including inflammatory bowel conditions, like Crohn’s disease or ulcerative colitis

If you have an average risk of developing rectal cancer, you’ll be invited to regular screenings to look for blood in the stool from the age of 60. If the stool test is positive, you will be invited for a colonoscopy. In some parts of the country, people are invited to have a flexible sigmoidoscopy (like a colonoscopy, but only examining the left half of the colon) at the age of 55, also known as bowel scope screening. If you have a higher than average risk due to one or more of the above factors, you may be invited to have regular colonoscopies before the age of 60.

However, don’t wait for a screening if you’re worried: if you’re experiencing symptoms you think might be caused by rectal cancer, see your doctor. To help make a diagnosis, your doctor will ask you about your medical history and symptoms, and may refer you for blood tests, a colonoscopy or digital rectal examination.

Treatment options vary individual by individual. Your treatment depends on a range of factors, such as the stage the cancer is at, your own wishes and your health profile. Because treatment is complex and involves multiple specialties, treatment options are usually discussed at a multidisciplinary meeting (MDT), consisting of colorectal surgeons, oncologists, radiologists, pathologists and a colorectal cancer specialist nurse (CNS).

In most cases, you’ll be recommended surgery, which could include:

• Local excision – if your tumour is small
• Resection and anastomosis – where the tumour and some surrounding tissue is removed, then the ends of your bowel rejoined
• Total mesorectal excision – the most commonly used surgery, this removes your rectum and lymph nodes surrounding it
• A temporary defunctioning ileostomy – where the bowel join in the rectum is rested for 3 to 6 months by diverting stool from the end of the small intestine into a bag on the tummy surface
• A permanent colostomy in people who are not fit enough to have the bowel joined up

In some cases, it is better to give oncological treatment to the tumour before surgery, in order to shrink it down and improve the chances of cure. This treatment takes the form of chemoradiotherapy (radiotherapy for 5 weeks accompanied by a small dose of chemotherapy), radiotherapy alone or chemotherapy alone.

If surgery doesn’t stop the cancer, other options are chemotherapy, radiation therapy, immunotherapy or palliative care. Your doctor will discuss your options with you in detail and recommend what they think is the best option.

If you’re unsure what treatment you should go for, or the above treatments don’t work for you, our team of expert specialists are here to help.