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The rectum is the last 5 or 6 inches of the intestinal canal just above the anus. Although, strictly speaking, the rectum is part of the colon, the location of this last portion of the intestinal canal presents special problems when it is the site of cancer.
35,000 people per year are diagnosed with rectal cancer.
Often the first sign of cancer is blood in the stool. Sometimes a small amount of blood will be overlooked by the patient, but even very small amounts of blood can be simply identified with special test cards provided to the patient by his or her physician. Once a problem is suspected, examination of the rectum and colon with a scope provides important information. At the time of this examination a biopsy of any suspicious area is obtained. Further examination of the biopsy material under a microscope will identify cancer if it is present. Next it is important to determine the extent of the disease. This is done by a CAT scan of the abdomen to see if there is any distant spread.
A detailed examination of the rectal area with ultrasound will identify the size, location, depth of invasion and lymph node involvement. Armed with this information on the stage of the tumor, the surgeon can prepare a plan of treatment individualized for the patient.
Patients with early stage cancer (no distant spread and minimal local extension) can proceed directly to surgical removal of the cancer. Other patients with more advanced stages of the disease can be "down staged" by the use of chemotherapy and radiation. Following this "pre-operative" treatment, surgery can be expected to be more effective.
After surgery and recovery a follow-up program is established with each of the team members: surgeon, radiation oncologist and medical oncologist. A genetic evaluation is also available. At Saint Barnabas Medical Center our team approach to this method of pre-operative staging, surgical treatment and follow-up have allowed increasing numbers of our patients to achieve the ultimate result, cure of rectal cancer.
Author: Mark Gilder, MD
Phone: (973) 467-2277
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Surgical Department
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