Rectal Cancer

What is rectal cancer?

Rectal or colorectal cancer is a type of cancer that starts in the rectum, the last few inches of the large intestine (colon). Since it is part of the same area of the body that also causes anal and colon cancer, it has some of the similarities in terms of symptoms and treatment options.

Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, and the second leading cause of cancer-related death. Rectal cancer is often curable, especially when diagnosed and treated early. Screening plays an important role in survival rates. Early detection may also allow for options for treatment that preserve the rectum and anal sphincter and avoid colostomy bags.

Understanding risk factors plays a role in screening, too. Monitoring your health and any changes you experience can be the first step in noticing signs or symptoms of rectal cancer.

Colon and Rectal Center of Excellence

The AHN Colon and Rectal Cancer Center of Excellence is accredited by the Commission on Cancers National Accreditation Program for Rectal Cancer (NAPRC). AHN is considered a high-volume center. We have experts in colorectal surgery; medical, surgical, and radiation oncology; pathology; radiology; and cancer support services and navigation. Together, every week, these highly trained and skilled providers review all rectal cancer and complex colon cancer cases in a multidisciplinary format to ensure the optimal plan is developed and tailored to each individual patient at each phase of their cancer journey.

Quick guide to rectal cancer

Rectal cancer symptoms and signs

Rectal cancer screening and diagnosis

Types and stages of rectal cancer

Rectal cancer treatment

Contact us

Rectal cancer symptoms

Rectal cancer often has no symptoms in its early stages.  Given the lack of major symptoms, it’s important to be aware of any changes to your health and speak with your doctor if those changes persist or worsen.

As the cancer grows, rectal cancer symptoms may include:

• Changes in bowel habits including diarrhea, constipation, or narrowing of the stool.
• Blood in your stool.
• Abdominal pain or cramping.
• Fatigue.
• Unexplained weight loss.

It can be worrisome to experience health changes, and you may want to avoid going to the doctor, but early detection of rectal cancer can lead to improved outcomes.

Rectal cancer risk factors

Do you know what causes rectal cancer? There are a few that are hereditary and others that are associated with lifestyle. Risk factors have a significant influence on the likelihood of a rectal cancer diagnosis.

Your risk of rectal cancer are very similar to the risk of colon cancer, and increases if you:

• Have a family history of colon cancer.
• Have inflammatory bowel disease (IBD), Crohn's disease, and/or ulcerative colitis.
• Are over 45.
• Are overweight.
• Do not regularly exercise.
• Eat a diet high in red and processed meat, or with insufficient fresh fruit and vegetables.
• Frequently drink alcohol.
• Use tobacco products.

Certain population groups are at higher risk, including those who are Black, Native American, and/or male.

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Rectal cancer screening

Staying on top of regular preventive care and getting age-appropriate screenings is key to early detection. Because rectal cancer can be asymptomatic, regular screening is crucial. Rectal cancer screening usually entails a physical exam, a colonoscopy, and potential biopsies of suspicious tissue. Alternatively, select people may be eligible for stool tests or blood tests. Screening for average-risk people begins at age 45. High-risk groups may start earlier. Any person with irregular bowel symptoms at any age should undergo colonoscopy.

At AHN, colorectal cancer screenings are important to your overall care plan and cancer prognosis. If you are diagnosed with colon or rectal cancer, a colorectal specialist will perform a physical exam and discuss your overall health and prognosis. From there, diagnostic tests are performed as needed to ensure we have a whole view of your health and can design a treatment plan that fits your needs.

Colonoscopy

A colonoscopy is a procedure that allows a gastroenterologist or a colorectal surgeon to examine the entire colon and rectum for any abnormalities. While colonoscopies will detect colon and rectal cancer in its early stages, a colonoscopy can also help to prevent colon cancer by removing precancerous polyps before they have the chance to grow into cancer.

With a colonoscopy, your doctor can examine the entire area for abnormalities including polyps and suspicious tissue. 

It's important to consult with your doctor to determine the most appropriate procedure for your individual needs. They will consider your medical history, risk factors, and symptoms to make the best recommendation.

Rectal cancer diagnosis

If you receive a rectal cancer diagnosis, the news can feel overwhelming. We see you — and a path forward. Your oncology team will be with you every step of the way and put together a plan that’s specific to your precise diagnosis.

To get to that precise diagnosis, your care team may order more tests and procedures to ensure they have a full understanding of the disease.

Imaging

Your care team may need more details that will help provide all the information on your specific prognosis. Additional imaging or tests may be needed. That could include:

• Transrectal ultrasound or endorectal ultrasound (ERUS): The colorectal surgical specialist may use a special ultrasound machine located within our AHN Cancer Institute Center of Excellence colorectal surgical office to stage certain early-stage rectal cancer tumors. In the hands of our expert board-certified colon and rectal surgeons, ultrasound is the most sensitive test for determining T-stage and can allow surgeons the opportunity to safely perform smaller and less invasive procedures to cure early cancers. Other tests, such as an MRI, may be better for larger lesions, but ERUS is the best way to predict whether a tumor can be cured with Transanal Microsurgical excision and minimize tissue loss and functional abnormalities.
• Computed tomography (CT) scan: A CT scan can help determine if the cancer has spread to the nearby lymph nodes, organs, or other areas of the body. The information can help your care team decide the treatment plan.
• Magnetic resonance imaging (MRI): An MRI plays a valuable role in rectal cancer staging and management and surveillance. With an MRI, the cancer stage can be better determined, treatment planning is more detailed because images can help radiation oncologists understand the tumor better, and your care team can use the images to monitor treatment response and any tumor recurrence. The MRI must be performed properly using a rectal cancer-specific protocol on a modern machine in order to provide accurate staging and to allow for assessments after chemotherapy and radiation to determine the response to treatment. Proper rectal cancer MRI is a key element to allow select patients to safely avoid surgery, a protocol also known as organ preservation or “watch and wait.” If a patient has an MRI that is performed improperly, it will need to be repeated in one of our expert facilities. At AHN, the Center of Excellence radiologists have all completed special training to ensure adherence to these principles. 
• Positron emission tomography (PET) scan: Similar to an MRI, a PET scan gives detailed images that inform your care team on the cancer stage and treatment planning. A PET scan can also detect areas of increased metabolic activity that are often associated with cancer cells. A PET scan ordered by your treatment team can assist with treatment planning, particularly with guidance for radiation therapy. Our nurse navigation team will work with our radiation oncology team to ensure the PET scan is performed with this treatment plan in mind.

Biopsy

If we discover a polyp (mass of cells) during a colonoscopy, we can perform a biopsy, a minimally invasive procedure, at the same time. The physician guides a tiny wire loop into the colon to remove the polyp. A specially trained doctor called a pathologist examines the cells under a microscope to determine if they are cancerous. All colorectal cancer specimens are tested for genomic abnormalities, including mismatch repair (MMR), also known as MSI-H. These tumor gene abnormalities may permit use of immunotherapy.  AHN pathologists in our Center of Excellence have all completed special training to ensure adherence to principles of rectal cancer diagnosis and staging.

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Types and stages of rectal cancer

Understanding the type and stage of rectal cancer can be helpful for you to make informed choices with your care team and emotionally prepare for any treatments or surgeries. A surgeon with specific expertise in treating rectal cancer will stage your cancer before treatment with a combination of a physical exam, endorectal ultrasound, rectal MRI, and CT scan.

• Stage 0: This is the earliest stage of rectal cancer, where abnormal cells are found only in the lining of the rectum. It is considered noninvasive and has a high cure rate with early treatment.
• Stage I: The cancer has grown into the inner layer of the rectal wall but has not spread to nearby lymph nodes or other organs.
• Stage II: Rectal cancer has spread to the outer layer of the rectal wall or to nearby organs but not to distant organs or to the lymph nodes.
• Stage III: Rectal cancer has spread to nearby lymph nodes but not to distant organs.
• Stage IV: Rectal cancer has spread to distant organs, such as the liver, lungs, or bones. This is the most advanced stage and has a poorer prognosis.

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Rectal cancer treatment

If you have a rectal cancer diagnosis, know that you have options. Your compassionate and skilled care team will review all your treatment options and talk with you about what those may entail and what is best for you and your health. Before treatment can begin, staging must be completed and each patient must be presented to the AHN Cancer Institute colorectal cancer multidisciplinary tumor board, a weekly conference including 20 – 30 health care providers with expertise and training in rectal cancer care to ensure an optimal treatment plan is developed.

Rectal cancer surgery

All our rectal cancer surgeons have specialized training in rectal cancer. That means that they have dedicated their careers to the study of GI tumors and are highly experienced at performing rectal surgery. These surgeons have completed special training programs offered by the National Accreditation Program for Rectal Cancer, the Commission on Cancer, and the American Society of Colon and Rectal Surgeons. They also regularly participate in the AHN Cancer Institute CRC tumor conference and in quality assurance programs that include a requirement to submit all their synoptic operative reports and specimen pathology to a stringent peer-review process.

We are committed to preserving as much of the rectum and bowel function as possible. Our advanced surgical options include:

• Laparoscopic robotic surgery: This minimally invasive technique uses small incisions and a camera to perform surgery, often resulting in faster recovery. This technology also provides better control of the operative field, improved magnified high-resolution 3D visualization of critical structures and augmented visualization of tissues.
• Transanal endoscopic microsurgery (TEMS) and transanal minimally invasive surgery (TAMIS): These are minimally invasive surgical techniques that allow treatment of early rectal cancer, polyps, and other benign growths through the natural orifice of the anus. This no-incision surgery is performed in highly selected cases by our expert colon and rectal surgeons.
• Rectal resection: This involves removing the tumor, the involved rectum, and all of the surrounding lymph nodes. Depending upon tumor location within the rectum and stage, this may include the entire rectum (called Total Mesorectal Excision, or TME surgery) or just the upper part of the rectum (called Tumor Specific Mesorectal Excision). In either case, our expert surgeons are dedicated to reconstructing the rectum whenever possible to avoid permanent colostomy.
• Sphincter-preservation surgery: Sphincter-preservation surgery is a type of surgical procedure for rectal cancer that aims to preserve the anal sphincter muscles, which are responsible for controlling bowel movements. This is a crucial goal because preserving sphincter function helps patients maintain bowel control after surgery. Sometimes this procedure involves operating on the rectum from both the abdominal side and the anal side, a special technique called TransAnal TransAbdominal or TATA TME.
• Plastic surgery reconstruction: Following a rectal cancer diagnosis and any previous treatments or surgeries, plastic surgery reconstruction may be needed to help restore function to the area.
• Advanced surgery: This will be different for each patient, but advanced surgery can include major surgeries where the entire rectum, anus, and surrounding tissues are removed. This includes pelvic exenteration surgery and may involve the creation of an ileal conduit. This surgery is required for larger and more advanced tumors, but is most commonly performed for recurrent cancer. At AHN, we have extensive expertise and experience treating all stages of cancer, as well as recurrent cancer, and our surgical team is equipped to handle even the most advanced cases.

Radiation therapy for rectal cancer

Radiation technologies have improved to deliver more targeted therapy to cancerous cells, maintaining the integrity of healthy cells. AHN radiologists are highly skilled, using innovative tools to deliver high-dose radiation to where it’s most effective.

We are the only radiation oncology network accredited in western Pennsylvania by both the American Society for Radiation Oncology and American College of Radiology. These accreditations mean that the Cancer Institute meets specific guidelines for patient safety, quality control, and efficiency of equipment. You can feel assured knowing you are receiving the highest quality care available.

Our advanced radiation treatments for rectal cancer include:

• Image-guided radiotherapy (IGRT): IGRT uses real-time imaging during treatment to ensure the radiation beam is precisely targeted at the tumor. This helps to minimize damage to surrounding healthy tissues.
• Intensity-modulated radiation therapy (IMRT): This delivers radiation in a highly precise and customized way. It shapes the radiation beam to conform to the tumor's shape, minimizing damage to surrounding healthy tissues.
• Stereotactic body radiotherapy (SBRT): SBRT is a highly precise form of radiation therapy that delivers a high dose of radiation to the tumor in a few treatments. It is often used for small, localized tumors.

Medical oncology for rectal cancer

Treating rectal cancer requires advanced medical oncology therapies. Your care team will review your specific diagnosis and configure an effective treatment plan.

Our advanced medical oncology therapies include:

• Chemotherapy: Using chemotherapy, your medical oncologist will administer drugs to target the cancer cells and reduce their ability to grow. This approach will be tailored to the specific patient and the stage of their cancer.
• Targeted therapy: This is a relatively new way to treat anal cancer. Targeted therapy focuses on specific rapidly dividing cancer cells to block the signals that tell the cancer to grow.
• Immunotherapy: Immunotherapy works by either boosting the immune system's ability to recognize and attack cancer cells, or by blocking specific proteins on cancer cells that help them evade the immune system, allowing the body's natural defenses to fight the disease.

Rehabilitation after rectal cancer treatment

AHN takes rehabilitation post-surgery as seriously as the surgery itself. To regain function, manage side effects, and improve quality of life, a personalized rehabilitation plan is created. This plan involves creating physical rehabilitation plans and also psychological and occupational rehabilitation.

Life after surgery

AHN uses the most minimally invasive procedures and surgical techniques so you can return to your life as soon as possible. Comprehensive rehab and your compassionate care team will help you adjust to any new changes.

We also offer specialized oncology rehab services in your own home, if needed, through our Healthcare@Home service.

Learn more about our rehabilitation program. 

The team assisting your complete rehabilitation includes:

• Anesthesiologists.
• Pain management specialists.
• Infection control specialists.
• Physical therapists.
• Nutritionists.
• Ostomy nurses.

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Contact us

Call the Hope Line at (412) 578-HOPE (412) 578-4673 to connect with a nurse navigator or schedule an appointment.

Schedule a colonoscopy

Colonoscopies save lives. Having regular, age and risk-factor appropriate colonoscopies can help detect cancer earlier when it’s easier to treat.

Referral to oncology

If you’ve received a referral to schedule with medical oncology, radiation rectal cancer oncology, or another rectal cancer oncology group, call (412) 578-HOPE (412) 578-4673 to connect with a nurse navigator and schedule an appointment.

Second opinions

If you have cancer, you have a team of oncology specialists ready to review your medical records and offer you a second opinion. After completing their review, they’ll talk with you about your goals to determine a course of treatment that’s right for you. To get started, fill out our Second Opinion Request form. A nurse navigator will contact you within the next 24 to 48 hours to discuss next steps and schedule.

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