Scripps Health teams are highly skilled in the diagnosis and treatment of rectal cancer. Our affiliated physicians and surgeons have decades of specialized experience and knowledge fighting cancer.
This means a singular focus by helping you defeat the disease while leveraging the most advanced approaches available.
As San Diego’s first-ever health-care provider, our number-one priority is your health and well-being.
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Colorectal cancer is the term used to describe cancers of the colon and rectum. The rectum is the final 6 inches of the large intestine — also known as the colon. Rectal cancer differs from colon cancer in location, but screening and diagnosis are similar. Colorectal screening may involve tests and procedures that include thin flexible tube-like instruments that allow physicians to examine areas closely through a tiny camera.
Screening tests and procedures can include:
- Digital rectal exam involves a physician inserting a gloved finger into the rectum to feel for abnormalities such as polyps.
- Colonoscopy, in which the physician inserts a flexible, lighted tube called a colonoscope through the patient’s anus to examine the rectum and the entire colon.
- Flexible sigmoidoscopy, in which a physician inserts a flexible, lighted tube called a sigmoidoscope in a patient through the anus to examine the sigmoid colon and rectum. The sigmoid colon is the part of the large intestine closest to the rectum.
- Double-contrast barium enema that enables the bowel lining to appear on an x-ray. A barium solution is given by enema before x-rays are taken and reviewed.
- High-sensitivity fecal occult blood test (FOBT), such as a stool guaiac test, which checks for hidden blood in three consecutive stool samples (recommended yearly.)
Being proactive about your colorectal cancer screenings remains the most effective way to improve your chances of having effective rectal cancer treatment. The reason is clear: patients treated for early-stage rectal cancer have dramatically higher survival rates than those treated with late stages of the disease.
A National Cancer Institute study has shown that:
- Nearly 90 percent of U.S. patients survived 5 years or longer after a Stage 1 rectal cancer diagnosis and treatment.
- Six percent survived 5 years or more after Stage 4 rectal cancer diagnosis and treatment.
Scripps Health makes colorectal cancer screening convenient through our physicians’ offices and facilities across San Diego County.
If you’re 50 or older and haven’t been screened yet, be sure to make an appointment as soon as possible.
Those at higher risk for developing rectal cancer should talk with their physician about being screened before age 50. Risk factors can include:
In addition to the rectal cancer screening, Scripps physicians may use other tests and procedures to detect and diagnose the disease:
- Biopsy involves removal of a small sample of suspicious tissue. The sample, which can be taken during a colonoscopy or sigmoidoscopy, is tested and examined by pathologists in a lab.
- Computed tomography (CT) scan is a form of X-ray imaging test that captures images of the body from different angles. The images are combined to detailed cross-sectional views of organs, bones and blood vessels.
- Magnetic resonance imaging (MRI) relies on a powerful magnet, radio waves and advanced digital technology to provide detailed images of organs, bone and soft tissue.
- Positron emission tomography (PET) involves imaging after the patient swallows a type of radioactive sugar that existing cancer cells will quickly absorb so they can be identified under a special camera. It is combined with a CT scan to give physicians the ability to view a picture of potentially cancerous areas through the PET while also seeing more detailed images from a CT scan.
- Endorectal ultrasound (ERUS) is the use of an instrument that is inserted into the anus and rectum with a probe at its end that emits ultrasound (high-energy) waves which pass through soft tissues and “bounce” off dense tissues and organs to create an image known as a sonogram.
- A complete blood count (CBC) test measures the total amount of red blood cells and white blood cells, hemoglobin and percentage of red blood cells (hematocrit).
For early-stage rectal cancer, surgery is the most common course of proven and effective treatment.
Treatment, however, can include a combination of surgery and chemotherapy or radiation therapy, depending on tumor size, proximity to sensitive tissues and other organs, general patient health and whether the rectal cancer is new or returning. Treatment options include:
If a rectal cancer has not spread to other parts of the body, surgery is usually the primary treatment. The surgeries can be traditional open surgeries or minimally-invasive surgeries, such as laparoscopic surgery or robotic-assisted surgery.
- Laparoscopic surgery is a minimally-invasive procedure where the surgeon makes several small incisions through which she or he uses long instruments to remove part of the rectum and lymph nodes. The surgery is named in part for a laparoscope with a small video camera that provides the surgeon a view inside the abdomen.
- Minimally-invasive robot-assisted surgery is performed with robotic tools through small incisions, the use of a magnified 3-D high-definition vision system and tiny wristed instruments that provide the surgeon greater range of mobility and dexterity than their own human hands and wrists. The movements of the advanced robotic tool are controlled by the surgeon and does not act on its own.
The most common rectal surgeries include:
- Polypectomy is the removal of polyps usually through an endoscope or colonoscope.
- Transanal excision is the removal of a tumor that performed surgically through the anus.
- Proctectomy is the removal of the rectum.
- Abdomino-perineal resection is the removal of the entire rectum and anus, necessitating a permanent end colostomy.
Scripps Health also offers a transanal minimally-invasive surgery (TAMIS) option that may be appropriate for some patients with benign neoplasms or early-stage rectal cancer. For the appropriately selected patient, this surgical approach can avoid a formal proctectomy leading to enhanced recovery and better functionality.
Because sphincter preservation often greatly impacts quality of life, Scripps teams strive to preserve the sphincter muscles and natural bodily functions. When that is not possible, a colostomy is required for the patient to pass bodily waste.
If a rectal cancer has spread to nearby organs such as the prostate, bladder, colon or gynecologic organs, the organs may be removed during surgery.
Scripps has the most comprehensive radiation therapy offerings in San Diego for rectal cancer, including 3D-conformal radiation therapy and intensity-modulated radiotherapy (IMRT).
- 3-D conformal radiation therapy allows physicians to visualize a patient’s anatomy in 3-D though the use of advanced computer software to match the radiation dose to the shape of the tumor while minimizing exposure of surrounding healthy tissues and organs.
- Intensity-modulated radiation therapy (IMRT) is an advanced form of radiation therapy that allows the radiation oncologist to specify the dose of radiation for the tumor while restricting the dose to surrounding healthy tissues.
Chemotherapy, in combination with radiation therapy, can be a curative therapy for rectal cancers, or it may be used alone as part of a treatment plan post-surgery to attack any cancer cells that are invisible to the eye. It can also be combined with radiation therapy for stage II rectal cancers prior to surgery or provided as palliative treatment for rectal cancers that have spread to other parts of the body.
Late-stage rectal cancer may be treated through systemic therapy that is designed to provide palliative care and reduce symptoms and pain.