Rectal Cancer: Symptoms, Causes, and More

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Rectal cancer is cancer that develops in cells in the rectum, which is below the sigmoid colon and above the anus.
Your rectum and colon are both part of the digestive system, so rectal and colon cancers are often grouped under the term colorectal cancer.
In the United States, colorectal cancer is the third most common type of cancer. It’s also the second deadliest, making early detection and treatment critical. Worldwide, colorectal cancer is the second most common cancer in females and the third most common cancer in males, according to a 2020 data from Worldwide Cancer Research Fund.
The American Cancer Society estimates there will be 44,850 new cases of rectal cancer in the United States in 2022. This compares with 106,180 new cases of colon cancer.

What are the symptoms of rectal cancer?

What are the symptoms of rectal cancer?
At first, rectal cancer may be asymptomatic.
As the cancer progresses, rectal bleeding is the most common symptom. Changes in your bowel habits may occur, lasting for more than a few days. You may also experience unexplained weakness and fatigue.
According to the Centers for Disease Control and Prevention (CDC), common symptoms of colorectal cancer may include:
rectal bleeding
changes in how often you have bowel movements
feeling that your bowel isn’t emptying completely
pain when you have a bowel movement
diarrhea or constipation
blood or mucus in your stool
unintentional weight loss and appetite changes
unexplained fatigue
frequent abdominal discomfort, gas, cramps, pain
Another possible sign of rectal cancer is iron-deficiency anemia, which may occur as a result of blood loss.

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What causes rectal cancer?

What causes rectal cancer?
While the exact cause of rectal cancer is unknown, malignant tumors develop when cancerous cells grow out of control and multiply. These cells can penetrate and destroy healthy tissue. What sets off this process isn’t always clear.
There are some inherited gene mutations that can increase your risk for rectal cancer. One of these is hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome. This disorder significantly raises the risk of colon and other cancers. In some cases, your doctor may recommend removing your colon as a preventive measure.
Another genetic condition that may cause rectal cancer is familial adenomatous polyposis (FAP). This is a rare disorder that can cause polyps to grow in the lining of the colon and rectum.
While these polyps start off as noncancerous, they may become malignant. In fact, most people with FAP develop cancer before the age of 50. Large bowel removal may also be a preventive surgery your doctor may recommend.

How does it spread?

How does it spread?
Like other types of cancers, rectal cancer can spread when cancerous cells grow in healthy tissue and travel to other areas of the body.
At first, rectal cancer may affect the tissues lining the rectum. In some cases, it affects the entire rectum. The cancer may then spread to nearby lymph nodes or organs, with the liver being commonly affected. Other possible areas of metastasis can include the:
abdomen
brain
lungs
ovaries

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What are the risk factors?

What are the risk factors?
While there’s no single known cause of rectal cancer, a number of known factors may increase your risk for developing this cancer at some point. These include the following:
Age. Diagnosis usually occurs after age 50, although rates are increasing among younger people.
Race. Black Americans are at higher risk than other groups of developing rectal cancer. One reason for this may be inequities in healthcare access.
Family history. Personal or family history of colorectal cancer can raise risk.
Genetics. Lynch syndrome or FAP are two genetic conditions that may increase your risk.
Radiation therapy. Previous radiation treatment to the abdomen can increase risk.
Other conditions that may increase risk include:
ovarian cancer
polyps
inflammatory bowel disease, especially if you’ve lived with it for 8 years or longer
obesity
type 2 diabetes that’s not well managed
Some lifestyle factors that may play a role in colorectal cancer are:
eating a diet low in vegetables and fiber
eatinga diet high in red and processed meat
a lack of exercise
smoking
consuming three or more alcoholic drinks per day

How is rectal cancer diagnosed?

How is rectal cancer diagnosed?
Rectal cancer is diagnosed with a combination of the following:
Physical exam and screening tests
The doctor will likely begin by taking your medical history and performing a physical exam. This may include inserting a gloved finger into your rectum to feel for lumps.
The doctor might next recommend a fecal immunochemical test (FIT) or a sigmoidoscopy. The screening schedule for these tests will vary depending on your risk level. If these tests are positive for cancer, a colonoscopy is the next step.
Colonoscopy
In a colonoscopy, a doctor uses a thin tube with a light and camera at the end to view the inside of your rectum and colon. They can usually remove any polyps they find at this time.
During the colonoscopy, the doctor can also collect tissue samples for later examination in a lab. These samples can be viewed under a microscope to determine if they’re cancerous. They can also be tested for genetic mutations associated with colorectal cancer.
Blood tests
The doctor may also order a blood test. A high level of carcinoembryonic antigen (CEA), a substance made by cancerous tumors, in your bloodstream may indicate rectal cancer.
Imaging tests
Once the doctor makes their diagnosis of rectal cancer, their next step is to determine how far it might have spread.
The doctor may use an endorectal ultrasound to examine your rectum and surrounding area. For this test, a doctor inserts a probe into your rectum to produce a sonogram, a type of image.
The doctor may use other imaging tests to look for signs of cancer throughout your body. These include:
CT or PET scan, which may help the doctor see the extent of cancer in the rectum, colon, and other organs
MRI, which can help the doctor determine the stage of the cancer

How is rectal cancer staged?

How is rectal cancer staged?
No matter where it starts, cancer can spread, or metastasize, through tissue, the lymphatic system, or the bloodstream to reach other parts of the body.
Staging cancer indicates how far the cancer has progressed, which can help doctors decide the best treatment.
Below are the stages of rectal cancer.
Stage 0 (carcinoma in situ)
Only the innermost layer of the rectum wall contains abnormal cells.
Stage 1
Cancer cells have spread past the innermost layer of the rectum wall but not to lymph nodes.
Stage 2
Cancer cells have spread into or through the outer muscle layer of the rectum wall but not to lymph nodes. This is often referred to as stage 2A. In stage 2B, the cancer has spread into the abdominal lining.
Stage 3
Cancer cells have spread through the outermost muscle layer of the rectum and to one or more lymph nodes. Stage 3 is often broken up into substages 3A, 3B, and 3C based on the amount of lymph node tissue affected.
Stage 4
Cancer cells have spread to distant sites, like the liver or lungs.

What are the treatment options by stage?

What are the treatment options by stage?
In recommending treatment, the doctor and care team will consider:
tumor size
where cancer may have spread
your age
your general health
This can help them determine the best combination of treatments, as well as the timing of each treatment.
Below are the general guidelines for treatment by stage. This list contains potential treatment options. Not all patients may require the treatment options listed for each stage.
Stage 0
removal of suspicious tissue during colonoscopy
removal of tissue during a separate surgery
removal of tissue and part of the surrounding area
Stage 1
local excision or resection
radiation therapy for some patients
chemotherapy for some patients
Stages 2 and 3
surgery
radiation therapy
chemotherapy
Stage 4
surgery, possibly in more than one area of the body
radiation therapy
chemotherapy
targeted therapies, such as monoclonal antibodies or angiogenesis inhibitors
cryosurgery, a procedure that uses a cold liquid or a cryoprobe to destroy abnormal tissue
radiofrequency ablation, a procedure in which radio waves are used to destroy abnormal cells
a stent to keep the rectum open if it’s blocked by a tumor
palliative therapy to improve overall quality of life

Clinical trials for rectal cancer

Clinical trials for rectal cancer
You can also ask your doctor about clinical trials that might be a good fit. Many current therapies for cancer began as clinical trials. These trials may try different combinations of current treatment, treatments that have been approved by the U.S. Food and Drug Administration (FDA) for other conditions, or new treatments.
In some cases, therapy as part of a clinical trial may be covered by insurance or covered by a sponsor of the trial.
Clinical trials can help advance scientists’ understanding of cancer and investigate new treatment options. Participating may offer additional options for your treatment. You can learn more about clinical trials for rectal cancer at the National Cancer Institute.

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