Colon and rectal cancer incidence was negligible before 1900. The incidence of colorectal cancer has been rising dramatically following economic development and industrialization. Currently, colorectal cancer is the third leading cause of cancer deaths in both males and females in the United States.
Adenocarcinomas comprise the vast majority (98%) of colon and rectal cancers. Other rare rectal cancers, including carcinoid (0.4%), lymphoma (1.3%), and sarcoma (0.3%), are not discussed in this article. Squamous cell carcinomas may develop in the transition area from the rectum to the anal verge and are considered anal carcinomas. Very rare cases of squamous cell carcinoma of the rectum have been reported.
Approximately 20% of colon cancers develop in the cecum, another 20% in the rectum, and an additional 10% in the rectosigmoid junction. Approximately 25% of colon cancers develop in the sigmoid colon.
The incidence and epidemiology, etiology, pathogenesis, and screening recommendations are common to both colon cancer and rectal cancer.
These areas are addressed together.
Causes of Rectal Cancer:
Rectal cancer usually develops over several years, first growing as a precancerous growth called a polyp. Some polyps have the ability to turn into cancer and begin to grow and penetrate the wall of the rectum.
The actual cause of rectal cancer is unclear.However, the following are risk factors for developing rectal cancer:
- Increasing age
- Smoking
- Family history of colon or rectal cancer
- High-fat diet and/or a diet mostly from animal sources
- Personal or family history of polyps or colorectal cancer
Family history is a factor in determining the risk of rectal cancer. If a family history of colorectal cancer is present in a first-degree relative (a parent or a sibling), then endoscopy of the colon and rectum should begin 10 years before the age of the relative’s diagnosis or at age 50 years, whichever comes first.
Types of Rectal Cancer:
Adenocarcinoma is the most common type of rectal cancer but there are many other forms as well. Examples include leiomyosarcoma, lymphoma, melanoma, and neuroendocrine tumors. This article provides an overview of each colon cancer type.
Adenocarcinomas– Adenocarcinomas are the most common type of colon cancer and originate in glands. Adenocarcinomas account for about 90-95 percent of all colorectal cancers and have two subtypes, mucinous and signet ring cell. The mucinous subtype comprises about 10-15 percent of adenocarcinomas while the signet ring cell subtype comprises less than 0.1 percent of adenocarcinomas.
Leiomyosarcomas– This type of colon cancer occurs in the smooth muscle of the colon. Leiomyosarcomas account for less than two percent of colorectal cancers and have a fairly high chance of metastasizing.
Lymphomas– Colorectal lymphomas are rare and are more likely to start in the rectum than in the colon. However, lymphomas that start somewhere else in the body are more likely to spread to the colon than to the rectum. Non-Hodgkins lymphoma accounts for about 0.5 percent of all colorectal cancers and has many forms.
Melanomas– This type of colon cancer is rare. Usually, it results from a melanoma that started somewhere else and then spread to the colon or rectum. Melanomas account for less than two percent of colorectal cancers.
Neuroendocrine Tumors- Neuroendocrine tumors are divided into two main categories: aggressive and indolent. Large cell and small cell neuroendocrine tumors are considered aggressive, while carcinoid tumors are considered indolent. (Learn more about agressive and indolent neuroendocrine tumors.)
Symptoms of rectal cancer treatment:
As with most cancers in their early, most treatable stages, there are no early symptoms of rectal cancer. For this reason, it is important to have regular screening tests to check for rectal cancer — even when you might not notice anything wrong.
As the cancer grows, rectal cancer symptoms can occur. Common symptoms include:
- A change in the frequency of bowel movements
- Diarrhea, constipation, or feeling that the bowel does not empty completely
- Either bright red or very dark blood in the stool
- Stools that are narrower than usual
- General abdominal discomfort (such as frequent gas pains, bloating, fullness, and cramps)
- Weight loss with no known reason
- Constant tiredness
- Vomiting.
Don’t wait to feel pain before you seek medical attention. Early rectal cancer usually doesn’t cause pain.
Sensation of Rectal Pressure or Fullness: If you feel like you have to empty your bowel, even after just doing so, or feel you are repeatedly not emptying your bowel fully, talk to your doctor. A mass in your rectum can give you that sensation.
Fatigue: Fatigue that last more than a few days can indicate a medical problem. Fatigue related to rectal cancer can be due to anemia, because of blood loss in the stool. Like other symptoms of rectal cancer, fatigue is a vague symptom and can be related to many other less serious conditions.
Rectal Cancer Treatment:
Rectal cancer is staged much the same way as colon cancer, but because the tumor is much lower down in the large intestine, the treatment options may vary. Surgery to remove the cancer is almost always the first treatment.
Stage 0 Rectal Cancer:
In Stage 0 rectal cancer, the tumor is located only on the inner lining of the rectum. To treat this early stage cancer, surgery can be performed to remove the tumor or a small section of the rectum where the cancer is located can be removed. Radiation treatment, given either externally (beamed in from the outside) or internally (radioactive beads are placed inside the rectum) may be considered. Also, chemotherapy may be given to heighten the effect of radiation.
Stage I Rectal Cancer:
Also called Dukes A rectal cancer, this is another early form or limited form of cancer. The tumor has broken through the inner lining of the rectum but has not made it past the muscular wall. Treatment usually involves:
- Surgery to remove the tumor
- If the tumor is small or you are very old or sick, radiation alone can be used to treat the tumor. This hasn’t proven to be as effective as surgery. Chemotherapy can also be added to heighten the effect of radiation.
Stage II Rectal Cancer:
Also called Dukes B rectal cancer, this cancer is a little more advanced. The tumor has penetrated all the way through the bowel wall and may have invaded other organs, like the bladder, uterus, or prostate gland. Treatment includes:
Surgery to remove all the organs involved with the cancer (wide-resection) is used to control the disease.
Some doctors will recommend radiation be used before, after, or during the surgery, while others recommend radiation and chemotherapy be used. Note that radiation before the surgery may keep the doctor from determining if the cancer has spread to the lymph nodes or into the pelvis.
Stage III Rectal Cancer-
Also called Dukes C rectal cancer, the tumor has spread to the lymph nodes (small structures that are found throughout the body that produce and store cells that fight infection). Treatment includes:
- Surgery to remove the tumor.
- Radiation therapy is also often used before or after surgery.
- Chemotherapy is offered after surgery. However, it can be given before surgery — sometimes along with radiation — to shrink a tumor and make surgery easier.
Stage IV Rectal Cancer-
Also called Dukes D rectal cancer, the tumor has spread to distant parts of the body (metastasized). The tumor can be any size and sometimes is not that large. The liver and lung are two places rectal cancer often spread.
The mainstay of treatment is chemotherapy, but sometimes surgery to remove the tumor may also be recommended.
Surgery, when performed, is often used to relieve or prevent blockage of the rectum or to prevent rectal bleeding. It is not considered a curative procedure. Surgeries of this type can also help a patient with stage IV rectal cancer live longer.
Surgery of Rectal Cancer:
Surgery (removing the cancer in an operation) is the most common rectal cancer treatment for all stages of the disease. The extent of surgery will depend on the location and size of the tumor, the stage of the cancer, and on the person’s general health.
A doctor may remove the cancer using one of the following types of surgery:
- Local excision
- Resection
- Resection and colostomy
Local Excision Surgery- If the rectal cancer is found at a very early stage, the doctor may remove it without cutting into the abdomen (stomach). If the cancer is found in a polyp (a growth that protrudes from the rectal mucous membrane), the operation is called a polypectomy.
Resection Surgery– If the cancer is larger, the doctor will perform a resection of the rectum (removing the cancer and a small amount of healthy tissue around it). The doctor will then perform an anastomosis (sewing the healthy parts of the rectum together, sewing the remaining rectum to the colon, or sewing the colon to the anus). The lymph nodes near the rectum will also be removed and examined under a microscope to see if they contain cancer.
Resection and Colostomy Surgery– If the doctor is not able to sew the rectum back together, a stoma (an opening) is made on the outside of the body for waste to pass through. This procedure is called a colostomy. A bag is placed around the stoma to collect the waste. Sometimes, the colostomy is needed only until the rectum has healed, and then it can be reversed. If the doctor needs to remove the entire rectum, however, the colostomy may be permanent.
Rectal Cancer Surgery procedure
Surgical removal of a tumor is the cornerstone of curative therapy for localized Rectal cancer. In addition to removing the rectal tumor, removing the fat and lymph nodes in the area of a Rectal cancer is also necessary to minimize the chance that any cancer cells might be left behind.
Four types of surgeries are possible, depending on the location of the tumor in relation to the anus.
- Transanal excision: If the tumor is small, located close to the anus and confined only to the mucosa (innermost layer), then performing a transanal excision, where the tumor is removed through the anus, may be possible. No lymph nodes are removed with this procedure. No incisions are made in the skin.
- Mesorectal surgery: This surgical procedure involves the careful dissection of the tumor from the healthy tissue. Mesorectal surgery is being performed mostly in Europe.
- Low anterior resection (LAR): When the cancer is in the upper part of the rectum, then a low anterior resection is performed. This surgical procedure requires an abdominal incision, and the lymph nodes are typically removed along with the segment of the rectum containing the tumor. The two ends of the colon and rectum that are left behind can be joined, and normal bowel function can resume after surgery.
- Abdominoperineal resection (APR): If the tumor is located close to the anus (usually within 5 cm), performing an abdominoperineal resection and removing the anal sphincter may be necessary. Lymph nodes are also removed during this procedure. With an abdominoperineal resection, a colostomy is necessary. A colostomy is an opening of the colon to the front of the abdomen, where feces are eliminated into a bag.
Risk for Rectal Cancer:
Every one of us is at risk for rectal cancer. Over 100,000 Americans will be diagnosed with colorectal cancer in 2008. The majority of people who develop colorectal cancer have no known risk factors.
Although the exact cause of colorectal cancer is not known, there are some factors that increase a person’s risk of developing the disease. These include:
- Age- The risk of developing colorectal cancer increases as we age. The disease is more common in people over 50, and the chance of getting colorectal cancer increases with each decade. However, colorectal cancer has also been known to develop in younger people.
- Gender- The risk overall are equal, but women have a higher risk for colon cancer, while men are more likely to develop rectal cancer.
- Polyps- Polyps are non-cancerous growths on the inner wall of the colon or rectum. While they are fairly common in people over 50, one type of polyp, referred to as an adenoma, increases the risk of developing colorectal cancer. Adenomas are non-cancerous polyps that are considered precursors, or the first step toward colon and rectal cancer.
- Personal history- Research shows that women who have a history of ovarian, uterine, or breast cancer have a somewhat increased risk of developing colorectal cancer. Also, a person who already has had colorectal cancer may develop the disease a second time. In addition, people who have chronic inflammatory conditions of the colon, such as ulcerative colitis or Crohn’s disease, also are at higher risk of developing colorectal cancer.
- Family history- Parents, siblings, and children of a person who has had colorectal cancer are somewhat more likely to develop colorectal cancer themselves. If many family members have had colorectal cancer, the risk increases even more. A family history of familial polyposis, adenomatous polyps, or hereditary polyp syndrome also increases the risk as does a syndrome known as hereditary non-polyposis colon cancer, or HNPCC. This latter syndrome also increases the risk for other cancers as well.
- Diet- A diet high in fat and calories and low in fiber may be linked to a greater risk of developing colorectal cancer.
- Lifestyle factors- You may be at increased risk for developing colorectal cancer if you drink alcohol, smoke, don’t get enough exercise, and if you are overweight.
- Diabetes- People with diabetes have a 30-40% increased risk of developing colon cancer.
Having one or more of these risk factors does not guarantee that you will develop rectal cancer. However, you should talk about these risk factors with your doctor. He or she may be able to suggest ways to reduce your chances of developing rectal cancer.
What is the Cost of Rectal Cancer Treatment Surgery in India?
- The cost of rectal cancer treatment surgery has decreased substantially over the last two years. This combined with the fact that patient outcomes have continued to improve.
- India offers low rectal cancer treatment surgery at various international hospitals.
- By getting the surgery done in India you can save up to 80% of the cost that you have to pay in other developed countries.
Follow-up
Because a risk exists of Rectal cancer coming back after treatment, routine follow-up care is necessary. Follow-up care usually consists of regular visits to the doctor’s office for physical exams, blood studies and imaging studies. In addition, a colonoscopy is recommended 1 year after a diagnosis of Rectal cancer. If the findings from the colonoscopy are normal, then the procedure can be repeated every 3 years.
Why India? India is fast growing reputation in medical tourism. Medical health centers of Mumbai, Goa and Hyderabad offers well experienced surgeons for Rectal cancer surgery in India. A patient can travel to India once in the same cost with the excellence health care treatment in India. So this is the best alternative available particularly for foreigners to travel to India with complete medical treatment. India is not only cheaper but the waiting time is almost nil. This is due to the outburst of the private sector which comprises of hospitals and clinics with the latest technology and best practitioners.
Recognized surgeons offer Rectal Cancer Surgery in India at low budget
Rectal cancer surgery in India is done at various cancer hospitals. Rectal cancer is a type of cancer that develops in the rectum, the last six inches of our large intestine. Like other organs in our body, the rectum is vulnerable to many diseases and conditions, such as cancer. Surgical removal of a tumor is the cornerstone of curative therapy for localized rectal cancer. In addition to removing the rectal tumor, removing the fat and lymph nodes in the area of a Rectal cancer is also necessary to minimize the chance that any cancer cells might be left behind. For Rectal cancer surgery in India the Indian medical fraternityis a developing concept whereby people from world over visit India for their medical needs. The reason India is a favorable destination is because of its infrastructure and technology which is at par with those in USA, UK and Europe.
