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Rectal Cancer

The rectum is the last part of the colon that connects the large intestine to the anus. The main task of the rectum is to store the stool to be excreted from the body. The rectum is approximately the last 12-15 cm of the large intestine. It starts in the last part of the colon and ends when it reaches the short and narrow passage that reaches the anus. The rectum consists of 3 layers. The mucous part, which consists of glands that secrete mucus to facilitate the passage of stool, covers the inner surface of the rectum. The layer called muscularis propria, which forms the middle layer of the rectum wall, consists of muscles that provide contraction. The last part of the rectum is the fat layer. Apart from these three parts that make up the rectum, lymph nodes, which are part of the immune system, surround the rectum.

What is rectal cancer?

Rectal cancer is a disease in which cancerous, that is, malignant cells, form in the tissues of the rectum. Rectal cancer is usually caused by polyps in the lining of the rectum. Rectal and Colon Cancers are often referred to as "Colorectal cancer".

What are the symptoms of rectal cancer?

Rectal cancer symptoms can manifest in many different ways. However, many rectal cancers are detected in routine screening without symptoms.

Rectal cancer symptoms generally include:

  • Bleeding in the rectum or blood in the stool is one of the most common symptoms of rectal cancer. Almost 8 out of 10 patients experience signs of bleeding.

  • mucus in stool

  • Changes in bowel movements such as constipation, diarrhea, and excessive gas can be the first sign of rectal cancer.

  • In addition to the change in bowel movements, the feeling that the bowel is empty or the inability to defecate adequately despite frequent toilet visits are among the symptoms of rectal cancer.

  • painful bowel movements

  • Unnoticed bleeding in the stool can lead to anemia. Shortness of breath, dizziness, rapid heartbeat due to anemia should be taken seriously in terms of rectal cancer symptoms.

  • Intestinal obstruction may occur as a result of the tumor growing and closing the exit path. Intestinal obstruction can cause severe pain and cramps in the abdomen.

  • The growth of the tumor can cause changes in stool size. Pen-thin stool can be a sign of rectal cancer.

  • Unexplained weight loss that is not due to diet or exercise is among the first signs of rectal cancer.

What causes rectal cancer?

The exact cause of rectal cancer is not known. However, there are many risk factors that cause rectal cancer.

  • The majority of rectal cancers occur in advanced age.

  • Alcohol and cigarette consumption increase the risk of rectal cancer


  • High-fat diet of animal origin may be the cause of rectal cancer.

  • A history of colorectal cancer or polyps can cause rectal cancer.

  • Chronic inflammatory diseases of the colon and rectum, such as ulcerative colitis and Crohn's disease, increase the risk of rectal cancer.

  • Genetic syndromes such as hereditary nonpolyposis colorectal cancer (Lynch) and familial adenomatous polyposis (FAP) are among the causes of rectal cancer.

  • A sedentary lifestyle and obesity

  • Receiving radiotherapy for cancer treatment, especially to the abdomen, can cause rectum and colon cancer.

  • Diabetes

  • Colon and rectal cancer in the family, especially in first-degree relatives, is an important cause of rectal cancer.

How is rectal cancer diagnosed?

  • Routine screening programs should be applied to detect rectal cancer early. Starting routine screening at the age of 50 in people without any risk factors is vital for early detection of rectal cancer. Screening age may start earlier in people with risk factors. Rectal cancer is diagnosed in the controls performed after rectal bleeding or iron deficiency, which is usually a symptom of rectal cancer.

  • Colonoscopy is the most commonly used method in screening programs and diagnosis . It is often possible to remove small tissue samples from suspicious-looking areas during colonoscopy. Laboratory analysis of tissue samples removed for biopsy is helpful in diagnosing rectal cancer.

Treatment of rectal cancer

Treatment is planned after the stages and grade of rectal cancer are determined. In the treatment of rectal cancer; Planning is done according to the stage and degree of cancer, the location of the tumor in the rectum, its size, the patient's age and general health.

Rectal cancer Chemotherapy and Radiotherapy treatment

Rectal cancer chemotherapy treatment usually consists of two or more drugs that target cancer cells. In rectal cancer, chemotherapy and radiotherapy can be used before surgery as well as after surgery. In the 1st stage treatment of rectal cancer, the surgical method may be the only necessary step in the treatment. In stage 1 rectal cancer, the risk of recurrence after surgery is low, and therefore chemotherapy is not usually recommended. In the 2nd and 3rd stages of rectal cancer, chemotherapy and radiotherapy are applied after the surgery to prevent the cancer from recurring. Rectal cancer stage 2 and stage 3 rectum cancer patients can be treated with chemotherapy and radiotherapy to shrink the tumor before surgery.  

Rectal cancer surgery

Surgery is one of the most commonly used methods in the treatment of rectal cancer. Rectal cancer surgery is planned according to the location and size of the tumor.

Rectal cancer surgery; It can be examined in 2 groups as breech-preserving rectum surgery and rectal surgery requiring breech loss.

In rectal cancer surgery;

  • End colostomycoloanal anastomosis

  • Low anterior resectionLocal excision - Local or Transanal Excision - Transanal Endoscopic Microsurgery

  • Intraoperative radiation therapy (IORT).

  • Abdominoperineal Excision (APR) - Extra-Levator Abdominoperineal Excisionpolypectomy

  • Radiofrequency ablationcryosurgery

  • Surgical techniques such as minimally invasive surgery can be used


Who Gets Rectal Cancer? Is it a Common Cancer?

Rectal cancer is more common in men than women. With the advancement of endoscopic and radiological examinations, the diagnosis of rectal cancer can be made more easily. With the increase in awareness, there is an increase in the incidence rates. About 1 million people in the world are diagnosed with colon and rectal cancer every year. Although there is no exact figure in our country, it is estimated that 30 thousand people are diagnosed with colon and rectal cancer every year. The most common type of rectal cancer is adenocarcinoma, a cancer originating from the mucosa.

Which Doctor Should Be Seen for Rectal Cancer?

In cases where one or more of the symptoms of rectum and colon cancer are observed, doctors of Gastroenterology or General surgery department should be consulted without delay. Since surgical methods come to the fore in the treatment procedure of rectum and colon cancer, it is important to choose a specialist doctor. Since the treatment of colorectal cancers requires a multidisciplinary approach by combining many medical units such as general surgery, gastroenterology and oncology, it is important to choose hospitals with adequate medical infrastructure.

Is Rectal Cancer Contagious?

There is no transmission from one person with rectal cancer to another. There is no evidence that cancer is transmitted by breathing, air, contact, or sexually. However, rectum and colon cancer carry genetic features. People with a family history of rectum and colon cancer are more likely to develop colorectal cancer.

What is the Difference Between Rectal Cancer and Colon Cancer?​

The symptoms and causes of rectal and colon cancer are very similar. Although rectal and colon cancers are similar in many ways, their treatments are different. This is mainly because the rectum sits in a narrow space that is barely separated from other organs and structures in the pelvic cavity.

Does Hemorrhoids Cause Rectal Cancer?

There is no relation between rectal cancer and hemorrhoids. However, bleeding and pain in the breech region are seen in hemorrhoids as well as in rectal cancer. Many people with colon and rectal cancer also have hemorrhoids. Patients may be delayed in applying to a doctor by attributing their distress to hemorrhoids. It is important for early diagnosis to consult a specialist without losing time with the onset of symptoms.

What Tests Are Done for Rectal Cancer Staging?

The stage of rectal cancer should be determined after the diagnosis of rectal cancer with a physical examination and colonoscopy examination by a general surgeon who is specialized in colorectal cancers. 

Rectal cancer staging is important for deciding the most appropriate route in the treatment process. The following tests can be used in the staging phase of rectal cancer.

  • Rectal Examination: It is a finger examination using a slippery glove placed in the rectum to feel the cancer in the rectal wall. In cases where the tumor is far from the anus, rectal cancer may not be detected in this examination. If an abnormality is detected by digital rectal examination, an endoscopy is performed for further evaluation of the cancer.

  • Flexible sigmoidoscopy: As in the colonoscopy method, a flexible tube with a camera is inserted through the anus and into the rectum. This examination can give an idea for both the diagnosis of rectal cancer and the stage of rectal cancer.

  • Rigid sigmoidoscopy: It is the placement of a rigid optical scope inserted through the anus into the rectum. Rigid sigmoidoscopy is usually performed by a gastroenterologist or general surgeon. The advantage of rigid sigmoidoscopy is that a more precise measurement of the distance from the tumor to the anus can be made.

  • Complete blood count: Determining whether the number of red blood cells in the blood is low is important in terms of showing whether the tumor has caused blood loss. High levels of white blood cells can be a sign of infection, with the risk of tumor growing through the wall of the rectum.

  • Tumor marker tests: Cancer can sometimes produce substances called tumor markers in the blood. The presence of more than normal tumor markers in the blood may be a sign of rectal cancer. Carcinoembryonic antigen and carbohydrate antigen can be checked for rectal cancer. Carcinoembryonic antigen (CEA) is normally found at very low levels in the blood of adults. CEA may be increased in certain types of cancer and in non-cancerous (benign) conditions.

  • Computed Tomography (CT): Computed tomography can be used to check whether colorectal cancer has spread to lymph nodes in the chest, abdomen, and pelvis, or to organs such as the lungs and liver. Rectal cancer staging can be done by determining how far the tumor is from the anus by computerized tomography.

  • Magnetic Resonance (MRI): A detailed image of the muscles, organs, and other tissues surrounding the tumor in the rectum can be provided. In addition, lymphs near the rectum and different tissue layers in the rectal wall can be visualized with magnetic resonance imaging.

  • Chest X-ray: Whether rectal cancer has metastasized to the lung can be determined by X-ray.

  • Endoscopic Ultrasound (EUS): It is based on combining the endoscopy method and the ultrasonography method. EUS shows the wall layers in the digestive tract in detail. It facilitates the diagnosis of diseases in the digestive system or in the organs adjacent to the digestive system.

  • PET scan (positron emission tomography scan) : It is a procedure to find malignant tumor cells in the body. A small amount of radioactive glucose is injected into the vein. The PET scanner rotates around the body and shows where glucose is used in the body. Malignant tumor cells appear brighter in the picture because they are more active and take up more glucose than normal cells.

  • Cell and tissue studies: Cells and tissue studies are studies to find the type of colon or rectal cancer. KRAS is a mutated gene in some colorectal cancer cells. The KRAS test is usually performed on metastasized colorectal tumors. It is important in terms of the appropriateness of targeted drug use. MSI testing may also be done to determine if the tumor is due to Lynch syndrome.

Rectal Cancer Stages

Rectal cancer grade and rectal cancer stage are important for the treatment to be applied. Rectal cancer grading is about how cancer cells look compared to normal and healthy cells. Knowing the degree of rectal cancer can give an idea about how fast the cancer can grow and how likely it is to metastasize.In low-grade rectal cancer, the cells are abnormal but look like normal cells. Low-grade rectal cancer tends to grow slowly and is less likely to metastasize. High-grade rectal cancer has more undifferentiated cancer cells. High-grade rectal cancer, whose cells are not like normal cells, tends to grow rapidly and are more likely to metastasize than low-grade cancers.Rectal cancer staging; Information obtained from examinations varies according to which parts of the rectum there is cancer, the size of the tumor, and whether the cancer has spread from where it first started. Staging is important for planning rectal cancer treatment. While staging of rectal cancer;

How deep the tumor is in the wall of the rectum

Whether there is cancer in the lymph

It is evaluated whether rectal cancer has metastasized to other organs such as the lung or liver.

Rectal cancer stages are evaluated in 5 groups.

Rectal Cancer Stage 0: Cancer cells are only found in the inner lining of the colon or rectum, called the mucosa. Cancer cells have not penetrated the muscle layer of the mucosa.

Rectal Cancer Stage 1: The tumor has spread to the connective tissue layer surrounding the mucosa or the thick outer muscle layer of the rectum.

Rectum Cancer Stage 2: Rectal cancer stage 2 is handled in three stages.  

Rectal Cancer 2 Stage- A; The cancer has reached the outermost layer of the rectum wall and has not spread to the surrounding organs. There is no metastasis to lymph and distant organs.

Rectal Cancer 2 Stage- B: Cancer has invaded all layers of the rectal wall but has not spread to surrounding organs or tissues. There is no lymph or metastasis to distant organs.

Rectal Cancer 2 Stage- C; The cancer has extended beyond the rectal wall. It has grown into nearby organs or tissues. There is no metastasis in lymph and distant organs.

Rectal Cancer Stage 3: The cancer has spread to nearby lymph. Rectal cancer stage 3 is divided into 3 parts, depending on where the tumor has grown and how many lymph nodes it has spread.

Rectum Cancer Stage 4 : In stage 4 of rectum cancer, metastases to organs such as the liver or lungs are experienced. Cancer may be in only 1 organ or distant lymph nodes. It is handled in 3 stages.

Rectal Cancer Stage 4-A: The cancer has spread to an area or organ not close to the rectum, such as the liver, lung, ovary, or a distant lymph.

Rectal Cancer Stage 4-B: The cancer has spread to more than one area or organ not close to the rectum, such as the liver, lung, ovary, or a distant lymph node.

Rectal Cancer Stage 4-C: The cancer may have spread to the tissue lining the abdominal wall and may have spread to other areas or organs.

What Are Rectal Cancer Metastases?

When cancer spreads to another part of the body, it is called metastasis. Cells of rectal cancer leave from where they started (the primary tumor) and may metastasize to different parts of the body through the lymph system or blood.

The answer to the question of which organs rectal cancer spreads includes;

  • Metastasis of rectal cancer is most common in nearby lymph nodes.

  • Rectal cancer can spread to the peritoneum.

  • Metastases may occur in tissues close to the abdomen or pelvis.

  • It can be seen in distant lymph nodes.

  • Rectal cancer can metastasize to the kidney and adrenal gland.

  • Rectal cancer liver metastasis is usually seen in Stage 4.

  • Rectal cancer lung metastasis is usually seen in Stage 4.

  • Rectal cancer metastases can be seen in the bones and brain.

How Long Is the Lifespan of Rectal Cancer?

One of the most curious subjects of rectal cancer patients is “How long does rectal cancer live?” comes the question. Rectal cancer life expectancy; It depends on many factors such as the degree and stage of cancer, Carcinoembryonic antigen (CEA) levels, general health status of the patient, the chosen treatment method, and the patient's response to treatment. How long does rectal cancer live? The root of such a problem is not certain and varies from patient to patient.

Rectal cancer survival statistics are very general estimates and should be interpreted very carefully.

According to the general statistics made in the world, the 5-year survival rates are as follows:

  • Rectal Cancer Stage 1 5-year survival 80-88%

  • Rectal Cancer Stage 2 5-year survival 60% - 81%

  • Rectal Cancer Stage 3 5-year survival 40-75%

  • Rectal cancer Stage 4 (Rectum cancer final stage) 5-year survival 8-13%

How should follow-up be after rectal cancer treatment?

Some of the tests done to diagnose rectal cancer or to find the stage of rectal cancer may be repeated after treatment. The decision whether to continue or change treatment may be based on the results of these tests.

After rectal cancer treatment, tests such as measuring carcinoembryonic antigen amounts, colonoscopy, virtual colonoscopy can be repeated to check whether the cancer has relapsed.

Can Rectal Cancer Be Prevented?

Rectal cancer is a preventable cancer like colon cancer. Rectal cancer can develop from benign rectal polyps in the rectal wall. Detection and removal of these polyps by colonoscopy reduces the risk of rectal cancer. Considering the family history, it is vital to screen for rectal cancer after the age of 45-50. The most accurate and effective screening test is colonoscopy. In addition to screening controls, there are many scientific studies showing that diet is also associated with rectal cancer. Consuming low-fat foods such as whole grains, fruits, vegetables, and nuts that are high in fiber can reduce the risk of developing rectal cancer.

In order to prevent rectal cancer in general;

  • Routine colorectal scans should not be neglected

  • Weight control should be ensured

  • An active life should be preferred. Exercise and sports should be done regularly

  • Vegetables such as salad greens, tomatoes, onions, broccoli, eggplant, carrots, garlic, and fruits such as melons, apples, pears, oranges, bananas should be consumed frequently. In addition, foods such as oats, black rice, barley, wild rice, lentils, beans should be added to the diet. Red meat, processed meat, fast food should be avoided.

  • Alcohol and smoking should be stopped.

Rectal Cancer Nutrition

Eating a balanced diet before, during or after the treatment of rectal cancer can contribute to the person's feeling of well-being and maintaining their strength, thus accelerating the recovery.

  • Get your weight control. Treatments such as chemotherapy, radiotherapy, and rectal cancer surgery can often cause unwanted weight loss. It is important to avoid excessive weight loss during treatment, as a poor and unbalanced diet can result in a reduced ability of the body to fight infection.

  • Eat small, frequent meals throughout the day. Eating frequent small meals ensures that your body is getting enough calories, protein and nutrients to tolerate the treatment. Small meals can also help reduce treatment-related side effects, such as nausea.

  • Choose protein-rich foods. Protein helps the body repair cells and tissues. It also helps the immune system recover from illness. Include a source of lean protein at all meals and snacks. Good sources of lean protein include: Lean meat such as chicken, fish, or turkey Eggs Low-fat milk or dairy products, such as milk, yogurt, and cheese Nuts beans soy foods 

  • Include whole grain foods in your diet. Whole grain foods provide a good source of carbohydrates and fiber, which helps keep your energy levels high.

Good sources of whole grain foods include: Rolled oats, Whole wheat breadsbrown rice, Whole grain pastas 

  • Eat a variety of fruits and vegetables every day. Fruits and vegetables offer antioxidants to the body, which can help fight cancer. Choose a variety of colorful fruits and vegetables to get the most benefits.

  • Choose healthy sources of fat. Avoid fried, greasy and oily foodsLimit sweets.

  • Don't forget to drink water. Drinking enough fluids during cancer treatment is important to prevent dehydration.

  • Pay attention to changes in bowel habits. Colorectal cancer and its treatments can often cause changes in bowel habits such as diarrhea, constipation, bloating and gas. Share any changes in your bowel habits with your doctor.

  • Talk to your healthcare team before taking any vitamins or supplements

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See Frequently Asked Questions here.

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