Rectal Cancer
Cancer of the rectum requiring specialized surgical approaches for cure and quality of life preservation.
Overview
Rectal cancer requires specialized multidisciplinary management different from colon cancer due to its pelvic location and proximity to sphincters. Total mesorectal excision (TME) is the surgical gold standard, with neoadjuvant chemoradiation for locally advanced tumors dramatically improving outcomes and sphincter preservation rates.
Causes
- Adenomatous polyps (adenoma-carcinoma sequence)
- Genetic mutations (APC, KRAS, TP53)
- Lynch syndrome (HNPCC)
- Familial adenomatous polyposis (FAP)
- Chronic ulcerative colitis
- Diet (red/processed meat, low fiber)
Risk Factors
- Age over 50
- Family history of colorectal cancer
- Personal history of polyps or IBD
- Obesity
- Sedentary lifestyle
- Smoking
- Heavy alcohol use
- Type 2 diabetes
Symptoms
Diagnosis
- Digital rectal examination
- Rigid/flexible sigmoidoscopy with biopsy
- MRI pelvis (T and N staging — essential for treatment planning)
- CT chest/abdomen (M staging)
- Endorectal ultrasound
- CEA tumor marker
- Colonoscopy (to rule out synchronous tumors)
Treatment Options
Surgical Treatment
TME-based surgery is the standard: Low anterior resection (LAR) for mid/upper rectal tumors preserving the sphincter, or abdominoperineal resection (APR) with permanent stoma for very low tumors invading the sphincter. Dr. Bhagat performs laparoscopic TME with emphasis on nerve preservation to maintain urinary and sexual function.
Recovery
LAR: 5-7 days hospital stay, temporary ileostomy (reversed at 8-12 weeks), some frequency of bowel movements initially (LARS) improving over 12-18 months. APR: permanent colostomy, stoma education and support provided.
Prevention
- Colonoscopy screening from age 45
- Remove polyps when found
- High-fiber diet
- Regular exercise
- Maintain healthy weight
- Limit red/processed meat
- Avoid smoking and excess alcohol
Frequently Asked Questions
Will I need a permanent bag (stoma)?
What is neoadjuvant chemoradiation?
Expert Consultation Available
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