Rectal Cancer Treatment is Changing

• Colon and rectal cancers are often thought of as one in the same. But while the two have a lot in common, rectal cancer treatment can often have a bigger impact on a patient’s quality of life.

  Colorectal cancer is an umbrella term for colon and rectal cancers—two types of large intestine cancers. Colon cancer forms in the colon, the first part of the large intestine. Rectal cancer forms in the rectum, the lower part of the large intestine where stool is stored.

  A person’s overall risk for developing colorectal cancer is a little more than 4 percent. Colon cancers tend to be more common than rectal cancers. But that’s simply because the colon is larger, so there’s more space for potential cancers to form, explained Namrata (Neena) Vijayvergia, MD, a hematologist/oncologist at Fox Chase Cancer Center.

  The risk for both colon and rectal cancers goes up with age. You’re also at higher risk if:

  • A first-degree relative has had colorectal cancer
  • You have inflammatory bowel disease
  • You have colorectal growths called polyps
  • You have certain rare genetic conditions like Lynch syndrome or familial adenomatous polyposis

  A Possible Better Treatment Plan

  Between ages 45 and 75, regular screening tests are recommended to help catch cancerous rectal (and colon) growths sooner, when they may be easier to treat. But even rectal cancers that are detected early many times require extensive—and often life-changing—surgery to remove the tumor.

  In many colon cancer cases, tumors can be removed by taking out a small part of the colon and joining the remaining sections together, Vijayvergia said. Sometimes a person may need a temporary colostomy—an opening in the belly to get rid of stool.

  Surgery to remove tumors in the rectum is often more invasive. Because the rectum stores stool, removing it can cause a person to lose their bowel function completely, Vijayvergia said. They may need a colostomy for the rest of their life.

  Some patients with rectal cancer undergo chemotherapy or radiation before surgery to shrink their tumor. At Fox Chase, doctors are looking at how chemo and radiation can be used to make tumors small enough to remove locally—so a patient’s bowel function isn’t permanently affected.

  Vijayvergia is currently involved in a clinical trial designed to treat early-stage rectal cancers without the need for colostomies.

  “We’re doing chemotherapy up front, then local surgery to remove the tumor, followed up by chemotherapy and radiation to ensure that the local procedure doesn’t decrease the chance of becoming cancer free,” she explained.

  While avoiding a colostomy will certainly improve patients’ quality of life in the short term, the question is whether a less invasive surgery is as good as a radical operation to keep the rectal cancer from coming back. The current study incorporates chemotherapy and radiation in addition to local surgery to the treatment plan.

  “The studies we have open are attesting to the fact that rectal cancer isn’t treated in a cookie-cutter matter anymore,” Vijayvergia said. “We need the expertise of surgeons, radiation oncologists, medical oncologists, and endoscopists.”

  Learn more about colorectal cancer treatment at Fox Chase.

  Vijayvergia’s clinical trial is currently recruiting patients with early-stage rectal cancer. You may be a candidate if:

  • Your surgical treatment would require a colostomy
  • You have been diagnosed with early-stage adenocarcinoma of the lower rectum and your imaging scans show that your rectal cancer hasn’t spread to your lymph nodes
  • You have not received prior therapy for rectal cancer

  For more information on the trial, click here.