Rectal Cancer

• Ronald Bleday, MD
• Joel Edward Goldberg, MD
• Jennifer Lynn Irani, MD
• Nelya Melnitchouk, MD
• James Yoo, MD

Factors that contribute to an increased risk for rectal cancer include:

• Older than age 50
• Diet high in fat
• Obesity
• Sedentary lifestyle
• Family history of cancer of the colon or rectum
• Certain hereditary conditions, such as familial adenomatous polyposis (FAP) and hereditary nonpolyposis colon cancer (HNPCC; Lynch Syndrome)
• History of colon or rectal polyps
• History of inflammatory bowel disease (ulcerative colitis and Crohn’s disease)
• History of cancer of the colon, rectum, ovary, endometrium or breast

Learn if you are at risk for rectal cancer.

Rectal cancer is often in a more advanced stage when symptoms present. Common symptoms are:

• Change in bowel habits
• Blood in stool
• Diarrhea
• Constipation
• Stools narrower than usual
• Frequent gas pains
• Bloating
• Cramps
• Weight loss
• Tiredness
• Vomiting

Learn more about symptoms of rectal cancer.

Beginning at age 50, men and women should follow one of these examination schedules:

• Fecal occult blood test or fecal immunochemical test every year
• Flexible sigmoidoscopy every five years
• Double-contrast barium enema every five years
• Colonoscopy every 10 years
• Virtual colonoscopy, a computer assisted approach that is less invasive than traditional colonoscopy every five years

People with colorectal cancer risk factors should begin screening procedures at an earlier age and/or be screened more often.

Learn more about colorectal cancer screening.

Learn about the Center for Community Health and Health Equity (CCHHE) colorectal screening program.

If you are having symptoms of rectal cancer, your surgeon will ask about your health history, your family’s history of cancer and risk factors. Diagnostic test include many of the same exams done for people without symptoms:

• Digital rectal examination
• Fecal occult blood test
• Sigmoidoscopy
• Colonoscopy
• Barium enema
• Biopsy
• Blood count
• Imaging tests such as a CT scan, PET scan, ultrasound, or MRI of the abdomen, may be done to look for tumors or other problems. These tests may also be done if colorectal cancer has already been diagnosed to help determine the extent (stage) of the cancer.

Learn more about diagnostic tests and procedures for rectal cancer.

After rectal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the rectum or to other parts of the body.

Learn more about the stages of rectal cancer.

Surgical Treatment

Surgery is the most common treatment for all stages of rectal cancer. Colon and rectal surgeons at Brigham and Women's Hospital have two main goals for treating patients with rectal cancer: removing all cancerous tissue and sparing the anal sphincter to avoid a permanent colostomy.

Sphincter-Sparing Surgical Techniques

Our colon and rectal surgeons are international leaders in minimally invasive operations that preserve the anal sphincter. These surgical techniques include:

• Low anterior resection involves removing all or part of the rectum and taking healthy bowel from the colon and then "anastomosing" (hooking up) it to the remaining rectum. Occasionally, if the hookup is very close to the anus (or anal sphincter), it is then recommended that the patient have a temporary, proximal, diverting ileostomy, or bag. This temporary bag allows the complicated surgery that has been performed to heal without stool passing across the new hookup. After a period of approximately two to three months, the temporary colostomy or ileostomy can be taken away with a second surgery and then the patient will be able to evacuate normally.
• Local excision is performed through the anus or through the tailbone area to remove the small cancer without a colostomy. The tumor is removed through the anus and the surgical excision is stitched closed. The lymph nodes near the rectum are removed and checked under a microscope for signs of cancer. Sometimes this procedure can be done on an outpatient basis. Depending on the extent of the small cancer, adjuvant, or extra, therapy with radiation and chemotherapy is sometimes recommended. The advantage of this procedure is that it is relatively minor and preserves the muscles of the anus so that a patient does not require a permanent colostomy. However, patients who do have a local excision need to be followed very closely to ensure that there is no recurrence.
• Abdominal-perineal resection: If you have a large cancer, or if it involves the muscles of continence (the anal sphincters), then a sphincter-sparing procedure cannot be performed. In this situation, an abdominoperineal resection (APR) procedure will need to be performed. The advantage of this operation is that it removes all of the cancerous tissue but it does leave you with a permanent colostomy. If you should require this operation, we will have you see one of our enterostomal therapists prior to the procedure to discuss and educate you about living with a colostomy. The enterostomal therapists also help the surgeon choose the best spot for the colostomy in order to avoid problems with the ostomy appliance on the abdominal wall. This teaching and education continues postoperatively, both in the hospital and at several follow-up outpatient visits. The quality of life has been shown to be good to excellent in patients with a well-functioning colostomy and, when necessary, allows the surgeon and the other treating physicians to aggressively and successfully treat your rectal cancer.
• Minimally invasive surgery is usually the first choice in preventing rectal cancer (Laparoscopically or Robotic)

Non-Surgical Treatment

• Radiation therapy
• Chemotherapy
• Radiofrequency ablation
• Cryosurgery
• Targeted therapies

Learn more about non-surgical treatments for rectal cancer.

You will receive a thorough diagnostic examination to evaluate if you have rectal cancer and determine what course of treatment is needed. Careful monitoring and the involvement of an experienced colon and rectal surgeon are important to the successful outcome for patients with rectal cancer.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be cared for in the operating room by surgeons, anesthesiologists and nurses who specialize in surgery for patients with rectal cancer. After surgery, you will recover in the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

Learn more about your hospital stay and returning home.

The Gastrointestinal Cancer Treatment Center at Dana-Farber Brigham Cancer Center provides the world's most advanced and innovative multidisciplinary care for patients with gastrointestinal diseases, such as rectal cancer. Our treatment team includes colon and rectal surgeons, medical and radiation oncologists, nutritionists, pathologists, anesthesiologists and gastroenterologists. In addition, patients have full access to BWH's world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.

Contact one of our cancer surgeons in the list at the top of the page to make an appointment.

Cancer Surgery Locations