Rectal cancer

The multidisciplinary treatment of colon cancer has many benefits for the patient, in that we can offer them the best and fastest treatment possible for their situation.”


Rectal cancer is a malignant tumor that appears in the cells of the rectal mucosa.

It is often referred to collectively as colorectal cancer, although the treatment is completely different from that given to a patient with colon cancer.

This malignant tumor can grow locally (invading the layers of the wall of the digestive tract and can reach the organs contained in the abdomen), by lymphatic spread to the nodes or by hematogenous spread (through the blood they go preferably to the liver, lung, bone and brain).

At the Clinica, we have a Gastrointestinal Cancer Area, composed of a multidisciplinary team of experts in the diagnosis and treatment of diseases of the digestive tract.  It includes specialists in the digestive system, radiology, pathological anatomy, surgery and medical and radiotherapeutic oncology and nursing support.

In addition to the laparoscopic approach, the specialists in General Surgery at the Clínica Universidad de Navarra have experience in robotic surgery to treat rectal cancer.


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What are the symptoms of rectal cancer?

The symptoms of rectal cancer are:

  • Change in bowel rhythm: diarrhea or constipation appears, intermittently, in people with a previously normal bowel rhythm.
  • Blood in the stool: one of the most frequent symptoms of colon cancer. Reddish or black in color. If the bleeding persists, anemia may appear.
  • Sensation of incomplete bowel movement (tenesmus).
  • Narrower stools: this is usually because the tumor is narrowing the bowel and does not allow normal passage of stool.
  • Abdominal pain: non-specific pain that improves after passing gas or stool.
  • Extreme tiredness or unexplained weight loss: these are general and non-specific symptoms that usually occur in certain diseases, such as tumors.

If you have any of them, it is advisable to see a Digestive specialist for diagnosis and treatment.

Do you have any of these symptoms?

You may have rectal cancer.

What are the causes?

The formation of rectal cancer depends on the interaction between genetic and environmental factors.

Environmental factors
Predominate in most cases of colon cancer. If these were identified, many colorectal cancers could be prevented. The most important causal factors appear to be dietary.

Hereditary factors
To check for genetic factors, a genogram is drawn up with a family history of cancer, not only of the colon, but also of other related cancers, such as stomach, ovarian, endometrial, brain, kidney or biliary tract cancer. Familial adenomatous polyposis and hereditary non-polyposis colorectal cancer can be hereditary.

At the Clinic we have a High Risk Digestive Tumor Prevention and Consultation Unit that has extensive experience and the latest technology to detect this genetic risk.

Risk factors and prevention

Each person has an individual risk of colorectal cancer that depends on many factors. Some are clearly established.

The risk is standard if you are over 50 years of age and do not have any of the following risk factors:

  • Personal family history of colon cancer or adenomatous polyps.
  • Family history (parents, siblings and/or children) with colon cancer or adenomatous polyps.
  • Family history of multiple cancers, especially breast, ovarian and uterine.
  • Diagnosed with chronic inflammatory bowel disease (ulcerative colitis, Crohn's disease).

How is rectal cancer diagnosed?


Rectal cancer may be found by chance during a colon examination or it may be suspected because the patient presents symptoms.

The tests that will be performed to reach an accurate diagnosis and know the extent of the disease, which will mark the type of treatment to be performed are:

Rectoscopy: an examination of the rectum and colon area is performed using an endoscope. If a suspicious lesion is detected, a biopsy will be performed to analyze it.

To determine the degree of extension, imaging tests such as abdominal abdominopelvic ultrasound, chest and/or abdominal scan, magnetic resonance imaging or positron emission tomography (PET) are performed.

How is rectal cancer treated?

In all cases in which it is possible, the tendency is to perform conservative surgery.

The treatment of rectal cancer without distant metastasis consists of removing the affected rectum.

There are three types of surgery for this pathology:

  • Anterior rectal resection. In high rectal tumors, the final section of the rectum can be preserved. If the tumor is lower, the entire rectum will be removed and a suture from the colon to the anus (coloanal anastomosis) will be performed. At the Clinic, specialists perform this procedure by robotic, laparoscopic or transanal laparoscopic surgery (TaTME), depending on the characteristics of the patient and the tumor.
  • Abdominoperineal amputation. When the tumor is very close to the anus or infiltrates the anal sphincter, the entire rectum and anal canal are resected. The colon is exteriorized through the abdominal wall by means of a permanent colostomy. At the Clinic the specialists perform this procedure by robotic and laparoscopic surgery, depending on the characteristics of the patient and the tumor.
  • Transanal surgery and TEM (transanal endoscopic microsurgery). If the rectal tumor is in a very early stage, local surgery through the anus is feasible to remove only the tumor with a sufficient margin. It avoids more aggressive surgery: resection of the rectum or abdominoperineal amputation. This surgery can be performed directly through the anus or by means of TEM (transanal endoscopic microsurgery).

Radiotherapy and/or chemotherapy is frequently administered before or after surgery to achieve the most complete eradication possible.

In addition to the laparoscopic approach, the specialists in General Surgery at the Clínica Universidad de Navarra offer robotic surgery to treat rectal cancer.

This is an approach that provides greater surgical precision, elimination of the surgeon's natural hand tremor and better visualization of the anatomical field being operated on.

This technique is especially indicated for male patients, people with obesity or cancer of the lower rectum.

Chemotherapy and radiotherapy in non-metastatic rectal cancer before surgery.

It consists of administering intensity modulated radiotherapy (IMRT) and chemotherapy before surgery.

It seeks to increase local control of the disease and to favor surgery, which will attempt to preserve the function of the anal sphincter. Tumor response to treatment correlates with survival.

IMRT allows the dose to be precisely administered to the areas to be treated and the irradiation of healthy tissues is significantly reduced; it shortens treatment time and combines chemotherapy agents that are more active against the tumor without increasing toxicity.

In patients with distal rectal tumors requiring amputation of the rectum (permanent colostomy), a chemo-radiotherapy protocol that favors maximum response followed by sphincter-sparing surgery, such as endoscopic transanal microsurgery (TEM), can be performed.

Proton therapy in rectal tumors is indicated because of the need to preserve critical tissues and organs from radiotherapy, such as the kidneys, small intestine, colon, liver, biliary tract or stomach.

Due to its location, rectal cancer is sometimes located in an area that is difficult for surgery and/or close to these organs, and this limits the radiation dose that would be administered with other advanced photon radiotherapy equipment.

Proton therapy makes it possible to deliver radiation adjusted to the area of tumor lesion and minimizing damage to healthy tissue, even in those tumors with complex anatomical location.

The Proton Therapy Unit at the Clinica Universidad de Navarra in Madrid is the most advanced in Europe and the first in a Cancer Center, with all its assistance, academic and research support.

The Clinic's Proton Therapy Unit incorporates a Hitachi synchrotron, this technology is present in 32 clinical and academic centers, among which are international references in cancer treatment, such as the Mayo Clinic, MD Anderson, John's Hopkins, St. Jude's Children's Research Hospital or Hokkaido University Hospital.

Where do we treat it?


The Gastrointestinal Cancer Area
of the Cancer Center Clínica Universidad de Navarra

The Gastrointestinal Cancer Area is composed of a multidisciplinary team of experts in the diagnosis and treatment of diseases of the digestive tract.

It includes specialists in the digestive system, radiology, pathological anatomy, surgery and medical and radiotherapeutic oncology and nursing support.

What diseases do we treat?

Imagen de la fachada de consultas de la sede en Pamplona de la Clínica Universidad de Navarra

Why at the Clinica?

  • Integral evaluation of the patient.
  • Cutting edge technology.
  • Expert professionals who are a national reference.

Our team of professionals