Rectal cancer
"The multidisciplinary approach allows addressing rectal cancer from all necessary perspectives to optimize treatment".
DR. IGNACIO MATOS GARCÍA
SPECIALIST. MEDICAL ONCOLOGY DEPARTMENT
Rectal cancer is a type of malignant tumour that originates in the cells lining the inside of the rectum, the final part of the large intestine that connects to the anus.
This cancer can develop in several ways: it can grow locally by invading the layers of the rectal wall and even reach nearby organs in the abdomen, or it can spread to other parts of the body.
Spread can also occur through the lymphatic system, affecting nearby lymph nodes, or via the bloodstream, which can carry cancer cells to organs such as the liver, lungs, bones and even the brain.
At the Clínica Universidad de Navarra, the Gastrointestinal Cancer Department brings together a multidisciplinary team of experts who work in a coordinated way to diagnose and treat this type of cancer.
In addition to using advanced techniques such as laparoscopic surgery, the specialists in General Surgery also have experience in robotic surgery, a tool that allows for greater precision and better results in the treatment of rectal cancer.
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What are the symptoms of rectal cancer?
Alterations in bowel rhythm
Diarrhoea, constipation or alternating between the two may occur in people who previously had regular bowel movements.
Blood in the stool
This is one of the most common symptoms. The blood may be bright red or black, depending on the source of the bleeding. If the bleeding persists, it may lead to anaemia.
Sensation of incomplete evacuation
Known as tenesmus, this is the sensation of not having completely emptied the bowel after going to the toilet.
Narrower stools
This occurs because the tumour may partially obstruct the passage of stool, reducing its size.
Abdominal pain
Usually non-specific pain that often improves after a bowel movement or passing gas.
Extreme tiredness or unexplained weight loss
These are general signs that, although not exclusive to cancer, can occur in diseases such as tumours.
Do you have any of these symptoms?
If you suspect that you have any of the above symptoms,
you should consult a medical specialist for a diagnosis.
What are the causes?
Environmental factors
These factors predominate in most cases of rectal and colon cancer. The most important environmental factors are:
- Diet: High consumption of red and processed meats, low-fibre and high-fat diets.
- Sedentary lifestyle: Obesity, sedentary lifestyle, alcohol consumption and smoking.
- Age: The risk increases after 45-50 years of age.
- Inflammatory diseases: Such as ulcerative colitis and Crohn's disease.
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 Clínica we have a High Risk Prevention and Consultation Unit for Digestive Tumours that has extensive experience and the latest technology to detect this genetic risk.
How is rectal cancer diagnosed?
Rectal cancer may be found by chance during an examination of the colon or it may be suspected because the patient presents symptoms. The tests that will be carried out to reach an exact diagnosis are:
- Rectoscopy: an examination of the rectum and colon area is performed using an endoscope. If a suspicious lesion is detected, it is biopsied for analysis.
- Imaging tests such as abdominal abdominopelvic ultrasound, chest and/or abdominal scan, magnetic resonance imaging (MRI) or positron emission tomography (PET) are used to determine the extent of the lesion.
How we treat rectal cancer
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.
What clinical trials do we have on cáncer de recto?
MR Linac | MRI-guided linear accelerator for radiation therapy
Advanced radiotherapy technology that combines a linear accelerator with an integrated magnetic resonance of 1.5 Teslas, it allows adaptive radiotherapy to be administered in real time, which adapts the dose and precision of the radiotherapy administered to the patient according to the characteristics of each person and each tumor.
Where do we treat it?
IN NAVARRA AND MADRID
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?
Why at the Clinica?
- Integral evaluation of the patient.
- Cutting edge technology.
- Expert professionals who are a national reference.
IN NAVARRE AND MADRID
Our team of rectal cancer experts
