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Rectal cancer
Therectumispartofthedigestivesystem.Oncefoodnutrientshavebeenabsorbedbythesmall intestines,thewasteismovedbymuscularcontractionsintothelargeintestine(bowel).Wateris removedandthewasteistemporarilystoredintherectum,whichmakesupthelast20cmorsoof thebowel.Fromtherectum,wastespassoutofthebodythroughtheanus.Therectumslining (epithelium)secretesmucusthathelpstolubricatethefaecesthroughtheanus. Canceroftherectumbeginsascellularchangesinthetopmostlayeroftheepithelium.Rectal cancertendstoaffectpeopleovertheageof50years,withmenmoreatriskthanwomen.Some peoplehaveanincreasedriskduetogeneticfactorsandmaydevelopthediseasesometimeafter theageof40years. Iftreatedinitsearlieststages,rectalcancerishighlycurable.Ifuntreated,straycancercellscan migratearoundthebodyviathelymphaticsystemanddevelopsecondarycancers. Symptoms Thesymptomsofrectalcancerinclude: Achangeinpreviousbowelhabits,suchasconstipationordiarrhoea Urgencytopassbowelmotions Asensationthatthebowelisntemptyaftergoingtothetoilet Bleedingfromtheanus Abdominalpain.

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Risk factors Factorsthatmayincreaseapersonsriskofrectalcancerinclude: Advancingage Familyhistoryofcoloncancer Polypsintherectum Pre-existinginflammatoryboweldisease,suchasulcerativecolitis Highfat,lowfibre,lowcalciumdiet Obesity.

Diagnosis Rectalcancerisdiagnosedusingarangeoftestsincluding: Rectal examinationthedoctorinsertsaglovedfingerintotherectumandfeelsfor lumps. Faecal occult blood testfaecalmatterisexaminedinthelaboratory. Proctoscope or sigmoidoscopeaslenderinstrumentisinsertedintotheanustoallow thedoctortolookattherectum. Colonoscopyalongerinstrumentisinserted(undersedation)tochecktherectumand colon. Biopsyasmalltagoftissueisremovedandexaminedinalaboratoryforthepresenceof cancerouscells. Barium enemaspecialfluidissquirtedintotherectumandx-raysaretaken. Endorectal ultrasoundanultrasounddeviceisinsertedandpicturestakenofthe rectum. Magnetic resonance imaging (MRI) ahigh-definitionscanisusedtodeterminethe sizeandspreadofrectalcancer.

Stages of the disease Rectalcanceriscategorisedintodifferentstagesincluding:

Rectalcancer

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Stage 0thecancerislimitedtothelining(epithelium)oftherectum. Stage 1thecancerhasspreadtothedeeperlayersoftherectallining. Stage 2thecancerhasspreadtotissuesbeyondtherectum,butnottothelymphnodes inthelocalarea. Stage 3thecancerhasspreadtothelymphnodesinthelocalarea. Stage 4thecancerhasdevelopedsecondarycancersatothersitesaroundthebody.

Treatment Treatmentforrectalcancerdependsonitsstage,butmayinclude: Surgerythecancerandassociatedrectaltissueaswellasnearbylymphnodesare removedeitherthroughtheanusorviaanabdominalincision.Therectumisthensewn backtogether.Ifalargeamountoftissueisremoved,itmaynotbepossibletoclosethe rectumandacolostomywillbeneeded,eithertemporarilyorpermanently. Radiation therapyhighdosesofpreciselytargetedradiationareusedtokillcancer cells. Chemotherapycancer-killingdrugsareadministeredbyintravenousinjectionorby mouth.

ThereareseveralspecialisedcentresinmostAustralianStatesandTerritoriesthattreatrectal cancer.Resultsfromtreatmentaregenerallybetterwhentreatmentisprovidedbythese specialisedcentres. Colostomy Sometimes,somuchtissueisremovedthattherectumcantbesewnbacktogetherorreattached totheanus.Inthiscase,thebowelisdivertedfromtheanustoasmallholeintheabdomen (stoma)andacolostomybagfitted.Acolostomybagismadefromplasticandisstucktothe stomawithspecialglue.Wastesarepassedintothebag,whichisthenthrownawayandreplaced withafreshone. Atemporarycolostomybagmaysometimesbeneededwhileasuccessfullyremodelledrectum healsproperly.Lessthanathirdofpatientsthathaveanoperationforrectalcancerwillrequire colostomy. Where to get help Yourdoctor TheCancerCouncilofVictoria,InformationandSupportServiceTel.131120

Things to remember

Therectummakesupthelast20cmorsoofthelargeintestine. Thefunctionoftherectumistotemporarilystorefaeces. Rectalcancerusuallyaffectspeopleovertheageof50years,withmenmoresusceptible thanwomen. Treatmentincludessurgery,chemotherapyandradiationtherapy.

This page has been produced in consultation with, and approved by:

CanberraHospital-GastroenterologyUnit

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Rectalcancer

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