Rectal cancer treatment

International standards for the diagnosis and treatment of rectal cancer

In many cases, rectal cancer is diagnosed at screening. To confirm the diagnosis, imaging methods are used: colonoscopy, sigmoidoscopy.

Colonoscopy

If a patient reports symptoms, they should have a colonoscopy. With this method, the doctor examines the inside of the rectum. The examination is done using a colonoscope: a thin, flexible tube that is inserted into the anus. There is a small chamber at its end. She transmits images from the intestines to the monitor.

Biopsy

If necessary, during a colonoscopy, the doctor takes tissue samples from suspicious areas. Then they are examined under a microscope for malignant changes.

Sigmoidoscopy and rectoscopy

When colonoscopy is contraindicated, less extensive methods are used. During sigmoidoscopy, only the last 30-40 centimeters of the intestine are examined. With rectoscopy, the study is carried out using only a rigid mirror.

Assessment of tumor spread

When choosing the optimal treatment, it is necessary to determine the degree and stage of the tumor. To do this, endosonography is performed – a method of ultrasound examination. In this case, the device is inserted into the anus and the intestinal wall can be scanned from the inside.

Other methods include:

• CT or MRI of the pelvis and abdomen,
• ultrasound of the abdominal cavity,
• X-ray.

If women suspect that cancer may have spread to the uterus or vagina, a pelvic examination is recommended.

Treatment

It depends on type of tumor, risk of spreading the disease, and general condition of the patient.

Surgical intervention

The goal of the surgery is to remove as much cancerous tissue as possible from the body. For this, partial (upper third) or complete (middle and lower third) mesorectal excision is used. This removes not only the tumor itself, but also the surrounding lymphatic vessels.

Operation options:
• removal from the inside of the rectum,
• removal of cancer along with part of the rectum,
• removal of rectum and anus including.

Radiation therapy

The tumor itself and the surrounding lymphatic pathways are irradiated. Patients are often advised to take a course before surgery. This increases the success of the surgery and reduces the risk of recurrence after the procedure.

Chemotherapy

This method uses active substances to influence cancer cells. Doctors usually recommend taking this course after surgery to kill any remaining cancer cells. The innovative clinics use HIPEC hot chemotherapy.

Radiochemotherapy

A course of this kind of therapy is prescribed before surgery for large and locally more advanced tumors. It can significantly reduce the size of the tumor before surgery. Current protocols recommend 5-fluorouracil (5-FU), an effective and well-tolerated chemotherapeutic agent.

Targeted therapy

Targeted therapy is aimed at slowing the growth and reproduction of cancer cells. For metastatic cancer, it is usually used in combination with chemotherapy. Medicines used:
• bevacizumab,
• cetuximab,
• panitumumab.

Immunotherapy

The drugs activate the human immune system. As a result, the body increases the number of cells that can recognize and destroy cancer cells.

Brachytherapy

This method uses radiopharmaceutical capsules. They are injected deep into the tumor and destroy the tumor from the inside. The main advantage is no effect on healthy tissues.