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Rectal Cancer: Symptoms, Causes, And More
Rectal cancer is cancer that develops in cells in the rectum, which is below the sigmoid colon and above the anus.
Your rectum and colon are both part of the digestive system, so rectal and colon cancers are often grouped under the term colorectal cancer.
In the United States, colorectal cancer is the third most common type of cancer. It's also the second deadliest, making early detection and treatment critical. Worldwide, colorectal cancer is the second most common cancer in females and the third most common cancer in males, according to a 2020 data from Worldwide Cancer Research Fund.
The American Cancer Society estimates there will be 44,850 new cases of rectal cancer in the United States in 2022. This compares with 106,180 new cases of colon cancer.
At first, rectal cancer may be asymptomatic.
As the cancer progresses, rectal bleeding is the most common symptom. Changes in your bowel habits may occur, lasting for more than a few days. You may also experience unexplained weakness and fatigue.
According to the Centers for Disease Control and Prevention (CDC), common symptoms of colorectal cancer may include:
Another possible sign of rectal cancer is iron-deficiency anemia, which may occur as a result of blood loss.
While the exact cause of rectal cancer is unknown, malignant tumors develop when cancerous cells grow out of control and multiply. These cells can penetrate and destroy healthy tissue. What sets off this process isn't always clear.
There are some inherited gene mutations that can increase your risk for rectal cancer. One of these is hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome. This disorder significantly raises the risk of colon and other cancers. In some cases, your doctor may recommend removing your colon as a preventive measure.
Another genetic condition that may cause rectal cancer is familial adenomatous polyposis (FAP). This is a rare disorder that can cause polyps to grow in the lining of the colon and rectum.
While these polyps start off as noncancerous, they may become malignant. In fact, most people with FAP develop cancer before the age of 50. Large bowel removal may also be a preventive surgery your doctor may recommend.
Like other types of cancers, rectal cancer can spread when cancerous cells grow in healthy tissue and travel to other areas of the body.
At first, rectal cancer may affect the tissues lining the rectum. In some cases, it affects the entire rectum. The cancer may then spread to nearby lymph nodes or organs, with the liver being commonly affected. Other possible areas of metastasis can include the:
While there's no single known cause of rectal cancer, a number of known factors may increase your risk for developing this cancer at some point. These include the following:
Other conditions that may increase risk include:
Some lifestyle factors that may play a role in colorectal cancer are:
Rectal cancer is diagnosed with a combination of the following:
Physical exam and screening testsThe doctor will likely begin by taking your medical history and performing a physical exam. This may include inserting a gloved finger into your rectum to feel for lumps.
The doctor might next recommend a fecal immunochemical test (FIT) or a sigmoidoscopy. The screening schedule for these tests will vary depending on your risk level. If these tests are positive for cancer, a colonoscopy is the next step.
ColonoscopyIn a colonoscopy, a doctor uses a thin tube with a light and camera at the end to view the inside of your rectum and colon. They can usually remove any polyps they find at this time.
During the colonoscopy, the doctor can also collect tissue samples for later examination in a lab. These samples can be viewed under a microscope to determine if they're cancerous. They can also be tested for genetic mutations associated with colorectal cancer.
Blood testsThe doctor may also order a blood test. A high level of carcinoembryonic antigen (CEA), a substance made by cancerous tumors, in your bloodstream may indicate rectal cancer.
Imaging testsOnce the doctor makes their diagnosis of rectal cancer, their next step is to determine how far it might have spread.
The doctor may use an endorectal ultrasound to examine your rectum and surrounding area. For this test, a doctor inserts a probe into your rectum to produce a sonogram, a type of image.
The doctor may use other imaging tests to look for signs of cancer throughout your body. These include:
No matter where it starts, cancer can spread, or metastasize, through tissue, the lymphatic system, or the bloodstream to reach other parts of the body.
Staging cancer indicates how far the cancer has progressed, which can help doctors decide the best treatment.
Below are the stages of rectal cancer.
Stage 0 (carcinoma in situ)Only the innermost layer of the rectum wall contains abnormal cells.
Stage 1Cancer cells have spread past the innermost layer of the rectum wall but not to lymph nodes.
Stage 2Cancer cells have spread into or through the outer muscle layer of the rectum wall but not to lymph nodes. This is often referred to as stage 2A. In stage 2B, the cancer has spread into the abdominal lining.
Stage 3Cancer cells have spread through the outermost muscle layer of the rectum and to one or more lymph nodes. Stage 3 is often broken up into substages 3A, 3B, and 3C based on the amount of lymph node tissue affected.
Stage 4Cancer cells have spread to distant sites, like the liver or lungs.
You can also ask your doctor about clinical trials that might be a good fit. Many current therapies for cancer began as clinical trials. These trials may try different combinations of current treatment, treatments that have been approved by the U.S. Food and Drug Administration (FDA) for other conditions, or new treatments.
In some cases, therapy as part of a clinical trial may be covered by insurance or covered by a sponsor of the trial.
Clinical trials can help advance scientists' understanding of cancer and investigate new treatment options. Participating may offer additional options for your treatment. You can learn more about clinical trials for rectal cancer at the National Cancer Institute.
Rectal cancer may spread outside of the rectum, eventually affecting surrounding tissues, lymph nodes, and organs.
You may also be at risk of developing second cancers, which occur after treatment of the initial cancer. Rectal cancer may especially increase the risk of secondary cancers affecting the:
A diagnosis of colorectal cancer in the early stages, before it spreads, can improve your chances of survival.
According to the CDC and the American Cancer Society, the best way to reduce your overall risk for developing colorectal cancer is to begin regular screenings beginning at age 45. Depending on family history, genetics, and other risk factors, your doctor may recommend screenings sooner than this.
Colon and rectal cancer can be diagnosed early when discovered through routine screenings, such as a routine colonoscopy or stool test. Highly sensitive stool tests can detect the presence of cancer. If abnormal cells are discovered, a timely colonoscopy should also be performed.
You may also be able to help prevent rectal cancer by adopting a healthy lifestyle and eliminating related risk factors such as inactivity, smoking, and eating red or processed meats.
Advances in treatment over the last few decades have improved the overall outlook for people with rectal cancer. In fact, many cases of rectal cancer can be treated successfully.
It's also important to consider the 5-year survival rate, which is determined based on the average number of people who are alive after 5 years or being diagnosed with a certain type of cancer and its stage. The overall 5-year survival rate for rectal cancer is 67 percent for all stages combined.
The 5-year relative survival rate by stage is:
It's important to note that these figures are based on information between 2010 and 2016. Since then, treatments may have been modified and improved. These numbers may not reflect current survival rates.
For people with rectal cancer, your outlook can depend on other factors that can include:
When it comes to your individual outlook, the best source of information is your own doctor.
Rectal cancer, commonly referred to as colorectal cancer, is common in both the United States and worldwide. The symptoms of rectal cancer may not appear until the later stages, which makes early, regular screenings an important factor in both detection and treatment.
Treatment and screening options may continue to evolve, but it's also important to reduce your own risk if you can. Talk with your doctor about any personal concerns you have about rectal cancer risks, and whether you're experiencing any unusual bowel-related symptoms.
Woman Shares Her Four Symptoms Of Bowel Cancer After Signs Of Incurable Disease 'ignored'
Bowel cancer: Dr Philippa Kaye lists the symptomsA young woman who said she was "ignored" despite suffering extreme symptoms of bowel cancer for months has been told her disease is incurable.
Ruby Rogers experienced a "constant back and forth" with healthcare professionals for seven months until she was left "screaming in pain" resulting in a CT scan that discovered the cancer.
The 28-year-old from Hull was initially told her symptoms were caused by colitis or irritable bowel syndrome (IBS)
Her main symptoms were:
She told Hull Live: "It has been a constant back and forth blaming myself and blaming the GP for not listening to me, me begging them to listen as I'd dropped almost two stone in weight at that point (now even more) yet my NHS note says, 'Weight is steady'.
READ MORE: Four 'red flags' for bowel cancer that can appear years before a diagnosis
Ruby Rogers shared the story of her bowel cancer diagnosis (Image: Ruby Rogers)"Make that make sense. Being told 'it's probably IBS or colitis'.
"How is it colitis when I don't have the symptoms?
"Constant calls of, 'This pain relief isn't working' and being put on more IBS medications like Buscopan and numerous other muscle relaxers which did nothing at all. Nothing.
"Convincing myself, 'No, it must be colitis - they know what they are doing, they're professionals' but knowing deep down it wasn't.
"Thinking back in October it was bowel cancer, but thinking, 'Surely the numerous bloods, stools, urine samples, ultrasounds would have shown something.'"
In desperate need for answers Ruby paid for a private consultation.
Ruby is determined to keep trying treatments (Image: Ruby Rogers)She said: "I was only taken seriously when I paid for a private consultation a few months ago and the consultant immediately told me, 'No this isn't x y z. We need an urgent CT scan and colonoscopy.'
"But the cost of going private made it impossible."
Eventually her symptoms became so severe she needed to go to A&E.
She recalled: "I was only taken seriously when I was taken from work, unable to walk and talk and screaming in pain yet again.
"I was finally listened to at A&E and had a CT scan that day. I was finally told, 'You have bowel cancer'."
Despite being told her disease is incurable, Ruby is undergoing chemotherapy in a bid to extend her life.
General symptoms of cancer to be wary of (Image: Express.Co.Uk)She said: "I'm not going to give up yet, myself and my family are looking at alternative medicines as there's so much proof out there of people being told they are incurable and trying alternative natural remedies and then the cancer disappearing."
Her sister Lisa has also set up a fundraising page to raise cash for private treatment.
Doctors are still unsure as to why Ruby developed bowel cancer.
"I don't eat red meat, I don't smoke, and I rarely drink - yet there I was at 27 being told I have bowel cancer which has spread to other parts of my body," she said.
"Every time I tell the doctors I don't do any of the above three things, they literally sigh in shock - they don't know why I have this. They say it could be genetic."
Ruby urged others to keep pressing for a diagnosis if they think something is wrong.
She added: "Please don't let doctors push this off as IBS or anything else if you have symptoms.
"Early diagnosis is so important. It's hard to get GPs to listen, trust me it really, really is."
According to the NHS, symptoms of bowel cancer can include:
Humber and North Yorkshire Integrated Care Board (ICB) has said Ruby's experience is upsetting, and while diagnosis of cancer has improved dramatically over the years, it accepts it is a particular challenge in younger people. A spokesman said: "We are really sorry to hear about Ruby's bowel cancer diagnosis.
"We would welcome the opportunity to work with Ruby and her GP practice to understand more about her experience if she is happy for us to. GPs play a vital role in diagnosing cancer at an early stage, when the opportunities to treat the patient are greater and their outcome is likely to be better.
"However whilst bowel cancer survival has more than doubled in the last 40 years due to a national focus on early diagnosis and advances in and the adoption of lifesaving cancer research, there is always more to do. It is widely acknowledged that diagnosis of cancer in young adults is more challenging, the statistics show that cancer in young people accounts for less than one per cent of all new cancer cases in the UK, therefore, this is clearly an area requiring increased focus for that one per cent to benefit from early diagnosis and increased survival rates."
The spokesman added: "If you have symptoms of bowel cancer it is important that you see your GP for further investigation. Symptoms include but are not limited to: bleeding from your bottom and/or blood in your poo, needing to poo more or less often than you are used to, stomach pain or unexplained weight loss."
To donate to the fundraiser to help Ruby visit justgiving.Com/crowdfunding/rubys-fundraiser?.
Bowel Cancer Symptoms - 'toilet Habit Changes' That May Be A Sign Of Something Serious
Nearly 43,000 people are diagnosed with bowel cancer in the UK every year. The main symptoms include bleeding from the back passage, blood in your poo or a change in your normal bowel habit
Tummy pain and bloating could be symptoms of bowel cancer (Image: Getty Images/iStockphoto)
Bowel cancer is one of the most common types of cancer in the UK - and nearly 43,000 people are diagnosed with it every year in the UK.
It can be found anywhere in the large bowel, which includes the colon and rectum. Screening can pick up cancer early which may mean it is easier to treat.
Cancer Research UK explains that the main symptoms of bowel cancer include bleeding from the back passage, blood in your poo or a change in your normal bowel habit, such as needing to go for a poo more often or feeling like you haven't emptied your bowels properly.
Other symptoms could be tummy pain, bloating, losing weight without trying, feeling breathless and feeling very tired for no reason, explains the NHS.
Nearly 43,000 people are diagnosed with bowel cancer every year in the UK (Image:
Getty Images)These symptoms can be caused by other conditions too, not just cancer, so it is important to get them checked by a doctor as soon as possible.
At a GP appointment, patients are usually asked about their symptoms, general health, medical history, and whether anyone in their family has had bowel cancer.
Depending on a patient's symptoms, the doctor may feel their tummy and do a rectal examination to check for any lumps.
The treatment offered depends on the size of the cancer, its location, whether it has spread to other parts of the body and the patient's age or general health.
Patients may be offered a combination of treatments including surgery, chemotherapy, radiotherapy, and targeted medicines.
Last year, journalist Dame Deborah James passed away after raising a whopping £7million for research into treating cancer through her Bowelbabe Fund.
After her death, a team of experts funded by Cancer Research UK – which has received cash from the Bowelbabe pot – found a way to stop late-stage bowel cancer from growing.
Steve Bland, husband of Deborah's You, Me and the Big C podcast co-host Rachael, said Deborah would have been "thrilled" by the encouraging news.
He added: "It's extraordinary what's happening in the world of cancer and the speed at which research is moving.
"The passion and drive that people have to make the lives of cancer patients better is amazing. I'm sure this is something Deb would have been thrilled about.
"Deb did so much and she was so passionate about research but we won't get to see the impact of the fundraising she did for decades to come."
The Cancer Research UK funding for the study was allocated several years ago but the Bowelbabe Fund is expected to help future testing of this kind.
A team led by Dr Kevin Myant has been able to block the messages telling cancer to grow, by targeting a specific gene that leaves healthy cells unaffected.
Dr Myant, based at the University of Edinburgh, said the new find could change how bowel cancer is treated in future. He said: "If we can stop splicing from being hijacked, we can stop bowel cancer from growing and make it more vulnerable to treatment.
"When we grew bowel cancer cells in the lab and blocked a gene which the cells need to run splicing, they stopped growing. When we blocked the same gene in normal bowel cells, they grew normally.
"There is an urgent need for better treatments for bowel cancer, particularly where it is caught at a later stage. This research could open up new approaches to treating bowel cancer in the future."
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