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How Does Rectal Cancer Differ from Colon Cancer?

Dr. Mathew Mutch treats patients at

Center for Advanced Medicine
GI Center
4921 Parkview Place, 8th Floor, Suite C
St. Louis, MO 63110

Phone:  314-454-7177     Fax: 314-454-5249

Center for Colorectal and Pelvic Floor Disorders (COPE)
1040 North Mason Road, Suite 120
Medical Building One
Creve Coeur, MO 63141

Phone:  314-454-7177

Question:  Colon cancer runs in my family and my 57- year- old father has just been diagnosed with rectal cancer. Is surgery the best option?

Answer:  The major difference between colon cancer and rectal cancer is location. Rectal cancer is defined as a tumor positioned within the last 12cm of the large intestine. Rectal cancer is very treatable disease, but it requires the teamwork of the surgeon, radiation oncologist and medical oncologist for the best result.

Determining how best to treat an individual patient depends upon the stage of the tumor at the time of diagnosis.

Transrectal ultrasound is used to determine how far into the wall of the rectum the tumor has grown and evaluate the lymph node around the rectum. A CT-scan helps to evaluate if the tumor has or has not spread to the patients liver and lungs.

Based on the results of these studies patients may proceed to surgery directly or be treated with radiation and chemotherapy before surgery.

Rectal tumors create different challenges from colon cancer because their location in the pelvis can make attaining adequate margins during surgery difficult. Because of this factor, small early cancers can be removed without any difficulty and these patients typically proceed directly to surgery. For larger tumors, patients are often treated with five weeks of radiation and chemotherapy followed by surgery eight weeks later.

The delay is to let the effects of the radiation continue to shrink the tumor and to allow the inflammation from the radiation to settle down. Thus the preoperative treatment shrinks the tumor, allowing for adequate margins and reducing the risk that the tumor will recur in the pelvis.

Historically, patients with rectal cancer were often committed to a permanent colostomy after surgery. Currently, a colostomy is required in the minority of cases. Technical advances are allowing us to restore intestinal continuity at lower and lower levels, and allowing us to perform these operations laparoscopically.

Currently, Washington University is the leading site in a national, multicenter trial comparing the laparoscopic to the traditional open approach for the surgical treatment of rectal cancer.
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Copyright 2015 Washington University School of Medicine