Rectal cancer

As with colon cancer, rectal cancer requires a focused examination to study the stage of the disease and its spread. However, in this case, in addition to spread to other organs (systemic), the spread to the organ of origin (local) must be carefully examined to determine the best therapeutic approach. Four types of examination are mainly used:

• rectal examination, performed with the surgeon’s finger;
• rectoscopy: a quick and well-tolerated examination performed by examining the rectum through a special instrument;
• ecoendoscopy: it is performed by means of an ultrasound probe inserted into the rectum, as in rectoscopy;
• magnetic resonance imaging (MRI).

There is a widespread belief that the diagnosis of rectal cancer must necessarily be followed by removal of the entire rectum with a final discharge (a permanent colostomy with a bag attached to the abdominal wall, where the intestine is excreted). This fear often leads to a delayed diagnosis.

In fact, the approach to treatment has changed radically over the years, and less than 7% of patients with rectal cancer now require such mutilating surgery. If, however, it is necessary for effective treatment, meetings with specialized personnel (enterostomists) are now provided to ensure that this situation is well tolerated.

For all locally disseminated tumors (which come in contact with the fatty tissue surrounding the rectum or involve perirectal lymph nodes), preoperative radiochemotherapy is given for 5 weeks to reduce tumor size. Approximately 20% of the treated patients have a complete disappearance of the tumor, and in another 60% the tumor is reduced by more than 50% of its mass. Surgery is performed 6-8 weeks after the end of chemotherapy after repeated instrumental examination to quantify the response to treatment.

With the use of appropriate surgical techniques, the possibility of adhering to the sphincter apparatus, which avoids the final deviation, is quite high, but the reconstruction of the removed sphincter is also possible. At our center, rectal resection is performed laparoscopically in more than 70% of cases.