Key Facts
Rectal cancer is the third most frequent cancer in both sexes in Europe.
Rectal cancer is not very fast growing - the cancer tends to double every three months. This means that by the time the cancer is 5cm in size, it has been developing for about 7 or 8 years.
Rectal cancer can be treated effectively, particularly if it has been diagnosed at an early stage.
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Key Figures
| Total number of new cancer cases in Europe (2006) |
3.2 million |
| Total number of cancer deaths in Europe (2006) |
1.7 million |
| Number of new colorectal cancer cases (2006) |
412,800 |
|
(217,400 men) |
|
(195,400 women) |
|
307,000 (EEA) |
|
(168,300 men) |
|
(138,700 women) |
|
297,200 (EU25) |
|
(163,100 men) |
|
(134,100 women) |
| Number of colorectal cancer deaths (2006) |
207,500 |
|
(107,600 men) |
|
(99,900 women) |
|
142,700 (EEA) |
|
(76,200 men) |
|
(66,500 women) |
|
139,400 (EU25) |
|
(74,500 men) |
|
(64,00 women) |
Rectal Cancer is estimated to make up of 30% of all colorectal cancers.
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Cancer Types
More than 95% of all cancers starting in the rectum are adenocarcinomas. The remainder are lymphomas and stromal tumours. Tumours of the anal canal are usually squamous cell cancers.
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Causes of Rectal Cancer
Rectal cancer is rare below the age of 40 - most cases affect people over 60 years of age.
Diet is the most significant risk factor. Eating red and processed meat increases the risk of developing rectal cancer. By contrast, eating fish, fibre and milk has a protective effect.
Obesity and alcohol are also risk factors for developing rectal cancer.
The disease can be more common in particular families and people with a family history (1st and 2nd degree relatives) of colorectal cancer should undergo screening.
Those who have had previous treatment for cancer of the colon, rectum, ovary, uterus (endometrial cancer) or breast are at increased risk of developing rectal cancer.
Those with hereditary conditions such as familial polyposis and hereditary non-polyposis colon cancer (Lynch syndrome) have a greater risk of developing rectal cancer.
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Prevention of Rectal Cancer
People at higher risk should attend regular screening (every 5 years) to ensure that any cancer that does develop is detected and treated early.
A healthy low-fat diet which is low in red and processed meat and high in protective foods like fish, milk and fibre is beneficial.
It is also important to drink alcohol in moderation to protect against developing the cancer.
Finally, combating obesity through having a healthy diet and taking regular exercise helps prevent rectal cancer and many other cancerous and non-cancerous conditions.
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Common Symptoms
Common symptoms include:
- A change in bowel habit with more frequent looser motions (particularly with mucus and blood). Stools that are narrower than usual can also be due to rectal cancer.
- Rectal bleeding - either bright red or very dark in colour and on the surface or mixed in with the stool. This should be reported even if the bleeding has stopped.
- A feeling that the bowel does not empty completely (tenesmus).
- A feeling of general discomfort in the abdomen sometimes with a feeling of being bloated or fullness.
And more rarely:
- Pain in the abdomen - especially in the lower left-hand side of the abdomen and cramp-like in nature.
- Weight loss with no known reason.
- Vomiting - particularly if associated with the other symptoms listed above.
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Screening for Rectal Cancer
Screening for rectal cancer is available in some European countries – usually to people in higher risk groups such as those over the age of 55 or with a family history.
Screening for rectal cancer may involve:
- Checking the stools (or faeces) for any sign of blood (this has been shown to be effective in reducing the mortality in a screened population).
- Sigmoidoscopy (for more details see below)
- Colonoscopy (for more details see below)
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Diagnostic Tests
A physical examination may show no signs of rectal cancer. A tumour in the lower part of the rectum can often be felt during a rectal examination. However, to be able to detect cancers higher up in the rectum various instruments are used:
- the colonoscope is a long thin, flexible, telescope that can be pushed all the way round the colon.
- a sigmoidoscope is shorter (about 25cm long) and can be used to examine the inside of the rectum and sigmoid colon.
Biopsies are also used in diagnosis of rectal cancer. Samples are taken using the colonoscope or sigmoidoscope.
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Treatment
Available treatments for rectal cancer are:
- surgery
- radiotherapy
- chemotherapy
- chemoradiation – combined radiotherapy and chemotherapy.
Patients may receive some or all of these treatments.
Surgery
Surgery can be performed at all stages of rectal cancer.
Early cancer can be completely removed using surgery. Polyps can often be removed using a sigmoidoscope or colonoscope.
Larger cancers are removed by cutting out the rectum containing the tumour and the mesorectum tissue (with lymph nodes) around it.
Preoperative radiotherapy with or without chemotherapy (together called chemoradiation) is standard treatment.
Radiotherapy
Radiotherapy is usually given before surgery or as an alternative to surgery.
External beam radiotherapy is normally given as a series of short regular treatments in a radiotherapy department (each treatment may be referred to as a fraction) which are carefully calculated by the treatment team.
All radiotherapy treatments are designed to conform to the shape of the cancer so that a higher dose of radiation can be more precisely targeted at the cancer avoiding neighbouring healthy tissue and resulting in fewer side effects.
External beam radiotherapy is usually given postoperatively:
- if not all of the cancer could be removed during surgery
- if the lymph nodes removed during surgery contain cancer cells
- as an alternative to surgery.
External beam radiotherapy is usually given as a short one week course or over a 5 to 6 week period with up to five treatments a week. Giving a large number of small doses reduces the damage to healthy tissues.
Chemotherapy
Chemotherapy drugs travel through the bloodstream killing cancer cells throughout the body.
Chemoradiation
Chemoradiation is chemotherapy and radiotherapy are often used as a combined treatment.
Monoclonal Antibody Treatment
Monoclonal antibodies are used in the treatment of many forms of cancer but as yet have not proved beneficial in rectal cancer. However, this remains an active area of research.
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Key Trends
In most countries the number of new cases diagnosed each year is stable or falling slightly.
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Important Research Areas
Important research areas include:
- Methods of identifying patients whose cancers will respond well to specific treatments
- The use of genetic and other markers to individualise therapy
- The use of monoclonal antibodies in the treatment of rectal cancer
- The evaluation of screening for rectal cancer.
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