Rectal Cancer Treatment and Surgical Options
Treatment and surgical options for rectal cancer often depend on the location of the tumor, stage of the disease and your overall health. Treatment may include one or more of the following: chemotherapy, biological therapy, radiation therapy or surgery.
Your doctor can discuss your options in detail, the expected side effects and results. You and your doctor can work together to decide on a plan that is best for you. Generally, treatment and surgical options for rectal cancer may include:1
Chemotherapy uses anticancer drugs in an effort to kill cancer cells. Anticancer drugs are usually given through a vein, but some may be given by mouth. You may be treated in as an out-patient, in the doctor's office, or at home. In rare cases, a hospital stay is needed.
The side effects of chemotherapy depend mainly on the specific drugs and the dose. Side effects can include: infection, bruising or bleeding easily, fatigue, hair loss, poor appetite, nausea and vomiting, diarrhea or mouth sores. Your health care team can suggest ways to control many of these side effects. Most side effects usually go away after treatment ends.
Some people with colon cancer that has spread receive a monoclonal antibody - a type of biological therapy. The monoclonal antibodies bind to colon cancer cells. They interfere with cancer cell growth and the spread of cancer. People receive monoclonal antibodies through a vein at the doctor's office, hospital, or clinic. Some people receive chemotherapy at the same time.
Side effects depend mainly on the monoclonal antibody used. Side effects may include rash, fever, abdominal pain, vomiting, diarrhea, blood pressure changes, bleeding, or breathing problems. Side effects usually become milder after the first treatment.
Radiation therapy (also called radiotherapy) uses high energy x-rays to kill cancer cells. It affects cancer cells only in the treated area. Doctors use different types of radiation therapy to treat cancer. The two more common types of radiation patients receive include:
External radiation comes from a machine. The patient is positioned on a table and the machine or arm of the machine is directed to the part of your body that will receive radiation – similar to what happens during an X-ray. Treatment is given at a hospital or clinic five days a week for several weeks.
Internal radiation (implant radiation or brachytherapy):
Internal radiation comes from radioactive material placed in thin tubes put directly into or near the tumor. The patient stays in the hospital, and the implants generally remain in place for several days. Usually they are removed before the patient goes home. Intraoperative radiation therapy (IORT) is a type of radiation given during surgery.
Side effects depend mainly on the amount of radiation given and the part of your body that is treated. Radiation therapy to your abdomen and pelvis may cause nausea, vomiting, diarrhea, or urgent bowel movements. Talk to your doctor about all potential benefits and risks of radiation.
If you have are facing rectal cancer surgery, your doctor may recommend a low anterior resection or an abdominal perineal resection.
Low anterior resection
For cancer that has spread to the lymph nodes and is located in the upper, middle and possibly lower rectum, the surgeon can remove the diseased part of the rectum without affecting the anus. The colon is then attached to the remaining part of the rectum. This allows patients to move their bowels in the usual way and avoid colostomy (portion of large intestine brought through the abdomen to carry stool out of the body) bag.
Abdominal perineal resection (AP)
This operation is more involved than a low anterior resection and may be used for cancers in the lower third of the rectum (the part nearest to the anus), especially if the cancer is growing into the sphincter muscle (muscle that keeps the anus closed and prevents stool leakage). The surgeon makes one incision in the abdomen, and another in the perineal area around the anus. This incision allows the surgeon to remove the anus, tissues surrounding it and sphincter muscle. Because the anus is removed, you will need a permanent colostomy to allow stool a path out of the body.
These operations – low anterior resection and abdominal perineal resection - can be done with traditional open surgery through a large incision or minimally invasively using laparoscopic surgery – through a few small incisions.
With open surgery, also called laparotomy, your surgeon must make a large abdominal cut/incision to reach your rectum and other organs. The incision must be large enough for your surgeon to fit his or her hands and surgical instruments inside your body. While open surgery allows your surgeon to see and touch your organs, it is invasive and can be traumatic on your body due to the large incision.
Minimally Invasive Surgery
Traditional Laparoscopic Surgery
Laparoscopic surgery is minimally invasive – meaning surgeons operate through a few small incisions instead of a large open incision. During traditional laparoscopy, long-handled instruments are inserted through the incisions. One of the instruments is a laparoscope – a thin, lighted tube with a tiny camera at the end. The camera takes images inside your body and those images are sent to a video monitor to guide surgeons as they operate on your colon.
da Vinci® Surgery
Another minimally invasive surgical option for patients facing rectal surgery is da Vinci Surgery. With the da Vinci System, surgeons make just a few small incisions instead of a large open incision - similar to traditional laparoscopy. The da Vinci System features a magnified 3D high-definition vision system and special wristed instruments that bend and rotate far greater than the human wrist. As a result, da Vinci enables your doctor to operate with enhanced vision, precision, dexterity and control.
da Vinci uses the latest in surgical and robotics technologies and is beneficial for performing complex surgery. Your surgeon is 100% in control of the da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body.
- "What You Need To Know About Cancer of the Colon and Rectum"; National Cancer Institute. Available from: http://www.cancer.gov/cancertopics/wyntk/colon-and-rectal
All surgery presents risk, including da Vinci Surgery. Results, including cosmetic results, may vary. Serious complications may occur may occur in any surgery, up to and including death. Examples of serious and life-threatening complications, which may require hospitalization, include injury to tissues or organs; bleeding; infection, and internal scarring that can cause long-lasting dysfunction or pain. Temporary pain or nerve injury has been linked to the inverted position often used during abdominal and pelvic surgery. Patients should understand that risks of surgery include potential for human error and potential for equipment failure. Risk specific to minimally invasive surgery may include: a longer operative time; the need to convert the procedure to an open approach; or the need for additional or larger incision sites. Converting the procedure to open could mean a longer operative time, long time under anesthesia, and could lead to increased complications. Research suggests that there may be an increased risk of incision-site hernia with single-incision surgery. Patients who bleed easily, have abnormal blood clotting, are pregnant or morbidly obese are typically not candidates for minimally invasive surgery, including da Vinci Surgery. Other surgical approaches are available. Patients should review the risks associated with all surgical approaches. They should talk to their doctors about their surgical experience and to decide if da Vinci is right for them. For more complete information on surgical risks, safety and indications for use, please refer to http://www.davincisurgery.com/da-vinci-surgery/safety-information.php.
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PN 1002203 Rev A 04/2013U 1-11-11