Rectal Cancer Treatment in Delhi, India

Colorectal cancer (CRC) is responsible for 10% of annual global cancer-related fatalities. There is a growing concern that the occurrence of CRC is on the ascent, particularly in developing nations such as India. Rectal cancer, also known as rectal tumour, ranks as the second most common cancer affecting the large intestine, presenting a substantial global health challenge.

In recent years, there has been a noticeable increase in the number of rectal cancer cases diagnosed, including among younger individuals. This trend has prompted a closer examination of the disease's characteristics, challenges and specialised management compared to tumours in other parts of the gastrointestinal tract or colon.

The rectum, located at the end of the large intestine, plays a crucial role in the digestive process by temporarily storing waste before elimination. Unfortunately, this anatomical location makes the rectum susceptible to the development of both benign and malignant tumours. When these tumours are malignant, they are referred to as rectal cancer, and their incidence has been on the rise.

One notable aspect of contemporary rectal cancer is the changing demographics of those affected. Traditionally, this cancer predominantly impacted older individuals, typically occurring after the age of 50. However, there has been a shift towards younger patients being diagnosed with rectal cancer. Researchers and medical professionals are actively investigating the factors contributing to this changing trend.

The increased accessibility and use of modern screening tools have played a significant role in the early detection of rectal tumours. These advancements in technology have allowed medical practitioners to identify cases that might have previously gone unnoticed. While this has led to a higher incidence of diagnoses, it has also offered the opportunity for timely intervention, potentially improving outcomes for patients.

Rectal tumours pose unique challenges due to their location near vital organs such as the bladder and reproductive organs. This necessitates a specialised approach to their management and treatment. Unlike tumours in other parts of the gastrointestinal tract or colon, rectal tumours require careful consideration of their potential impact on nearby structures and functions.

Symptoms of rectal tumours can vary, with common indicators including rectal bleeding, changes in bowel habits, abdominal discomfort, unexplained weight loss and fatigue. It's crucial to note that these symptoms can resemble those of other gastrointestinal conditions, emphasising the importance of seeking timely medical evaluation and diagnosis.

When a rectal tumour is suspected or confirmed, patients typically undergo various diagnostic tests, including digital rectal examinations, colonoscopies, biopsies and imaging studies. An accurate diagnosis is essential for determining the tumour's nature, stage and extent, which in turn guides the treatment plan.

The treatment of rectal cancer is highly individualised and dependent on factors such as tumour stage, size and location. Treatment options may include surgery, radiation therapy, chemotherapy, targeted therapy or a combination thereof. The primary goal is to eliminate or control the cancer while preserving the patient's quality of life and minimising the impact on adjacent organs and functions.

Rectal Tumour Types

Rectal tumours are a significant health concern. To gain a better understanding of this condition, let's learn more about the different types of rectal tumours:

• Adenocarcinoma

  • Adenocarcinoma is the most common type of rectal tumour, accounting for approximately 95% of cases.

  • It develops from the glandular cells lining the inside of the rectum.

  • Risk factors for adenocarcinoma include age, family history, smoking and a diet high in fat and low in fibre.

  • Symptoms can include changes in bowel habits, blood in the stool, abdominal pain and unintended weight loss.

  • The best treatment for adenocarcinoma depends on the stage of the cancer.

  • Early-stage tumours may be treated with surgery alone, while more advanced cases may require a combination of surgery, chemotherapy and radiation therapy.

  • In recent years, targeted therapies have shown promise in treating advanced rectal tumours by specifically targeting cancer cells while sparing healthy tissues.

• Carcinoid Tumours

  • Carcinoid tumours are rare neuroendocrine tumours that can occur in the rectum.

  • They develop from specialised cells called neuroendocrine cells.

  • Carcinoid tumours may not always cause noticeable symptoms and are often discovered incidentally during other medical procedures.

  • Treatment options for carcinoid tumours include surgery to remove the tumour and nearby lymph nodes if necessary.

  • In some cases, medications may be used to control symptoms or slow down tumour growth.

• Gastrointestinal Stromal Tumours

  • Gastrointestinal stromal tumours (GISTs) are another rare type of rectal tumour that originates from cells in the wall of the gastrointestinal tract.

  • GISTs can occur in the rectum, as well as other parts of the digestive system.

  • Surgery is the primary treatment for GISTs, and in some cases, targeted therapy drugs may also be used to shrink or control tumour growth.

• Lymphoma

  • Lymphoma is a cancer that begins in cells of the lymphatic system.

  • Although rare, lymphoma can affect the rectum.

  • Treatment for lymphoma typically involves chemotherapy and radiation therapy.

  • In some cases, surgery may be performed to remove the affected lymph nodes.

• Hereditary Rectal Cancer

  • Some individuals may have a higher risk of developing rectal cancer due to inherited gene mutations.

  • Genetic testing can help identify those at risk for hereditary rectal cancer.

  • Management options for individuals with hereditary rectal cancer may include increased surveillance through regular screenings or prophylactic surgery to remove the rectum.

Rectal Tumour Stages

When it comes to rectal tumours, understanding the different stages is crucial for determining the best treatment options. These stages help doctors assess the size and spread of the tumour, guiding them in making informed decisions about the most effective interventions.

• Stage 0: At stage 0, also known as carcinoma in situ, cancerous cells are found only in the innermost lining of the rectum. They have not yet invaded deeper into the rectal wall or nearby tissues. At this early stage, complete recovery is possible if appropriate treatment is provided.

• Stage 1: In stage 1, cancer has grown beyond the innermost lining of the rectum but has not spread to nearby lymph nodes or other organs. The tumour remains small, localised and highly treatable at this stage.

• Stage 2: At stage 2, cancer has grown further into the layers of the rectal wall but still hasn't spread to nearby organs or lymph nodes. The tumour remains localised, although it may be larger than in earlier stages.

• Stage 3: In stage 3, cancer has spread to nearby lymph nodes but has not yet reached distant organs. The tumour may have invaded surrounding tissues as well.

• Stage 4: At stage 4, cancer has spread to distant organs such as the liver, lungs or bones. While this is considered an advanced stage, there are still treatment options available to help manage symptoms and improve quality of life.

Understanding the stages of rectal tumours is crucial for determining the most appropriate treatment approach. From early-stage tumours that can be treated with local excision or transanal endoscopic microsurgery (TEM) to more advanced stages where a combination of surgery and other therapies is necessary, there are various options available depending on the stage of the tumour.

Rectal Cancer Causes

Rectal cancer can be caused by various factors. While it is essential to acknowledge the seriousness of this condition, it is equally important to understand that there are steps that can be taken to reduce the risk and seek early treatment. Some of the common causes of rectal cancer are.

• Obesity: Obesity has been linked to an increased risk of developing rectal tumours. Excess body fat, especially around the abdomen, can lead to chronic inflammation and insulin resistance, which are risk factors for cancer development.

• Eating processed meat: Consumption of processed meats such as bacon, sausages and hot dogs has been associated with an increased risk of rectal tumours. These meats often contain nitrates and nitrites, which can convert into compounds that may damage the cells in the colon and rectum.

• Smoking: Smoking not only increases the risk of lung cancer but also poses a significant threat when it comes to rectal tumours. The chemicals in tobacco smoke can be absorbed into the bloodstream and affect various organs, including the rectum.

• Certain diseases and conditions: Some diseases and conditions can increase the likelihood of developing rectal tumours. Conditions like inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, can significantly raise the risk.

• Family history: A family history of colorectal cancer or rectal tumours can increase your own risk. If you have a close relative who has had these conditions, your doctor may recommend earlier screening tests, such as colonoscopies, to detect any abnormalities at an early stage.

• Race: Studies have shown that certain ethnic groups, particularly African Americans, have a higher incidence of rectal tumours.

• Gender: Rectal tumours affect both men and women, but some studies suggest a slightly higher incidence in men.

• Age: The risk of developing rectal tumours increases with age. Most cases are diagnosed in individuals over the age of 50.

Rectal Tumour Symptoms

It is crucial to be aware of the symptoms associated with rectal cancer to detect the disease early and seek appropriate medical attention. While these symptoms may not always indicate the presence of a rectal tumour, it is essential to consult a doctor if one experiences any of the following signs:

• Rectal bleeding: One of the most common symptoms of rectal tumour is rectal bleeding. This may manifest as bright red blood in your stool or on the toilet paper after wiping.

• Blood in your stool (poop): Another noticeable symptom is blood in the stool. Dark or blackish-coloured stools could be an indication of bleeding within the digestive tract.

• Diarrhoea: Persistent and unexplained episodes of diarrhoea can be a sign of a rectal tumour.

• Constipation: If one experiences difficulty passing stool or observes a notable change in their bowel movements, such as infrequency or difficulty, it may also be indicative of rectal tumours.

• A sudden change in your bowel habits: Any sudden changes in one's bowel habits should not be ignored. This includes a shift from regular bowel movements to irregular patterns or experiencing alternating periods of constipation and diarrhoea.

• Narrow stool: A narrower-than-usual stool, resembling a pencil shape, could be an indication of a blockage caused by a rectal tumour.

• Tiredness and weakness: Fatigue, tiredness and weakness are common symptoms associated with various health conditions, including rectal tumours. These symptoms may worsen over time as the tumour grows.

• Abdominal pain: Persistent abdominal discomfort, cramping or pain can be signs of rectal tumours.

• Unexplained weight loss: Unintentional and unexplained weight loss can occur in individuals with rectal tumours.

It is important to note that these symptoms may vary from person to person, and some individuals may not experience any symptoms at all in the early stages of rectal tumour. Therefore, regular screenings and check-ups are crucial for early detection.

Who Needs Rectal Cancer Treatment

While anyone can develop rectal cancer, certain factors increase the risk. Here's who needs rectal cancer treatment:

• Individuals with a family history of colorectal cancer: If an individual has close relatives with a history of colorectal cancer, especially at a young age, they may face an increased risk of developing rectal cancer.

• People with a personal history of polyps or inflammatory bowel disease: Polyps are small growths on the lining of the colon or rectum that can turn into cancer over time. Inflammatory bowel disease, such as ulcerative colitis or Crohn's disease, also increases the risk of developing rectal cancer.

• Those aged 50 and above: The risk of rectal cancer increases with age, and screenings are recommended for individuals aged 50 and above.

• Individuals with a sedentary lifestyle and poor dietary habits: Lack of physical activity and diets high in red meat and processed foods have been associated with an increased risk of rectal cancer.

For individuals falling into any of these categories, it is crucial to discuss their risk factors with their doctors. Doctors can recommend appropriate screenings and suggest the best treatment for rectal tumours if necessary.

Rectal Cancer Diagnosis

When it comes to rectal tumours, early detection is crucial for successful treatment. There are several diagnostic procedures that can help identify the presence of a rectal tumour and determine the best course of action. Let's take a closer look at these diagnostic methods:

• Biopsy: A biopsy is the gold standard for diagnosing rectal tumours. During this procedure, a small piece of tissue is removed from the affected area and examined under a microscope to determine if cancer cells are present.

• Polypectomy:If a rectal tumour is found during a colonoscopy or sigmoidoscopy, a polypectomy may be performed. This involves the removal of the tumour along with a margin of healthy tissue.

• Colonoscopy: A colonoscopy is a procedure that allows doctors to examine the entire colon and rectum using a flexible tube with a camera at its tip. It is considered one of the best methods for detecting rectal tumours and other abnormalities.

• Sigmoidoscopy: Sigmoidoscopy is similar to colonoscopy but focuses on examining only the lower part of the colon and rectum. While it may not provide as comprehensive a view as a colonoscopy, it can still detect rectal tumours.

• Faecal occult blood test: This non-invasive test checks for hidden blood in the stool, which can indicate the presence of a rectal tumour or other gastrointestinal conditions.

• Barium enema: In this procedure, a liquid containing barium is inserted into the rectum, which coats the lining of the colon and rectum. X-rays are then taken to identify any abnormalities, including tumours.

• Digital rectal exam: This physical examination involves your doctor inserting a gloved finger into your rectum to check for any abnormal growths or lumps.

If an individual experiences any symptoms such as persistent changes in bowel habits, blood in the stool or unexplained weight loss, they need to consult with their doctors to discuss possible screening options. It's essential to remember that early detection is key in finding the best treatment for rectal tumours.

Rectal Cancer Treatment

Rectal cancer is a serious medical condition that requires prompt and effective treatment. Fortunately, advancements in medical technology and research have led to a variety of treatment options for rectal tumours.

Surgery

In many cases, surgery is the primary treatment option for rectal tumours. The type of surgery performed depends on the size, location and stage of the tumour. Here are some surgical procedures commonly used for rectal cancer:

• Removing very small cancers from the inside of the rectum: This procedure involves removing small tumours that are confined to the inner lining of the rectum. It is called local excision or transanal endoscopic microsurgery (TEM).

• Removing all or part of the rectum: This procedure, known as anterior resection, involves removing either a portion or the entire rectum while preserving the anus. It is often performed for larger tumours that have not spread beyond the rectum.

• Removing the rectum and anus: In more advanced cases where the tumour has spread extensively, a procedure called abdominoperineal resection (APR) may be necessary. This involves removing both the rectum and anus, with a permanent colostomy bag being created for waste elimination.

Chemotherapy

Chemotherapy is often used in conjunction with surgery to treat rectal cancer. It involves using powerful drugs to kill cancer cells and prevent their further growth.

Radiation therapy

Radiation therapy uses high-energy X-rays or other particles to destroy cancer cells. It can be used alone or in combination with surgery and chemotherapy.

Combined chemotherapy and radiation therapy

This approach combines chemotherapy and radiation therapy to treat cancer, particularly in cases where the tumour is locally advanced or hard to surgically remove. Radiation therapy shrinks the tumour with focused radiation, and chemotherapy targets cancer cells throughout the body. This combination can be especially effective for tumour reduction before surgery or when surgery isn't an option.

Some key points about this combined therapy include:

• It can be administered before or after surgery.

• It can also be used as the primary treatment for patients who cannot undergo surgery due to various reasons.

• Chemotherapy can be in pill form or infused directly into a vein.

• Side effects may occur, such as hair loss or nausea, but these can be managed with proper medical support.

Targeted drug therapy

Targeted drug therapy for rectal tumours precisely targets genetic mutations or abnormal proteins, providing personalised treatment based on the tumour's unique profile. It may be used alone or with traditional treatments, depending on the case and goals.

Immunotherapy

Immunotherapy enhances the immune system's response against rectal cancer cells through techniques like checkpoint inhibitors, vaccines and adoptive cell therapies. It's used when other treatments are ineffective, offering new rectal cancer treatment possibilities.

Supportive (palliative) care

Supportive care focuses on managing symptoms, providing pain relief and improving overall quality of life for patients. Some key points about supportive care include:

• It helps manage side effects of treatment, such as pain, nausea and fatigue.

• Palliative care specialists work closely with the medical team to address emotional and psychological needs throughout the treatment process.

Risk Factors of Rectal Cancer

While it is important to acknowledge the severity of rectal cancer, it is also essential to understand the risk factors associated with this disease. By being aware of these risk factors, individuals can take proactive steps towards prevention and early detection.

• Ovarian cancer: Studies have shown a link between ovarian cancer and rectal tumour. Women who have been diagnosed with ovarian cancer are at a higher risk of developing rectal tumours.

• Polyps: Polyps are abnormal growths that can form in the colon or rectum. While not all polyps are cancerous, certain types of polyps, such as adenomatous polyps, can increase the risk of developing rectal tumours.

• Inflammatory bowel disease: Chronic conditions such as Crohn's disease and ulcerative colitis, collectively known as inflammatory bowel disease (IBD), can increase the risk of developing rectal tumour. These conditions cause inflammation in the digestive tract, which can lead to cellular changes over time.

• Obesity: Research has shown a correlation between obesity and an increased risk of developing various types of cancer, including rectal tumours. Maintaining a healthy weight through regular physical activity and a balanced diet can help reduce this risk.

• Type 2 diabetes: Individuals with type 2 diabetes may have a higher risk of developing rectal tumours compared to those without diabetes. Individuals with diabetes must manage their blood sugar levels and adopt a healthy lifestyle to lower their risk.

Prevention of Rectal Tumour

Rectal tumours are a serious health concern that can greatly impact an individual's quality of life. While the best treatment for rectal cancer is early detection and intervention, there are steps you can take to reduce your risk and protect your overall health.

• Talk to your doctor about cancer screening: Regular screenings are crucial for detecting any abnormalities or potential signs of rectal tumours. Speak to your doctor about the recommended age to start screening and how often you should be screened based on your risk factors.

• Exercise most days of the week: Engaging in regular physical activity has numerous benefits for overall health, including reducing the risk of developing various types of cancers, including rectal tumours. Aim for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise each week.

• Eat a variety of fruits: Fruits are rich in vitamins, minerals and antioxidants that can help support a healthy immune system and protect against cancer. Include a variety of colourful fruits in the diet, such as berries, citrus fruits, apples, and pears.

• Maintain a healthy weight: Adopting a healthy lifestyle that includes a balanced diet and regular exercise can help you achieve and maintain a healthy weight. Focus on consuming nutrient-dense foods, such as whole grains, lean proteins, and vegetables while limiting processed foods high in sugar and unhealthy fats.

• Stop smoking: Smoking is a significant risk factor for many types of cancers, including rectal tumours. If you currently smoke, seek support and resources to quit. Quitting smoking not only reduces your risk of developing rectal tumours but also improves your overall health and well-being.

• Drink alcohol in moderation: Heavy alcohol consumption has been associated with an increased risk of rectal tumours. If you choose to drink alcohol, do so in moderation. Limit your intake to no more than one drink per day for women and two drinks per day for men.

Rectal Tumour Complications

While rectal tumours themselves can be a cause for concern, their effects can extend to various organs in the body. Some of the potential complications that can occur due to rectal tumours are in the following organs:

• Anus: One of the most common complications associated with rectal tumours is the obstruction of the anus. Anus cancer can make it difficult for individuals to pass stools and may cause severe discomfort. Another potential complication is anal bleeding, which can occur when the tumour grows and puts pressure on the surrounding tissues.

• Colon: Since rectal tumours are located close to the colon, they can potentially obstruct or narrow the passage for stool to pass through. Colon cancer can lead to symptoms such as constipation or changes in bowel habits. In some cases, a rectal tumour may spread to the nearby colon tissue, causing further complications and increasing the risk of metastasis.

• Kidneys: As rectal tumours grow and progress, they can potentially spread to nearby organs such as the kidneys. This can lead to kidney cancer, damage and other related complications.

• Lungs: The lungs are another organ that can be affected by rectal tumours when they metastasize. This occurs when cancer cells break away from the primary tumour and travel through the bloodstream or lymphatic system to reach distant organs.

• Small Intestine: In rare cases, rectal tumours can spread to the small intestine. This can lead to complications such as intestinal obstruction or impaired absorption of nutrients from food.

• Vagina: For women, a rectal tumour can potentially spread to the vagina. Vagina cancer can cause symptoms such as pain during intercourse, vaginal bleeding or discharge.

Why Choose BLK-Max Hospital for Rectal Cancer Treatment?

BLK-Max Hospital is a top choice for anyone seeking the best treatment for rectal tumours. The team of highly skilled specialists ensures accurate diagnoses and tailors treatment plans to individual needs. Equipped with cutting-edge technology, including robotic and laparoscopic procedures, the hospital ensures precision and faster recovery times. What sets BLK-Max Hospital apart is the multidisciplinary approach, where experts from diverse fields collaborate to create personalised treatment strategies. Recognising the emotional toll of rectal tumours, BLK-Max provides comprehensive support services, from counselling to support groups. With a proven track record of high success rates and a commitment to continuous research, BLK-Max Hospital leads the way in delivering effective and compassionate care for rectal tumours.

Conclusion

Rectal tumours pose a significant medical concern necessitating timely attention and treatment. Encouragingly, medical advancements have markedly improved survival rates. Early detection remains vital for favourable outcomes. Those experiencing symptoms related to rectal cancer should promptly consult their doctor for guidance. By staying informed, being proactive and seeking suitable medical care, individuals can take charge of their rectal cancer diagnosis and enhance the likelihood of positive results. Raising awareness and exploring optimal treatment options for rectal tumours collectively contribute to better outcomes.

Frequently Asked Questions

1. What is the role of a multidisciplinary team in managing rectal tumours?

A multidisciplinary team coordinates personalised treatment plans, combining expertise from various specialities for optimal rectal tumour management.

2. Are there any lifestyle changes or preventive measures to reduce the risk of rectal cancer?

Yes, adopting a healthy lifestyle with a balanced diet, regular exercise, limited alcohol consumption and avoiding smoking can help reduce the risk of rectal cancer. Screening is also crucial.

3. Where can I find a specialised healthcare facility or expert for the treatment of rectal cancer?

Specialised healthcare facilities and experts for rectal cancer treatment can be found in major hospitals and cancer centres or by consulting with your doctor for referrals.

4. Is surgery the primary treatment for rectal cancer, and what are the different surgical approaches?

Surgery is a common primary treatment for rectal cancer. Various surgical approaches include local excision, transanal minimally invasive surgery and more extensive procedures like abdominoperineal resection or low anterior resection, depending on cancer size and location.

5. Can rectal tumours recur after treatment, and what is the recommended follow-up plan?

Yes, rectal tumours can recur after treatment. Follow-up plans typically include regular medical check-ups, imaging and colonoscopies to monitor for recurrence and ensure early intervention if needed.