RECTAL CANCER

WHAT IS RECTAL CANCER?

Is a disease in which cancer cells form in the

tissues of the rectum. The rectum is the last part of
the large intestine and leads to the anus, which is
the opening to the outside of the body.

Although rectal cancer is a life-threatening disease,

it is a highly curable form of cancer if found early.

ANATOMY AND
PHYSIOLOGY
OF THE RECTUM

About 15cm long, at

the level of the middle
of the sacrum.
The rectum is the last
part of the large
intestine and leads to
the anus, which is the
opening to the outside
of the body.

FUNCTIONS:

The main functions of the colon and rectum are

to absorb water and nutrients from what we eat
and to move food waste out of our body.
The rectum is a holding area for the stool.

SIGNS AND SYMPTOMS:

Pruritus
Hematochezia
Tenesmus
Change bowel habits
Pain in the buttocks
Weight loss
Diarrhea
Constipation

DIAGNOSTIC WORKUPS

MODALITIES USED

Magnetic Resonance Imaging

Endoscopic Ultrasound

Colonoscopy

CT Scan

Proctosigmoidoscopy

Barium Enema

LABORATORY TEST:
Complete Blood Count
Liver and renal function test

PATIENT PREPARATION

Before colorectal cancer surgery, your surgeon

will give you instructions for preoperative bowel
preparation which may include being on a clear
liquid diet and taking laxatives.
Call your surgeon at once if you have any changes
in your health, such as a fever or cold, within 23
hours before your scheduled surgery. Be sure to
tell your surgeon if you are pregnant.
Patient should drink a lot of water to allow
distention of the bladder

Do not eat or drink anything after midnight the

night before your surgery unless told otherwise
by your doctor or nurse.
Do not smoke or drink alcohol 24 hours before
your surgery.
Arrange for a family member to be your recovery
coach. This approach requires you to take an
active role in your recovery.

TREATMENT PLANNING

Surgery is the treatment of choice for rectal

cancer. The type of procedure depends on the
location of the tumor.
Patient Position Prone position
Materials used Belly board, Wedge filter, rectal
tube and Tampon soaked with iodinated contrast
media.
Portal used Three field techniques, four field
portals and opposed lateral field.

DOSE
Preoperative Radiotherapy

Short course: 25 cGy in 5 daily fractions of 5 Gy

given in 1 week with surgery within 1 week is
recommended (Grade A).
Long course: 45 Gy in 25 fractions over 5 weeks
followed by a 610 week gap prior to surgery is
also widely used.

Post-operative Radiotherapy

The standard fractionation is 45Gy in 25

fractions in 5 weeks with an optional reduced
volume boost of 5.49Gy in 3-5 fractions.
Selected patients should be offered post-operative
radiotherapy for rectal cancer with 45Gy in 25
daily fractions over 5 weeks (Grade B).