Rectal cancer and bowel cancer represent the same disease occuring in a different part of the bowel. Rectal cancers are within 14 cm of the Anus and are treated as a seperate group because of differences in their treatment and the surgery required to remove them.
The treatment of rectal cancer can be more complex, there are more options for treatment and the outcomes for the different options may also differ. Some of the decisions depend on the stage of the disease when it is diagnosed and some depend on exactly how close to the anus the cancer is.
The accuracy of the preoprative staging of rectal cancer is vital in deciding the most appropriate treatment. The staging investigations are undertaken under the guidance of the cancer MDT.
The most important factors are;
Has the cancer already spread elsewhere in which case preoperative chemotherapy may be the most appropriate treatment
Is the cancer locally advanced within the pelvis so that it may not be possible to remove the whole of the cancer by surgery, in which case preoperative chemo / radio therapy may be the most appropriate treatment.
Is the cancer very close to the anus, in which case an operation to remove both the rectum and the anus leaving a permenant colostomy or a combined TATME may be the most appropriate operation.
Is the cancer of a very early stage where it may be safely removed by TAMIS leaving the rectum and anus intact.
Once the cancer has been removed the specimen will be sent for pathological assesment. All of the infomation about the patient and the actual cancer can then be combined to give a post operative stage. This is used to determine the need for any further adjuvant treatment.