RECTAL CANCER

RECTAL CANCER1WHAT 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 RECTUMAbout 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:PruritusHematocheziaTenesmusChange bowel habitsPain in the buttocksWeight lossDiarrheaConstipationDIAGNOSTIC WORKUPSMODALITIES USEDMagnetic Resonance Imaging

it visualizes not only the intestinal wall but also the surrounding pelvic anatomy.

8Endoscopic Ultrasound

The findings of rectal endoscopic ultrasound determine the type of surgery as well as the use of preoperative chemoradiation.9Colonoscopy

A procedure to look inside the rectum and colon for polyps (small pieces of bulging tissue), abnormal areas, or cancer. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.

10CT Scan

Proctosigmoidoscopy

Barium Enema

Laboratory test:Complete Blood CountLiver and renal function testPATIENT PREPARATIONBefore 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 PLANNINGSurgery 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.

DOSEPreoperative 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).