“Despite previously high mortality rates, deaths due to this form of cancer have been steadily decreasing in recent years, as significant advances have been made in both early diagnosis and treatment,” points out Mr. Christos Liakos Director of the Minimally Invasive Surgery and Surgical Oncology Clinic of Metropolitan Hospital and completes:

“Furthermore, the application of minimally invasive surgery in the treatment of rectal cancer significantly reduces the complications of the surgery and at the same time significantly increases the quality of life of the patients.”

What are the symptoms that indicate the existence of colon and rectal cancer?

“The straight it is the final part of the large intestine before the anus, with a length of about 12-15 cm, where the faeces are stored before emptying. Because of its location, rectal cancer and its symptoms are often confused with those of other parts of the colon, but its treatment differs. Usually, rectal cancer starts as a small, initially benign and asymptomatic lesion in the lining of the intestine, called a polyp, and if not treated in time, it develops into cancer over time. One of the main symptoms is the appearance of blood in the stool, which is often mistakenly attributed to hemorrhoids.

Other symptoms that require immediate medical evaluation include,” says the expert:

• Change in bowel habits (diarrhea, constipation)
• Tenismus (sensation of incomplete emptying)
• Mucus secretion
• Local irritation
• Anemia
• Blood in the stool
• Unexplained weight loss
• Continued feeling of fatigue

What factors contribute to rectal cancer?

“The main risk factor for rectal cancer is age, with over 80% of cases occurring in people over 60, with the average age of diagnosis being 70 years. People with a family history of colorectal cancer should have a colonoscopy every 5 years starting at age 40 or even earlier.

In addition, there are well-documented risk factors for developing rectal cancer, such as inflammatory bowel disease, ulcerative colitis, and Crohn’s disease. In these cases, patients should undergo a colonoscopy every 1-2 years. Also, some rare conditions, such as familial adenomatous polyposis and Lynch syndrome, are often associated with an increased risk of rectal cancer.

In addition to these, obesity, lack of physical exercise, alcohol abuse and a diet rich in animal fats and poor in plant fibers and antioxidants are important risk factors,” says the expert.

How is rectal cancer diagnosed?

“Diagnosis of the disease is made by a combination of clinical evaluation, including digital rectal examination and endoscopy.

The use of rectosigmoidoscopy and colonoscopy provides the ability to directly check the inside of the organ for the existence of polyps or masses and allows a biopsy to be taken if required. After a diagnosis of rectal cancer has been made, a magnetic resonance imaging (MRI) scan of the rectum is usually performed, which provides very important information about the stage and severity of the disease. Also, the use of transrectal ultrasound can provide additional information on the stage and severity of the disease locally,” explains Mr. Liakos.

How is rectal cancer treated?

“Less invasive surgical treatment, whether laparoscopic resection or robotic rectal resection, is considered the preferred option by the majority of patients with this form of cancer.

This invasive method offers a faster recovery, minimal post-operative pain and allows for a faster start of post-operative chemotherapy, if deemed necessary based on the characteristics of the tumor,” he emphasizes.

What is the rectal cancer treatment technique from two entrances?

“In the event that the tumor is above the level of the sphincter, the surgeon can remove the tumor without completely cutting the sphincter, allowing the patient to maintain normal function, without the need for a permanent unnatural seat (colostomy).

This operation is called a “low anterior resection.” During this operation, the intestine is joined using a stapler and applied to tumors up to 3 cm from the sphincter, approximately 5 cm from the annulus.

However, if the tumor is close to the level of the sphincter mechanism, a more demanding procedure is required, known as a transsphincteric rectal resection or a two-entry approach (transabdominal and transanal). This technique requires great experience and expertise, as the bowel must be detached from the sphincter without causing permanent incontinence. The anastomosis of the anus is usually done by suturing the healthy intestine to the sphincter, with absorbable sutures and the functional results are very good, thus avoiding the need for a permanent unnatural seat even in these difficult cases.

In this case, the patient must have a temporary unnatural seat, which is removed and fully restored after the healing of the anastomosis, usually in a period of 1-2 months,” explains Mr. Liakos.

Is radiation therapy or chemotherapy necessary and when?

“Preoperative radiation and chemotherapy for rectal cancer should be applied in cases where the tumor extends beyond the rectal wall or when metastases are suspected in enlarged lymph nodes,” he points out, then citing the preoperative results of this treatment:

• Reduces the size of the tumor and downgrades it, resulting in a reduction in the stage of the disease
• Increases the chances of survival and preservation of the sphincter, thus avoiding a permanent unnatural seat
• Expands the margins of safe tumor resection
• Provides better control or even disappearance of local disease and micrometastases
• Achieves the complete elimination of rectal cancer in a percentage of approximately 20-25%.

What are the possible side effects?

“Patients undergoing radiation therapy and chemotherapy for rectal cancer commonly experience treatment-induced side effects. Side effects due to radiation therapy usually include diarrhea, abdominal cramps, pressure in the rectal area, frequent urination, burning sensation when urinating, skin irritation, nausea and feeling tired. These symptoms are usually temporary and gradually disappear after the end of the treatment.

The side effects of chemotherapy, on the other hand, depend on the drugs used. It is important to note that the patient receiving radiation therapy does not emit radiation, so it is safe for other people to come into contact with him, including pregnant women or small children,” he emphasizes.

What is the difference between rectal cancer and colon cancer?

“Rectal cancer has important similarities with colon cancer, but it also has some important differences, which is why it requires special attention. These special features are the following” concludes Mr. Liakos:

• A large percentage of rectal cancers can be detected with a simple digital exam, which highlights the importance of seeing the doctor. It is therefore crucial to have medical follow-up.
• The treatment of rectal cancer is more demanding than that of colon cancer. The surgery is more complex and should only be performed by specialized surgeons.
• Coordination between specialists, including gastroenterologist, surgeon, oncologist and radiation therapist, must be flawless. Often, treatment with chemotherapy drugs and especially radiation therapy must precede surgery.
• There is a higher rate of local disease recurrence, which is difficult to treat and is often determined by the oncological efficacy of the initial surgery.

*The Metropolitan Hospital has an organized Colon Surgery Department of the Minimally Invasive Surgery Clinic and Surgical Oncology, fully equipped to the highest standards. With its qualified scientific and nursing staff, the center is always accessible to patients, ready to deal with any medical need, 24 hours a day.