Causes of Rectal Cancer

Although some factors causing rectal cancer have been identified, about 75% of patients do not have a clear risk factor. The main known risk factors are:

• Family history: If there is a history of colorectal cancer in the family, especially in first-degree relatives, the risk of developing the disease increases. It is recommended that these individuals start screening colonoscopy at age 40.

• Colon polyps: Polyps can turn into cancer over time. Individuals with detected polyps have a 3-7 times higher risk of colorectal cancer.

• Hereditary diseases:

  • HNPCC (Hereditary Nonpolyposis Colorectal Cancer): This genetic disease carries a high risk of cancer in many organs, including the rectum. Regular colonoscopy follow-up is essential.

  • FAP (Familial Adenomatous Polyposis): Hundreds of polyps develop in the colon, with a high chance of becoming cancerous. It is inherited through genetic mutation.

• Inflammatory bowel diseases: Individuals with long-standing ulcerative colitis or Crohn’s disease have an increased cancer risk.

• Nutrition: Diets high in red meat and saturated fats increase risk, while diets rich in fiber can be protective.

• Other factors: Alcohol consumption, smoking, and advanced age are also important risk factors.

• Previous colorectal cancer: Patients who have had colorectal cancer in another region have a risk of recurrence.

Symptoms of Rectal Cancer

Symptoms of rectal cancer can vary between individuals and may not appear in early stages. The most common symptoms are:

• Changes in bowel habits (constipation, diarrhea)

• Blood from the anus

• Blood and mucus in stool

• Narrowing of stool

• Feeling of incomplete bowel emptying after defecation

• Abdominal pain, gas, and bloating

• Weight loss and loss of appetite

• Fatigue, weakness

• Iron deficiency anemia

• Pain in the hip area

• Palpable mass in the abdomen

• Nausea and vomiting

Since these symptoms can also be seen in other diseases, especially individuals over 50 should undergo regular screening.

Diagnosis and Staging of Rectal Cancer

Various tests and imaging methods are used to diagnose rectal cancer:

• Blood tests (complete blood count, liver function tests, tumor markers: CEA, CA19-9)

• Fecal occult blood test

• Rectal examination, anoscopy, rectoscopy, colonoscopy

• Endorectal ultrasound

• Pelvic MRI and CT

• PET-CT scans

• Genetic tests (for diseases like HNPCC, FAP)

Staging of rectal cancer:

• Stage 1: Cancer involves superficial layers.

• Stage 2: Cancer has spread through the entire bowel wall but not to lymph nodes.

• Stage 3: Cancer has spread to lymph nodes.

• Stage 4: Cancer has metastasized to distant organs (liver, lungs, etc.).

Treatment of Rectal Cancer

The primary treatment for rectal cancer is surgery. During surgery, the tumor and affected lymph nodes are removed following oncological principles.

The treatment process varies depending on the stage of the disease:

• In early-stage patients, surgery alone may be sufficient. The success rate is 80-90%.

• In advanced stages, preoperative radiotherapy and/or chemotherapy are applied to shrink the tumor. Additional treatment may be needed after surgery.

• In some patients, the tumor may have spread to surrounding organs. In this case, parts or all of adjacent organs such as the uterus, bladder, or ovaries may be removed.

• In rare cases, a colostomy (a bag for stool collection outside the body) may be required. This is applied in less than 5% of patients.

Conclusion:

Rectal cancer is a disease that can be completely treated with early diagnosis. Even if there are no symptoms, it is crucial for individuals over 50 to participate in regular screening programs. For those with a family history or risk factors, earlier screening is recommended.