Rectal Cancer Treatment

In the surgical and Oncology Department at Herzliya Medical Center in Israel, the most modern methods of treatment of rectal cancer are made available to patients. The clinic accepts patients from around the world, ensuring complete professionalism and high-quality service, including support and services throughout all stages of the process and patient’s stay in Israel.

What is Rectal cancer?

Rectal cancer occurs in one-third of cases of malignant lesions of the colon, affecting the lower part of the colon that connects the anus to the large bowel. The most common type of tumor-associated with rectal cancer is adenocarcinoma, cancer that originates from epithelial tissue cells. Adenocarcinoma of the rectum and bowels are characterized by the following:

• Narrowing of the intestinal lumen leads to obstruction
• Infiltration of the mucosa, submucosa, muscular, and serous membranes of the intestines, which may compromise organ health and cause perforation and massive bleeding
• Ability to spread to adjacent pelvic organs may degrade functioning and contribute to the formation of adhesions and fistula
• Metastatic spread, mainly through lymphatic vessels to regional pelvic lymph nodes, lymphoid structures of the mesentery, omentum, and retroperitoneum. Metastasis may also reach organs distant (liver, lungs, bones, etc.)
• The anatomical structure of the intestine contains an abundance of lymph nodes, made up of a dense network of lymphatic vessels, which contribute to early metastasis and proliferation of colorectal cancer.

Symptoms of colon cancer

Symptoms of colon cancer depend on the size of the tumor, degree of invasiveness, and presence of secondary lesions.

• Primary symptoms of colon cancer include bowel movement complications, such as frequent constipation or pain falsely indicating an urge to defecate (tenesmus). Filling of the lumen rectum or rectal valve may cause a change in feces. Tumor growth in the rectal valve can result in partial or complete intestinal obstruction, which may require emergency surgery.
• The secretion of a mixture of blood and mucus is also an indication of the compromised integrity of the capsule tumors. Other symptoms include prolonged rectal bleeding leading to severe anemia, which may accompany sudden massive bleeding from the rupture of a large vessel in the region. This type of rupture may be life-threatening.
• Pain begins with discomfort during a bowel movement. In advanced stages of colorectal cancer, pain is ongoing and becomes chronic. Patients may experience bowel perforation and secondary inflammation of the peritoneum (peritonitis)
• Disrupted functioning of pelvic organs, in women such as vaginal bleeding, urinary retention, and blood in the urine, are symptoms known to characterize severe forms of the disease and involve the development of tumors in neighboring anatomical structures.
• As symptoms continue, other symptoms include weakness, weight loss, or intermittent fever. Later stages of the disease present indications of colon cancer spread (metastasis) and depending on the patient, secondary spread to affected organs.

If the patient experiences one or more of the above symptoms, it is necessary to seek medical attention immediately.

Diagnosis of colorectal cancer

Colon cancer experts recommend a number of diagnostic methods to determine a presumptive diagnosis. Among the most prominent methods of diagnosis are the following:

• Sigmoidoscopy (endoscopic examination of the rectum) is conducted independently or in combination with a full examination of the large intestine – Colonoscopy. An important advantage of endoscopic techniques is the ability to biopsy suspicious tumor sites to histological confirmation of the diagnosis.
• Methods using Ultrasound (US), Radiology (X-ray, or CT-scan) as well as Magnetic Resonance Imaging (MRI) help determine the exact location and size of the tumor, as well as the presence of lesions of adjacent organs and secondary lesions.
• Methods for studying metabolic activity (PET-CT) to decipher patient’s hypermetabolic foci – characteristic of both primary and metastatic cancer.
• Laboratory screenings for diagnosis are used to determine the level of tumor marker CEA (carcinoembryonic antigen), which is of great importance in early diagnosis and monitoring patients at later stages of treatment.
• Histology test through biopsy allows a definitive diagnosis to determine the degree of sensitivity of tumors to targeted drug therapy.

Stages of colorectal cancer

Colorectal cancer is composed of three major elements, accepted by international classification and known as TNM staging:

• T (Tumor) – the primary tumor foci
• N (Node) – involvement of lymph nodes
• M (Metastasis) – the spread of cancer to remote secondary lesions

A full diagnosis of colorectal cancer for a patient includes a description of the primary tumor, the status of the lymph nodes, the presence of distant foci, and precise histological characteristics. A complete diagnosis enables the selection of the most effective method of treating colorectal cancer in Israel and maximizing optimum results.

Treatment of rectal cancer in Israel

Specialists at HMC in Israel treat patients individually to determine the best form of treatment. Consideration of histological features, stage of the disease, and other factors including the patient’s age and the presence of preexisting or ongoing medical problems. Surgery for treating colorectal cancer at HMC in Israel includes removing a primary tumor and regional lymph nodes using one of the following techniques:

• Removal of the affected area of ​​the bowel with internal anastomosis (connection) of the rectum and complete preservation of anal sphincter
• Surgery to remove the tumor with a temporary stoma breeding – connection of the intestine to the abdominal wall. The surgery involves regions located in close proximity to the anal sphincter. At the end of treatment, experts confirm the absence of disease recurrence reinforced by a second surgery to close the stoma with the ability to retain the anatomic integrity of the intestine
• For rectal cancer, a permanent stoma is often extended to the anal sphincter
• Cytoreduction surgery for rectal cancer in Israel is performed with the goal of removing the bulk of the tumor, as well as metastatic lesions, effected regional lymph nodes, retroperitoneal nodes, omentum, and mesentery. Cytoreduction significantly increases the effectiveness of other therapies to improve the prognosis of a favorable outcome among previously considered inoperable stages of colorectal cancer
• Palliative surgery for rectal cancer is done to prevent degradation of, or restore the functioning of the pelvic organs effected by progressive cancer.

Surgeons at Herzliya Medical Center in Israel use laparoscopic techniques and perform most operations noninvasively. This reduces the likelihood of postoperative complications and shortens rehabilitation.

Along with surgery, oncologists successfully apply the fundamental methods of treatment of colorectal cancer in Israel, which are integral components of the complex therapy:

• Chemotherapeutic medicine is used for colorectal cancer treatment, including FOLFOX and XELOX (with active components being Fluorouracil,
• Oxaliplatin, Irinotecan, Capecitabine, 5-fluorouracil)
• Drug-targeted therapy (Cetuximab, Bevacizumab) may be used in combination with chemotherapeutic agents or used for monotherapy

Rectal cancer: Prognosis

Early diagnosis and the use of highly effective methods of treatment help to improve the prognosis of the treatment of colorectal cancer. Among the most favorable prognoses for colorectal cancer are when observed in a non-invasive form and absent from regional lymph node lesions.