RECTUM CANCER TREATMENT OPTIONS

Rectum cancer, a type of colorectal cancer affecting the lower part of the large intestine, requires a multi-faceted approach to treatment. Depending on the stage of the cancer and the patient’s overall health, treatment options can vary significantly. This article will explore the primary treatment approaches for rectum cancer, including surgery, chemotherapy, radiation therapy, and targeted therapy. Additionally, it will discuss how treatment choices are influenced by the stage of the cancer and the patient’s health status. Finally, the importance of palliative care for patients with advanced-stage rectum cancer will be highlighted.

TREATMENT APPROACHES FOR RECTUM CANCER

Surgery:

Surgery is often the primary treatment for rectum cancer, particularly for early-stage cancers. The goal of surgery is to remove the cancerous tumour along with some of the surrounding healthy tissue to ensure that no cancer cells remain.

Types of Surgical Procedures for rectum cancer:

1. Local Excision: This procedure is used for very early-stage cancers. It involves removing the cancerous tissue and a small margin of healthy tissue through the rectum. This is often done via a colonoscope and is minimally invasive.
2. Resection: In cases where the cancer is more advanced, a resection may be required. This involves removing part of the rectum and the surrounding tissues. Depending on the location and extent of the cancer, this may include removing nearby lymph nodes as well.
3. Abdominoperineal Resection (APR): For cancers located in the lower part of the rectum, APR may be necessary. This surgery involves removing the rectum and the anus, creating a permanent colostomy, where the colon is diverted to an opening in the abdomen.

Considerations:

• Recovery Time: Recovery from surgery varies based on the type of procedure and the patient’s overall health. Post-surgery care often includes managing pain, preventing infections, and adjusting to changes such as a colostomy.
• Potential Side Effects: Side effects of rectal cancer surgery can include changes in bowel habits, sexual dysfunction, and urinary problems.

Chemotherapy for rectum cancer:

Chemotherapy uses drugs to kill cancer cells or stop them from growing. It is commonly used either as a primary treatment for rectal cancer or as an adjunct to surgery.

When is Chemotherapy Used?

1. Adjuvant Therapy: After surgery, chemotherapy may be administered to eliminate any remaining cancer cells and reduce the risk of recurrence. This is particularly common in cases where the cancer has spread to nearby lymph nodes.
2. Neoadjuvant Therapy: In some cases, chemotherapy is given before surgery to shrink the tumor, making it easier to remove and potentially allowing for less extensive surgery.

Types of Chemotherapy Drugs:

• Fluorouracil (5-FU): Often used in combination with other drugs, it helps to interfere with the cancer cell’s ability to replicate.
• Oxaliplatin: This drug is frequently used in combination with fluorouracil and leucovorin to enhance effectiveness.
• Capecitabine: An oral form of fluorouracil that is used as an alternative to intravenous administration.

Considerations:

• Side Effects: Chemotherapy can cause side effects such as nausea, vomiting, fatigue, hair loss, and an increased risk of infection. These side effects vary depending on the specific drugs used and the patient’s overall health.
• Effectiveness: The effectiveness of chemotherapy depends on the cancer’s stage and the patient’s response to the drugs.

Radiation Therapy for rectum therapy:

Radiation therapy uses high-energy rays to target and kill cancer cells. It is often used in combination with other treatments for rectal cancer.

When is Radiation Therapy Used?

1. Preoperative (Neoadjuvant) Radiation: Radiation therapy may be given before surgery to shrink the tumor, which can improve the chances of a successful surgery and reduce the extent of surgery required.
2. Postoperative (Adjuvant) Radiation: After surgery, radiation therapy may be used to target any remaining cancer cells, especially if the cancer was close to the surface or if the margins were not clear.
3. Palliative Radiation: For advanced-stage rectal cancer, radiation therapy can help relieve symptoms such as pain, bleeding, and obstruction.

Types of Radiation Therapy:

• External Beam Radiation: Delivered from outside the body using a machine that directs radiation at the cancerous area.
• Brachytherapy: Involves placing a radioactive source inside or very close to the tumor, though this is less commonly used for rectal cancer.

Considerations:

• Side Effects: Side effects of radiation therapy may include skin irritation, fatigue, and gastrointestinal issues such as diarrhea and rectal bleeding.
• Treatment Duration: Radiation therapy is typically administered in daily sessions over several weeks, depending on the treatment plan.

Targeted Therapy:

Targeted therapy uses drugs that specifically target cancer cells’ unique characteristics, such as genetic mutations or specific proteins involved in cancer growth. This approach is more selective compared to traditional chemotherapy and may be used in conjunction with other treatments.

Types of Targeted Therapy:

• Anti-VEGF Therapy: Drugs like bevacizumab (Avastin) target vascular endothelial growth factor (VEGF), which helps tumours develop new blood vessels. By inhibiting VEGF, these drugs can restrict tumor growth.
• EGFR Inhibitors: Drugs such as cetuximab (Erbitux) target the epidermal growth factor receptor (EGFR), which is often overexpressed in cancer cells. These inhibitors help block the signals that promote cancer cell growth.

Considerations:

• Side Effects: Targeted therapies can have side effects including skin rashes, diarrhoea, and liver problems. The side effects vary depending on the specific drug and its mechanism of action.
• Effectiveness: The effectiveness of targeted therapy depends on the presence of specific biomarkers in the cancer cells. Genetic testing may be required to determine eligibility.

CHOOSING THE RIGHT TREATMENT FOR RECTUM CANCER

The choice of treatment for rectal cancer depends on various factors, including the stage of the cancer, the patient’s overall health, and their personal preferences.

Stage of Cancer

• Early-Stage Cancer: For cancers diagnosed at an early stage, surgery is often the primary treatment. Adjuvant chemotherapy or radiation may be recommended based on the specific characteristics of the cancer.
• Locally Advanced Cancer: For cancers that have spread beyond the rectum but are still confined to the pelvic region, a combination of chemotherapy and radiation therapy is often used to shrink the tumor before surgery. This approach can also include targeted therapy depending on the molecular characteristics of the cancer.
• Advanced or Metastatic Cancer: For cancers that have spread to distant organs, treatment often focuses on managing symptoms and improving quality of life. This may include chemotherapy, targeted therapy, and palliative radiation. Surgery may be considered for isolated metastases or to relieve symptoms.

Overall Health

• Patient’s General Health: The patient’s overall health and comorbid conditions play a significant role in determining the appropriate treatment. For instance, patients with other health issues may not tolerate certain therapies well and may require adjustments to their treatment plan.
• Age and Functional Status: Older patients or those with reduced functional status may require a more tailored approach to treatment, focusing on therapies that offer the best balance between efficacy and quality of life.

IMPORTANCE OF PALLIATIVE CARE FOR RECTUM CANCER PATIENTS

For patients with advanced-stage rectal cancer, palliative care plays a crucial role in managing symptoms and improving quality of life. Palliative care is designed to provide relief from pain and other distressing symptoms, regardless of the stage of the cancer.

Key Aspects of Palliative Care:

• Symptom Management: Palliative care teams focus on managing symptoms such as pain, nausea, fatigue, and difficulty breathing. This approach can significantly improve comfort and

quality of life for patients facing advanced cancer.

• Psychosocial Support: Palliative care also addresses the emotional and psychological needs of patients and their families. This includes providing counseling, support groups, and assistance with coping strategies to manage the emotional impact of the disease.
• Care Coordination: Palliative care teams work closely with oncologists, surgeons, and other healthcare providers to ensure that all aspects of the patient’s care are coordinated effectively. This holistic approach helps in managing complex symptoms and provides a comprehensive support system for the patient and their family.
• Advance Care Planning: Palliative care involves discussions about future care preferences and goals, including end-of-life decisions. This planning ensures that the patient’s wishes are respected and helps guide medical decisions in alignment with their values and preferences.

CONCLUSION.

Rectal cancer treatment involves a range of approaches tailored to the specific stage of the cancer and the patient’s overall health. Surgery, chemotherapy, radiation therapy, and targeted therapy each play a vital role in managing the disease, with the choice of treatment often guided by the cancer’s stage and the patient’s condition. In addition to these primary treatments, palliative care is essential for patients with advanced-stage rectal cancer to manage symptoms and improve quality of life. By understanding these treatment options and their implications, patients and their families can make informed decisions and work with their healthcare team to develop a personalized treatment plan that best meets their needs.

REFERENCES:

• American Cancer Society. (2023). Colorectal Cancer Treatment. Retrieved from https://www.cancer.org/cancer/colon-rectal-cancer/treating.html
• National Cancer Institute. (2022). Rectal Cancer Treatment (Adult) (PDQ®)–Health Professional Version. Retrieved from https://www.cancer.gov/types/colorectal/hp/rectal-treatment-pdq
• Mayo Clinic. (2023). Rectal cancer treatment: Options for your care. Retrieved from https://www.mayoclinic.org/diseases-conditions/rectal-cancer/diagnosis-treatment/drc-20326095
• U.S. Preventive Services Task Force. (2021). Colorectal Cancer: Screening. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening

Written by Fawzi Rufai, Medically Reviewed by Sesan Kareem