The rectum is the lowest 15cm of the large intestine (“bowel”) just inside the anus. The rectum is contained within the pelvis and is closely surrounded by organs such as the bladder, prostate, uterus, vagina and ovaries and also by important nerves and blood vessels.
The most common symptoms of rectal cancer are blood on or in the stool, a change in bowel habit to loose, frequent or erratic bowel motions, or sometimes a feeling of incomplete emptying. The diagnosis is made at colonoscopy where a biopsy is taken.
The Mater Hospital is a designated centre of excellence for the treatment of all forms of rectal cancer. When a patient is diagnosed with rectal cancer they first undergo tests to determine how big the cancer is and if there is any spread around the body. Tests include a CT scan and a MRI. In some cases other tests such as PET-CT or liver biopsy are necessary to accurately stage the cancer. Each patient and their test results are then individually discussed at a multidisciplinary meeting to plan their treatment. Our colorectal cancer specialist nurses support and guide patients through their tests and treatment.
There are five rectal cancer surgeons in the Mater who treat the entire spectrum of rectal cancer from very early polyp cancers right through to advanced rectal cancer that has spread outside of the rectum. The surgical team have specialist experience in laparoscopic (keyhole), endoscopic, major open and transanal (TAMIS, taTME) surgery, peritonectomy & HIPEC, exenteration and sacrectomy. We also work together with our liver surgeons, cardiothoracic surgeons, urologists and spinal surgeons to tackle advanced and recurrent rectal cancers. The Mater is the only hospital in Ireland that offers all of these treatments.
Following surgery the patient recovers in the high dependency unit and then the specialist colorectal ward. Some rectal cancer patients will need a stoma bag after surgery and dedicated stoma therapists will teach and support them in managing it.
A few weeks after surgery the laboratory report on the tumour that was removed is discussed at the multidisciplinary meeting and the next stage of treatment decided on. Most commonly this involves a course of chemotherapy or a 5-year period of close observation.
The treatment of malignant rectal cancer is more complex than that for colon cancers because there is a higher risk for the cancer to reoccur after surgery as well as the risk of damage to surrounding organs, nerves and arteries. Radiotherapy before surgery reduces the risk of cancer recurrence if used in the correct patients. Surgery for rectal cancer can be technically challenging and there is an increased risk of recurrent cancer if not done correctly. For these reasons, rectal cancer surgery has been centralised to eight dedicated centres by the National Cancer Control Programme.
The Multidisciplinary Team Meeting
|Colorectal Surgeons||Radiologists||Cancer Specialist Nurses|
|Liver Surgeons||Medical Oncologists||Cardiothoracic Surgeon|
|Histopathologists||Interventional Radiologists||Data Manager|