• Surgery

Surgery is the main treatment for rectal cancer. The type of operation used to remove the rectal cancer depends on the extent and location of the cancer. There are two types of surgery for rectal cancer such as Low Anterior Resection Surgery (LAR) which rectal cancer is located well above the anus and Abdominoperineal Resection Surgery (APR) which rectal cancer is located close to the anus, sometimes the anus must be removed with the cancer in an operation .

Low Anterior Resection Surgery (LAR)

LAR is when the entire rectal cancer, adjacent normal rectal tissue and surrounding lymph nodes are removed through an incision made in the lower abdomen. After the cancer is removed, the cut ends of the rectum are sewn back together. If the cancer is lower in the rectum, the cut end of the large bowel may be attached directly to the anus. Patients undergoing an LAR may experience lower abdominal pain after the operation. Other than that, less common complications related to surgery include bleeding, infection and temporary difficulty with emptying the bladder.

Abdominoperineal Resection Surgery (APR)

APR is when the entire rectal cancer, adjacent normal rectum, rectal sphincter or anus, and surrounding lymph nodes are removed through an incision in the lower abdomen and the perineum. After removal the cancer, the incision in the perineum is sewn shut. The cut end of the large intestine is attached to an opening in the abdominal wall, called a colostomy. This opening is covered with a bag, which serves to collect stool as it passes through the large intestine and through the colostomy. Besides, to a LAR, the colostomy is permanent.

• Chemotherapy

After surgery the cancer will be examined carefully under the microscope. If cancer cell are found in the blood or lymph vessels very close to the cancer then doctor may recommend chemotherapy. Chemotherapy is supported treatment after surgery. The aim of this treatment is to reduce the risk of cancer to coming back. Adjuvant chemotherapy for rectal cancer is usually given with a drug called 5 fluorouracil (5FU). 5FU is usually given with given with a vitamin called folinic acid (leucovorin), which makes it more effective.

• Radiotherapy

Radiotherapy uses high energy rays to kill cancer cells. Usually, doctors do not often use to treat cancer in the large bowel. Otherwise, they often use to treat cancer that start in the back passage (rectum). There are containing three types of rectal cancer that are external radiotherapy before surgery, internal radiotherapy before surgery and radiotherapy after surgery.

• External radiotherapy before surgery

5 radiotherapy treatments in the week before surgery are needed. It is because to kill many of the cancer cells. This treatment can lower the risk of the cancer coming back after surgery and shrink tumor and make the m easier to remove completely.

• Internal radiotherapy before surgery

Internal radiotherapy is the newer treatment for some cancers in the middle or lower third of the rectum is high does rate (HDR) internal radiotherapy. The purpose of this treatment is to shrink the tumor so that it is easier to completely remove it.

Firstly the doctor pushed a tube through anus into rectum and places it close to the tumor. Then, radiographer may take an X-ray to check the tube is in the right place. The tube is attached to the brachytherapy machine. The radioactive source moves from the machine into the tube by remote control. It is left in place to deliver the correct dose of radiation to the tumor. This treatment may take 10 to 15 minutes. The staff and doctor can see you on a TV monitor and talk to you through an intercom. When the treatment is over the radioactive source move back to the machine and the tube is taken out.

• Radiotherapy after surgery

Radiotherapy after surgery is called adjuvant radiotherapy and radiotherapy treatments over 4 to 5 weeks are needed. Each individual treatment is called fraction. Other than that, giving the treatment in small fractions reduces the side effects to healthy tissues. This treatment is occur when the cancer was difficult to remove after surgery, cancer cells may be left behind and cancer had grown through the bowel wall or spread to nearby lymph nodes.

RECTAL CANCER TREATMENT

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