Rectal cancer is a type of cancer that begins in the last part of the large intestine, called the rectum — the section just before the anus. It is one of the common cancers of the gastrointestinal (GI) tract, especially in people above 45 years, but it is increasingly being seen in younger adults too.

Why Does Rectal Cancer Happen?

There is no single reason, but risk factors include:

• 
  

  Family history of colorectal cancer or polyps

  
  


• 
  

  Diet low in fiber & high in red/processed meat

  
  


• 
  

  Obesity & lack of physical activity

  
  


• 
  

  Smoking & alcohol

  
  


• 
  

  Inflammatory bowel disease (especially Ulcerative Colitis)

  
  


• 
  

  Genetic conditions (rare but important)

  
  

Often the cancer starts as a small growth called a polyp, which slowly turns into cancer over years.

Common Symptoms of Rectal Cancer

Rectal cancer may show early warning signs, but they are often ignored as “piles/hemorrhoids” or “diet issues.” Important symptoms include:

1. Blood in stools

• 
  

  Can be bright red or mixed with stool

  
  


• 
  

  Often mistaken for piles, leading to delayed diagnosis

  
  

2. Change in bowel habits

• 
  

  New onset constipation or diarrhea

  
  


• 
  

  Narrow or ribbon-like stools

  
  


• 
  

  Feeling of incomplete evacuation

  
  

3. Persistent urge to pass stool

• 
  

  Called tenesmus

  
  


• 
  

  Common in rectal tumors

  
  

4. Abdominal or pelvic pain

5. Unexplained weight loss & loss of appetite

6. Fatigue or Weakness

• 
  

  Sometimes due to low blood hemoglobin (anemia)

  
  

?? Important Point: If symptoms continue beyond 2–3 weeks, especially bleeding, one should get evaluated — early diagnosis saves life.

What Tests & Investigations Are Needed?

For proper diagnosis and staging, doctors usually advise:

1. Colonoscopy

• 
  

  Camera test to see inside colon and rectum

  
  


• 
  

  Biopsy taken to confirm cancer

  
  


• 
  

  Most important diagnostic test

  
  

2. MRI Rectum

• 
  

  Special scan that shows how deep the cancer has grown

  
  


• 
  

  Helps decide the best treatment plan

  
  


• 
  

  Essential for rectal cancer (not just CT)

  
  

3. CT Scan Chest/Abdomen/Pelvis

• 
  

  Checks if cancer has spread (metastasis)

  
  

4. Blood Tests

• 
  

  CBC (anemia)

  
  


• 
  

  LFT (liver)

  
  


• 
  

  CEA (tumor marker)

  
  

5. PET Scan (Sometimes)

• 
  

  Used in complex/metastatic cases for complete mapping

  
  

Treatment Options for Rectal Cancer (Explained Simply)

Treatment depends on the stage, location in rectum, and overall health of the patient. Management is usually multidisciplinary.

Stage 1 (Early tumors)

Treatment:

• 
  

  Surgery only

  
  


• 
  

  Often done laparoscopically or robotically

  
  

Stage 2 & Stage 3 (Locally advanced)

These tumors usually need 3 steps:

Step 1: Chemoradiotherapy (CRT)

• 
  

  Combined chemotherapy + radiation

  
  


• 
  

  Done before surgery to shrink tumor

  
  


• 
  

  Helps preserve anal sphincter (avoid permanent colostomy)

  
  

Step 2: Surgery

Type of operation depends on tumor location:

• 
  

  Low Anterior Resection (LAR) → if tumor is higher

  
  


• 
  

  Abdominoperineal Resection (APR) → if very low tumor (may need permanent stoma)

  
  


• 
  

  TME (Total Mesorectal Excision) → gold standard technique

  
  

Step 3: Chemotherapy (Post-surgery)

• 
  

  To reduce recurrence chances

  
  

Stage 4 (Spread to liver/lung)

Treatment goals depend on whether spread is resectable.

Options include:

• 
  

  Chemotherapy

  
  


• 
  

  Targeted therapy

  
  


• 
  

  Immunotherapy (for MSI-high tumors)

  
  


• 
  

  Sometimes surgery for liver/lung metastasis

  
  

Even in stage 4, long-term survival is possible in selected cases.