Rectal Cancer

• Understanding the disease
• Treatment options
• Side effects of treatment

Stephen Shamp, MD MSEE

David Bloom, MD PhD

Matthew Culbert, MD

Rectal Cancer

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1. Patterns of spread.
2. B. T categories. The patterns of spread and the primary tumor classification are similarly color coded:
3. Tis (cancer in situ of mucosa), yellow;
4. T1 (infiltrates the submucosa), green; \
5. T2 (penetrates the muscularis externa), blue;
6. T3 (reaches the subserosa), purple; and
7. T4 (invades through the serosa into a neighboring viscera), red.

Rectal Cancer Stage

Surgery

• The primary treatment for most patients with rectal cancer is surgery
• In patients with Stage II-III (T3/4 or N+) rectal cancer or cancers that are low lying (near the sphincter), or with a threatened margin, radiation and chemotherapy are often used to shrink the tumor
• This has been shown to improve the chance of surgery removing everything, reduce the chance of the cancer recurring, and improves the rates of preserving the sphincter complex

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Radiation is often used before surgery to shrink the tumor. Increasing the chance of a complete surgical removal, and being able to spare the sphincter

www.nccn.org

CT simulation (planning session)

• We will build a cradle to hold you in the same position with each treatment.
• Temporary or permanent marks will be made
• CT images are obtained and then imported into the treatment planning computer
• You bladder should to be full and your rectum empty

RapidArc IMRT Rectal Radiation Plan

Logistics of Chemoradiation:

• Usually 28 daily treatments
• Chemotherapy, if recommended, will often start on the same day
• Treatment days are Monday-Friday 5 days per week, 5.5 weeks in total
• Daily treatment takes 15 minutes or less. You will be given a schedule
• You do not feel anything during treatment, you will not be radioactive, you are allowed to drive yourself to and from treatment if you are currently allowed to drive

Logistics of Short Course Radiation:

• Option for Certain Patients
• Usually 5 treatments
• Treatment days are Monday-Friday 5 days per week, 1 week in total
• Daily treatment takes 15 minutes or less. You will be given a schedule
• You do not feel anything during treatment, you will not be radioactive, you are allowed to drive yourself to and from treatment if you are currently allowed to drive

• Lasers and/or imaging is used to precisely deliver the daily radiation treatment.
• Expect to be on the treatment table less than 15 minutes.
• You will not feel any immediate effects.

Side Effects of Female Pelvic Radiation

Radiation fields

Organs that may be affected

Colon

Bladder

Prostate

Side Effects of Male Pelvic Radiation

Short Term Side Effects: Fatigue and Irritation of rectum, skin, bladder, bowel, vagina/prostate

1. Painful or frequent defecation.
2. Urinary frequency or urgency
3. Slight burning or stinging with urination (drink cranberry juice)
4. Diarrhea or more frequent, softer bowel movements, rectal soreness (take Imodium)
5. Potential irritation of skin near anus or around the pelvis
6. Fatigue is common
7. Females may have irritation of the vagina

Radiation

zone

Radiation

zone

Chronic radiation proctitis or cystitis: occasional episodes of blood in the urine or with bowel movements, this usually responds to medication (e.g. cortisone suppositories) The risk of serious damage to the bladder and rectum is now less than 1%�Incontinence: Rare, but possible effects on the sphincter complex can increase risk of fecal incontinence

Infertility: Radiation can affect fertility in both males and females and can affect ovarian function

Very low risk of rare but serious complications including but not limited to secondary malignancy, small bowel obstruction, ulcer, fistula, vaginal stenosis

Long Term Side Effects: Possible irritation of rectum, bowel, bladder, or vagina

Chemo-Radiation will often shrink the cancer making surgery easier