Rectal Cancer Treatment

To treat and prevent the return of rectal cancer, specialized care is often needed before and/or after surgery. Virginia Mason, with the largest gastrointestinal program in Seattle, is the best place to have pre- and post-surgical treatments that may include chemotherapy and radiation. Patients receive their care from all their specialists at one time and in one setting.

A critical part of treatment occurs early on. This is the accurate “staging” of the cancer necessary to determine the best approach for care. At Virginia Mason, a combination of endoscopy, MRI, CT and other advanced imaging will help accurately pinpoint the stage of a patient’s cancer. Is it early or advanced? These tests are often all done on the same day for a faster diagnosis so that treatment can begin immediately. It is possible to cure patients with early-stage rectal cancer by trans-anal or other minimally invasive surgery. Patients may also elect to participate in several ongoing rectal cancer trials at Virginia Mason that provide an opportunity for the latest treatments and procedures.

Surgery for Rectal Cancer

Surgery is often the fastest and most effective treatment. Rectal cancer operations require an extremely high level of surgical skill such as that of Virginia Mason surgeons. With rectal cancer, a high level of expertise is particularly critical because the tumors occur in a tight space close to other vital organs in the pelvic cavity. A surgeon’s experience and skill increase the chance that nearby organs will not be affected by removal of cancerous tumors.

Surgical care and sequencing of rectal cancer treatments is complex and largely determined by the preoperative staging of the tumor(s). Large tumors or tumors with cancer in the lymph nodes will most probably receive radiation and chemotherapy before surgery (“neoadjuvant” treatment).

Primary surgery is either a low anterior resection or an abdominal-perineal resection (APR) that is used for cancers located close to the anus. APR involves removal of the rectum from both an abdominal incision as well as an incision around the anus. Once the anus and the anal sphincters are removed, a permanent colostomy is required for waste removal.

Tumors of the mid- or upper rectum can be removed through an abdominal incision and the colon attached to the lower rectum or anus as a “low anterior resection” or a colo-anal anastomosis, which is a surgical connection between two structures or areas of the body. Very early cancers near the anus can be removed through the anus without a skin incision.

Virginia Mason surgeons are on the cutting edge developing procedures and nerve-sparing techniques that result in higher cure rates and decreased chances of sexual impotency. Specific surgical proficiencies at Virginia Mason are trans-anal minimally invasive surgery, trans-anal total mesorectal excision, and robotic- or laparoscopic-assisted minimally invasive surgery. This means faster recovery and a high rate of restoring continuity of the bowels.

Sphincter Preservation

Operations that remove rectal cancers without affecting the anal sphincter, thus preserving fecal continence and maintaining normal bowel function, are called “sphincter-preservation” procedures. Advances in surgical techniques used at Virginia Mason have enhanced our surgeons’ ability to achieve sphincter preservation in most rectal cancer patients.

This is often done through anastomosis. While the traditional colorectal anastomosis can be achieved four to six centimeters from the anus, rectal cancer patients at Virginia Mason can now be treated with a colo-anal anastomosis at the anal canal, thus removing the entire rectum and increasing the chances of sphincter preservation.

Total Mesorectal Excision (TME)

Virginia Mason surgeons continue to develop techniques that are producing enhanced local control rates and quality of life. For example, total mesorectal excision (TME) and nerve-sparing procedures are resulting in higher cure rates and decreased chances of sexual impotency, respectively.

TME is a surgical technique that improves the surgeon's ability to remove all of the rectal lymph nodes that may contain metastatic deposits of cancer cells. Several studies have shown that the risk of rectal cancer recurring after surgery is lower if the surgeon performs a TME. Surgeons at Virginia Mason have been at the forefront of developing and perfecting the TME technique.

Sexual Potency and Nerve Preservation

Damage to the nerves controlling erection or sexual potency is common after surgery for rectal cancer. Together with the development of total mesorectal excision (see TME above), surgeons have perfected techniques to preserve the nerves that control sexual potency. The surgical team at Virginia Mason is specially trained in these nerve preservation techniques. The majority of our patients who undergo surgery for rectal cancer maintain sexual potency.

In summary, few patients with rectal cancer treated at Virginia Mason will require permanent colostomies and, for most, their sexual potency will remain intact. This is because Virginia Mason is on the forefront of new surgical techniques that facilitate sphincter preservation, enhance local cancer control rates and improve bowel and sexual function.

To learn more about rectal cancer care at Virginia Mason or to make an appointment, please call (206) 341-1200.