General
What is the difference between colon cancer and rectal cancer?
Although both are colorectal cancers, rectal cancer has important particularities. Rectal cancer often requires neoadjuvant radiotherapy (before surgery), pelvic MRI for staging, total mesorectal excision (TME), and may involve a stoma. Colon cancer usually does not require radiotherapy and rarely involves a permanent stoma.
Can rectal cancer be cured?
Yes, rectal cancer diagnosed at early or locally advanced stages can be cured. The 5-year survival rate varies by stage: over 90% for stage I, 70-80% for stage II-III, and lower for stage IV. Early diagnosis and correct treatment are essential.
At what age does it most commonly appear?
It most commonly appears after age 50, but in recent years there has been an increase in cases under 50 (early-onset colorectal cancer). Screening is recommended starting at age 45, or earlier if risk factors are present.
Treatment
Will I need surgery?
Most patients with rectal cancer require surgery. The exception is patients who achieve a complete clinical response after chemoradiotherapy and are eligible for the Watch & Wait strategy, as well as patients with very early tumors treated by transanal local excision.
What does neoadjuvant chemoradiotherapy mean?
Neoadjuvant means “before surgery.” The combination of chemotherapy and radiotherapy administered before surgery aims to shrink the tumor, facilitating complete surgical resection and reducing the risk of local recurrence.
Can surgery be performed laparoscopically or robotically?
Yes, most rectal cancer surgeries can be performed using a minimally invasive approach (laparoscopic or robotic). The advantages include smaller incisions, faster recovery, less pain, and shorter hospital stay, with oncological outcomes similar to open surgery.
Stoma
Will I have a permanent stoma?
Not necessarily. A permanent stoma is only required when the rectum and anal sphincter must be completely removed (abdominoperineal resection). Most patients receive a temporary stoma (protective ileostomy) that is closed 3-6 months after surgery.
Can I lead a normal life with a stoma?
Yes. Patients with a stoma can work, travel, exercise, have intimate relationships, and participate in social activities. It requires an adjustment period and the support of a stoma therapist, but quality of life can be very good.
Recovery
What is LARS syndrome?
LARS (Low Anterior Resection Syndrome) is a set of symptoms that occur after low anterior resection: defecation urgency, increased frequency, stool fragmentation, and minor incontinence. It improves gradually over 1-2 years, but in some patients it may persist. Effective management strategies are available.
How long does recovery after surgery take?
Full recovery usually takes 6-12 weeks for normal activities. Functional bowel recovery (in case of LARS) may take 1-2 years. Return to work depends on the type of activity — usually 4-8 weeks.
Can I exercise after surgery?
Yes, physical activity is recommended and beneficial. It can be gradually resumed 6-8 weeks after surgery, starting with walking and gradually increasing intensity. Avoid heavy lifting in the first 3 months.
Follow-up
How often should I have check-ups after treatment?
In the first 2 years, check-ups are every 3-6 months. In years 3-5, every 6 months. After 5 years, annually. Each check-up includes clinical examination, blood tests (CEA), and periodic CT scans and colonoscopy.
What signs should worry me?
See a doctor urgently if you have: fever above 38°C (100.4°F), heavy rectal bleeding, severe abdominal pain, persistent nausea and vomiting, stoma changes (dark color, lack of function), or any symptom that worries you.