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Because they perform many rectal cancer surgeries, Mayo Clinic surgeons have the experience and skill to produce outstanding outcomes for their patients. Rectal cancers have a higher rate of local recurrence than cancers elsewhere in the large intestine, and it is crucial that the surgeon remove as much cancerous tissue as possible. Studies show that patients treated by high-volume rectal surgeons are less likely to have local recurrence and to have better survival rates.
In addition, Mayo Clinic in Rochester, Minnesota ranked No. 1 among U.S. hospitals in the specialty of digestive disorders in the 2008 U.S. News Best Hospitals ranking.
Mayo Clinic offers several procedures for rectal cancer that may not be widely available. These include minimally invasive (laparoscopic) surgery, intraoperative radiation therapy, colostomy-sparing surgery and treatments for synchronous tumors (tumors that have spread from the rectum to other organs). Once the treatment team has pinpointed the location of the cancer, the surgeon may remove that section of the rectum and reattach remaining sections to preserve function. In some cases, the patient may need to undergo a colostomy, a procedure that allows waste to be expelled into a small bag worn externally.
Through surgery, physicians can better assess the location and extent of the cancer, which this can help in planning further treatment, including chemotherapy and radiation. Mayo Clinic's unique practice of immediately freezing and analyzing tissue samples taken during surgery helps surgeons remove as much of the cancer as possible. In some cases, this procedure can avert the need for a second surgery. The surgeon may remove the cancer using one of these procedures:
When the cancer is located very close to the anal opening, the rectum and anus must be removed, and the patient needs a colostomy. Surgeons make an opening in the abdomen wall, and body wastes are eliminated through the opening into a special bag.
When a locally advanced cancer penetrates the rectum wall and invades other organs such as the pelvic sidewall, vagina or bladder, surgical removal is extensive and is coordinated with radiation (external beam and intraoperative) and chemotherapy.
Mayo Clinic has extraordinary experience with highly specialized colostomy-sparing surgical procedures that preserve the anal sphincter, the muscle that pushes stool out of the body. This averts the need for a permanent colostomy bag. In a procedure called a coloanal anastomosis (pouch), the surgeon attaches the end of the colon to the top of the anal canal if most of the rectum must be removed and the anal canal is not involved. After surgery, patients should regain control of their bowel movements, although they may have a temporary ileostomy. Other colostomy-sparing procedures include low anterior resection, in which the surgeon removes the cancer, some surrounding normal tissue and the lymph nodes; and local excision, in which the surgeon removes only the cancer and some surrounding normal tissue.
Minimally invasive surgery uses tiny cameras inserted through small holes in the skin to guide the surgeon. Minimally invasive surgery has several benefits, including smaller incisions, a shorter stay in the hospital and a quicker overall recovery. A recent study led by Mayo Clinic found that minimally invasive surgery is a safe and effective alternative to traditional open surgery.
Chemotherapy uses drugs to destroy cancer cells. Chemotherapy may be recommended before or after surgery. It can be used alone or with radiation therapy. Chemotherapy continues for six months to one year.
Doctors at Mayo Clinic are conducting numerous clinical trials seeking new drugs or new combinations of drugs to prevent the spread or recurrence of cancers. Mayo research was integral in the U. S. Food and Drug Administration's approval of the drug oxaliplatin for use in the treatment of metastatic colon and rectal cancer. Prior to the introduction of this drug, the Mayo Clinic-developed regimen of 5-fluorouracil and leucovorin served as a frequent standard to which other chemotherapy regimens were compared.
Radiation therapy is the use of X-rays to kill cancer cells that may remain if treated with surgery alone. This treatment is used frequently for rectal cancers. If the cancer has spread through the wall of the rectum, physicians may recommend external beam radiation treatments in combination with chemotherapy before or after surgery. For patients with large tumors, radiation plus chemotherapy can be given before an operation in an attempt to shrink the tumor so that they can be removed more easily.
For patients with cancers in the lower rectum (closer to the anus), preoperative radiation and chemotherapy are often recommended to shrink the cancer and improve the likelihood of colostomy-sparing surgery procedures. This sequencing may also be recommended for mid or upper rectal cancers that are shown (by the aid of imaging procedures including endorectal ultrasound, CT or MRI) to extend beyond the rectal wall and involve lymph nodes.
Radiation fields are designed using sophisticated CT-based treatment planning systems and 3-D conformal techniques. They allow Mayo physicians to treat the tumor and lymph node sites while excluding as much of the sensitive surrounding organs and tissues as feasible. Mayo Clinic radiation oncologists are world leaders in the design and delivery of radiation fields for patients with rectal cancer.
Mayo Clinic is a leader in radiating tumors while they are exposed during surgery, to boost the effective dose of radiation to the tumor. This procedure is known as intraoperative radiation therapy (IORT). Mayo Clinic, offers IORT as part of treatment for patients with locally advanced primary rectal cancer and for locally recurrent rectal cancer. This specialized technique is not available in many other centers.
Biological therapies try to specifically target cancer cell characteristics. They may be used after surgery and in combination with other treatments. New biologic agents such as anti-angiogenic drugs (e.g., bevacizumab) and EGF-receptor targeting agents (e.g., cetuximab) have become available for the treatment of metastatic rectal cancer or are in clinical trials. Mayo Clinic is conducting clinical trials that include biologic tumor-targeted agents.
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