Overview

The rectum is the last several inches of the large intestine. It starts at the end of the final segment of your colon and ends when it reaches the short, narrow passage leading to the anus.

Cancer inside the rectum (rectal cancer) and cancer inside the colon (colon cancer) are often referred to together as "colorectal cancer."

While rectal and colon cancers are similar in many ways, their treatments are quite different. This is mainly because the rectum sits in a tight space, barely separated from other organs and structures in the pelvic cavity. As a result, complete surgical removal of rectal cancer is challenging and highly complex. Additional treatment is often needed before or after surgery — or both — to reduce the chance that the cancer will return.

In the past, long-term survival was uncommon for people with rectal cancer, even after extensive treatment. Thanks to treatment advances over the past 30 years, rectal cancer can now, in many cases, be cured.

Mayo Clinic's approach to rectal cancer care

Symptoms

Common symptoms include:

  • A change in your bowel habits, such as diarrhea, constipation or more-frequent bowel movements
  • Dark or red blood in stool
  • Mucus in stool
  • Narrow stool
  • Abdominal pain
  • Painful bowel movements
  • Iron deficiency anemia
  • A feeling that your bowel doesn't empty completely
  • Unexplained weight loss
  • Weakness or fatigue

When to see a doctor

Make an appointment with your doctor if you have symptoms suggesting rectal cancer, particularly blood in your stool or unexplained weight loss.

Causes

Rectal cancer occurs when healthy cells in the rectum develop errors in their DNA. In most cases, the cause of these errors is unknown.

Healthy cells grow and divide in an orderly way to keep your body functioning normally. But when a cell's DNA is damaged and becomes cancerous, cells continue to divide — even when new cells aren't needed. As the cells accumulate, they form a tumor.

With time, the cancer cells can grow to invade and destroy normal tissue nearby. And cancerous cells can travel to other parts of the body.

Inherited gene mutations that increase the risk of colon and rectal cancer

In some families, gene mutations passed from parents to children increase the risk of colorectal cancer. These mutations are involved in only a small percentage of rectal cancers. Some genes linked to rectal cancer increase an individual's risk of developing the disease, but they don't make it inevitable.

Two well-defined genetic colorectal cancer syndromes are:

  • Hereditary nonpolyposis colorectal cancer (HNPCC). HNPCC, also called Lynch syndrome, increases the risk of colon cancer and other cancers. People with HNPCC tend to develop colon cancer before age 50.
  • Familial adenomatous polyposis (FAP). FAP is a rare disorder that causes you to develop thousands of polyps in the lining of your colon and rectum. People with untreated FAP have a greatly increased risk of developing colon or rectal cancer before age 40.

FAP, HNPCC and other, rarer inherited colorectal cancer syndromes can be detected through genetic testing. If you're concerned about your family's history of colon cancer, talk to your doctor about whether your family history suggests you have a risk of these conditions.

Risk factors

The characteristics and lifestyle factors that increase your risk of rectal cancer are the same as those that increase your risk of colon cancer. They include:

  • Older age. The great majority of people diagnosed with colon and rectal cancer are older than 50. Colorectal cancer can occur in younger people, but it occurs much less frequently.
  • African-American descent. People of African ancestry born in the United States have a greater risk of colorectal cancer than do people of European ancestry.
  • A personal history of colorectal cancer or polyps. If you've already had rectal cancer, colon cancer or adenomatous polyps, you have a greater risk of colorectal cancer in the future.
  • Inflammatory bowel disease. Chronic inflammatory diseases of the colon and rectum, such as ulcerative colitis and Crohn's disease, increase your risk of colorectal cancer.
  • Inherited syndromes that increase colorectal cancer risk. Genetic syndromes passed through generations of your family can increase your risk of colorectal cancer. These syndromes include FAP and HNPCC.
  • Family history of colorectal cancer. You're more likely to develop colorectal cancer if you have a parent, sibling or child with the disease. If more than one family member has colon cancer or rectal cancer, your risk is even greater.
  • Dietary factors. Colorectal cancer may be associated with a diet low in vegetables and high in red meat, particularly when the meat is charred or well-done.
  • A sedentary lifestyle. If you're inactive, you're more likely to develop colorectal cancer. Getting regular physical activity may reduce your risk of colon cancer.
  • Diabetes. People with poorly controlled type 2 diabetes and insulin resistance may have an increased risk of colorectal cancer.
  • Obesity. People who are obese have an increased risk of colorectal cancer and an increased risk of dying of colon or rectal cancer when compared with people considered normal weight.
  • Smoking. People who smoke may have an increased risk of colon cancer.
  • Alcohol. Regularly drinking more than three alcoholic beverages a week may increase your risk of colorectal cancer.
  • Radiation therapy for previous cancer. Radiation therapy directed at the abdomen to treat previous cancers may increase the risk of colorectal cancer.

Prevention

Talk to your doctor about when you should start getting screened for colorectal cancer. Guidelines generally recommend having your first colorectal cancer screening test at age 50. Your doctor may recommend more-frequent or earlier screening if you have other risk factors, such as a family history of colon or rectal cancer.

The most accurate screening test is a colonoscopy. In this test, a doctor examines the lining of your rectum and large intestine using a long, flexible tube with a tiny video camera at its tip (colonoscope). The colonoscope is inserted in the anus and advanced through the rectum and colon. As the scope's camera moves through the bowel, it sends a video of the rectal and colonic lining to a monitor the doctor sees. If a polyp or suspicious-looking area of tissue is found, the doctor can also take samples of tissue from these areas with instruments inserted in the colonoscope.

Rectal cancer care at Mayo Clinic

Aug. 15, 2017
References
  1. AskMayoExpert. Colorectal cancer. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015.
  2. Bailey HR, et al., eds. Management of rectal cancer. In: Colorectal Surgery. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.clinicalkey.com. Accessed Jan. 4, 2017.
  3. Rectal cancer treatment (PDQ). National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/rectal/HealthProfessional. Accessed Dec. 30, 2016.
  4. Fischer J, et al. Outcome for stage II and III rectal and colon cancer equally good after treatment improvement over three decades. International Journal of Colorectal Disease. 2015;30:797.
  5. Peres-Ruiz E, et al. Immunological landscape and clinical management of rectal cancer. Frontiers in Immunology. 2016;7:1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761957/. Accessed Feb. 22, 2017.
  6. Niederhuber JE, et al., eds. Cancer of the rectum. In: Abeloff's Clinical Oncology. 5th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2014. http://www.clinicalkey.com. Accessed Jan. 4, 2017.
  7. Etzioni DA, et al. Patient survival after surgical treatment of rectal cancer: Impact of surgeon and hospital characteristics. Cancer. 2014;120:2472.
  8. Renouf DJ, et al. Improvements in 5-year outcomes of stage II/III rectal cancer relative to colon cancer. American Journal of Clinical Oncology. 2013;36:558.
  9. Colorectal cancer. American Cancer Society. https://www.cancer.org/cancer/colon-rectal-cancer.html. Accessed Jan. 4, 2017.
  10. Macrae FA, et al. Clinical presentation, diagnosis, and staging of colorectal cancer. http://www.uptodate.com/home. Accessed Feb. 4, 2016.
  11. Ryan DP, et al. Overview of the management of rectal adenocarcinoma. http://www.uptodate.com/home. Accessed Feb. 4, 2016.
  12. Mahipal A, et al. Role of biologics in first-line treatment of colorectal cancer. Journal of Oncology Practice. 2016:12:1219.
  13. Holman FA, et al. Results of a pooled analysis of IOERT containing multimodality treatment for locally recurrent rectal cancer: Results of 565 patients of two major treatment centers. European Journal of Surgical Oncology. 2017;43:107.
  14. Holman FA, et al. Results of intraoperative electron beam radiotherapy containing multimodality treatment for locally unresectable T4 rectal cancer: A pooled analysis of the Mayo Clinic Rochester and Catharina Hospital Eindhoven. Journal of Gastrointestinal Oncology. 2016;7:903.
  15. Larson DW (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 30, 2016.