Colorectal cancer, which has become the second most common type of cancer in Turkey as people’s lifestyles got more modern, ranks third among the most common cancers throughout the world. Early diagnosis saves lives in rectal cancer; when the disease is detected while it is at stage 1 and surgically treated right away, it is possible for the recovery rate to reach 100%.
Cancer, the nightmare of modern times, has been becoming more and more common due to unhealthy diets, inactivity, excessive weight, harmful habits and stress. Some cancer types have been drawing attention with the speed of the increase in their rates of incidence. Rectal cancer is also one of these! The lowest section of the large intestine, of which the length is 12 to 16 cm, is referred to as the rectum and the malign tumors which originate in this area are collectively referred to as rectal cancer. Rectal cancer is the third most common type of cancer in the world. Being a subtype of colorectal cancers, of which the rate of incidence in Turkey has increased rapidly in the recent years and which have become the second most common group of cancers in the country, rectal cancer is slightly more dangerous than large intestine tumors. Professor Bilgi Baca, the head of the General Surgery Department of Acıbadem University Atakent Hospital, states that unhealthy diets and environmental factors are among the primary risk criteria for rectal cancer and says that excessive meat consumption, high amount of fatty foods in diets and insufficient consumption of fruits, vegetables and high-fiber foods pave the way to rectal cancer. Development of rectal cancer can also be due to genetic factors, diseases such as ulcerative colitis and treatment methods applied for other cancers.
HEMORRHOIDS CAN CONCEAL THE DISEASE
A disadvantage in rectal cancer is the fact that hemorrhoids can conceal the disease. This is because the symptom of blood in stools, which is one of the most important indications of cancer, is generally thought to be due to hemorrhoids and, as a result, people tend to be completely unaware that changes in defecation are signs of a disease that can result in death. Professor Baca says, “The symptoms of colorectal cancer vary in accordance with the location of the disease. Major symptoms include defecation four or five times a day when the person usually only defecates once a day, excessively long time spent while defecating, feeling constantly in need of defecation or feeling the need of defecation again right after defecating, and bleeding. People who have any of these symptoms must absolutely be examined by a general surgeon and undergo colonoscopy if they are over age 50. Since all of these symptoms can be thought to be due to hemorrhoids, hemorrhoidal diseases tend to conceal rectal cancer”.
Both the lack of awareness in the public and the fact that patients are embarrassed to tell their symptoms to doctors generally cause for the disease to be diagnosed late. Professor Baca states that around 70 to 80% of patients consult a general surgeon while the disease is at stage 2 or 3, and that these stages are phase where rectal walls are also involved and suspicions lymphatic nodes are formed.
COLONOSCOPY IS A MUST FOR THOSE OVER THE AGE OF 50!
Rectal cancer occurs most frequently in people over 50. Professor Baca emphasizes that people over the age of 50 need to undergo colonoscopy regardless of whether they have any symptoms or not and says, “Unless there are suspicious findings and a family history involving the disease, it is enough for people to undergo colonoscopy every 10 years. If a formation such as a polyp is found, colonoscopy should be performed five years after polypectomy and if the findings indicate cancer, it should be performed one year after surgery. Furthermore, if there is someone with colorectal cancer in the patient’s family history, the patient needs to start 10 years before he reaches the age at which his relative developed the disease”.
EARLY DIAGNOSIS IS CRITICALLY IMPORTANT
Early diagnosis has vital importance in rectal cancer. When the disease is intervened with at the early stage, which is stage 1, the five-year survival rate can reach 100%. The success rate is 60 to 80% in stage 2, 50 to 60% in stage 3 and around 20% in stage 4. Similar to all other cancer types, the treatment of rectal cancer is planned in accordance with the clinical stage detected.
MOST IDEAL TREATMENT IN STAGE 1 IS SURGERY!
Professor Bilgi Baca emphasizes that the best treatment in stage 1 rectal cancer is surgery and states that despite the fact that certain minimally invasive methods can be applied as well, the rate of risk for lymphatic metastasis is approximately 20%, even in stage 1 tumors. Professor Baca says, Therefore, the most ideal treatment in stage 1 is surgery. We generally recommended surgery for stage 2 as well. However, rectal cancer differs from colon cancers in that it is more dangerous and since stage 2 and 3 cancers involve the intestinal wall completely, it is necessary for chemotherapy to be applied together with short term (one week) or long term (five weeks) radiotherapy before surgery. Our approach involves supplication of chemotherapy together with long term radiotherapy. Then we wait for two months before performing surgery. We have patients on whom we apply short term radiotherapy as well. During the waiting period before surgery, tumors continue to shrink”.
Stage 1: The tumor is only present on the inner layer of the rectum and there are no visible lymphatic nodes.
Stage 2: It is possible for the tumor to involve the whole wall. There are still no visible lymphatic nodes.
Stage 3: The tumor involves the wall and there are suspicious lymphatic nodes.
Stage 4: The tumor has metastasized to distant organs, mostly the liver and lungs, or has spread within the abdomen.
NEW TREATMENT METHODS INCREASE HOPE
The significant progress in the treatment of the disease by means of the rapid developments in technology and increase in the experience of doctors is very promising. Now, operations can be performed with the method of laparoscopic surgery or, in other words, closed surgery, as well as assistance from fully-equipped robots. Professor Bilgi Baca states that the laparoscopic method has a major role in rectal surgery and that it provides patients with many advantages when compared to open surgery. For instance, patients who undergo laparoscopic surgery can get up on their feet and return to work in only a few days due to less pain, less blood loss and smaller incisions; laparoscopic surgery also reduces the hospitalization period and minimizes the risk of wound infections, incisional hernia and abdominal adhesions. Professor Baca states that they can now perform laparoscopic operations through robotic surgery and emphasizes that robot use is entirely dependent on the hospital’s conditions and the surgeon’s experience, and that robotic surgery is advantageous for both the patient and the surgeon.
HIGH VISIBILITY IN NARROW AREAS
Robotic methods are particularly important in rectal surgery. They provide high visibility with higher proximity in narrow areas and make it possible for even the smallest and finest details to be seen. Professor Bilgi Baca states that it is necessary to avoid harming the surrounding tissue while working in narrow areas and says, “We have to protect the nerves that support the urinary and sexual functions of the patient. Since laparoscopic imaging provides larger images, it becomes easier to protect these nerves. Robotic surgery ensures a higher movement capability than conventional laparoscopic surgery. It provides 3D images of higher quality with more details, eliminates the problem of shaky hands and can perform actions that cannot be done manually. For instance, robots have a movement capability with angles up to 540 degrees. They provide both the patient and the surgeon with very important advantages”.