Blood in the stool is a warning sign: puzzling trend: colon cancer is migrating and is now occurring more frequently elsewhere
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Colorectal cancer is not always colon cancer. While the incidences of colon cancer are falling slightly thanks to ever better preventive measures, they are increasing in rectal cancer – especially among younger people. Gastroenterologist Berndt Birkner explains what warning signals are and when you should see a doctor.
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When it comes to colon cancer, most people mean colon cancer in general, namely colon cancer. Because in the colon, the middle of the three sections of the large intestine, cancer has so far been by far the most common. Now, however, new diseases occur more often, with colon cancer forming in the last section of the large intestine, i.e. after the colon.
Rectal Cancer: What Kind Of Colon Cancer Is It?
This last section of the intestine is the rectum, or rectum, medically. Colon cancer that develops in this section is called rectal cancer, rectal cancer, or rectal cancer.
The rectum is about 8 inches long and slightly curved. This rectum closes with the three centimeter short anal canal, which seals the intestine from the outside and through which the stool leaves the body. The function of the rectum is to store the feces so that bowel movements are not necessary all the time, but only once or twice a day, depending on the situation.
Rectal cancer affects more and more people
In the past two decades, rectal cancer made up at most a third of colorectal cancer cases, but the new trend is now emerging: “Colon cancer is tending to decrease, while rectal cancer is showing an upward trend,” reports Berndt Birkner, expert on colon cancer and prevention, a member of German and international gastroenterological societies and volunteer on the board of trustees of Felix Burda Foundation.
Current figures for the whole of Germany are not yet available, i.e. how many of the around 61,000 new cases of colon cancer affect the rectum. In Bavaria, however, that would be almost half of all colon cancer cases, according to the gastroenterologist. This agrees with US data, which speak of a significant increase in rectal cancer.
Patients under the age of 50 are relatively young for colorectal cancer, which otherwise mainly affects older cohorts. The risk of colon cancer, on the other hand, does not increase significantly until the mid-50s or 60s.
Read more on the topic: Colon cancer affects more and more young people: If you have four signs, you should see a doctor
Less colon cancer, but more rectal cancer
But why is colon cancer decreasing and the number of rectal cancer diseases increasing? The explanation for the positive trend in colon cancer is simple: Colon cancer screening is successful. After all, it helps prevent up to 70 percent of colon cancer cases. Older people in particular have used this preventive measure so far.
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Why rectal cancer is on the rise in those under 50 is not yet fully understood. There are studies that examined genetic changes at the molecular level, but found no differences, explains expert Birkner. Testing the molecular genetic profile is therefore of little use. Only around five percent of total colon cancer cases are hereditary.
But the familial accumulation has not yet been investigated, continues Berndt Birkner. Only the family history is available as a basis, but not molecular genetic markers. The Felix Burda Foundation is committed to using even more data such as those from the Cancer Atlas for scientific purposes. Analysis of these data could provide clues as to the extent to which and why rectal cancer increases in younger years.
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The colon cancer specialist already has at least one assumption: being overweight and obese could have a strong influence on the risk of rectal cancer. A BMI over 30, as well as other diseases such as diabetes, could play an important role in the development of rectal cancer. Corresponding indications are available from the USA, where obesity is much more common and more pronounced than in Germany – and even among people under 50 years of age. Scientific proof of these relationships is still pending and is the subject of current research.
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Risk factors for rectal cancer
In addition, other circumstances play a role in the development of rectal cancer, which, as is well known, can promote the development of cancer. That’s about
- the high consumption of meat and processed meat, i.e. ham and sausage,
- the lack of fiber,
- Alcohol consumption and
- Smoke.
Cells in the intestinal mucosa change first due to the influence of inflammatory substances and pollutants. Adenomas, i.e. polyps, form, which in turn can be a precursor to colon cancer.
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Blood in the stool is the main warning sign of rectal cancer
Among the various symptoms such as abdominal pain or changing digestion with diarrhea and constipation, blood in the stool is a real warning sign – especially for rectal cancer. Because in colon cancer, which grows and bleeds in the upper parts of the intestine, the blood in the stool is often invisible to the naked eye.
If, on the other hand, there is bleeding in the rectum, blood is usually clearly red as a layer or mixed with the stool. Although this fresh blood in the stool can also be caused by hemorrhoids or a polyp, it can also be caused by rectal cancer. “But because the blood doesn’t tell you where it comes from, you definitely have to look,” emphasizes the expert. In this case, neglecting always means: colonoscopy.
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Diagnosing rectal cancer – why a small colonoscopy is not good advice
The first and most important diagnostic tool is the colonoscopy, the colonoscopy. If rectal cancer is suspected, a so-called small colonoscopy, or rectoscopy (sigmoidoscopy), is still sometimes recommended. The gastroenterologist only examines the last 35 centimeters of the intestine. All you need to do to prepare is the enema. This stripped-down form of colonoscopy is therefore easier for the patient to prepare.
“Please do not rely on the small colonoscopy,” warns Berndt Birkner. Because if something suspicious is found in the rectum during this examination, the entire intestine must definitely be inspected, i.e. a colonoscopy must also be performed. So the patient has to come for the examination again. In addition, the colonoscopy is better prepared, enables a more precise examination and therefore delivers reliable results, the expert describes the superiority of colonoscopy.
On the subject: Colon Cancer Suspected? You should have eight pieces of information ready for the doctor
The colonoscopy is not only the first method of choice for diagnosing rectal cancer, it is also an instrument of therapy – because the doctor can remove cancer precursors such as adenomas, i.e. polyps.
If cancer is diagnosed, the small pelvis should also be examined more closely with magnetic resonance imaging (MRI). “This makes it possible to determine how extensive the tumor is and to what extent the lymph nodes are affected,” explains gastroenterologist Birkner. Endosonography is also often advisable, with the ultrasound probe inserted into the intestine. This can be used to determine which layers the tumor has penetrated.
Rectal cancer – the different stages
Colonoscopy, endoscopic ultrasound and MRI make it possible to divide rectal cancer into different stages. Size, extent of spread, involvement of neighboring organs and lymph nodes as well as metastases are the basis of the tumor classification. The main difference between stages one and two is the size of the tumor. The neighboring lymph nodes are not involved in these stages, and there are no metastases.
Stages three and four differ in the number of lymph nodes involved. In stage four, metastases also occur.
Therapy for rectal cancer is different than for colon cancer
Depending on the stage, the experts determine the treatment plan on the tumor board. In principle, the treatment of rectal cancer is similar to that of colon cancer. But there is one crucial difference: “This is neoadjuvant chemoradiotherapy or radiotherapy,” explains Berndt Birkner. It means that in the case of larger tumors, radiation or radiation chemotherapy is carried out before the operation. This has two advantages:
1. This treatment can shrink the tumor and thereby make it more operable overall. This can often avoid the need to intervene in the area of the small pelvis, which is difficult to operate.
2. Micrometastases in the neighboring lymph nodes are also destroyed with neoadjuvant therapy. In contrast to colon cancer, rectal cancer often forms local recurrences. “Radiochemotherapy or radiotherapy significantly reduces this recurrence rate,” emphasizes Birkner.
The neoadjuvant radio- or radiochemotherapy is a particularly useful option for rectal cancer “and last but not least, I have sometimes experienced that after this treatment the tumor has completely disappeared and the operation is no longer necessary,” reports the expert on the Idela case.
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Targeted therapy for rectal cancer using antibodies
However, if an operation is necessary, chemotherapy and radiation therapy then round off the treatment, depending on the requirements. The new cancer therapies, summarized under the term targeted therapy, are also used for rectal cancer. These are antibodies that are designed to specifically slow down or even stop cancer growth. In this context, they have been approved in Germany so far
- Bevacizumab
- Cetuximab
- Panitumumab.
This treatment option exists for advanced rectal cancer with metastases.
Artificial anus (anus praeter) is less and less necessary
The heart of the therapy, however, is always the operation: “With rectal cancer, especially when it is deep, so near the anus, there is unfortunately still the risk that an anus praeter will have to be created,” reports the colon cancer specialist. In contrast to colon cancer, in which the two ends of the colon can usually be reconnected after the tumor has been removed, this is sometimes not possible with rectal cancer.
However, the number of artificial bowel openings has been falling for years, thanks to treatment strategies such as neoadjuvant radio- or radiochemotherapy. In some cases, the doctors also create a so-called temporary, i.e. temporary, anus praeter. After the surgical area in the rectum has healed, the artificial exit can be moved back again.
Chances of recovery in the early stages almost never
Rectal cancer is a special form within the various types of colon cancer. Its treatment requires careful planning. “The chances of recovery from rectal cancer have increased significantly in recent years – since neoadjuvant radio- or radiochemotherapy has been used as standard,” explains the expert. In stages one and two, they are around 95 percent, i.e. the same as in colon cancer.
This positive prognosis is the convincing argument for going to colon cancer screening and not waiting. This applies to people over 50 if they receive the invitation letter from the health insurance company as part of the colon cancer screening. Please take advantage of the offer, but do not hesitate to have this examination carried out if you have symptoms. Younger people should take the warning signal blood in the stool seriously. Clarified early, there is a good chance of detecting a possible tumor at an early stage and thus significantly increasing the chances of recovery.
Note: FOCUS Online, like the Felix Burda Foundation, belongs to Hubert Burda Media.
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