Malignant tumors that develop in the rectum are referred to as rectal cancer or rectal cancer. The rectal cancer is one of the colorectal carcinomas, which represent the second most common cancer in Germany in both men and women.

What is rectal cancer?

Rectal cancer is the collective name for all malignant tumors of the rectum. The rectum is part of the rectum and, at the same time, part of the large intestine. It is about 15-18 cm long intestinal section between the sigmoid colon and anal canal.

It serves to store intestinal contents until the next defecation and is lined with intestinal mucosa, which differs significantly from that of the upstream colon sections. The cancer of the rectum (rectal cancer) can be differentiated from colon cancer, although both cancers are similar and are therefore often referred to as colorectal carcinoma.


A rectal cancer usually arises as adenocarcinoma, ie the tumor is derived from glandular tissue. The tumor cells multiply uncontrollably and without regard to surrounding tissue. As with other cancers, mutations are also responsible for the uncontrolled division of tumor cells in rectal cancer.

In about 95% of cases fatal genetic mutations occur sporadically; only in 5% are they hereditary. It is believed that rectal cancer develops only after several benign precursors to the malignant cancer. The precursors are termed colonic adenomas or polyps and may persist for years as benign growths before they degenerate.

Symptoms, complaints & signs

Rectal cancer often does not produce clear symptoms at the beginning. In the course of the disease, the tumor can cause stomach cramping and constipation or intestinal obstruction. The constant pain is usually associated with a reduction in performance and fatigue. Those affected generally feel very exhausted, with fatigue becoming worse as the disease progresses.

In most cases, an appetite loss occurs, which can lead to weight loss. Rectal cancer is manifested by visible bleeding from the anus and pain during bowel movements. The bowel habits may seem to change groundlessly. These signs are accompanied by general symptoms such as fever and a growing malaise.

The symptoms of rectal cancer develop insidiously, often over several years, and become more severe over time. In the advanced stage, chronic stomach pain sets in. Patients also develop intolerances to certain foods, especially meat, spicy foods, alcohol and coffee.

If the cancer is not treated, it progresses and causes serious complications. An untreated cancer is usually fatal. First, the physical condition decreases sharply and the person is bedridden, resulting in further health problems.

Diagnosis & History

Colorectal carcinoma is one of the most common cancers in Germany. The annual number of new cases is 20 to 40 per 100, 000 inhabitants, with the peak of the disease in the 6th and 7th decade of life.

For early detection, older insured persons are entitled to colonoscopy and stool tests at regular intervals. In addition, symptoms such as blood in the stool, a noticeable change in bowel movements, pain, weight loss and fatigue can lead the patient to the doctor. For diagnosis, the history and current complaints are consulted.

The diagnosis is confirmed by colonoscopy, in which biopsies are taken. Subsequently, a pathologist examines the tissue sample to differentiate between benign and malignant growths. Further apparatus examinations can be X-ray contrast enemas, computed tomography or ultrasound examinations.

If the diagnosis of rectal cancer is confirmed, the tumor stage must be determined. For this purpose, it is examined how deep the tumor cells have penetrated into the intestinal wall and whether they have already metastasized into adjacent organs or lymph nodes or even infested remote structures such as the liver or lungs.


Rectal cancer first leads to indigestion and severe pain. Typical complications are also the intestinal obstruction due to the tumor and subsequently the perforation of the intestinal wall. This can lead to peritonitis with life-threatening sepsis. Sometimes the cancer attacks on neighboring organs (bladder, vagina, liver) or pushes off vital blood vessels.

This can lead to tissue necrosis, so the infarction and death of the intestine or the surrounding organs. Highly advanced rectal cancer often forms metastases. These can affect the liver and cause coagulation disorders, edema and inflammation. Ultimately, it leads to liver failure and death of the patient. After bowel cancer surgery, wound infection, bleeding and pain may occur.

A transient intestinal failure can lead to intestinal paralysis and subsequently to indigestion. In addition, a so-called anastomotic leakage may occur in which the suture between two bowel ends is leaking. Occasionally, complications such as digestive problems, incontinence and bladder and sexual function disorders persist. On the other hand, the complications caused by the prescribed drugs (eg side effects, allergic reactions, interactions) usually do not last long.

When should you go to the doctor?

Prolonged or increasing complaints of digestion should be clarified by a doctor. If discomfort occurs repeatedly during bowel movements, this should be discussed with a doctor. For tiredness, loss of appetite or fatigue, a visit to a doctor is advisable. A quick exhaustion in performing everyday as well as light physical tasks is cause for concern. If this condition sets in despite a restful night's sleep, a doctor is needed. If there is an unwanted loss of weight, a deterioration in overall performance or stomach problems, a doctor should be consulted. Pain in the upper abdomen or intestine, a general malaise and a feeling of being unwell are to be examined and treated by a doctor.

Complaints at the toilet, blood leakage from the intestines and pain in the anus are also signs of an existing irregularity. A visit to a doctor is necessary for a clarification of the cause. Fever, a social withdrawal, irritability and a decrease in well-being indicate a health impairment. Since the cancer of the rectum can lead to a fatal course of disease untreated, a doctor's visit should be made even at the first discrepancies. If the symptoms increase in size and intensity, consultation with a doctor is strongly recommended. In case of emerging incompatibilities with food, spicy food, caffeinated drinks and alcohol, a doctor should be consulted.

Treatment & Therapy

Treatment planning for rectal cancer depends on a variety of factors, including the size and spread of the tumor, the degree of metastasis, and the patient's general condition.

In most cases, the treatment begins with an operative clearance of the tumor tissue from the intestine. Nowadays, a natural chair passage can often be obtained. If the sphincter muscle has to be removed, an artificial colon exit (colostoma) is created. To kill remaining tumor cells and prevent recurrences, chemotherapy or radiotherapy is used after surgery.

These may also be indicated as a palliative therapy when cure is no longer possible but the patient's life expectancy and / or quality of life can still be improved. Even in patients with a good prognosis, careful follow-up of the tumor is indispensable: regular follow-up examinations should be carried out up to 5 years after successful tumor resection. The 5-year survival rate for rectal cancer is 40 to 60%.

Outlook & Forecast

Critical to the healing and survival prospects is the disease stage at diagnosis. If no metastases have formed yet, there is a good chance of recovery. Five years after the start of treatment, about three quarters of such patients still live. Significantly worse prospects arise in metastasis of the lung or liver. Such forms can not be resolved successfully.

Rectal cancer, like many other tumors, carries a high risk of relapse. Anyone who wants to live a life-long, symptom-free life can not avoid regular follow-up care. The life-threatening tumors arise when the original tumor has not been completely removed. The experience and the skill of the surgeon decisively shape the prognosis.

The risk of illness increases significantly in old age. Most patients are 60 and older at the time of diagnosis. Conspicuously often found among them long-term smoker. Even persons with an intense alcohol past are sometimes to be found. In total, about 30 out of every 100, 000 people suffer from rectal cancer each year. The renunciation of a treatment proves to be a serious mistake. Because the disease progresses continuously. The infestation of vital organs is no longer to be slowed in a late diagnosis.


An advanced age is a major risk factor for rectal cancer. But there are also influenceable risk factors: Long-term smoking significantly increases the risk of disease.

High consumption of red meat is also suspected to increase the risk of colon cancer. On the other hand, the consumption of fish and fiber should have a protective effect, as should an adequate supply of vitamin D, which can be ensured through food or sufficient sunlight. D

Preventive examinations also serve as a preventive measure: Early detection and preventive removal of polyps can help to prevent their degeneration as a rectal cancer. Especially people with known colon cancer cases in the family history should take the screening tests.

You can do that yourself

In everyday life, dealing with a cancer is particularly challenging. Helpful there can be the contact with self-help groups. Diseased people can exchange views here in an anonymous setting and give each other tips to tackle various challenges. A cure of the disease is very unlikely without medical care. Therefore, cooperation with the attending physician is very important.

In individual cases, there are reports that the change in lifestyle, a relief of the symptoms has been achieved. However, there is no proven and statistically verifiable method. A healthy lifestyle helps to improve general wellbeing. The diet should be balanced and full-bodied. Especially important is the intake of many fiber, vitamins and minerals. Despite an anorexia or nausea, it is important to ensure adequate food intake. The consumption of pollutants and toxins such as nicotine, alcohol and drugs should always be avoided.

Relaxation techniques are recommended for mental support and stabilization of the psyche. Yoga, meditation, autogenic training or Qi Gong are the methods that are used very often. As far as health permits, physical activity can be promoted by sufficient exercise. Walks or light exercises to strengthen the muscles promote well-being. At the same time, a heavy burden on the organism should be avoided.

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