Rectal Cancer

Rectal Cancer

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Duke’s colorectal cancer specialists use the latest medical and surgical advances to detect and treat rectal cancer at the earliest possible stage. We are conveniently located in Raleigh and Durham, and have the advanced training and expertise to perform sphincter-sparing procedures that remove anal tumors while reducing your chance of having a permanent colostomy. We give you the personalized care you need to maximize your quality of life and your health.

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Advanced Care for Rectal Cancer

If you or a loved one is concerned about rectal cancer, you need an experienced and skilled healthcare team. Our colorectal doctors and surgeons work closely with rectal cancer patients every day. Our researchers are recognized experts in identifying rectal cancer tumors.

We are leaders in testing new cancer treatment options, including the development of the targeted therapy Avastin, which shrinks tumors and extends survival in patients with colon cancer that has spread. We continue to test new therapies and explore genomics so we can provide you with more personalized treatment options.

Our Locations
Duke Health offers locations throughout the Triangle. Find one near you.

Treatments

Surgery

Surgery is the most common treatment for rectal cancer. The type of surgery is based on the location and size of the tumor, and whether cancer has spread. Whenever possible, our surgeons use a minimally invasive approach to surgery that results in less scarring, reduced pain and infection risk, shorter hospital stays, and quicker recovery. Our extensive training and expertise let us perform surgeries that minimize the need for a permanent colostomy. Sometimes a temporary stoma, or opening, is needed to allow for the removal of waste from the body.

Polypectomy

Removal of polyps during a colonoscopy.

Partial Proctectomy

Removes the area of the rectum where the cancer is located as well as surrounding healthy tissue. If appropriate, lymph nodes may be removed to determine if cancer has spread. The procedure is often performed laparoscopically with robotic tools, which makes it possible for your surgeon to reach more areas. We are currently investigating whether robotic surgery will improve sexual function compared with other treatment options.

Whole Proctectomy

Removes the entire rectum and anus and results in a permanent colostomy. It may be performed in patients with hereditary cancers, multiple polyps, or cancer recurrence.

Transanal Endoscopic Microsurgery

We are one of few centers in the region experienced in performing this minimally invasive approach on less invasive rectal cancers and large rectal polyps that cannot be removed through an endoscopic procedure. Surgeons use a proctoscope to perform microsurgery inside the rectum. There are no visible scars, and you recover faster and experience minimal pain.

Pelvic Exenteration

If the tumor has spread to organs near the rectum, it may be necessary to remove the lower colon, rectum, and bladder. In some women, the cervix, vagina, ovaries, and nearby lymph nodes may be removed. In men, the prostate may be removed. Our skilled surgeons created artificial openings that allow body waste to empty into a permanent colostomy bag.

Three-Dimensional Conformal Radiation Therapy (3D-CRT)

Imaging and special computer software map the location of your cancer. A treatment plan is developed involving external radiation beams, which are shaped and aimed at the tumor from several directions. This minimizes the amount of radiation to your healthy tissue. Radiation may be combined with chemotherapy before or after surgery to stop or slow tumor growth in people who are at high risk for cancer recurrence.

Intraoperative Radiotherapy (IORT)

An intraoperative radiation facility at Duke University Hospital allows the care team to deliver a highly specialized form of radiation directly to the tumor without interfering with other sensitive organs.

Brachytherapy

Shrinks the size of the tumor before surgery. Radioactive seeds are surgically placed in or near the tumor, and release radiation over time.

Endoscopic Mucosal Resection

Performed by a gastroenterologist on less invasive cancers and large polyps that are not cancerous. The mass is removed through a proctoscope inserted in the rectum. An electrified needle cuts and removes the suspicious area and surrounding healthy tissue.

Endoluminal Stent Placement

A minimally invasive endoscopic procedure performed by surgeons and gastroenterologists. Expanding metal stents are placed in the rectum when a tumor is blocking the intestine.

Chemotherapy

Kills tumor cells or slows their growth. Sometimes recommended before surgery to shrink the tumor, after surgery if recurrence risk is high, and if cancer has spread to lymph nodes or beyond.

Targeted Therapies

Our doctors are leaders in testing new drugs for rectal cancer, including the development of bevacizumab (Avastin). These intravenous (IV) drugs work on certain rectal cancers by targeting a protein called vascular endothelial growth factor (VEGF) and cutting off the supply of blood and nutrients that help tumors continue to grow and survive. You may also be able to participate in clinical trials studying additional targeted therapies for rectal cancer.

Palliative Stenting

A small metal cylindrical device is inserted to keep the rectum open if it has been blocked by a tumor. The stent relieves painful symptoms and improves quality of life.

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Tests

Finding rectal cancer early and obtaining an accurate diagnosis is key to your health. Several methods are used to detect and diagnose rectal cancers.

Digital Rectal Exam

A physical exam during which your physician will check for abnormal growths.

Blood and Stool Tests

Detecting rectal cancer requires a combination of stool tests, which look for blood in the stool, and blood tests, which look for certain antigens.

Flexible Sigmoidoscopy

A camera at the tip of a flexible plastic tube is inserted in the rectum to evaluate the lower part of the colon.

Colonoscopy

A longer version of sigmoidoscopy that lets doctors view the entire colon.

Double-Contrast Barium Enema

The lower part of the colon is coated with barium liquid, then drained and filled with air. This makes the area visible on X-rays so doctors can look for cancer and other abnormalities.

Endoscopic Ultrasound

Produces high-definition images inside the rectum and surrounding structures. Images are generated via a long tube inserted into the rectum, combined with high-frequency ultrasound waves. The technology is used to detect, remove, and sometimes biopsy polyps, tissue, and suspicious lesions and cancerous masses.

Advanced Imaging

Noninvasive imaging techniques -- including MRI, PET, and CT colonography (also known as virtual colonoscopy) -- may be used to look inside the rectum to identify tumors and polyps.

Among the Best Cancer Hospitals in U.S.
Where you receive your cancer care is important. Duke University Hospital's cancer program is ranked among the nation's best by U.S. News & World Report for 2019–2020.

Why Choose Duke

High-Definition Colonoscopies
We routinely use high-resolution imaging scopes to create clearer colonoscopy images that better detect and allow for removal of polyps and cancer not seen with standard colonoscopy.

One-Day Evaluations
As a first-time patient here, you will undergo a thorough, day-long evaluation and consultation. You will leave with a comprehensive cancer treatment plan that meets your needs. We can expedite the process even further if you bring with you the results of scans or blood work that were performed prior to your visit. If you need additional imaging or testing, we have conveniently located these services within our facilities.

A Nationally Ranked Program
We are a National Cancer Institute-designated Comprehensive Cancer Center and are part of the National Comprehensive Cancer Network, an alliance of the nation’s leading cancer centers dedicated to improving care for our patients.

Targeted Radiation Treatments
Sophisticated technology allows us to better target the maximum dose of radiation directly to your tumor while minimizing exposure to surrounding healthy tissue. Because radiation is delivered more precisely, fewer treatments are needed.

Enhanced Recovery Reduces Hospital Stays and Readmissions
Our enhanced recovery program minimizes pre-operative fasting, encourages immediate post-operative physical rehabilitation, and incorporates specialized pain management to reduce the stress of colon surgery. Duke research shows that this enhanced recovery approach decreases post-operative complication rates and reduces the length of hospital stays.

A Comforting Environment
Our Duke Cancer Center features spacious waiting areas, a Quiet Room, large infusion rooms, and a rooftop garden where patients -- if their cancer treatment regimen permits -- can receive chemotherapy outdoors.

Access to Clinical Trials
You may be able to participate in our ongoing clinical trials, which test new anti-cancer targeted therapies, new surgical approaches, and new ways to minimize patient concerns and cancer-related symptoms. Participating in a clinical trial may afford you access to new treatment approaches before they become widely available.

More Minimally Invasive Options
Nearly 80 percent of surgeries are performed with a small lighted tube called a laparoscope, which is inserted in the body through small incisions. This minimally invasive method is used to identify and sometimes remove tumors. As a result, you are likely to experience smaller wounds, less pain and scarring, lower risk of infection, a shorter hospital stay, and a faster recovery.

A Team of Specialists
Our rectal cancer specialists -- medical, radiation, and surgical oncologists; gastroenterologists; radiologists; pathologists; geneticists; specially trained nurses; nutritionists; and social workers -- meet regularly to discuss your care, collect opinions, and offer coordinated and advanced surgical, medical, and follow-up care for your cancer treatment.

Hereditary Cancer Clinic
If you are at high risk for or have a family history of rectal cancer, you may want to work with the genetic counselors in our hereditary cancer clinic to identify and reduce your risk.

Support for You and Your Family
Our comprehensive support services range from helping patients minimize the side effects of cancer treatment to coping with the emotional and psychological effects of diagnosis and treatment. View all of our cancer support groups in our event calendar.