Cáncer de recto

Durante un procedimiento endoscópico, su equipo de atención utiliza un tubo delgado con una luz y una cámara para observar más de cerca el interior del recto. Los dos principales procedimientos de endoscopia utilizados para diagnosticar el cáncer de recto son la colonoscopia y la sigmoidoscopia.

• Colonoscopy: A Colonoscopia provides a view of the inside of the entire colon and rectum. It also allows your doctor to take samples of polyps or tissue in the rectum and send them to the lab to help with a diagnosis.
• Sigmoidoscopy: This endoscopic procedure is similar to a colonoscopy, but instead of viewing the entire colon, your care team only looks at the lower portion of the colon. A sigmoidoscopy also may require taking tissue samples for testing.

Las pruebas de heces buscan signos de sangre o ADN en las heces que podrían ser un signo de cáncer colorrectal o pólipos en el colon o el recto. Por lo general, estas pruebas se realizan desde la comodidad de su hogar, lo que le permite recolectar muestras de heces cuando le resulte conveniente. Si las pruebas de heces son positivas, generalmente van seguidas de una colonoscopia.

• Guaiac-based fecal occult blood test (gFOBT): Fecal occult blood testing looks for blood in the stool and requires multiple samples to be sent to the lab. With this test, you may need to change your medications or diet.
• Fecal immunochemical test (FIT): A fecal immunochemical test is an at-home test to help detect blood in the stool. With this stool test, you’ll collect multiple samples, but you don’t have to change your diet or medications.
• DNA stool test: Along with checking for blood, a DNA stool test also checks for pieces of DNA in the stool that could be signs of rectal cancer.

Especialmente después de un diagnóstico inicial de cáncer de recto, su médico puede utilizar varios tipos de pruebas de imágenes para ayudar a determinar el estadio del cáncer de recto. Estas pruebas pueden proporcionar imágenes más detalladas de su recto o buscar signos de que el cáncer de recto se ha diseminado a otras áreas del cuerpo.

• CT scan: As a screening for rectal cancer, CT imaging may be used during a CT colonoscopy, also known as a virtual colonoscopy. After a diagnosis, CT scans often help determine how much rectal cancer has spread or how well your treatment is working.
• MRI: After a rectal cancer diagnosis, you may have an MRI (magnetic resonance imaging) to help with rectal cancer staging. This test uses strong magnets and radio waves to create cross-section images of your body.
• PET/CT scan: This imaging test helps highlight cells in the body that might be cancerous. It’s often used to see if rectal cancer has spread to other places in the body or the lymph nodes, which helps decide the stage of the cancer.
• Chest X-ray: A chest X-ray lets your care team look for signs of rectal cancer spreading to the lungs.
• Angiography: During an angiography, your doctor injects dye into your arteries to provide images of your blood vessels. It’s often used to examine the blood vessels supplying blood to a tumor if bleeding heavily.
• Ultrasound: Ultrasounds create images using sound waves, which are used in several ways in rectal cancer. You may have an endorectal ultrasound that takes images inside the rectum or an abdominal ultrasound to look for signs of cancer spreading to other organs. Intraoperative ultrasound is when an ultrasound is used during surgery.
• Barium enema: A barium enema is a type of X-ray imaging test. During this imaging procedure, barium is inserted into the rectum to coat it and help provide a clear silhouette of the rectum and colon.

La cirugía para extirpar el cáncer es una de las principales opciones de tratamiento en cada etapa del cáncer de recto. El tipo de cirugía que le realicen depende de cuánto se haya propagado el cáncer. En muchos casos, nuestros cirujanos le brindan opciones mínimamente invasivas que utilizan incisiones más pequeñas durante la cirugía de cáncer de recto para una recuperación más rápida.

• Local excision: During the earliest stages of rectal cancer, your main treatment may be a procedure to remove the rectal polyp, called a polypectomy, or the local area of cancer in the rectum.
• Transanal endoscopic microsurgery (TEM): Your care team could recommend TEM for early-stage rectal cancer located a little higher in the rectum. This procedure removes cancer without the need for an incision in your abdomen. A scope is inserted through the anus into the rectum to view the tumor, and microsurgical tools are used to remove it.
• Transanal minimally invasive surgery (TAMIS): TAMIS is a minimally invasive surgical procedure to remove a tumor in early-stage rectal cancer that was developed as an alternative to TEM.
• Low anterior resection (LAR): A low anterior resection removes the tumor in your rectum along with part of the rectum. Then, your surgeon can reattach the colon to the remaining rectum, called an anastomosis, to prevent the need for a colostomy. To give your rectum time to heal, you may need a temporary ileostomy with this surgery, where your surgeon connects the small intestine to an opening in the abdomen that allows stool to pass out of your body.
• Proctectomy with coloanal anastomosis: Proctectomy removes all the rectum, including the rectal cancer. It’s often used in deeply invasive rectal cancers. To avoid needing a permanent colostomy, your surgeon will create a coloanal anastomosis, where a small pouch is made at the end of the colon to collect stool to replace the rectum.
• Abdominoperineal resection (APR): This surgical procedure uses an incision in the abdomen and incisions around the anus to remove the rectum, anus and tissues around them. APR surgery is more common in low, larger, deeply invasive rectal cancer and requires a permanent colostomy to allow you to pass stool.
• Diverting colostomy: When cancer blocks the rectum, causing you to be unable to pass stool, your care team may perform a diverting colostomy procedure. This procedure connects the end of the colon to an opening in the abdomen to allow stool to pass out of the body.

Quimioterapia is a treatment option for rectal cancer that’s most often used in stage 3 when cancer has spread to lymph nodes (the body’s defense mechanism), and stage 4, when cancer cells have spread to the liver, lungs, or other sites outside the rectum. These drugs help destroy rapidly multiplying cells in the body, including cancer cells.

• Neoadjuvant chemotherapy: This term refers to chemotherapy used before surgery in rectal cancer, most often to treat any possible spread to other sites.
• Adjuvant chemotherapy: This type of chemotherapy is used after surgery. The goal is to destroy any remaining cancer cells that weren’t removed by the operation and reduce the chances of cancer returning.

Several types of Terapia de radiación are used to treat rectal cancer, which uses high-energy beams or radiation seeds to destroy cancer. You may have radiation therapy for a few different reasons, such as shrinking a tumor before surgery in conjunction with chemotherapy, and rarely as an alternative to surgery or to relieve the symptoms of rectal cancer.

Inmunoterapia is a treatment that uses your immune system to help fight rectal cancer. These drugs are used most often in advanced rectal cancer. Checkpoint inhibitors are the most common immunotherapy currently approved by the FDA for certain types of rectal cancer.

Terapia de anticuerpos monoclonales is a targeted therapy for rectal cancer. It uses specific proteins to help your body recognize and fight cancer cells. Targeted therapies may be used with other treatments or as another option when rectal cancer doesn’t respond to other treatments.