Colorectal cancer is the 3rd most common cancer in France with 45,000 new cases per year, including 15,000 rectal cancers.
The main risk factors are alcohol consumption, overweight and obesity, smoking, low fiber diet with excessive consumption of red meat or processed meat, sedentary lifestyle and physical inactivity.
A family or personal history of colorectal cancer can also be a risk factor.
The average age of diagnosis is 65 years with a recent change in epidemiology and an increase in the number of patients diagnosed before 50 years.
It is important to get tested as soon as possible to increase the chances of recovery.
This is why a screening program is offered in France to all people aged 50 to 74 by looking for blood in the stool. Nevertheless, despite the prevention campaigns, the participation rate in the general population remains low and does not exceed 35%.
A balance sheet
In the event of a positive screening test and/or the appearance of symptoms (anaemia, recent transit disorder, unexplained weight loss, bleeding in the stools, etc.) your attending physician will refer you to a gastroenterologist who will carry out a complete pretherapuetic assessment. - with :
- A complete colonoscopy with biopsy necessary to confirm the diagnosis,
- A thoraco-abdominopelvic CT scan (to rule out other location(s),
- An MRI of the rectum (accurate visualization of the diseased part).
The earlier the diagnosis, the more your surgeon will be able to offer you an appropriate and least invasive therapeutic strategy.
The management of Rectal cancer
For superficial lesions or small tumours, endoscopic resection or trans-anal tumorectomy is proposed.
According to French recommendations, the standard treatment for larger tumors of :
- Upper rectum (located between 10-15 cm from the anus): Partial removal of the rectum,
- Lower (located between 0-5 cm from the anus) and mid rectum (located between 5 and 10 cm from the anus): Total removal of the rectum with placement of a temporary stoma for 2 at 3 months. A second intervention is necessary to close it.
This surgery may be associated with chemotherapy and/or radiochemotherapy treatment in order to limit the risk of local recurrence.
It can also lead to bowel functional disorders such as stool fragmentation, fecal urgency and anal incontinence. These sequelae may improve over time, but a postoperative bowel rehabilitation program is systematically proposed in our Institute in order to accelerate recovery of bowel function.
Thanks to a hyper-specialized team, depending on the stage of the tumour, your personal history and in accordance with recent data from the literature, it is possible to offer you a personalized strategy.
Today thanks to our experience and this personalization of treatment :
- The use of stoma is no longer systematic but is proposed according to the patient's risk factors.
- Ablation of the rectum can be avoided in case of complete or near-complete response after medical treatment (chemotherapy and/or radiochemotherapy).
A team specializing in rectal cancer should be able to offer patients all management strategies, from rectum preservation to multi-organ resection surgeries for large cancers, using all approaches available (open, laparoscopic, robotic, trans-anal), in order to offer the least invasive surgery possible, while limiting functional sequelae and increasing the quality of life of patients.
All this must be discussed with the patient during the various consultations, explaining to him the risks and constraints of each treatment.
