What are the differences between colon cancer and rectal cancer?

Written by Cui Fang Bo
Oncology
Updated on January 02, 2025
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The fundamental difference between colon cancer and rectal cancer lies in their locations of occurrence. Both are collectively referred to as colorectal cancer, which is one of the more prevalent malignancies of the digestive system in China. Colon cancer originates from the mucosa of the colon, while rectal cancer originates from the mucosa of the rectum, with different points of origin. In terms of treatment, there are significant differences between colon and rectal cancer. In surgical treatment, both cancers typically require surgery as the first choice. However, patients with colon cancer can preserve their anus, whereas some patients with low rectal cancer might face situations where anus preservation is not possible. In internal medicine, the chemotherapy drugs used for colon and rectal cancer are quite similar. In terms of radiation therapy, there are notable differences; radiation treatment is generally not included for colon cancer but is an important treatment method for rectal cancer.

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Is rectal bleeding an indication of rectal cancer?

Rectal bleeding is not necessarily colorectal cancer; there are several reasons for rectal bleeding: First, caused by constipation, which leads to difficulty during bowel movements and tearing of the anal mucosa, resulting in bleeding. Second, ulcerative colitis, which commonly presents symptoms such as abdominal pain, diarrhea, and blood and mucus in the stool. Third, rectal or colon cancer, where the main symptoms also include abdominal pain, changes in stool characteristics, and rectal bleeding. Fourth, ischemic bowel disease, generally seen in older patients with some cardiovascular and ischemic diseases, where symptoms mainly include significant abdominal pain and rectal bleeding. Therefore, not all cases of rectal bleeding are due to rectal cancer; there are many causes, and it is essential to diagnose clearly before treatment.

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Is a severely blocked anus a symptom of rectal cancer?

Is anal blockage a manifestation of rectal cancer? The answer could be yes, but it could also be due to hemorrhoids, or other diseases. The main common symptoms of rectal cancer include changes in bowel habits and the characteristics of the stool. There may be frequent bowel movements, diarrhea, or constipation, or alternating constipation and diarrhea, a sensation of anal heaviness, or associated with vague abdominal pain. Symptoms of abdominal pain, intestinal obstruction, and abdominal masses might also appear. When the tumor grows to a certain extent, an abdominal mass can be palpated, which might cause some compressive symptoms, possibly leading to anal blockage as one of the symptoms.

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What tests are used to check for rectal cancer?

When clinical symptoms such as diarrhea or constipation, changes in bowel habits, bloody stools, and abdominal pain occur, we should be vigilant about the possibility of rectal cancer. The examination for rectal cancer can start with a digital rectal exam, especially for low-lying rectal cancer, which is closer to the anus; these tumors can be detected through this method. Then, a colonoscopy should be performed to take a biopsy to confirm the diagnosis, which is the gold standard for confirmation. Additionally, blood tests for tumor markers can be conducted. Generally, carcinoembryonic antigen (CEA) and CA199 levels may be elevated, but this is not absolute as their specificity and sensitivity are not very high. An enhanced CT scan of the abdomen can also be done. In such scans, we can see thickening of the intestinal wall where the tumor is located, and the enhancement can show the intensified thickening of the intestinal wall. Combining all these methods can confirm the diagnosis of rectal cancer.

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Does stage II rectal cancer require chemotherapy?

Whether a stage II colorectal cancer patient needs adjuvant chemotherapy after surgery depends on the specific circumstances. For example, stage IIA patients are classified as T3, N0, M0. The necessity of adjuvant chemotherapy for these patients should be determined based on the pathological report. If the report indicates the presence of vascular invasion, neural invasion, poor differentiation, or if microsatellite stability testing shows poor prognostic factors, then such patients should undergo postoperative adjuvant chemotherapy. If none of these conditions are present in a stage IIA patient, then postoperative adjuvant chemotherapy may not be necessary. Generally, stage IIB patients, whose tumors have penetrated the full thickness of the intestinal wall, are recommended to undergo postoperative adjuvant chemotherapy. Therefore, the specific conditions of the patient need to be considered.

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Is rectal cancer without metastasis curable?

Can rectal cancer without metastases be treated successfully? If rectal cancer has not metastasized, its prognosis and outcome are relatively much better compared to cases where there are metastases and recurrences. If surgery is performed for rectal cancer and there is no recurrence or metastasis afterwards, then the five-year survival rate is naturally higher. However, if rectal cancer is initially treated surgically and cleaned thoroughly but then quickly recurs, with liver metastases, lung metastases, etc., then the five-year survival rate would be much lower. Therefore, if rectal cancer has not metastasized, the treatment and prognosis are much better. Thus, if there is no liver or lung metastasis in rectal cancer, the treatment is relatively easier.