Tratamiento del cáncer de recto

Rectal cancer is a type of cancer that forms in the tissues of the rectum.

The rectum is part of the body's digestive system. The digestive system takes in nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The digestive system is made up of the esophagus, stomach, and the small and large intestines. The colon (large bowel) is the main part of the large intestine and is about 5 feet long. Together, the rectum and anal canal make up the last part of the large intestine and are 6 to 8 inches long. The anal canal ends at the anus (the opening of the large intestine to the outside of the body).

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Anatomy of the lower gastrointestinal (digestive) system showing the colon, rectum, and anus. Other organs that make up the digestive system are also shown.

Health history affects the risk of developing rectal cancer.

Signs of rectal cancer include blood in the stool or a change in bowel habits.

These and other signs and symptoms may be caused by rectal cancer or by other conditions. Check with your doctor if you have:

• blood (either bright red or very dark) in the stool
• a change in bowel habits
  • diarrea
  • constipación
  • feeling that the bowel does not empty completely
  • stools that are narrower or have a different shape than usual
• general abdominal discomfort (frequent gas pains, bloating, fullness, or cramps)
• change in appetite
• pérdida de peso sin razón conocida
• fatiga

Tests that examine the rectum and colon are used to diagnose rectal cancer.

Además de preguntarle sobre su historial de salud personal y el de su familia y hacerle un reconocimiento físico, su médico podría realizar las siguientes pruebas y procedimientos:

• Digital rectal exam (DRE) is an exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual. In women, the vagina may also be examined.
• Colonoscopia is a procedure that uses a colonoscope to look inside the rectum and colon for polyps (small pieces of bulging tissue), abnormal areas, or cancer. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.
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  Colonoscopy. A thin, lighted tube is inserted through the anus and rectum and into the colon to look for abnormal areas.
  

• Biopsy is the removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. Tumor tissue that is removed during the biopsy may be checked to see if the patient is likely to have the gene mutation that causes Lynch syndrome (also known as hereditary nonpolyposis colorectal cancer). This may help to plan treatment. Learn about the type of information that can be found in a pathologist's report about the cells or tissue removed during a biopsy at Pathology Reports.
• Immunohistochemistry is a laboratory test that uses antibodies to check for certain antigens (markers) in a sample of a patient's tissue. The antibodies are usually linked to an enzyme or a fluorescent dye. After the antibodies bind to a specific antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to help diagnose cancer and to help tell one type of cancer from another type of cancer.
• Microsatellite instability (MSI) is a laboratory test in which tumor tissue is checked for cells that may have a defect in genes involved in DNA repair. The findings may indicate whether or not the patient has a type of cancer linked to an inherited cancer syndrome such as Lynch syndrome.

After rectal cancer has been diagnosed, imaging tests are done to find out if cancer cells have spread within the rectum or to other parts of the body.

The process used to find out whether cancer has spread within the rectum or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

Las siguientes pruebas y procedimientos pueden utilizarse en el proceso de estadificación:

• La radiografía de tórax es un tipo de radiación que puede atravesar el cuerpo y generar imágenes de los órganos y huesos dentro del tórax.
• CT scan (CAT scan) uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body, such as the abdomen, pelvis, or chest. The pictures are taken from different angles and are used to create 3-D views of tissues and organs. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI (magnetic resonance imaging) uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the rectum. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• PET scan (positron emission tomography scan) uses a small amount of radioactive sugar (also called glucose) that is injected into a vein. Then a scanner rotates around the body to make detailed, computerized pictures of areas inside the body where the glucose is taken up. Because cancer cells often take up more glucose than normal cells, the pictures can be used to find cancer cells in the body.
• Endorectal ultrasound is used to examine the rectum and nearby organs. An ultrasound transducer (probe) is inserted into the rectum and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The doctor can identify tumors by looking at the sonogram. This procedure is also called transrectal ultrasound.
• Carcinoembryonic antigen (CEA) assay is a test that measures the level of CEA in the blood. CEA is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of rectal cancer or other conditions.

Algunas personas deciden buscar una segunda opinión.

You may want to get a second opinion to confirm your rectal cancer diagnosis and treatment plan. If you seek a second opinion, you will need to get medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans. They may agree with the first doctor, suggest changes or another treatment approach, or provide more information about your cancer.

Learn more about choosing a doctor and getting a second opinion at Finding Cancer Care. You can contact NCI's Cancer Information Service via chat, email, or phone (both in English and Spanish) for help finding a doctor, hospital, or getting a second opinion. For questions you might want to ask at your appointments, visit Questions to Ask Your Doctor About Cancer.

Hay algunos factores que afectan al pronóstico (es decir, la posibilidad de recuperación) y a las opciones de tratamiento.

El pronóstico y las opciones de tratamiento dependen de:

• the stage of the cancer (whether it affects the inner lining of the rectum only, involves the whole rectum, or has spread to lymph nodes, nearby organs, or other places in the body)
• whether the cancer is related to a defect in genes involved in DNA repair
• whether the tumor has spread into or through the bowel wall
• where the cancer is found in the rectum
• whether the bowel is blocked or has a hole in it
• whether all of the tumor can be removed by surgery
• the patient's general health
• si el cáncer acaba de ser diagnosticado o ha regresado (regresado)

El estadio del cáncer describe la extensión del cáncer en el cuerpo, como el tamaño del tumor, si se ha propagado y qué tan lejos se ha propagado desde donde se formó originalmente.

There are several staging systems for cancer that describe the extent of the cancer. Rectal cancer staging usually uses the TNM staging system. The cancer may be described by this staging system in your pathology report. Based on the TNM results, a stage (I, II, III, or IV, also written as 1, 2, 3, or 4) is assigned to your cancer. When talking to you about your diagnosis, your doctor may describe the cancer as one of these stages.

Learn about tests to stage rectal cancer. Learn more about Cancer Staging.

The following stages are used for rectal cancer:

Estadio 0 (carcinoma in situ)

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Stage 0 (rectal carcinoma in situ). Abnormal cells are shown in the mucosa of the rectum wall.

In stage 0 rectal cancer, abnormal cells are found in the mucosa (innermost layer) of the rectum wall. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I (also called stage 1) rectal cancer

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Stage I rectal cancer. Cancer has spread from the mucosa of the rectum wall to the submucosa or to the muscle layer.

In stage I rectal cancer, cancer has formed in the mucosa (innermost layer) of the rectum wall and has spread to the submucosa (layer of tissue next to the mucosa) or to the muscle layer of the rectum wall.

Stage II (also called stage 2) rectal cancer

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Stage II rectal cancer. In stage IIA, cancer has spread through the muscle layer of the rectum wall to the serosa. In stage IIB, cancer has spread through the serosa but has not spread to nearby organs. In stage IIC, cancer has spread through the serosa to nearby organs.

Stage II rectal cancer is divided into stages IIA, IIB, and IIC.

• Stage IIA: Cancer has spread through the muscle layer of the rectum wall to the serosa (outermost layer) of the rectum wall.
• Stage IIB: Cancer has spread through the serosa (outermost layer) of the rectum wall to the tissue that lines the organs in the abdomen (visceral peritoneum).
• Stage IIC: Cancer has spread through the serosa (outermost layer) of the rectum wall to nearby organs.

Stage III (also called stage 3) rectal cancer

Stage III rectal cancer is divided into stages IIIA, IIIB, and IIIC.

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Stage IIIA rectal cancer. Cancer has spread through the mucosa of the rectum wall to the submucosa and may have spread to the muscle layer, and has spread to one to three nearby lymph nodes or tissues near the lymph nodes. OR, cancer has spread through the mucosa to the submucosa and four to six nearby lymph nodes.

In stage IIIA, cancer has spread:

• through the mucosa (innermost layer) of the rectum wall to the submucosa (layer of tissue next to the mucosa) or to the muscle layer of the rectum wall. Cancer has spread to one to three nearby lymph nodes, or cancer cells have formed in tissue near the lymph nodes; or
• through the mucosa (innermost layer) of the rectum wall to the submucosa (layer of tissue next to the mucosa). Cancer has spread to four to six nearby lymph nodes.

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Stage IIIB rectal cancer. Cancer has spread through the muscle layer of the rectum wall to the serosa or has spread through the serosa but not to nearby organs; cancer has spread to one to three nearby lymph nodes or to tissues near the lymph nodes. OR, cancer has spread to the muscle layer or to the serosa, and to four to six nearby lymph nodes. OR, cancer has spread through the mucosa to the submucosa and may have spread to the muscle layer; cancer has spread to seven or more nearby lymph nodes.

In stage IIIB, cancer has spread:

• through the muscle layer of the rectum wall to the serosa (outermost layer) of the rectum wall or has spread through the serosa to the tissue that lines the organs in the abdomen (visceral peritoneum). Cancer has spread to one to three nearby lymph nodes, or cancer cells have formed in tissue near the lymph nodes; or
• to the muscle layer or to the serosa (outermost layer) of the rectum wall. Cancer has spread to four to six nearby lymph nodes; or
• through the mucosa (innermost layer) of the rectum wall to the submucosa (layer of tissue next to the mucosa) or to the muscle layer of the rectum wall. Cancer has spread to seven or more nearby lymph nodes.

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Stage IIIC rectal cancer. Cancer has spread through the serosa of the rectum wall but not to nearby organs; cancer has spread to four to six nearby lymph nodes. OR, cancer has spread through the muscle layer to the serosa or has spread through the serosa but not to nearby organs; cancer has spread to seven or more nearby lymph nodes. OR, cancer has spread through the serosa to nearby organs and to one or more nearby lymph nodes or to tissues near the lymph nodes.

In stage IIIC, cancer has spread:

• through the serosa (outermost layer) of the rectum wall to the tissue that lines the organs in the abdomen (visceral peritoneum). Cancer has spread to four to six nearby lymph nodes; or
• through the muscle layer of the rectum wall to the serosa (outermost layer) of the rectum wall or has spread through the serosa to the tissue that lines the organs in the abdomen (visceral peritoneum). Cancer has spread to seven or more nearby lymph nodes; or
• through the serosa (outermost layer) of the rectum wall to nearby organs. Cancer has spread to one or more nearby lymph nodes, or cancer cells have formed in tissue near the lymph nodes.

Stage IV (also called stage 4) rectal cancer

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Stage IV rectal cancer. The cancer has spread through the blood and lymph nodes to other parts of the body, such as the lung, liver, abdominal wall, or prostate.

Stage IV rectal cancer is divided into stages IVA, IVB, and IVC.

• Stage IVA: Cancer has spread to one area or organ that is not near the rectum, such as the liver, lung, prostate, or a distant lymph node.
• Stage IVB: Cancer has spread to more than one area or organ that is not near the rectum, such as the liver, lung, prostate, or a distant lymph node.
• Stage IVC: Cancer has spread to the tissue that lines the wall of the abdomen and may have spread to other areas or organs.

Stage IV rectal cancer is also called metastatic rectal cancer. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if rectal cancer spreads to the liver, the cancer cells in the liver are actually rectal cancer cells. The disease is called metastatic rectal cancer, not liver cancer. Learn more in Metastatic Cancer: When Cancer Spreads.

Rectal cancer can recur (come back) after it has been treated.

Recurrent rectal cancer is cancer that has come back after it has been treated. If rectal cancer comes back, it may come back in the rectum or in other parts of the body, such as the colon, pelvis, liver, or lungs. Tests will be done to help determine where the cancer has returned. The type of treatment for recurrent rectal cancer will depend on where it has come back.

Obtenga más información en Cáncer recurrente: cuando el cáncer Volver . Puede encontrar información que lo ayudará a sobrellevar la situación y a hablar con su equipo de atención médica en el folleto Cuando el cáncer regresa .

There are different types of treatment for people with rectal cancer.

Different types of treatments are available for rectal cancer. You and your cancer care team will work together to decide your treatment plan, which may include more than one type of treatment. Many factors will be considered, such as the stage of the cancer, your overall health, and your preferences. Your plan will include information about your cancer, the goals of treatment, your treatment options and the possible side effects, and the expected length of treatment.

Talking with your cancer care team before treatment begins about what to expect will be helpful. You'll want to learn what you need to do before treatment begins, how you'll feel while going through it, and what kind of help you will need. To learn more, visit Questions to Ask Your Doctor About Treatment.

Se utilizan los siguientes tipos de tratamiento:

Se están probando nuevos tipos de tratamiento en ensayos clínicos.

Para algunas personas, participar en un ensayo clínico puede ser una opción. Existen distintos tipos de ensayos clínicos para personas con cáncer. Por ejemplo, un ensayo prueba nuevos tratamientos o nuevas formas de utilizar los tratamientos existentes. Los ensayos de atención de apoyo en el cáncer y cuidados paliativos buscan formas de mejorar la calidad de vida, especialmente para quienes tienen efectos secundarios a causa de la enfermedad y su tratamiento.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. Puede encontrar ensayos clínicos patrocinados por otras organizaciones en el sitio web ClinicalTrials.gov.

Más información sobre ensayos clínicos, incluido cómo encontrar y participar en uno de ellos, en Información sobre ensayos clínicos para pacientes y cuidadores.

Treatment for rectal cancer may cause side effects.

Para obtener información sobre los efectos secundarios causados por el tratamiento para el cáncer, visite nuestra página sobre efectos secundarios.

A veces se necesitan cuidados de seguimiento.

A medida que avanza el tratamiento, se le realizarán pruebas o controles de seguimiento. Es posible que se repitan algunas pruebas para diagnosticar o estadificar el cáncer con el fin de evaluar qué tan bien que está funcionando el tratamiento. Las decisiones sobre si continuar, cambiar o suspender el tratamiento pueden basarse en los resultados de estas pruebas.

Algunas de las pruebas se seguirán realizando de forma periódica después de que haya terminado el tratamiento. Los resultados de estas pruebas pueden mostrar si su afección ha cambiado o si el cáncer ha recidivado (regresado).

After treatment for rectal cancer, a blood test to measure amounts of carcinoembryonic antigen (a substance in the blood that may be increased when cancer is present) may be done to see if the cancer has come back.

Acerca del PDQ

Physician Data Query (PDQ) es la base de datos integral sobre el cáncer del Instituto Nacional del Cáncer (NCI). La base de datos del PDQ contiene resúmenes de la última información publicada sobre prevención, detección, genética, tratamiento, atención médica de apoyo y medicina complementaria y alternativa relacionada con el cáncer. La mayoría de los resúmenes se redactan en dos versiones. Las versiones para profesionales de la salud contienen información detallada escrita en lenguaje técnico. Las versiones para pacientes están redactadas en un lenguaje fácil de entender, que no es técnico. Ambas versiones contienen información sobre el cáncer correcta y actualizada. La mayoría de las versiones también están disponibles en español.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Propósito de este resumen

This PDQ cancer information summary has current information about the treatment of rectal cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Revisores y actualizaciones

Los consejos editoriales escriben los resúmenes de información sobre el cáncer del PDQ y los mantienen actualizados. Estos consejos están conformados por equipos de especialistas en el tratamiento del cáncer y otras especialidades relacionadas con esta enfermedad. Los resúmenes se revisan periódicamente y se modifican cuando hay información nueva. La fecha de actualización al pie de cada resumen indica cuándo fue el cambio más reciente.

La información de este resumen para pacientes procede de la versión para profesionales de la salud, la cual el Consejo Editorial del PDQ sobre el tratamiento para adultos revisa y actualiza de forma periódica según sea necesario.

Información sobre ensayos clínicos

Un ensayo clínico es un estudio para responder a una pregunta científica; por ejemplo, si un tratamiento es mejor que otro. Los ensayos se basan en estudios anteriores y en lo que se ha aprendido en el laboratorio. Cada ensayo responde a ciertas preguntas científicas para descubrir mejores maneras de ayudar a los pacientes con cáncer. Durante los ensayos clínicos de tratamiento, se recopila información sobre los efectos de un tratamiento nuevo y su eficacia. Si un ensayo clínico demuestra que un tratamiento nuevo es mejor que uno que se utiliza actualmente, el tratamiento nuevo puede convertirse en “estándar”. Participar en un ensayo clínico puede ser una opción para los pacientes. Algunos ensayos clínicos están abiertos solo a pacientes que aún no han comenzado el tratamiento.

Los ensayos clínicos se pueden encontrar en línea en el sitio web del NCI. Para obtener más información, llame al Servicio de Información sobre el Cáncer (CIS, por sus siglas en inglés), el centro de contacto del NCI, al 1-800-4-CANCER (1-800-422-6237).

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La forma recomendada para citar este resumen del PDQ es:

PDQ® Adult Treatment Editorial Board. PDQ Rectal Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/colorectal/patient/rectal-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389378]

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