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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Rectal cancer stage III

Rectal cancer staging is based on the TNM system. "T" refers to the primary tumor, and its stage depends on which layer of the bowel wall the tumor has invaded. "N" is based on whether there are lymph node metastases and the number of lymph nodes involved. "M" indicates whether there are metastases to distant organs. Staging is determined according to the TNM situation, where Stage I is the earliest and Stage IV is the latest. Stage III indicates lymph node metastasis without distant organ metastases, such as to the liver or lungs. In such cases, irrespective of whether T is T1 to T4, if there is lymph node involvement without distant organ metastasis, it is staged as Stage III.

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Stage II colorectal cancer

Rectal cancer staging is based on the TNM system. "T" refers to the primary tumor, "N" indicates whether there are lymph node metastases, and "M" indicates the presence of distant metastases. Staging is determined according to these factors. Stage II generally refers to patients with T3, N0, M0, or T4, N0, M0. What does this mean? T3 indicates that the tumor has penetrated the base layer reaching the subserosal layer, or has invaded the tissues adjacent to parts of the colon or rectum that are not covered by peritoneum, which is described as T3. T4 means that the tumor has invaded through the entire bowel wall, perforated the visceral peritoneum, and involved other organs or structures, which is called T4. N0, M0 means there are no lymph node metastases and no distant metastases, such as to the liver or lungs. Such patients are clinically staged as stage II rectal cancer.

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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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Could having blood in the stool for five years be rectal cancer?

If there has been blood in the stool for five years, whether it's colorectal cancer or not, this can only be confirmed through a colonoscopy. Furthermore, pathological tissue analysis and biopsy are necessary to make a definitive diagnosis. Pathological examination is the gold standard for diagnosing cancer. If cancerous changes are present, surgical treatment should be undertaken promptly to prevent the spread of cancer cells. If there are no malignant changes, symptomatic treatment measures can be adopted. Conditions such as chronic colitis, ulcerative colitis, or hemorrhoids could also cause blood in the stool.

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Is a rectal polyp the same as rectal cancer?

Rectal polyps and rectal cancer are two different diseases, so it cannot be assumed that rectal polyps are rectal cancer. Rectal polyps are relatively common in clinical practice, especially among middle-aged and young patients, as they are often incidentally found during colonoscopy due to abnormal stools or abdominal discomfort. Generally, rectal polyps are small, ranging from a few millimeters to a maximum of one centimeter. Most rectal polyps are benign lesions, which can be managed with regular follow-ups or removed via endoscopy. Rectal cancer is generally considered a malignant tumor of the rectum, more commonly seen in older patients, who often exhibit alarming symptoms such as abdominal pain, rectal bleeding or abnormal stools, and in some cases, weight loss. Typically, malignant lesions in the rectum and tumor-like changes can be detected under colonoscopy. The main treatments include chemotherapy and surgical intervention.