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Melanie Cole (Host): For patients with rectal cancer, there’s a minimally invasive surgery that is an option. My guest is Dr. Traci Hedrick. She’s a colorectal surgeon at UVA Cancer Center who specializes in minimally invasive colon and rectal surgery. Welcome to the show, Dr. Hedrick. Tell us a little bit about what would send up red flags. What are some symptoms of rectal cancer?

Dr. Traci Hedrick (Guest): Thank you, Melanie, for having me. The main symptoms that most people have with rectal cancer are rectal bleeding. A lot of times, patients mistake that for hemorrhoids in the beginning. But rectal bleeding that particularly is mixed in with the stool should be evaluated and can be a sign of rectal cancer.

Melanie: You said mixed in with the stool. So if you see bright red blood -- because people get terrified. They could eat beets and see bright red blood when they go to the bathroom. So this has got to be something a little bit different that’s mixed in. That’s what would send them to see you.

Dr. Hedrick: That’s the most worrisome. But certainly, even if it is bright red blood, any bleeding, if it persists, should be evaluated by a physician. But certainly, most bright, red bleeding is from hemorrhoids. But an older person with any kind of bleeding should be evaluated.

Melanie: If they are diagnosed with rectal cancer, what is the standard treatment?

Dr. Hedrick: Well, the treatment depends largely on the stage of the cancer, and that includes how deep the cancer has faded into the rectum, but also whether or not it spread anywhere. For cancers that have spread into the wall of the rectum or have spread to the lymph nodes, the treatment usually includes chemotherapy and radiation for about five weeks, followed by a very large operation, but oftentimes can include at least a temporary, if not permanent, colostomy, and then more chemotherapy. For smaller tumors that haven’t spread quite so extensively, in most cases, the patients still require a very large operation for the earliest of cancer. So if they’re caught in time, the minimally invasive approach through the bottom may be an option.

Melanie: So you use this minimally invasive approach, the trans-anal endoscopic microsurgery. How is that different than the standard approach?

Dr. Hedrick: It is quite different. Unlike the standard approach, where we’re making an incision in the abdomen to completely remove the rectum, trans-anal endoscopic microsurgery or TEM, as we refer to it, is a lot like laparoscopy, and that’s the way that most patients have their gallbladders removed, with the long instruments and the scope and the high-definition camera. We’re using all that same equipment except for that we’re doing this surgery through the actual rectum itself, and it allows us to take out tumors within the rectum that we are unable to reach otherwise.

Melanie: So what are some advantages to patients for this type of surgery?

Dr. Hedrick: Well, the surgery itself is very well tolerated because we’re not making any incision in the skin. In many cases, patients don’t have any pain at all. That’s a relatively minor surgery. The patients usually go home either the same day or early the following morning, and there really is a very low complication rate with the surgery itself. That’s compared to a very large operation if we have to completely remove the rectum, which can forever change a patient’s quality of life and can be associated with high complication rates. This surgery is not right for everybody. It’s only effective for patients with very early cancers, but it’s something that certainly can be an option in that situation.

Melanie: And what about something like bowel obstructions after surgery? Is that an increased risk with this or less?

Dr. Hedrick: Much less because we’re not making incisions into the abdomen. There is a risk of scar tissue in the rectum itself from the surgery, but that chance is very low.

Melanie: In addition to rectal cancer, can endoscopic microsurgery be used for other conditions?

Dr. Hedrick: It can be used for other conditions. It’s highly effective for treating polyps, which are what we know are the precursors to cancer. There are a lot of patients out there that have very large polyps in the rectum that can be very difficult to treat and are at risk of turning into cancer. Without TEM many times, these patients have to go undergo repeated procedures to try to keep these polyps at bay from turning into cancers, and they have a tendency of coming back. Or the alternative in that case as well is to have a very large operation to have the rectum removed. However, with TEM, I'm able to completely remove the polyp with a very low chance of it ever coming back or turning into a cancer. And in fact, I'm getting ready to do one for that reason right now. That’s the main other indication. It has been described for treating other conditions such as fistula, which are connections that can occur between the rectum and other structures. But for the most part, TEM is really used to either prevent cancer by getting rid of a polyp or to treat early rectal cancers.

Melanie: What are some advances, Dr. Hedrick, in rectal cancer? What are some of the new things going on today?

Dr. Hedrick: Well, rectal cancer, like many other cancers, is really becoming an individualized condition. Here at UVA, whenever a patient is diagnosed with rectal cancer, we have a multidisciplinary group, and we get together and we discuss that patient. There really are several different options. One is this minimally invasive approach through the bottom. If it’s too extensive to be taken up that way, either there are minimally invasive approaches to doing the larger operation as well, which we’re doing here at UVA. We actually have a couple of clinical trials that are available to patients with rectal cancer here. One of the large cooperative national trial that looks at whether or not we can avoid radiation in some patients that have rectal cancer. I actually have a clinical trial that I'm doing as well where we’re looking at potentially being able to sample the lymph nodes with TEM to try to be able to expand this minimally invasive procedure to patients with even more advanced rectal cancers. There’s really a lot on the horizon with rectal cancer, as there is with many other cancers as well.

Melanie: Thank you so much, Dr. Hedrick. In just the last minute, please, why should patients come to UVA for their cancer care?

Dr. Hedrick: Well, unlike many other centers, at UVA, we have physicians and nurses in every specialty that are dedicated to specializing in colorectal cancer. Like I mentioned before, we have these weekly multidisciplinary meetings where we focus and individualize the care for each patient. With regard to surgery, my partner and I specialize in colorectal surgery. It’s all we do, and we do hundreds of these complex operations every year as opposed to only a handful. We have these various innovative ways for dealing with patients with rectal cancer. Certainly, for rectal cancer, it’s been shown that patients do better and they live longer if their surgery is done by a specialist in colorectal surgery. So I think for all those reasons, we are top-notch at colorectal cancer care.

Melanie: Thank you so much, Dr. Traci Hedrick. You’re listening to UVA Healthsystem Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening, and have a great day.