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Colorectal cancer can arise in the colon, the upper part of the bowel, or the rectum, the last six inches of the bowel. Because rectal cancer is typically surrounded by bone in the pelvis and is close to the nerves that control bladder and sexual function, it is more challenging to treat.

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Max, I would like to add one comment to orient people if there is some confusion. I also want to caution to you that this is a simple question that when I throw at our oncology fellows, it some times takes them a while to articulate the answer.

That said, to make sure we are all on the same page, we are talking about colon cancer, rectal cancer and colorectal cancer.

From an anatomical perspective you have a small intestine and a large intestine. The large intestine, which is what we are talking about, is what we call bowel cancer or colorectal cancer, a cancer of the large intestine.

The last six inches before the outside world is the rectum, the rest of it is the colon. The difference is more a matter of structure than function or biology. The rectum is deep down in the pelvis. It’s technically more difficult to reach from a surgeon’s perspective. Colon cancer surgery is relatively easy; however, rectal cancer surgery is a highly evolved subspecialty and requires a great skill and an enormous amount of experience.

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