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What is the Treatment of Rectal Cancer:

Colorectal cancer (CRC) is a common and lethal disease. It is estimated that approximately 141,210 new cases of large bowel cancer will be diagnosed in the United States in 2011 including 40,000 rectal cancers.

Surgical resection is the primary treatment modality for CRC, and outcome is most closely related to the extent of disease at presentation.

Screening with fecal occult blood testing, endoscopy, or radiology can lead to diagnosis at an earlier stage of disease and thereby reduce cause-specific mortality.

Five-year survival rates according to tumor stage at diagnosis (using the older 2002 AJCC staging criteria for 119,363 patients with colon cancer reported to the SEER (Surveillance, Epidemiology and End Results) database between 1991 and 2000 were as follows:

• Stage I (T1-2 N0) — 93 percent
• Stage IIA (T3N0) — 85 percent
• Stage IIB (T4N0) — 72 percent
• Stage IIIA (T1-2 N1) — 83 percent
• Stage IIIB (T3-4 N1) — 64 percent
• Stage IIIC (N2 disease) — 44 percent

Surgery for Rectal Cancer:

The surgeon has three major curative options for rectal cancer: local excision, sphincter-preserving abdominal surgery (low anterior resection or LAR), and abdominal perineal resection (APR). The depth of tumor invasion into the rectal wall, the presence or absence of regional lymph node metastases, the size and macroscopic appearance of the cancer, and tumor location are all critical in determining the best surgical option. Although superficially invasive small cancers may be effectively managed with local excision, the majority of patients have more deeply invasive tumors that require more extensive surgery, such as LAR or APR.

Even patients with advanced disease may benefit from palliative surgery since local disease symptoms (eg, colonic obstruction, bleeding) can impact significantly on long-term quality of life. If resection of the primary lesion is not feasible or desired, then diversion of the fecal stream with a colostomy can also improve the patient's immediate status.

The usual criteria used to determine suitability for potentially curative local excision are:

• Tumor size less than 4 cm
• Location 8 cm or less from the anal verge
• Well or moderately well differentiated histology
• Mobile, not ulcerated tumor
• No suspicion of perirectal or presacral nodes (by CT or endoscopic ultrasound [EUS])
• Tumor involves less than one-third of the circumference of the rectal wall
• Tumor stage ≤T2

Chemoradiation Therapy for Locally Advanced Rectal Cancer:

The only definitive indication for neoadjuvant chemoradiotherapy, supported by the results of randomized trials, is the presence of T3 or T4 rectal cancer. These are patients who, if resected initially, would likely require postoperative RT. Data from randomized trials suggest that the preoperative approach is associated with a more favorable long-term toxicity profile and fewer local recurrences than postoperative therapy.

cT3N0 tumors — The optimal management of clinical T3N0 rectal cancer (cT3N0 based upon preoperative transrectal ultrasound [TRUS] and/or MRI) is unclear. Some of these patients have a sufficiently favorable prognosis that questions have been raised as to the necessity of postoperative adjuvant therapy after upfront total mesorectal excision.

On the other hand, as many as one-fifth of these patients may be understaged by preoperative imaging. In a review of 188 patients with TRUS/MRI staged T3N0 rectal cancer patients who received preoperative chemoradiotherapy, 41 (22 percent) were found to have pathologically positive mesorectal lymph nodes at the time of surgery [6]. Given the downstaging effect of chemoradiotherapy, it is likely that an even larger number of these patients would have been found to have node-positive disease (and recommended for postoperative adjuvant therapy) had surgery been undertaken initially.

Thus, given the limitations of current imaging, all patients with cT3N0 rectal cancer by TRUS or MRI are appropriate candidates for neoadjuvant chemoradiotherapy.

Issues related to locoregional staging in patients with newly diagnosed rectal cancer are discussed in detail elsewhere.

Thanks uptodate.com

Here, Dr. Tony Talebi discusses the treatment of locally advanced stage 1 to 3 rectal cancer with Dr. Laurence Sands, professor of surgery and chief of colorectal surgery at the University of Miami.   The discussion includes Chemotherapy for rectal cancer, rectal cancer awareness month, rectal cancer symtoms, warning signs of rectal cancer, rectal cancer screening, stage 4 rectal cancer, symptons of rectal cancer, chemo for rectal cancer, stage four rectal cancer, rectal cancer diet, how to check for rectal cancer, what are symptoms of rectal cancer, stage iv rectal cancer, rectal cancer bowel movements, preventing rectal cancer, rectal cancer support groups, rectal cancer foundation, sigmoid rectal cancer, about rectal cancer, cure for rectal cancer, facts about rectal cancer, rectal cancer warning signs, rectal cancer hereditary, metastatic rectal cancer, signs of rectal cancer in men, rectal cancer hereditary, surgery for rectal cancer, rectal cancer definition, advanced rectal cancer, rectal cancer com, can rectal cancer be cured, diet for rectal cancer, treating rectal cancer, rectal cancer color, can rectal cancer be cured, treating rectal cancer, rectal cancer surgery, symptoms rectal cancer women, is rectal cancer hereditary, stage 3 rectal cancer life expectancy, signs and symptoms of rectal cancer.

Dr. Laurence Sands credentials:

Certifications

• American Board of Surgery
• American Board of Colon & Rectal Surgery

Specialties

• Surgery
• Colon & Rectal Surgery

Roles

• Professor and Chief, Division of Colon and Rectal Surgery

Clinical Interests

Colorectal surgery, anal surgery, laparoscopic intestinal surgery, general abdominal surgery, Crohn's disease, ulcerative colitis, hernia, polyps, colonoscopy

Education:

2009 MBA:
University of Miami

Undergraduate:
Northwestern University

Graduate:
Northwestern University Medical School

Residency:
Albert Einstein Medical Center

Fellowship:

Cleveland Clinic Florida