During treatment, what options do patients with rectal cancer have? While there are no established standards for rectal cancer treatment, certain types of therapies have proven to be more effective than others. One study of stage 0 rectal cancer showed that preoperative chemoradiation therapy significantly reduced the risk of local recurrence. The results of this study were reported in the journal Ann Surg. This study is an example of the efficacy of a multidisciplinary approach to the treatment of rectal cancer.
The primary goals of rectal cancer treatment are local and distant oncologic control, minimizing treatment-related morbidity, promoting rapid recovery, and preventing recurrence. Moreover, treatment of rectal cancer involves the use of modern imaging techniques such as transrectal ultrasonography. The multidisciplinary approach is important because of the complexities of the disease. As a result, multidisciplinary cancer teams work together to optimize the patient’s prognosis and quality of life.
Preoperative chemoradiation is a popular option for advanced stage rectal cancer. Preoperative radiation therapy is generally associated with a reduced risk of local recurrence in patients undergoing TME surgery. However, in stage II or III rectal cancer, postoperative irradiation to the tumor bed may also be considered. Despite the limitations of preoperative irradiation, postoperative irradiation is still considered in 30% of patients with T4 tumors in the retroperitoneal portions of the colon. The only limitation of this research was its slow accrual, which limited its ability to identify an improvement in overall survival or disease-free survival.
PET/CT has limited evidence to support its use for staging early stage of rectal cancer. Although PET/CT may be useful in detecting metastases and occult synchronous tumors, its low yield of diagnostic accuracy cannot justify the additional cost and radiation exposure. Although it may be an excellent choice for staging cancer, it is not the only choice for rectal cancer patients. The accuracy of this test is dependant on the quality of the imaging.
Approximately 10% of polypectomy specimens harbor early stage colorectal cancer. Surgical endoscopic polypectomy is likely to be adequate for most benign-appearing polyps. However, patients with polyps 2 cm in diameter or those that are close to the anal canal should undergo excision. Patients with suspected dysplasia should undergo immediate evaluation to determine whether surgical intervention is needed. A biopsy before healing is recommended in patients with cancer.
Most patients with rectal cancer will exhibit a variety of symptoms and will not have a specific disease diagnosis. Although the symptoms of CRC are nonspecific, they can help clinicians guide their diagnosis and referral decisions. In particular, age, gender, and family history should be factors in the diagnosis and treatment of patients. Additionally, genetic counseling can provide appropriate risk assessment and timely notification for family members who may be at increased risk. While there are no definitive tests for rectal cancer, it is crucial to consider genetic testing as a screening option for the disease.
Improved imaging techniques have improved our understanding of the natural course of rectal cancer and helped determine treatment options. Increasingly accurate preoperative imaging has improved patient selection for neoadjuvant CRT. This treatment has been associated with decreased local recurrence but has not improved overall survival. For patients who are unable to undergo surgery, laser photoablation may be an alternative treatment option. This treatment has the advantage of reducing the risk of recurrence and allowing patients to return to work sooner.
