Optimal Care of Patients with Rectal Cancer
Management of rectal cancer advanced significantly in the past two decades, resulting in decreased rates of cancer recurrence and improved survival. Advances include better imaging modalities for tumor localization and staging, introduction of neoadjuvant (before surgery) radiation and chemotherapy, and a greater focus on surgical technique for adequate resection. Five-year survival approaches 75% for rectal cancer patients that receive guideline-recommended care but is considerably less for patients not receiving that standard.
Presentation and Staging
Patients with rectal cancer often present initially with symptoms including bleeding, rectal pain and tenesmus or cramping. Patients may also notice narrowed-caliber stool or a sensation of incomplete evacuation of their bowels, which they frequently describe as “constipation.” Others will be asymptomatic and diagnosed on a screening colonoscopy. Finally, a smaller group of patients will present initially with obstruction, requiring urgent intervention.
After a patient is diagnosed with biopsy-proven adenocarcinoma of the rectum, it is critical that they undergo accurate staging with laboratory and radiologic studies prior to initiating treatment:
Patients with low-risk early stage rectal cancer may undergo surgery alone as definitive treatment. However, patients with locally advanced (stage II or III) disease benefit from multimodality treatment with radiation and/or chemotherapy prior to surgical intervention. Patients with metastatic disease at the time of diagnosis (stage IV) may still be candidates for curative surgical resection depending upon the pattern and extent of spread of the cancer and response to preoperative chemotherapy.
A critical component of both APR and LAR is sharp total mesorectal excision (TME), in which the mesentery adjacent to the rectum containing the draining lymph nodes is taken as a complete, undisrupted packet along with the rectum. The quality of the pathology specimen and status of the distal and circumferential margins are closely associated with cancer recurrence, emphasizing the importance of precise dissection by an experienced surgeon.
For more information:
Given the complexity of rectal cancer management, decisions regarding individual treatment plans are best made collaboratively by a multidisciplinary team involving medical and radiation oncologists, radiologists and surgeons with rectal cancer expertise. It is also preferable for patients with potentially resectable cancer to be evaluated by a colorectal surgeon prior to initiating treatment. At UW Health, we have a multidisciplinary team of physicians that meets weekly to discuss treatment planning for all patients with rectal cancer. For questions or to refer a patient, please call the UW Health Colorectal Surgery Clinic at the Digestive Health Center.
UW Health Digestive Health Center