Rectal Cancer

Week 31: Rectal Cancer

1. If you are a colo-rectal surgeon, how are you going to treat a rectal tumour?

All rectal tumours should be removed, ideally by meso-rectal excision. Pre-operativeley patients should be staged with a CT Thorax and abdomen and full colonoscopy.

Sometimes however surgery is performed as an emergency to relieve bowel obstruction, in which case the surgery may differ and staging must be done post-operatively.

The SIGN Guidelines for Rectal Cancer give a very helpful summary of screening, GP investigations, and management including surgery, radiotherapy and chemotherapy.

2. If you are an Oncologist how are you going to treat the same disease?

This depends on the stage. Some rectal cancers benefit from short course radiotherapy prior to surgery, to allow sterilisation of the area and to minimise local recurrence.

A Meta-analysis has shown that pre-operative radiotherapy reduces local recurrence and death from rectal cancer ( but early death from other causes was increased).

Other cancers are too locally advanced to be successfully operated on in a curative fashion, so a combination of chemotherapy and radiotherapy may be used first to try to shrink the tumour down to render it resectable.

If the tumour has spread beyond the rectum, to the liver, chemotherapy will be used to reduce tumour burden. However, sometimes it is also possible to resect the liver metastases.

3. What are the long term sequelae of such treatment?

Following surgery the patient may or may not have a stoma.

Radiotherapy can cause long term fibrosis of bowel and rarely bleeding and perforation.

This is discussed here here in more detail.

Chemotherapy mostly has its side effects acutely rather than long term.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: