rectal carcinoma
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Pathology
- adenocarcinoma
- squamous cell carcinoma
- retroperitneal location & lack of serosa (peritoneal covering) result in high local recurrence[4]
Genetics
- implicated genes CCNDBP1
Diagnostic procedures
Radiology
- MRI sensitive for predicting clear margins after surgical resection[3]
- endorectal ultrasonograpy
Staging
- stage 1: T1/T2, N0, M0
- stage 2A: T3, N0, M0
- stage 2B: T4, N0, M0
- stage 3A: T1/T2, N1, M0
- stage 3B: T3/T4, N1, M0
- stage 3C: T any, N2, M0
- stage 4: T any, N any, M1
also see staging of colorectal carcinoma
Management
- surgical resection is 1st-line therapy
- stage 1 rectal cancer*[4]
- surgical resection alone
- total mesorectal excision is superior to local excision for stage 1 rectal carcinoma
- transanal total mesorectal excision comparable to open or laparoscopic total mesorectal excision[9]
- examination of mesorectal tissue & lymph nodes to confirm stage 1 rectal carcinoma
- reassess tumor stage as indicated[4][5]
- surgical resection alone
- all rectal cancers beyond stage 1[4]
- neoadjuvant chemotherapy with 5-fluorouracil or capecitabine
- surgery with post-operative radiation & adjuvant chemotherapy[4]
- neoadjuvant chemoradiation therapy followed by surgery[10]
- deeply invasive of node-positive rectal cancer
- pelvic pre-operative irradiation (30-50 Gy)
- reduces recurrence at 1 year
- does not increase 5 year survival
- total neoadjuvant therapy: chemoradiation & chemotherapy administered prior to surgery[6][8]
- adjuvant chemotherapy with 5-fluorouracil
- pelvic pre-operative irradiation (30-50 Gy)
- chemoradiation with a watch-and-wait strategy for patients with locally advanced rectal cancer (T2,T3, including node-positive) who sustain a clinical complete response results in low 3-year recurrence[4][8]
- liver metastases: resection if metastases restricted to a single lobe of the liver with or without adjuvant chemotherapy[4]
- prognosis:
- rectal carcinoma tends to have worse prognosis than colon cancer
- 45% 5 year survival
- 25% 10 year survival
* see staging. T2,N0 is stage 1
More general terms
Additional terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 670-671
- ↑ Journal Watch 21(23):187, 2001 Colorectal Cancer Collaborative Group. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet 358:1291, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11684209
Minsky BD Adjuvant radiation therapy for rectal cancer: is there finally an answer? Lancet 358:1285, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11684204 - ↑ 3.0 3.1 MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: Prospecitve observational study. BMJ 2006, 333:779 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16984925
Finlay I. Preoperative staging for rectal cancer. BMJ 2006, 333:766 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17038713 - ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 5.0 5.1 Garcia-Aguilar J, Holt A. Optimal management of small rectal cancers: TAE, TEM, or TME? Surg Oncol Clin N Am. 2010 Oct;19(4):743-60 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20883951
- ↑ 6.0 6.1 Cercek A, Roxburgh CSD, Strombom P et al Adoption of Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer. JAMA Oncol. Published online March 22, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29566109 https://jamanetwork.com/journals/jamaoncology/fullarticle/2675916
Hong TS, Ryan DP. Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer - The New Standard of Care? JAMA Oncol. Published online March 22, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29566113 https://jamanetwork.com/journals/jamaoncology/fullarticle/2675911 - ↑ Allegra CJ, Yothers G, O'Connell MJ Neoadjuvant 5-FU or Capecitabine Plus Radiation With or Without Oxaliplatin in Rectal Cancer Patients: A Phase III Randomized Clinical Trial. J Natl Cancer Inst. 2015 Sep 14;107(11). PMID: https://www.ncbi.nlm.nih.gov/pubmed/26374429 Free PMC Article
- ↑ 8.0 8.1 8.2 Fernandez LM et al. Conditional recurrence-free survival of clinical complete responders managed by watch and wait after neoadjuvant chemoradiotherapy for rectal cancer in the International Watch & Wait Database: A retrospective, international, multicentre registry study. Lancet Oncol 2021 Jan; 22:43 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33316218 https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30557-X/fulltext
- ↑ 9.0 9.1 Caycedo-Marulanda A, Lee L, Chadi SA et al Association of Transanal Total Mesorectal Excision With Local Recurrence of Rectal Cancer. JAMA Netw Open. 2021;4(2):e2036330 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33533932 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775826
- ↑ 10.0 10.1 Nassoiy S, Christopher W, Marcus R et al Treatment Utilization and Outcomes for Locally Advanced Rectal Cancer in Older Patients. JAMA Surg. 2022;157(11):e224456. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36169964 PMCID: PMC9520439 (available on 2023-09-28) https://jamanetwork.com/journals/jamasurgery/fullarticle/2796756
- ↑ 11.0 11.1 NEJM Knowledge+ Gastroenterology
- ↑ Rectal Cancer (PDQ): Treatment http://www.nci.nih.gov/cancertopics/pdq/treatment/rectal/HealthProfessional