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Current Options for the Management of Rectal Cancer

  • Gastrointestinal Malignancies
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Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Patients diagnosed with rectal cancer should undergo locoregional staging with transrectal endoscopic ultrasound (EUS) or surface coil array MRI of the pelvis if that technique is available. Patients thought to have more than very early stage (T1 or T2) disease should undergo abdominal imaging as well by CT or MRI, and chest imaging with either CXR or preferably CT. The care of rectal cancer patients should be coordinated amongst an experienced multidisciplinary team to maximize the chance of cure and to minimize both local recurrence and complications of therapy. For patients with very early stage disease (T1N0 or T2N0), local resection with or without chemoradiation may be adequate therapy, but these patients must be selected carefully and should be without any poor prognostic factors. For the majority of patients with T3N0 or greater rectal cancer, standard therapy consists of neoadjuvant continuous 5-FU and radiation followed by surgery and further chemotherapy (either with 5-FU, capecitabine, or FOLFOX). The use of capecitabine, irinotecan, and oxaliplatin during radiotherapy shows promise, but remains investigational pending results of phase III studies. Neoadjuvant therapy is preferred because it decreases local recurrence and appears to result in improved postoperative bowel function in comparison with postoperative therapy. Select patients with high (>10 cm from the anal verge) uT3N0 tumors may be at sufficiently low risk of local recurrence to justify omission of radiotherapy. Patients who experience pathologic complete response to radiotherapy should still receive postoperative adjuvant chemotherapy to reduce systemic recurrence risk until data demonstrate that this is not necessary. Patients with stage IV rectal cancer may still require local therapy with radiation, surgery, or both; however, care should be taken in these patients that chemotherapy is not excessively delayed as this is the one modality in this case that can result in improved survival.

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Acknowledgment

Dr. O’Neil’s grant is supported by NIH 5K23CA118431-02.

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Authors and Affiliations

  1. UNC Lineberger Comprehensive Cancer Center, 101 Manning Dr., 3009 Old Clinic Bldg, CB #7305, Chapel Hill, NC, 27599, USA

    Bert H. O’Neil MD

  2. Department of Radiation Oncology, UNC Lineberger Comprehensive Cancer Center, NC Clinical Cancer Center, Rm 1043, 101 Manning Drive, Campus Box No. 7512, Chapel Hill, NC, 27599-7512, USA

    Joel E. Tepper

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  1. Bert H. O’Neil MD
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Correspondence to Bert H. O’Neil MD.

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O’Neil, B.H., Tepper, J.E. Current Options for the Management of Rectal Cancer. Curr. Treat. Options in Oncol. 8, 331–338 (2007). https://doi.org/10.1007/s11864-007-0048-7

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