Our Summary

This research paper discusses various treatment strategies for advanced rectal cancer. Currently, there are three main approaches. The first involves radiation therapy before surgery, along with a chemotherapy drug that makes the cancer more sensitive to the radiation. This approach is easier on the patient than chemotherapy and radiation after surgery, and it can also help shrink the tumor and improve the results of surgery. After surgery, more chemotherapy is given.

The second approach is a shorter course of radiation therapy before surgery, again followed by chemotherapy after surgery. This can help reduce the chance of the cancer coming back in the same place.

The third approach is called total neoadjuvant therapy. It involves chemotherapy followed by chemoradiotherapy before surgery. This can improve the results of surgery and make it easier to give chemotherapy after surgery.

There are also some new strategies being studied. One of these is giving chemotherapy alone before surgery, which may allow some patients to avoid radiation. Another is not doing surgery at all if the cancer seems to have completely responded to chemotherapy and radiation, with surgery only being used if the cancer comes back.

The results of these studies are expected to help doctors better tailor treatment to individual patients based on the characteristics of their cancer and how it responds to treatment.

FAQs

  1. What are the three primary strategies for managing locally advanced rectal cancer (LARC)?
  2. What are the potential benefits of neoadjuvant chemotherapy alone for patients with favorable LARC?
  3. What is the potential role of nonoperative management in the treatment of patients who have complete clinical responses to neoadjuvant chemotherapy and RT?

Doctor’s Tip

A helpful tip a doctor might tell a patient about proctectomy is to discuss with their healthcare team the different treatment strategies available for managing locally advanced rectal cancer, such as preoperative long-course radiotherapy combined with radiosensitizing chemotherapy, preoperative short-course radiotherapy alone, or total neoadjuvant therapy. It is important to understand the potential benefits and risks of each approach in order to make an informed decision about the best treatment plan for their specific situation. Additionally, staying informed about new strategies and advancements in treatment for rectal cancer can help patients and their healthcare team make the most appropriate decisions for their care.

Suitable For

Patients with locally advanced rectal cancer (LARC) are typically recommended proctectomy, which is the surgical removal of the rectum, as part of their treatment plan. Proctectomy is often recommended for patients who have not responded well to other treatments such as chemotherapy and radiation therapy, or for those who have a high risk of recurrence or spread of the cancer. Proctectomy may also be recommended for patients with other conditions such as inflammatory bowel disease or familial adenomatous polyposis that affect the rectum. Additionally, proctectomy may be recommended for patients with severe symptoms such as rectal bleeding, pain, or obstruction that cannot be managed with other treatments.

Timeline

  • Before proctectomy:
  1. Patient is diagnosed with locally advanced rectal cancer (LARC) through imaging studies and biopsy.
  2. Patient undergoes staging tests such as CT scans, MRI, and possibly PET scans to determine the extent of the cancer.
  3. Treatment plan is discussed with a multidisciplinary team including surgeons, medical oncologists, and radiation oncologists.
  4. Patient may receive neoadjuvant therapy, which can include long-course radiotherapy with chemotherapy, short-course radiotherapy alone, or total neoadjuvant therapy with induction chemotherapy.
  5. Patient undergoes preoperative evaluations and preparations for surgery, which may include bowel preparation and counseling on postoperative care.
  6. Proctectomy surgery is performed to remove the rectum and surrounding tissues affected by cancer.
  • After proctectomy:
  1. Patient undergoes a recovery period in the hospital, which may involve pain management, monitoring for complications, and initiation of bowel function.
  2. Patient may receive adjuvant chemotherapy to further reduce the risk of recurrence.
  3. Patient undergoes follow-up visits with the medical team for surveillance and monitoring of cancer recurrence.
  4. Patient may experience changes in bowel function, sexual function, and quality of life post-surgery.
  5. Long-term follow-up is necessary to monitor for any signs of cancer recurrence or complications related to surgery.
  6. Patient may be referred to support services such as physical therapy, nutrition counseling, and psychological support to aid in recovery and adjustment to life after proctectomy.

What to Ask Your Doctor

  1. What are the risks and benefits of a proctectomy for my specific condition?
  2. What other treatment options are available for locally advanced rectal cancer?
  3. How will a proctectomy impact my quality of life, including bowel function and sexual function?
  4. What is the recovery process like after a proctectomy?
  5. Are there any potential complications or side effects I should be aware of?
  6. How long will I need to stay in the hospital after the surgery?
  7. Will I need any additional treatments, such as chemotherapy or radiation therapy, after the proctectomy?
  8. How often will I need follow-up appointments or surveillance after the surgery?
  9. Are there any specific dietary or lifestyle changes I should make before or after the proctectomy?
  10. Can you provide me with information about support groups or resources for patients undergoing a proctectomy?

Reference

Authors: Smith CA, Kachnic LA. Journal: J Natl Compr Canc Netw. 2018 Jul;16(7):909-915. doi: 10.6004/jnccn.2018.7032. PMID: 30006431