RECTAL

CANCER
RECTAL CANCER

Patient symptoms Mc Hematochezia.

Preoperative evaluation
Labs: CEA

Colonoscopy – eval for other lesions

CT chest, abdomen, and pelvis

Endorectal ultrasound or rectal MRI (Determine the T stage and distance between tumor
and mesorectal fascia)
NEOADJUVANT CHEMORADIATION

Indicated : (T3 or greater) rectal cancers of the mid or distal

rectum, or any node positive disease

5000 cGy of radiotherapy concurrently with 5-FU-based over 5-6

weeks

If after neoadjuvant therapy there appears to be a complete

clinical response, patient still needs a resection – LAR or APR
SURGERY

Local excision: Option in T1N0 lesions

without (ie, no lymphovascular or
perineural invasion, well- to moderately
differentiated).

<4 cm in size, <⅓ circumference of bowel

lumen, need 2 mm margins, and must be
within 8 cm of anal verge.

Upper ⅓ of rectum:

Low anterior resection with tumor specific

mesorectal excision with 5 cm margin.

Mid to lower ⅓ of rectum:

LAR vs APR with total mesorectal excision

with 2 cm margin
ADJUVANT THERAPY

Patient stage III and above disease who did not receive
neoadjuvanttherapy.

Provided to patients with high risk stage II and stage III disease
who did receive neoadjuvant chemoradiation

FOLFOX
(5-FU, leucovorin, oxaliplatin)
ANAL CANAL

SCC. Cloacogenic, Basaloid, Epidermoid, Mucoepidermoid

Risk Factor : HPV (especially 16 & 18) Anal intercourse,

Immunosuppression (HIV, transplant, immune disorders), Multiple sexual
partners, Prior lower genital tract dysplasia or carcinoma, Smoking.

Treatment Nigroprotocol

5-FU with mitomycinC & external beam radiation with at least 45 Gy.

If disease recurs or is persistent 6 months after treatment (15-30%), APR

is performed
Treatment differs slightly for anal margin lesions

T1, N0, well differentiated and <5cm local excision

T2-T4, N0 or Any T, N+ or >5cm Nigro protocol

Metastatic disease Cisplatin-based chemotherapy +/- RT