Clinical Presentation

• Asymptomatic
• Change in quality and quantity of stool
• Abdominal discomfort
• Cachexia
• Lethargy
Acute Symptoms
• Intestinal Obstruction
• Perforation
Signs
• Abdominal Mass
• Pallor
• Mass in return (DRE)
• Nodular liver
• Ascites
diagnosis
• History- family Hx or colorectal CA or Polyps
• Physical Exam- DRE, pelvic exam, sphincter function
• Proctoscopy
• Biopsy
• Colonoscopy
• Barium enema and imaging
• Transrectal USG
• CT scan
• MRI
Treatment
• Surgical
• Chemotherapy
• Radiotherapy
surgery
• This option is most common
• After resection, local failure is common & recurrence
Types
• Local Excsion- for minimally invasive tumours
-With unfavourable histological pathology,patient should undergo total
mesorectal dissection, with/without sphincter preservation
• Low Anterior resection- for tumours in upper/mid rectum, to preserve sphincter
• Abdominoperineal resection- leads to permanent colostomy
• Total mesorectal incision
• Pelvic extenteration
Adjuvant therapy
• Chemotherapy
• Radiation with chemotherapy
• Radiation alone
radiochemotherapy
• Reduce tumour size
• To facilitate sphincter preserving procedure
• Can cure patients without surgery, those with high surgery risk
radiotherapy