The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment. The following is a general overview of the treatment of recurrent rectal cancer. Circumstances unique to your situation and the prognostic factors of your cancer may ultimately influence how these general treatment principles are applied. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies.
For the quantitative variables, the means and standard deviation SD or median and range are presented. Willet et Cancer rectal recurrent. The information in these summaries should not be used to make decisions about insurance reimbursement. Postoperative care requires frequent side-to-side turning and regular recurrwnt observations. Corresponding author. CRM The surgical resection of rectal cancer has been standardized by the worldwide introduction of TME, which was first described in Bruckner, Y. Use of Amatuer teen model brachytherapy in the management of locally Cancer rectal recurrent rectal cancer
Female in panties. Background
The lymph nodes near the rectum are removed and checked under a microscope for signs of cancer. The standard postoperative surveillance program at our institute consists of routine follow-up at 3-month intervals for the first 2 years rechrrent at 6-month intervals thereafter, during which, a full history is obtained and a physical rsctal is performed. Recurrenr given before surgery is called neoadjuvant therapy. Cancer Reporting Fellowships. Some treatments are standard the currently used treatmentand some are being tested in clinical trials. Table 2 Multivariate analysis of clinicopathological factors with respect to early and late recurrence. The value of serum carcinoembryonic antigen in predicting recurrent disease following curative Cancer rectal recurrent of colorectal cancer. RT—PCR can be Cancer rectal recurrent to check the activation of certain genes that may indicate the presence of cancer cells. Following your cancer treatmentyour doctor will suggest frequent screening tests prevent a recurrence. Rectal Brookland boyz starts in the lining of the rectum rectal mucosa.
Surgical salvage is considered appropriate in the curative setting as well as select cases with palliative intent.
- It is important that clinicians discuss the fear of recurrence with their patients, which can be initiated by direct questions or through the use of a short questionnaire tool.
- People with rectal cancers that have not spread to distant sites are usually treated with surgery.
The digestive system takes in nutrients vitamins , minerals , carbohydrates , fats, proteins , and water from foods and helps pass waste material out of the body. The digestive system is made up of the esophagus , stomach , and the small and large intestines. The colon large bowel is the first part of the large intestine and is about 5 feet long. Together, the rectum and anal canal make up the last part of the large intestine and are inches long. The anal canal ends at the anus the opening of the large intestine to the outside of the body.
Enlarge Anatomy of the lower digestive system, showing the colon and other organs. Anything that increases your chance of getting a disease is called a risk factor. Talk to your doctor if you think you may be at risk for colorectal cancer. The chance of getting cancer increases as you get older. These and other signs and symptoms may be caused by rectal cancer or by other conditions.
Check with your doctor if you have any of the following:. Tests used to diagnose rectal cancer include the following:. The prognosis chance of recovery and treatment options depend on the following:. Cancer can spread through tissue , the lymph system , and the blood :.
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began the primary tumor and travel through the lymph system or blood.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if rectal cancer spreads to the lung , the cancer cells in the lung are actually rectal cancer cells. The disease is metastatic rectal cancer, not lung cancer. These abnormal cells may become cancer and spread into nearby normal tissue. Recurrent rectal cancer is cancer that has recurred come back after it has been treated. The cancer may come back in the rectum or in other parts of the body, such as the colon , pelvis , liver , or lungs.
Different types of treatment are available for patients with rectal cancer. Some treatments are standard the currently used treatment , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. The cancer is removed using one of the following types of surgery:. After the cancer is removed, the surgeon will either:. Treatment given before surgery is called neoadjuvant therapy. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:. External radiation therapy is used to treat rectal cancer. Short-course preoperative radiation therapy is used in some types of rectal cancer.
This treatment uses fewer and lower doses of radiation than standard treatment, followed by surgery several days after the last dose. Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing.
When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body systemic chemotherapy. When chemotherapy is placed directly in the cerebrospinal fluid , an organ, or a body cavity such as the abdomen , the drugs mainly affect cancer cells in those areas regional chemotherapy. Chemoembolization of the hepatic artery is a type of regional chemotherapy that may be used to treat cancer that has spread to the liver.
This is done by blocking the hepatic artery the main artery that supplies blood to the liver and injecting anticancer drugs between the blockage and the liver. Only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on what is used to block the artery.
The liver continues to receive some blood from the hepatic portal vein , which carries blood from the stomach and intestine. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer.
Tests include the following:. Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Types of targeted therapies used in the treatment of rectal cancer include the following:. Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.
This type of cancer treatment is also called biotherapy or biologic therapy. Immune checkpoint inhibitor therapy is a type of immunotherapy:. Information about clinical trials is available from the NCI website. For information about side effects caused by treatment for cancer, see our Side Effects page. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process.
Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future.
Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring coming back or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Clinical trials supported by other organizations can be found on the ClinicalTrials. Some tests will be repeated in order to see how well the treatment is working. Some of the tests will continue to be done from time to time after treatment has ended.
These tests are sometimes called follow-up tests or check-ups. After treatment for rectal cancer, a blood test to measure amounts of carcinoembryonic antigen a substance in the blood that may be increased when cancer is present may be done to see if the cancer has come back.
For information about the treatments listed below, see the Treatment Option Overview section. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Treatment of rectal cancer that has spread to other organs depends on where the cancer has spread.
For general cancer information and other resources from the National Cancer Institute, see the following:. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language.
The PDQ summaries are based on an independent review of the medical literature. This PDQ cancer information summary has current information about the treatment of rectal cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care. Editorial Boards write the PDQ cancer information summaries and keep them up to date.
These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory.
Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard.
Clinical trials can be found online at NCI's website. PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly.
Journal of Clinical Oncology. Funding for Cancer Training. Table 2 Multivariate analysis of clinicopathological factors with respect to early and late recurrence. If the cancer does recur, it's usually in the first 2 to 3 years after surgery, but it can also recur much later. Thinking about colon cancer recurrence and obsessing over it are two different things.
Cancer rectal recurrent. INTRODUCTION
Rectal Cancer Treatment (PDQ®)–Patient Version - National Cancer Institute
Locally recurrent rectal cancer LRRC is a complication that occurs following primary rectal cancer resection. Although progress has been made in decreasing the LR rate, it remains a problem that is associated with a poor quality of life and short survival time.
LRRC was considered a contraindication for curative surgical intervention, with surgeries only performed as palliative methods to relieve tumor-related symptoms, including obstruction and hemorrhage. Limited improvements to this prognosis have been noted with palliative adjuvant chemoradiotherapy CRT only. As experience accumulated, radical surgical resection was introduced into clinical practice in a select group of LRRC patients.
Data from numerous centers have been collected and analyzed, and a curative reoperation has been shown to be the only chance to achieve a curative effect. The surgical safety and post-operative quality of life were declared acceptable. Although a curative surgical approach may be provided in patients with good systemic and local tumor conditions, the majority of patients do not qualify and have already lost the chance of curative surgery when diagnosed with LRRC.
Studies have identified factors that may cause a high risk of LR. Certain factors may be prevented during the treatment of the primary tumor. The present study reviewed the literature to analyze the significant risk factors that lead to LR following primary rectal cancer resection. The relevant factors affecting the prognosis following a resection of LRRC are also discussed in this study.
A low tumor location was defined as rectal cancer below the level of peritoneal reflection, which was considered to be an independent factor affecting the risk of LR in certain studies 4 , but this remains controversial 1.
Improved intraoperative exposure and easier surgical manipulation also contribute to a better prognosis with a lower LR rate 2 , 5. Patients treated with a primary abdominoperineal resection APR were noted to have a higher rate of LR than those who underwent a low anterior resection LAR 6.
Discussions led to the belief that selection bias may explain this difference. In primary rectal cancer cases, bulky, extensive and poorly-differentiated tumors in the lower part of the rectum usually require an APR procedure to ensure oncological safety. Indications for a sphincter-preserving procedure in low rectal cancer patients should be carefully handled, since an inappropriate ultralow anterior resection in advanced cases may significantly increase the risk of LR 8. The newly developed intersphincteric resection ISR expanded the sphincter-preserving options for low and ultralow rectal cancer patients.
The surgical type affecting the rate of LR should be the pathological pattern of the primary tumor. An intraoperative perforation of a tumor is generally regarded as a severe problem to the prognosis. In the majority of cases, perforations were accompanied by an inadequate excision of tissue surrounding the tumor or an incomplete tumor resection.
Prevention methods include pre-operative CRT, appropriate types of surgical procedures and an increased intraoperative focus of surgeons. The pathological examination of surgical resection specimens is critical in assessing the risk of recurrence. Pathologists play a key role in assessing an accurate CRM determination. Ignorance of CRM involvement may lead to a negative pathological report, thus misdirecting the expectations of the prognosis. The specimens should be carefully dealt with and be sampled at the closest possible distance from the tumor and positive lymph node to the CRM.
The majority of researchers tend to consider angioinvasion as an adverse risk factor for LR However, this is inconsistent with the follow-up data recorded by Lee et al , although a significant difference was observed between distant metastasis and overall survival The surgical resection of rectal cancer has been standardized by the worldwide introduction of TME, which was first described in With the mesorectum removed, the assessment of CRM becomes important and should be indicated in the pathological report.
A positive CRM is defined as tumor extension and positive lymph nodes within 1 mm of the CRM, and this concept has been widely accepted. In the study by Nagtegaal et al 24 , patients with a positive CRM caused by tumor extension had a lower chance of LR than those with a positive CRM due to positive lymph nodes, but the P-value narrowly missed reaching statistical significance Neoadjuvant and adjuvant therapy may partly offset the poor prognosis in CRM-positive patients.
Neoadjuvant therapy decreases the risk of a positive CRM prior to surgery, while adjuvant procedures contribute to the prevention of LR following a positive CRM being diagnosed.
In a study by Kang et al , which consisted of patients, no significant differences were observed for the LR rate between the CRM-positive and CRM-negative groups In CRM-negative cases, a complete resection of the mesorectum is also confirmed to be an indicator of the TME surgical quality.
Sphincter preservation and oncological safety are conflicting factors prior to choosing a type of surgery. Decisions are based on a balance, but assurance of radicality should always be the golden rule. The initial principle of TME requires the incision to be 5 cm distal to the inferior aspect of the tumor to avoid deposits of tumor cell being left.
In the past few decades, the safe distal margin has been gradually shortened from 5 cm to 5 mm 30 , A further understanding of regional lymphovascular anatomy and evidence based medicine aids in the renewal of the minimal safe distal margin A marked regression from the fresh specimen to a formalin-fixed status was observed, and this made the pathological report of the distal resection margin conservative.
CEA has been widely used as clinical tumor marker. By tracking patients who have undergone radical surgery, the continuous process of monitoring serum CEA levels is useful in forming an LR diagnosis.
Young et al evaluated patients who underwent radical surgery and identified an association between a high post-operative CEA level and a poor prognosis high recurrence rate and poor survival Also, a decrease from relatively high pre-operative CEA levels to low post-operative levels usually indicates a good tumor radicality and predicts a good prognosis.
During follow-up visits subsequent to the primary rectal surgery, CEA monitoring is valuable to aid in predicting the prognosis and the recurrence risk. A Swedish systematic review analyzed 42 clinical trials and three meta-analyses containing a total of 26, patients By contrast, a poor reaction under exposure of nCRT was another risk factor for a poor prognosis For primary APR patients, the earliest complaint to confirm a diagnosis of LRRC is usually pelvic pain, which may indicate severe intrapelvic invasion.
To achieve an R0 resection in these patients, an extended resection procedure is required and is accompanied by an increased rate of complication and short-term mortality. Tr1 is classified as an LR invading the submucosa or limited muscularis at the primary resection site, while Tr2 is defined as a full thickness invasion of the muscularis propria. Tr3 is a full thickness penetration into the perirectal soft tissue.
LR with an extensive invasion into an adjacent organ is classified as Tr4. Tr5 cases are an LR with extensive pelvic invasion. Intrapelvic recurrence following APR is directly sorted into Tr5 Fixation indicates advance recurrence, increases surgery difficulty and deteriorates the prognosis of LRRC compared with the mobile tumors in the study by Hahnloser et al Distant metastasis combined with LRRC is common according to reviews of the literature. The majority of studies regarded this situation as a contraindication for further curative surgery, and palliative therapy was usually provided.
Whether LR was resectable or unresectable showed no difference in median survival time when distant metastasis was detected in LRRC patients Bleeding and bowel habit changes are usually the only complaint prior to the detection of LRRC. The presence of symptoms is significantly associated with the resectability of LRRC. This may explain the poorer prognosis following a reoperation When the curative reoperation is accomplished, the response of symptomatic relief is regarded as a positive prognostic factor Surgical treatment for LRRC is no longer considered a palliative procedure, but a curative intention due to the improvements in the techniques, experience and development of nCRT.
This conclusion was confirmed by a subsequent study Although regarded as a failed radical resection resulting in a poorer prognosis compared with an R0 resection, microscopically-positive resection margin cases result in a longer survival time compared with palliative or untreated cases. The location of the recurrence site has proved to be a crucial factor affecting surgical radicality and resulting in various levels of surgical difficulty and tumor invasion.
The isolated recurrent site from the anastomosis was defined as the central type, also known as the anastomosis type. As summarized by Moore et al , patients with central site recurrence are identified to have the highest rate of radicality, while presacral LR has the poorest surgical outcome When a complete resection was achieved, no statistical difference existed between the survival and recurrence rates among the anatomical types Relatively improved intraoperative vision and less adjacent organ invasion may assist in achieving a radical resection.
Recurrence involving the lateral pelvic side wall has the worst resectability potential and prognosis from clinical experience. At the cost of increased surgical trauma, morbidity and a decreased quality of life, the anterior type of LR with adjacent organ invasion bladder, uterus, prostate requires an extended combined organ resection to achieve radicality, while sacrectomy is widely applied in presacral LR.
Essentially, it is the site-related surgical difficulty of oncological clearance that mainly causes the difference in radicality. The involvement of the iliac vessels and the pelvic side wall are considered unlikely to reach an R0 resection As concluded from the surgical experiences of several centers, presacral LRRC is usually associated with a large tumor volume and invasion into the sacrum.
Increased surgical risks and complications have been reported, particularly during a curative abdominotranssacral resection. Sacrectomy has proved its value in treating a posterior type of LR, with satisfied survival rates and affordable morbidity. However this concept may be changed in the near future Experiences of performing high sacrectomy have been accumulated in several studies. The post-operative R0 life expectancy was close to other surgical types for LRRC, but a poor quality of life limited the clinical application of this surgical type.
The level of the high sacrectomy and the associated information with regard to the long-term consequences of this procedure should be addressed pre-operatively and at follow-up visits Scientists are making efforts in the biochemical field to develop new reconstruction techniques using myocutaneous flaps or artificial materials following a sacrectomy A larger cohort of patients is required for further establishment of oncological safety.
Multidisciplinary treatment is increasingly being used to improve the clinical outcome. Dassanayake et al used a multi-factorial linear logistic model for analyzing LRRC patients who did not undergo pre-operative CRT, and the result supported the significance of nCRT in rectal cancer Further studies are required to confirm this aggressive method of treatment with curative intention. As palliative therapy, a total dose of 45 Gy is usually administered to LR patients who are unsuitable for surgical intervention, with the aim of relieving their pain rather than radically treating the tumor.
The median duration of symptom control has been recorded as approximately five months, with a survival duration of six months, as discussed in a Korean study IORT provides three times the biological effect of external beam radiotherapy, with a reduced dose of irradiation and with the normal structure shielded from the irradiation field.
The toxicity complications may also be decreased. However, data obtained from a study by Dresen et al did not record any difference in a comparison between patients with and without IORT One negative point hindering the popularization of IORT is the costly equipment and complex manipulation.
LRRC is no longer defined as a termination of treatment, but is now a potentially curable disease process. Multidisciplinary treatment, the radical resection of LR in conjunction with adjuvant, nCRT and other combined approaches are the current dominant treatment trends. With regard to a curative aim, an R0 resection is the root of success to be emphasized in this system in a carefully selected group of patients.
Further investigation with regard to LR risk factors is critical in preventing recurrence when treating the primary rectal cancer.