Diagnosis and Treatment of Rectal Cancer

摘要: Carcinoma of the rectum, a common malignancy in developed countries, accounts for approximately one third colorectal cancers. Although majority localized rectal cancers are potentially curable, local recurrence remains serious problem with severe disability and impaired quality life. Rectal cancer, which was surgically-managed tumour, now requires coordinated efforts multidisciplinary team, surgery, radiation oncology, medical radiology others. In addition to staging workup, pre-treatment evaluation disease, by endorectal ultrasound (EUS) multislice computer tomography (CT) magnetic resonance imaging (MRI), is utmost important determine surgical approach need various other treatment modalities: chemotherapy (ChT). The introduction Total Mesorectal Excision (TME) neoadjuvant Radiation Therapy (RT) have led significant improvement loco-regional control 90–94%. TME widely accepted as standard technique cancer. Local rates been shown decrease significantly alone. However, therapy has furthered this improvement, especially patients having circumferential resection margin (CRM) that involved tumour on pre-operative imaging. There two modalities used solid tumours, external beam (EBRT) brachytherapy (BT). cancer EBRT primarily optimize rate achieved surgery. Numerous clinical trials confirmed its benefit, or without chemotherapy, improving control. survival advantage impact distant metastasis controversial. view normal organ toxicity associated EBRT, newer delivery techniques explored. High dose (HDRB) delivers an endoluminal approach, avoiding through organs, such, decreases toxicity. emerging prospective data very promising international phase III study being conducted. Despite control, over last decade, continue fail at distance, metastases. role conjunction neo-adjuvant modality been, mostly, routine North America. date, evidence from Phase III-randomized studies fails demonstrate any benefit additional post-operative adjuvant 5-fluorouracil (FU)-based terms disease-free overall locally advanced achievements past decade becoming care. Such allows selection those who cured surgery alone, well risk failing locally, thus achieving balance between risks gains.