Treatment of Ca. Rectal
Management of rectal cancer relies primarily on surgical removal of the tumor and some surrounding tissues. The need for further treatment with chemotherapy or radiation therapy is determined upon evaluation of the resected cancer. Surgery is the oldest method of treating this cancers, with the idea being complete removal of the cancer from the body. Cure is possible in cases where the cancer is limited to the bowel with no spread to the other tissues. Surgery is done in the hospital and under general anesthesia. Patients may stay in the hospital for 7-10 days after surgery. With removal of the rectum, most patients have to compromise with a Colostomy.
In the laboratory, the pathologist will examine the margins of the removed piece of bowel. He will also determine the depth of penetration of the cancer, as well as any lymph node involvement. This is referred to as Pathological Staging. The need for further treatment is dependent on the full staging of the cancer.
Treatment Guidelines
Stage 1 or Duke A: Surgery alone can cure a great majority of patients in this stage. There is no need for any future treatments.
Stage 2 & 3 or Duke B and C: Surgery followed by adjuvant Radiation and chemotherapy for most patients. Certain patients are treated with Neo-Adjuvant Chemo and radiation therapy prior to surgery in order to shrink the size of the cancer and facilitate the surgical treatment.
Adjuvant Radiation and Chemotherapy
This treatment refers to usage of radiation and chemotherapy drugs to reduce the risk of recurrence of the cancer. Adjuvant therapy should be offered to all patients with stages 2 and 3 (Duke B and C). It is the duty of the surgeon and the medical oncologist to inform each and every patient of the stage of his/her disease as well as potential treatment options.
Radiation and chemotherapy can be used with a variety of schedules. There are many acceptable regimens of Chemotherapy, most of which use some sort of continuous infusion of 5-FU with or without Leucovorin during and after radiation therapy. Treatment can be given weekly and for several months. Patients undergoing this treatment should have a Port-A-Cath. The chemotherapy used for this condition is very well tolerated and has minimal side effects. Treatment may have to be given for four weeks and stopped for two weeks so that the body can recover from the side effects.
Stage 4 or Duke D: Surgery followed by chemotherapy in all patients who can tolerate chemotherapy. This is a rather difficult condition to treat. Unfortunately, cure is not possible and the goal of treatment is to prolong the survival of the patients and help them with complications of the illness. Chemotherapy should be offered to all patients with stages 4 (Duke D). This is the duty of the surgeon and the medical oncologist to inform each and every patient of the stage of their disease, prognosis as well as potential treatment options. Patients undergoing treatment should have a Port-A-Cath.
Common regimen that are used in this situation are:
5-FU (Flurouracil), Leucovorin and Oxaliplatin in a combination known as FOLFOX regimen,
5-FU (Flurouracil), Leucovorin and Irinotecan in combination
Avastin and Erbitux are two of the newer drugs for treatment of colorectal cancer and are used in conjunction with above two combinations.
Patients who have metastatic disease to liver only, should be considered for surgical removal of the involved section of their liver.
Chemotherapy complications:
Chemotherapy is normally well tolerated. However, one has to be aware of potential complications and side effects. In severe cases, chemotherapy should be reduced or discontinued until the side effects resolve. Following is a list of the most important side effects:
- Soreness in the mouth
- Abdominal pain
- Diarrhea
- Sun sensitivity
- Increased tear formation
- Lowering of white blood count
- Anemia
Radiation therapy:
Radiation is given to the pelvis to eradicate any remaining cancer cells in patients who have Duke B or C. Radiation is also used for those who develop metastatic disease to brain, bone or spine. Pelvic radiation may be associated with some side effects:
- Tiredness
- Diarrhea
- Pelvic skin irritation
- Urinary problems
Follow-Up:
After completion of treatment, all patients have to be followed carefully with frequent
- Physical examination
- Blood tests, CEA
- Hemeoccult test
- Annual Colonoscopy
