lakeswim wrote:49 - Female
DX: RC
Size: 6cm near (?) anus
lakeswim wrote:Great info - thank you so much. Though I was unclear about my stats. My GI who did colonoscopy said it was large and 5-6 cm long. I understood it to be the length of the polyp - not that far from anus. I will have to ask how far it is because I’m sure that matters.
I was told this afternoon by a cancer hematologist (friend of friend) that they do surgery (resection) FIRST. And then do scans. I thought they did scans first. He told me the surgery gives them far more info than any radiology. I was surprised he said this because I have only read so far that they do lots of scans first. Anyway - more confusion.
Thanks so much for your informative reply. Good graphic too.
O Stoma Mia wrote:With rectal cancer, the stage and location of the tumor/polyp are very important and ultimately determine the treatment plan.
The rectum is about 15 cm long and can be divided roughly into three equal parts: low-rectum, mid-rectum, and upper-rectum. It is very important to know exactly where the tumor is located. The surgeon will have to remove the tumor/polyp and leave at least 2cm of clear margin below it. If the tumor/polyp is already very close to the sphincter, then this poses a problem for a sphincter saving operation (SSO).
It is very important to line up the best board-certified rectal surgeon that you can find, because you will want to have a surgeon who has had a lot of experience with successful sphincter-saving operations.
The main options for treatment are shown below, and depend on the T value (tumor invasion level), the stage, and the location of the tumor within the rectum. The decision process is a bit complicated, so you need to have a very experienced rectal cancer surgeon who can properly evaluate all of the available options and choose the best option for you.
FIGURE 30-3. Treatment options for rectal cancer depending on stage and location.
Reference: The ASCRS Textbook of Colon and Rectal Surgery: Second Edition, 2011, Surgical Treatment of Rectal Cancer, Chapter 30. p. 421
Treatment options for rectal cancer depending on stage and locationReference: http://www.springer.com/cda/content/document/cda_downloaddocument/9780387248462-c30.pdf
- Stage I (T1N0, T2N0—The cancer is confined to the rectal wall and no nodes are involved)
● Distal rectal cancers: T1 (invasion into the submucosa only)■ Local excision
● Distal rectal cancers: T2 (invasion into the muscularis propria)
■ Radical resection, often an APR
■ Adjuvant therapy is usually not recommended.■ Local excision with preoperative or postoperative adjuvant therapy
● Mid rectal cancer: T1
■ Radical resection without adjuvant therapy, often an APR■ TEM
● Mid rectal cancer: T2
■ Radical resection, usually an LAR with low anastomosis. A temporary proximal diverting ostomy is often required.
■ Adjuvant therapy is usually not recommended.■ TEM with either preoperative or postoperative adjuvant therapy
● Upper rectal cancers: T1 and T2
■ Radical resection similar to a T1 cancer
■ Adjuvant therapy is not recommended if a radical resection is performed but is recommended after a TEM resection.■ LAR
- Stage II and Stage III cancers [Stage II cancers have invasion into the mesorectal fat (T3) but no involved mesorectal lymph nodes. Stage III cancers are any rectal cancer (T1, T2, or T3) but with involved lymph nodes.]
● Distal rectal cancers■ Preoperative adjuvant therapy is most often recommended followed by a radical resection, usually an APR.
● Mid rectal cancers
■ If preoperative imaging does not clearly define the stage of the cancer, resection can be done first followed by postoperative adjuvant
therapy.■ Same as above for distal rectal cancers except an LAR is usually performed instead of an APR.
● Upper rectal cancers■ LAR, with either preoperative or postoperative adjuvant therapy
- Stage IV cancers
● Treatment for any cancer is dependent on the extent of metastasis. With better surgical and medical treatments for metastatic disease,
locoregional control of the primary should be aggressive and similar to the above recommendations except in the most advanced cases.
(Key: LE, local excision; short XRT, short-course radiation therapy given 2 times a day for 5 days in larger fractions; ChXRT, long-course
therapy given in 30 smaller fractions over 6 weeks in combination with chemotherapy)
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