Rectal Cancer Follow-up

  • Author: Burt Cagir, MD, FACS; Chief Editor: Jules E Harris, MD   more...
 
Updated: Nov 11, 2011
 

Deterrence/Prevention

On December 22, 2010, the US Food and Drug Administration approved the use of quadrivalent human papilloma virus (HPV) vaccine (Gardasil) for prevention of anal cancer and associated precancerous lesions in people aged 9-26 years. HPV is associated with about 90% of anal cancer. In a study of homosexual males, HPV vaccine was shown to be 78% effective in prevention of HPV 16- and 18-related anal intraepithelial neoplasms.

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Prognosis

Overall 5-year survival rates for rectal cancer are as follows:

  • Stage I, 90%
  • Stage II, 60% to 85%
  • Stage III, 27% to 60%
  • Stage IV, 5% to 7%

Fifty percent of patients develop recurrence, which may be local, distant, or both.

Local recurrence is more common in rectal cancer than in colon cancer.

  • Disease recurs in 5-30% of patients, usually in the first year after surgery.
  • Factors that influence the development of recurrence include surgeon variability, grade and stage of the primary tumor, location of the primary tumor, and ability to obtain negative margins.
  • Surgical therapy may be attempted for recurrence and includes pelvic exenteration or APR in patients who had a sphincter-sparing procedure.
  • Radiation therapy generally is used as palliative treatment in patients who have locally unresectable disease.
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Patient Education

A study by Thong et al found that survivors of rectal cancer may benefit from increased focus, both clinical and psychological, on the possible long-term morbidity of treatment and its effects on health.[43]

For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center and Cancer and Tumors Center. Also, see eMedicine's patient education articles Colon Cancer, Colonoscopy, Sigmoidoscopy, Abdominal Pain in Adults, Rectal Bleeding, and Rectal Cancer.

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Contributor Information and Disclosures
Author

Burt Cagir, MD, FACS  Assistant Professor of Surgery, State University of New York Upstate Medical University; Consulting Staff, Director of Surgical Research, Robert Packer Hospital; Associate Program Director, Department of Surgery, Guthrie Clinic

Burt Cagir, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, Association of Program Directors in Surgery, and Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Coauthor(s)

Douglas R Trostle, MD, MBA, FACS  Chairman of Surgery, The Guthrie Clinic and Robert Packer Hospital; Clinical Professor of Surgery, The Medical College of Pennsylvania

Douglas R Trostle, MD, MBA, FACS, is a member of the following medical societies: Alpha Omega Alpha, American Association of Clinical Endocrinologists, American Association of Endocrine Surgeons, American College of Physician Executives, American College of Surgeons, American College of Surgeons Oncology Group, American Society of General Surgeons, Pennsylvania Medical Society, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, Society of Laparoendoscopic Surgeons, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

from Memorial Sloan-Kettering - Philip Schulman, MD  Chief, Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center

from Memorial Sloan-Kettering - Philip Schulman, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Hematology, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Wendy Hu, MD  Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center

Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

Additional Contributors

eMedicine gratefully acknowledges the contributions of Elizabeth Cirincione, MD, to previous versions of this article.

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Diagnostics. Staging and workup of rectal cancer patients.
Staging and treatment. Rectal cancer treatment algorithm (Surgery followed by adjuvant chemotherapy and radiotherapy). Initial stages are Endorectal ultrasound staging (uT)
Table 1. Comparison of AJCC Definition of TNM Staging System to Dukes Classification.
Rectal Cancer StagesTNM StagingDuke Staging5-Year Survival
Stage IT1-2 N0 M0A>90%
Stage IIAT3 N0 M0B60%-85%
BT4 N0 M060%-85%
Stage IAT1-2 N1 M0C55%-60%
BT3-4 N1 M035%-42%
CT1-4 N2 M025%-27%
Stage IVT1-4 N0-2 M15%-7%
Table 2. Acceptable Minimal Distal and Proximal Resectional Margins for Rectal Cancer.[19]
Resection MarginsProximal Resection Margin(cm)Distal Resection Margin (cm)
Ideal Margins5 cm or more2 cm or more
Minimally acceptable margins5 cm or more1 cm or more
Table 3. Colorectal Chemotherapeutic Regimens
COLON AND RECTAL CANCER



COMMON CHEMOTHERAPY REGIMENS



FOLFOX (every 2 weeks)Oxaliplatin 85 mg/m2 day 1



Leucovorin 200 mg/m2 day 1



5-FU 400 mg/m2 IV Bolus day 1 and 2



5-FU 600 mg/m2 IV Infusion day 1 and 2 (22 hours)



FOLFOX 4



(every 2 weeks)



(4 cycles)



Oxaliplatin 85 mg/m2 day 1



Leucovorin 200 mg/m2 day 1



5-FU 400 mg/m2 IV Bolus day 1 and 2



5-FU 2400 mg/m2 IV Infusion day 1 (46 hours)



mFOLFOX 6



(Every 2 weeks)



(4 cycles)



Oxaliplatin 85 mg/m2 day 1



Leucovorin 400 mg/m2 day 1



5-FU 400 mg/m2 IV Bolus day 1 and 2



5-FU 1200 mg/m2 IV Infusion day 2 days



CapeOX



(Twice daily x 14 days)



(every 3 weeks)



Oxaliplatin 130 mg/m2 day 1



Capecitabine 850 mg/m2 PO BID for 14 days



FOLFIRI



(every 2 weeks)



Irinotecan 165 mg/m2 day 1



Leucovorin 200 mg/m2 day 1



5-FU 400 mg/m2 IV Bolus day 1 and 2



5-FU 600 mg/m2 IV Infusion day 1 and 2 (22 hours)



FOLFOXIRI



(every 2 weeks)



Irinotecan 180 mg/m2 day 1



Oxaliplatin 85 mg/m2 day 1



Leucovorin 200 mg/m2 day 1



5-FU 3200 mg/m2 IV Infusion day (48 hours)



Bevacizumab5-10 mg/kg IV every 2 weeks with chemotherapy
Cetuximab400 mg/m2 IV day 1, then 250 mg/m2 IV weekly
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