Rectal Cancer Follow-up

Updated: May 31, 2018
  • Author: Burt Cagir, MD, FACS; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Follow-up

Deterrence/Prevention

On December 22, 2010, the US Food and Drug Administration approved the use of quadrivalent human papillomavirus (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. Approval was based on a study of men who have sex with men in which HPV vaccine was shown to be 78% effective in prevention of HPV 16– and 18–related anal intraepithelial neoplasms. [98]   

As of October 2016, the only HPV vaccine available in the United States is Gardasil 9 (Merck, Whitehouse Station, NJ). It provides coverage of coverage of HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. Gardasil 9 is approved for prevention of HPV-associated anal cancer and genital warts (condyloma acuminata) in males and females 9 to 26 years of age. [95]

 

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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%

A review of 111,453 patients in the National Cancer Data Base who were diagnosed with early-stage (T1N0 or T2N0) rectal cancer from 1998 to 2010 found that increasing age, male sex, higher comorbidity score, and positive or unknown final surgical margins were associated with poorer long-term adjusted overall survival. [41]

Recurrence of rectal cancer, which usually develops in the first year after surgery, carries a poor prognosis. Recurrence may be local, distant, or both; local recurrence is more common in rectal cancer than in colon cancer. Reported rates of local recurrence have ranged from 3.7% to 50%. [96] Factors that influence the development of recurrence include the following:

  • Surgeon variability

  • Grade and stage of the primary tumor

  • Location of the primary tumor (eg, low rectal cancers have higher rates of recurrence

  • Ability to obtain negative margins

Surgical therapy may be attempted for recurrence and includes pelvic exenteration or abdominal perineal resection 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. [97]

For patient education resources, see the Digestive Disorders Center and Cancer Center. Also, see the patient education articles Colon Cancer, Colonoscopy, Sigmoidoscopy, Abdominal Pain in Adults, Rectal Bleeding, and Rectal Cancer.

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