MKSAP Quiz: treating rectal cancer
MKSAP Quiz: treating rectal cancer
A 56-year-old woman undergoes initial screening colonoscopy. An abnormality is found 10 cm from the anal verge. Biopsy specimens confirm the diagnosis of a moderately differentiated adenocarcinoma. Rectal ultrasonography shows that the tumor has extended into the perirectal fat, but no lymphadenopathy is noted. Chest radiograph and CT scan of the abdomen and pelvis show no metastatic disease.
Which of the following is the most appropriate treatment at this time?
A. Surgical resection and adjuvant chemoradiation therapy
B. Chemotherapy alone
C. Radiation therapy alone
D. Surgical resection alone
E. Surgical resection and postoperative radiation therapy alone
MKSAP Answer and Critique
The correct answer is A) Surgical resection and adjuvant chemoradiation therapy. This item is available to online to MKSAP 15 subscribers as item 77 in the Hematology and Oncology module.
This patient has T3N0M0 stage II rectal cancer and is likely to benefit from a combined-modality approach. Stage II rectal cancer is treated with surgery and adjuvant chemoradiation therapy. Recurrence and death in stage II and III rectal cancer are decreased when radiation therapy is added to the recommended surgical and chemotherapy approaches. Preoperative chemoradiation with low anterior resection is becoming the treatment of choice to reduce the need for permanent colostomy, local recurrences, and long-term toxicity. However, in a randomized study comparing preoperative to postoperative chemoradiation, disease-free survival and overall survival were similar. Possible complications of radiation therapy include proctitis, intestinal obstruction, stricture, and fistula, often occurring long after treatment.
Radiation therapy as an adjunct to surgery for rectal cancer has been shown to reduce local recurrence but has not improved survival. Radiation therapy alone or chemotherapy alone is inadequate treatment of stage II rectal carcinoma.
Key Point
- Surgery and adjuvant combined chemotherapy and radiation therapy are the standard treatment for patients with stage II and III rectal cancer.