Rectal Cancer
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Our Treatments
Rectal Cancer
Rising in urban India due to sedentary lifestyle and low-fiber diets
Location
- Cancer arising in the last 15 cm of the large intestine, just above the anal canal
- Management differs from colon cancer due to proximity to pelvic organs
Treatment by Stage
Stage
Treatment Approach
Early-stage (T1–T2, N0)
Local excision (for very early T1) or surgery alone (Total Mesorectal Excision – TME)
Locally Advanced (T3/T4 or N+)
Neoadjuvant chemoradiation (CRT) → Surgery (TME) → Adjuvant chemotherapy
Metastatic (Stage IV)
Systemic chemotherapy ± targeted therapy; surgery or RT for selected cases
Role of Radiation Therapy
Indication
Regimen
Neoadjuvant (Standard of care)
45–50.4 Gy in 25–28 fractions + capecitabine or 5-FU
Short-course RT (alternative)
25 Gy in 5 fractions over 1 week
Adjuvant RT
If not given before surgery (rare)
Palliative RT
For bleeding, pain, obstruction
Surgery
- TME (Total Mesorectal Excision) is the gold standard
- Done 6–10 weeks after neoadjuvant CRT
- Sphincter-sparing possible in many cases, depending on tumor location
Chemotherapy
- Neoadjuvant CRT: Capecitabine or 5-FU with radiation
- Adjuvant chemo: FOLFOX or CAPOX post-surgery for high-risk cases
- Total Neoadjuvant Therapy (TNT): Emerging strategy – chemo + CRT before surgery
Key Points
- Neoadjuvant CRT improves local control and allows sphincter preservation
- Surgery remains the cornerstone of treatment
- Short-course RT is preferred in certain protocols for early-stage bulky tumors
Anal Canal Cancer
Site:
- Anal verge to anorectal ring
Risk Factors:
- HPV infection (type 16)
- Anal intercourse, HIV, immunosuppression
- Smoking
Treatment:
- Definitive chemoradiation (Nigro protocol)
- Surgery (abdominoperineal resection) reserved for salvage
RT Role:
- Combined with chemotherapy (5-FU + mitomycin C)
- Dose: 50.4–54 Gy over 5–6 weeks
- Organ preservation approach with excellent local control