Categorized | Cancer

Dr. Mai Brooks Rectal Cancer Statistics

In the United States in 2017, there will be an estimated 40,000 new cases of rectal cancer and 96,830 colon cancers.  Dr. Mai Brooks believes in 2017, approximately 50,310 people will die from these two malignancies.

Once rectal cancer is diagnosed, a complete colonoscopy and a contrast-enhanced CT of the chest abdomen and pelvis should be done.  Furthermore, an MRI or endorectal ultrasound is carried out to determine the depth of the tumor and potential involvement of lymph nodes.  This is important to decide what kind of surgery to recommend to the patient.  For selected early small superficial cancer, transanal excision is appropriate.  This operation is performed through the lumen of the anorectum, without any incision in the abdomen.  In most patients, abdominal surgery is required.  If the tumor is far enough from the anus, a Low Anterior Resection (LAR) operation removes the middle and upper rectum and reconnects the colon to the rest of the anorectum.  However, if the tumor is close to the anus, an AbdominoPerineal Resection (APR) is required.  Here, the patient receives a permanent colostomy.  Both LAR and APR may be performed with an open midline incision in the abdomen, or with the laparoscope via multiple small incisions.  Both approaches have similar long-term outcome in regards to recurrence and survival.

If preoperative testing indicates that the tumor has penetrated the wall of the rectum or cancer has spread to surrounding lymph nodes, the patient should have chemotherapy (and radiation) up front.  Dr. Brooks says this treatment is often successful in shrinking the tumor enough to make surgical resection more successful, and decrease the chance of a permanent colostomy.

Many cancer cases present with concurrent spread to the liver.  If possible, the liver metastasis should be resected as well as the cancer in the rectum.  If surgery is not feasible, the liver metastasis may be treated with:

1) Chemotherapy delivered into the hepatic artery

2) Occlusion of the artery feeding the cancer

3) Radiation

4) radio-frequency ablation

Sometimes, a patient may have a single metastatic nodule in the lung that can be removed with surgery.  .  For selected early small superficial cancer, transanal excision is appropriate.  This operation is performed through the lumen of the anorectum, without any incision in the abdomen.  In most patients, abdominal surgery is required. In advanced or metastatic cases, chemotherapy is usually administered first.  This treatment may sometimes be successful in shrinking the tumor enough to make surgical resection possible.

 

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