The rectum has distinctive anatomic and physiologic features, which increase the risk of local spread and recurrence among rectal cancers as compared to colon cancers. Essential to the management of rectal cancers is accurate endoscopic localization as well as preoperative imaging assessment of local and distant disease. Successful oncologic care is multidisciplinary including input from Gastroenterologists, Surgeons, Medical and Radiation Oncologists, Radiologists, and Pathologists. Extensive planning of curative intent is mandatory as failures of upfront treatment present great long-term difficulty for patients and caregivers. Local recurrences are frequently associated with major morbidity including bowel and urinary obstruction, severe pain, and significantly diminished quality of life. Distant recurrence is associated with lower survival. Over the last two decades, there have been many advances in diagnostic imaging techniques as well as surgical techniques including transanal endoscopic microsurgery for very early stage cancers. Progress in curative management paradigms includes shorter courses of preoperative radiotherapy and chemotherapy doublet paradigms for perioperative treatment. This review describes the diagnosis, workup, and multimodality curative intent treatment of rectal cancers. It is emphasized that success begins in the hands and eyes of the gastroenterologist.
1Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada. 2Department of Hematology and Oncology, CancerCare Manitoba, Winnipeg, MB, Canada. 3Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. 4Department of Surgery, University of Manitoba, Winnipeg, MB, Canada. 5Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Received 24 November 2017; accepted 11 May 2018; published online 16 July 2018