Many patients, once they find out they are suffering from rectal cancer, often go to the hospital with their family members to seek treatment urgently and ask the doctors to remove the tumor as soon as possible. In fact, the treatment of modern rectal cancer is different from that of the past, and the time of surgery is determined by the doctor according to the condition and the overall treatment, and some cases are prone to local recurrence and many cases even lose the opportunity to preserve anus.
Therefore, for patients suffering from rectal cancer, it is very crucial to find a hospital and a specialist to carry out systematic treatment. We hope this article can help patients to get reasonable treatment and get a chance to preserve anus.
Colorectal cancer is a common malignant tumor in the gastrointestinal tract. Originally, colon cancer and rectal cancer were collectively referred to as colorectal cancer, but recently it has been found that rectal cancer and colon cancer have many differences in biological behavior and treatment methods, therefore, rectal cancer and colon cancer have been distinguished in the professional field and treatment guidelines have been formulated separately.
Among gastrointestinal tumors, colorectal cancer has a relatively good prognosis, with a median survival of more than 30 months after comprehensive treatment, even at advanced stages. A distinct difference from the colon cancer treatment system is that treatment of rectal cancer involves preservation or restoration of important organ functions, mainly including: preservation of the anus, good postoperative sexual function, urinary function, and bowel function.
The treatment of rectal cancer is far more complicated than that of colon cancer for the following reasons: first, anatomical reasons, the anatomical structure of this area is complex, and there are many important adjacent organs, such as genitourinary organs mainly concentrated in this area; second, functional reasons, the preservation of anus should be considered during surgery, and attention should also be paid to sexual function and urinary function, etc.; third, the complexity of treatment, the treatment plan should be reasonably formulated according to the condition before and after surgery. The third is the complexity of the treatment, which requires a rational treatment plan before and after surgery, such as the rational implementation of radiotherapy;
Fourth, the difficulty of doctors’ mastery of the treatment system of this disease. The doctors’ mastery of the diagnosis and treatment system of rectal cancer requires both a mentor and sufficient understanding, otherwise it is difficult to implement the principles required by the guidelines to the individual patients and to achieve the best individualized treatment. In fact, rectal cancer can be detected early.
In fact, rectal cancer can be detected at an early stage, and frequent blood in the stool is an important symptom, but many people tend to take it lightly or are reluctant to see a doctor, but in fact, a rectal finger examination or a simple colonoscopy can confirm the diagnosis. Grasp such a scale: if blood in stool is more than two weeks, you should go to hospital for relevant examination. Adhering to this point, most rectal cancers can be detected early.
The current professional field divides rectal cancer in four stages.
Stage I tumor is located in the mucosal layer, which is an early stage tumor and can be cured by local excision without the need of other treatments such as radiotherapy and chemotherapy.
Stage II tumor invades into the muscular layer, but there is no lymph node metastasis, surgical resection is the main eradication means.
Stage III tumor invades the muscular layer or goes outside the muscular layer and has lymph node metastasis. Pre- and post-operative radiotherapy is usually supplemented with radiotherapy to reduce metastasis and recurrence.
Stage IV belongs to advanced stage, mainly with distant metastasis, and comprehensive treatment is the main treatment means, such as surgery, radiotherapy, chemotherapy, targeted therapy, etc. As part of comprehensive treatment, surgery is used to remove the primary lesion, relieve obstruction, bleeding, etc., and sometimes it is also a means to obtain a cure. However, advanced stage of rectal cancer is not equal to incurable, which is the difference between colorectal cancer and other tumors, such as isolated or resectable liver metastases and lung metastases, the long-term survival rate after resection is still about 30%.
More than 60% of the patients met in the clinic belong to the third or fourth stage, that is, the middle and late stage, in order to improve the efficacy, it is particularly important to design a reasonable comprehensive treatment
The pre-treatment staging is based on the experience of the surgeon, preoperative examinations such as MRI, intracavitary ultrasound, and CT, and is not as correct as the postoperative pathological staging. However, preoperative staging is important because a lot of treatment has to be performed before surgery, when the doctor’s experience and authority will be the primary consideration.
In the past, whether to preserve anus for rectal cancer was often determined by the distance of the tumor from the anus, for example, <7cm was often considered not to preserve anus. With the development of science and technology and the deepening of the understanding of this disease, this is no longer a consensus, but depends more on the combination of various factors rather than the single distance factor. For example, the surgeon's technique, the hospital's equipment, and the application of comprehensive treatment. Therefore, when a doctor thinks that anal preservation is not possible, it is better for the patient to go to a more authoritative institution or to have a more authoritative doctor in anal preservation to assess whether anal preservation is possible and to avoid the regret of a doctor's arbitrary decision. < p="">
Surgical treatment: Up to now, surgical resection is still the means to obtain a complete cure for rectal cancer. From the analysis of evidence-based medicine, the surgeon’s careful and standardized surgical operation will obviously affect the patient’s prognosis, such as the recurrence rate will be reduced by the surgical operation according to the principle of TME, and recently, laparoscopic resection of rectal cancer has been carried out. However, for the patient, the short-term quick recovery or small wound is really not something to be strongly concerned about, but the long-term survival is what is important.
The important reason is that there is a learning curve for laparoscopic techniques, and the patient will undoubtedly not benefit from practicing during this learning curve, while oncology patients generally have only one chance for radical surgery, so reliability is the most important. You will understand why this is the case if you understand the cautiousness of laparoscopic surgery for oncology patients in developed countries.
There are many surgical methods for rectal cancer, which are summarized into anal preservation surgery and non-anal preservation surgery
Anal conserving surgery: DIXON surgery, local excision, PARK surgery, trans-sphincter interval surgery, etc.
Non-protective surgery: Miles surgery, ELAPE surgery, columnar resection, etc.
Since the rectum is located in the pelvis, it is often difficult or inadequate to expose the view during surgery, so it is not easy to do a good job in this area.
Chemotherapy: reasonable drug treatment can extend survival and reduce recurrence rate to some extent, and the application of chemotherapy before surgery, also known as neoadjuvant chemotherapy, is of more concern to surgeons, the use of preoperative anti-cancer drugs can play a role in reducing the metastasis of cancer cells caused by surgery, thereby reducing recurrence, and the current common prescription is FOLFOX or XELOX. The results from practice do not show such problems.
Preoperative radiotherapy for rectal cancer has been standardized and used clinically, and has been helpful in reducing recurrence rates and downgrading and increasing anus preservation, and its preoperative use is superior to postoperative.
Some other treatments, such as heat therapy, Chinese herbal medicine and biological therapy, can be applied, especially the prospect of biological targeted therapy is more optimistic.
To sum up, a patient diagnosed with rectal cancer should visit a specialized department, look for a more authoritative doctor for systematic evaluation and preoperative staging, and formulate a corresponding overall treatment plan, including preoperative radiotherapy and chemotherapy, and choose the right time for surgery. Through these processes, it should be possible to achieve the best treatment benefits without leaving too many regrets in the whole treatment process.