Flashcards in B10. Radiotherapy, surgical, and pharmacological treatment of rectal tumours Deck (15):
Signs of rectal tumors
Signs of Rectal Tumours: Blood in stool, Altered bowel habits, Pain, Obstipation (severe constipation)
T1a or Tis (in situ) rectal tumor treatment
Total excision with transanal endoscopic operation or transanal minimally invasive surgery
T1a-2 rectal tumor treatment
Radical surgery alone. Resection of rectum, perirectal fatty tissue, and its enveloping fascia. This is called total mesorectal excision
T3-4, N1-3, M0 rectal cancer treatment
Preoperative radiotherapy or simultaneous chemoradiotherapy
Metastatic rectal cancer treatment
Chemotherapy combined with targeted therapy is the first option for treating metastatic rectal
cancers. In these cases, radiotherapy and surgery are only recommended if R0 resection is
achievable for every visible tumour, and these are under systemic controlby chemo-biological therapy. After initial pharmaceutical therapy, if downsizing is adequate, simultaneous surgery may be possible for small rectal tumours, possibly followed by adjuvant
chemoradiotherapy. However, two-stage surgeries are much more common, where the metastases and the primary tumour are excised separately.
Two basic types of rectal surgery
1.) Dixon’s method of low anterior resection, conserves sphincter. (Typically requires deviating stoma to protect sphincter while it heals, usually a ileostoma)
2.) Abdominoperineal rectal extirpation, formation of an end sigmoidostoma with one opening
When is radiotherapy used in rectal cancers
Pre or postoperative, unresectable tumors, definitive or palliative.
External beam radiotherapy
Two radiotherapy protocols for rectal carcinoma
-Short course treatment delivers a 5 gray for 5 consecutive days. (Surgery has to be following weeks)
-Long course treatment is a total dose of 50.4 grays (1.8 grays per day). Usually combined with 5-FU
Palliative radiotherapy depends on?
General condition of the patient
Radiotherapy side effects
Diarrhea, abdominal cramps, radiation induced cystitis are most common.
Also bleeding secretion, urge to defecate, obstipation, fetal incontinence, intestinal adhesions, sexual dysfunction
Is adjuvant chemotherapy given in stage II (T3-4, N0, M0)?
Not routinely recommended
T3N0M0 rectal tumors need adjuvant chemotherapy
Increased risk factors include bowel obstruction, perforation, vascular and/ or perineural invasion, and grade III histological type
When is chemotherapy given after surgery? Which drug?
6-8 weeks after surgery with 5 FU
In stage III rectal tumors which drug is given? For how long?
Oxaliplatin for 6 months (12 bi weekly cycles)