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Rectal cancer and systemic therapy of colorectal cancer 

Rectal cancer and systemic therapy of colorectal cancer
Chapter:
Rectal cancer and systemic therapy of colorectal cancer
Author(s):

Regina Beets-Tan

and Bengt Glimelius

DOI:
10.1093/med/9780199656103.003.0038_update_002

Updates

Location of the primary tumour in metastatic disease may be important.

Checkpoint inhibition is an emerging therapy in metastatic colorectal cancer with deficient mismatch repair.

New data provided for the timing of rectal cancer surgery after neoadjuvant (chemo)radiotherapy.

Stricter criteria for when lymph nodes on imaging are considered to be metastatic have been defined.

Updated on 29 March 2019. The previous version of this content can be found here.
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date: 23 October 2019

In rectal cancer treatment, surgery is most important. Dissection outside the mesorectal fascia, total mesorectal excision is required for cure in most cases; a local procedure is possible in the earliest tumours. Appropriate staging is required prior to treatment decision to stratify patients into risk groups. In early tumours surgery alone is sufficient whereas in intermediate cancers local recurrence rates are too high and preoperative radiotherapy is indicated. A short-course schedule is convenient, low toxic, although some prefer long-course chemoradiotherapy. The addition of a fluoropyrimidine enhances the radiotherapy. In locally advanced tumours preoperative chemoradiotherapy is required. The value of adjuvant chemotherapy in rectal cancer is controversial, particularly if preoperative chemoradiotherapy was used. Palliative chemotherapy prolongs life and improves well-being in patients with metastatic disease. Targeted drugs further improves the results to some extent. In some patients, chemotherapy may convert non-readily resectable metastases to resectable, and result in long-term cure.

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