Rectal
Cancer
Rectal
Cancer
Anatomic Location of CRC
Cecum
14 %
Ascending colon 10 %
Transverse colon
12 %
Descending colon
7 %
Sigmoid colon
25 %
Rectosigmoid
9 %
Rectum
23 %
70
%
Epidemiology
Increasing Incidence of CRC
Incidence 30-40 / 100000 / year
>70 year 300 / 100000 / year
third most common malignant
disease
second most common cause of
cancer death
Epidemiology
Lifetime risk
1 in 10 for men
1 in 14 for women
Generally affect patients > 50 years
(>90% of cases)
Forms
Hereditary
Family history, younger age of onset, specific
gene defects
F.ex.Familial adenomatous polyposis (FAP),
hereditary nonpolyposis colorectal cancer
(HNPCC or Lynch syndrome)
Sporadic
Absence of family history, older population,
isolated lesion
Familial
Family history, higher risk of index case is young
(<50years) and the relative is close (1
st
degree)
Histopathology
Generally adenocarcinoma
Decreasing mortality of CRC
5-year Survival
1960-70
1980-90
Colon cancer
40-45%
60%
Rectal cancer
35-40%
58%
Tis
Tis
T
T
1
1
T
T
2
2
T
T
3
3
T
T
4
4
Extension
Extension
to an adjacent
to an adjacent
organ
organ
Mucosa
Mucosa
Muscularis
Muscularis
mucosae
mucosae
Submucosa
Submucosa
Muscularis
Muscularis
propria
propria
Subserosa
Subserosa
Serosa
Serosa
TNM Classification
Symptoms and metastasis
Rectal carcinoma symptoms
PR bleeding, mucus
Change of bowel habits
Anal, perineal, sacral pain
Local invasion
Bladder symptoms
Female genital tract symptoms
Metastasis
Liver (hepatic pain, jaundice)
Lung (cough)
Bone (leucoerythroblastic anaemia)
Regional lymph nodes
Peritoneum (Sister Marie Joseph nodule)
Others
Purpose of
Radio(chemo)therapy in
Rectal Cancer
To lower local failure rates and improve
survival in resectable cancers
to allow surgery in primarly inextirpable
cancers
to facilitate a sphincter-preserving procedure
to cure patients without surgery: very small
cancer or very high surgical risk
Rectal Cancer
Surgery is the mainstay of treatment of RC
After surgical resection, local failure is
common
Local recurrence after conventional surgery:
15%-45% (average of 28%)
Radiotherapy significantly reduces the
number of local recurrences
Colonoscopy
Double-contrast
Barium enema
Thank
you