Local recurrence of rectal cancer. Treatment options. 7
“Better cancer surgery technique decreased the risk of local recurrence of rectal cancer from 25% to 5% or 10%”. Why local relapse of rectal cancer should only be treated by few specialized colorectal surgeons? How to achieve 70% cure rate in locally recurrent rectal cancer? Rectal cancer: local recurrence treatment and prognosis. Dr. Anton Titov, MD. Recurrent rectal cancer surgery. Leading Swedish rectal cancer surgeon discusses locally recurrent rectal cancer treatment. Medical second opinion confirms that locoregional recurrence of rectal cancer diagnosis is correct and complete. Dr. Anton Titov, MD. Medical second opinion also confirms that locally recurrent rectal cancer surgery is required. Best treatment for recurrent rectal cancer. Medical second opinion helps to choose the best treatment for locally recurrent rectal cancer. Get medical second opinion on rectal cancer and be confident that your treatment is the best. Best rectal cancer treatment center and cancer surgeon to treat local recurrence of rectal cancer. Video interview with leading expert in rectal cancer treatment surgery and locally recurrent rectal cancer treatment. Rectal cancer local recurrence treatment prognosis. Dr. Anton Titov, MD. Modern methods of rectal cancer treatment, correct selection of the surgical procedure, radiation therapy and chemotherapy for each patient reduce risks of rectal cancer coming back. However 5% to 10% of rectal cancer patients have local recurrence of rectal cancer. How do you treat locally recurrent rectal cancer? Dr. Anton Titov, MD. What are the treatment options for patients who have rectal cancer come back in the pelvis? Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). First of all, we have to remember that the treatment of locally recurrent rectal cancer is extremely difficult. The chance of curing the patient with the local recurrence of rectal cancer is not great. When rectal cancer returns locally, it is very difficult to treat and it is difficult to cure. However now we see much fewer patients with local recurrence of rectal cancer. Because the risk of recurrence has gone from 25% to 5% or 10%, as you said. Reduced risk of rectal cancer recurrence means this. It is now even more challenging to treat patients with rectal cancer recurrences than before. Before we saw local recurrence of rectal cancer in the remaining mesorectum or close to anastomosis after surgical operation. Recurrence was happening centrally in the pelvis. Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). Those patients with recurrent rectal cancer were easy to cure. Because you could just do the complementary total mesorectal excision and get the locally recurrent rectal cancer out. This would cure the colorectal cancer patient. Now the local recurrence of rectal cancer is much more complex. Recurrent rectal cancer often grows into the pelvic wall, or into the sacrum or into the prostate or into the urinary bladder. These patients are much more difficult to cure. But some patients will have local recurrence of rectal cancer. The first and most important thing is to stage rectal cancer correctly in these patients. Surgeon should begin recurrent rectal cancer staging with an MRI. Then these patients should be referred to a specialized colorectal cancer centre. You have to send patients with recurrent rectal cancer to surgeons who are used to operate and treat locally recurrent rectal caner. Because it’s a very very difficult situation. So good staging of recurrent rectal cancer tumor is important. Dr. Anton Titov, MD. Patients must be referred to specialist centre for recurrent rectal cancer treatment. Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). Often such patients should have radiation therapy again to treat recurrence of rectal cancer. we hope there is a possibility for radiotherapy. Sometimes patients with locally recurrent rectal cancer have not received radiotherapy before. Then they should all have radiotherapy and chemotherapy before surgery. Surgeons should plan for usually a multi-organ resections. Nowadays for local rectal cancer recurrence you have to be prepared to do pelvic exenteration (pelvic evisceration) surgical operation. Or you have to do sacrectomy (resection of sacrum). Sometimes cancer surgeon has to remove a part of the pelvic sidewall. You have to do extensive surgery. Usually patients with recurrent rectal cancer bleed quite a lot. You need a multidisciplinary surgical team consisting of colorectal surgeons, orthopedic surgeons, plastic surgeons. Maybe you need a urologist too. So a variety of surgical expertise is required. Then you can plan to treat locally recurrent rectal cancer patient. Even if you have such comprehensive surgical team, a prerequisite for cure of locally recurrent rectal cancer is a radical operation with R0 resection margins. Sometimes you can achieve R0 resection. Then you can cure 65% to 70% of patients with local recurrence of rectal cancer. Dr. Anton Titov, MD. You can cure those rectal cancer patients who already have the cancer come back locally? That requires performing the correct method of surgical operation. Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). Sometimes you do the correct operation in the correct way in local recurrence of rectal cancer. When you achieve R0 resection, the prognosis can still be good. But if you do a bad operation and have a positive tumor margin (R1 or R2), you would not cure the patient. Because surgical operations in patients with locally recurrent rectal cancer are much more difficult and much more complex. All patients with recurrent rectal cancer have to be referred to a highly specialized center. This is crucial for success in treatment of locally recurrent rectal cancer. Dr. Anton Titov, MD. Rectal cancer. Local recurrence treatment requires highly specialized colorectal cancer surgeon and multidisciplinary team method. 70% cure rate in skilled hands of cancer surgeon.
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