Leading Swedish rectal cancer surgeon discusses ongoing advances in rectal cancer treatment. Wider use of tumor molecular markers predicts patients at risk of rectal cancer relapse and risk of distant metastases. Precision medicine meets precision surgery. Better educated patients will demand the best treatment methods from their surgeons and oncologists. Minimally invasive rectal cancer surgery methods will be used more often. Rectal cancer treatment options in the future. Dr. Anton Titov, MD. Personalized medicine in rectal cancer treatment. Precision medicine in rectal cancer therapy. Molecular markers to select personalized treatment for each patient with rectal cancer. Rectal cancer patients should demand best care and find best surgeons and oncologists on internet. Dr. Anton Titov, MD. Multidisciplinary teams must review all rectal cancer patients for multimodality treatment of rectal cancer by surgery, radiation therapy and chemotherapy. Patients must demand the best rectal cancer treatment quality. Advanced rectal cancer surgery. Medical second opinion confirms that rectal cancer diagnosis is correct and complete. Medical second opinion also confirms that rectal cancer surgery is required. Best treatment for rectal cancer. Dr. Anton Titov, MD. Medical second opinion helps to choose the best treatment for 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. Video interview with leading expert in rectal cancer treatment surgery and minimally invasive rectal cancer treatment. Rectal cancer treatment options in the future. Dr. Anton Titov, MD. Dr. Holm, you have more than forty years of experience treating rectal cancer patients in very difficult situations. You have achieved international authority status globally on rectal cancer treatment. Dr. Anton Titov, MD. What is the future for rectal cancer treatment? What kind of advances rectal cancer patients can hope for in the next several years? Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). It is a good and also very difficult question. I think we're living in time where we have more and more focus on personalized medicine. That means that rectal cancer treatment must be tailored to the individual patient. I think rectal cancer patients are getting more and more aware of how cancer should be treated. Rectal cancer patients are on the internet, they read a lot. We also have cancer patients' registries in many countries. There is quality scoring of the hospitals. So many rectal cancer patients will seek treatment in hospitals that are highly ranked for good skills. So I think that is one important future trend in rectal cancer treatment. The patient will demand high quality treatment much more than today. I mean today or in the past, patients had just gone to the local hospital they have met their doctor and they have trusted that doctor. Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). In the future patients would be much more aware, much more educated. Patients would seek the treatment in the hospital for the best results, I am sure. Also for the individual rectal cancer patients we will have molecular markers in the near future. Tumor markers will predict rectal cancer prognosis with high accuracy. So in the near future we will predict prognosis for rectal cancer patient from biopsies. We will see what kind of genetic pattern the rectal cancer tumor has. We will be able to tailor the treatment for rectal cancer much better. Some rectal cancer patients may not benefit from radiation therapy. Some rectal cancer patients may not benefit from chemotherapy. Some patients with rectal cancer have a very low risk of metastasis. Other rectal cancer patients have high risk of metastases. We will predict that much better just by multiple molecular markers in the future. Also I think minimally invasive procedures for rectal cancer treatment will be much more common than they are today. We can already see that minimally invasive surgery for rectal cancer treatment is increasing very rapidly. Now with the new robotic surgery more patients have minimally invasive surgery to treat rectal cancer. Recently a new method of transanal total mesorectal excision of rectal cancer has been launched. This surgery method is now taking over quickly. Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). In one way treatment of rectal cancer has become more and more complex today. There are so many options and there are so many possibilities in treatment of rectal cancer. We have to tailor the treatment for each individual patient. That means that to deal with patients with rectal cancer you have to be very very well educated. Again, that means that you have to centralize treatment in hospitals with high volumes. Where doctors know how to treat rectal cancer well. This is the future of rectal cancer treatment: high-volume surgical departments, well-educated patients, individualized treatments based on molecular assessments, and then more minimally invasive surgery. That is the summary of future trends in rectal cancer treatment. Dr. Anton Titov, MD. Clearly these are recurring themes in cancer treatment. It requires multidisciplinary treatment teams and high volume surgical procedures. Dr. Anton Titov, MD. For best treatment results, cancer surgeon has to have high-volume surgery in that particular type of surgical operation that has to be done on the patient. These are recurring themes that come up in our conversations across various medical and surgical specialties. Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). Today you should not be allowed to treat patients with rectal cancer unless you discuss them in the multidisciplinary team meeting before and even after surgery. So the decision can be taken. Does rectal cancer patient need more treatment? How the patient should be followed up? It's obvious that some patients with rectal cancer have a very low risk of recurrence. Maybe you don't have to follow them at all. Some rectal cancer patients have a high risk of cancer recurrence. They should be followed very intensively. All of these things would be much more demanding in the future. That's why you need the multidisciplinary treatment teams. That's why you need the high volume surgical units to treat patients with rectal cancer. Dr. Anton Titov, MD. There is also initiative and activity by the patients seeking the correct treatment. Patients should understand the value of going to the best cancer surgeon. That surgeon must have the most experience in doing the correct surgery. Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). Then we have obstacles to best treatment of rectal cancer. Because at least in the Swedish health system there is no free market. So the patient cannot go to any hospital they want to go to. The government decides how many operations each hospital is allowed to do every year. This is a problem. But hopefully the demand by patients will solve that in the future. So that if the rectal cancer patient wants to go to hospital, then the government will pay for it. So that hospital will increase their workload. Hospitals that are not so popular will have to close down. I hope that will be the future. The availability of treatment has to be tailored to the patient's needs. It should be the patients who decide who should treat them. Not the way it has been to date, when doctors decide who should treat the patient. Dr. Anton Titov, MD. So patients should become true consumers of health care. For some reason the term "client" or "consumer" has had negative connotations in medicine. That's absolutely not true. Because "patient" means somebody who is patiently awaits. That's not the way medicine is going. Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). Future will be completely different. Patients will demand a lot of information, they will demand to come to special treatment units. Patients will demand to have the best possible treatment. Patients will find out about best treatment options on the Internet and in the open registries. That would be the future. Dr. Anton Titov, MD. Professor Holm, thank you very much for this very informative conversation. It's a very exciting area of oncology. Dr. Anton Titov, MD. Rectal cancer is a difficult problem, but so much has been achieved. In our conversation today it is clear a lot more will be achieved in the future. Thank you very much! Dr. Holm. Thank you! Rectal cancer best treatment options require multidisciplinary team and active patient role in cancer therapy. Surgery, radiotherapy and chemotherapy combined.