Rectal Cancer: Preoperative Chemo & Radiation Therapy

Medically reviewed by: Gary H. Hoffman, MD

Rectal Cancer.  Before Surgery.  Los Angeles Colon and Rectal Surgical Associates.

With modern screening protocols,  and following years of patient education, the incidence of colon and rectal cancer seems to be declining.  By removing polyps before they can become malignant, colon and rectal surgeons (proctologists) in Los Angeles, and all cities across the country, have made an impact on cancer diagnosis rates and rectal cancer death rates.

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Unfortunately, not infrequently, cases of anal cancer still are seen and require treatment.  It is at this point that the disease becomes multidisciplinary.  The care of the patient is now shared by the colon and rectal surgeon, the radiation therapist and the oncologist.  Working together, this team of specialists can give patients the best odds for survival.

What Is The Preoperative Regimen for Rectal Cancer?

Once the diagnosis of rectal cancer is made, many tests are ordered and consultants are asked to help in the treatment.  Over many years the regimen for the treatment has evolved.  The treatment is named the Nigro protocol, after Norman Nigro, a colon and rectal surgeon who discovered the effects of chemotherapy and radiation therapy on rectal cancer. The regimen of chemoradiation is known as neoadjuvant therapy.  It is given before the operative removal of the tumor.

After the consultations have made performed, patients are given chemotherapy for 6 weeks.  The regimen consist of two drugs.  They are 5-Fluororacil (5-FU) and leucovorin.  During the 6 weeks of chemotherapy, the patient is also given 6 weeks of radiation therapy, 5 days per week.  The chemotherapy sensitizes the rectal cancer to the effects of irradiation.

After the completion of this course of treatment, the patient is given a 6 to 8 week rest period.  It has been shown that the tumor-killing effects of chemoradiation continue during the rest period.

Why The Neoadjuvant Therapy?

It is believed that in addition to shrinking the rectal cancer, the chemoradiation seals the lymphatic vessels next to the tumor.  The lymphatics drain the tumor field and tumor, if not treated preoperatively,  can enter the lymphatics, spread to the lymph nodes and decrease survival.  For anal cancer, neoadjuvant therapy is all that is needed.  However, sometimes, an operation is rquired in order to adequately remove the tumor.

Long term survival has increased with this treatment.  The recurrence rate has decreased, as has the suture line recurrence rate (recurrence of tumor at the area where the two “good” pieces of the rectum have been reconnected).  Neoadjuvant therapy has an important role to play in the treatment of rectal cancer.

Los Angeles Colon and Rectal Surgical Associates

The board certified surgeons of Los Angeles Colon and Rectal Surgical Associates are specifically educated in the diagnosis and treatment of rectal cancer.  They have many years of combined experience in treating all diseases of the colon rectum and anus.

By calling (310)273-2310, you can take the first step to maintaining your health, or restoring you to your normal good health.

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