Rectal Cancer: A Cure Without An Operation?

Medically reviewed by: Gary H. Hoffman, MD

What Is Neoadjuvant Therapy?

Rectal cancer is a frightening diagnosis for anyone.  With the advent of newer chemotherapy drugs, combined with radiation therapy, cure rates have risen and death rates have fallen.  Good news. However, patients continue to require complex operations to remove the tumor. This requires removing all or part of the rectum, depending on the exact location of the tumor.   This operation is performed by a colon and rectal surgeon, also known as a proctologist.

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An Interesting Observation. The Tumor Is Gone.

Chemoradiation is routinely administered prior to the operation.  Interestingly, it has been noted that in many patients, the tumor seemed to “melt away” after treatment, but before the operation was performed.   This gave rise to the question as to whether or not patients could be treated with chemotherapy and radiation alone.  Often, after the operation was completed, the pathologist would report that there was no residual tumor seen in the specimen.  Great news!

Do I Really Need The Operation?

Of course, it did not take long for researchers to begin evaluating the question of which patients might possibly be treated with chemoradiation alone.  Doctor Angelita Habr-Gama, in Argentina, found that many patients had no visible tumor after chemoradiation, and she began a study in which she and her colleagues chose not to operate, and simply followed some of these patients after chemoradiation alone.

The results were startling.  26% of patients had no visible tumor after treatment.  All survived 5 years.  Other surgeons in the field confirmed these results.  Also, many patients who did not completely respond were able to have less drastic operations.  Finally, in other studies, those patients who did experience a recurrence after non-operative treatment, successfully underwent operative intervention.

Who Is A candidate For This Type Of Therapy?

At present, few institutions are offering this non-operative approach.  Furthermore, patients must be rigorously assessed after treatment to evaluate the rectum to be sure that the tumor has indeed regressed completely.  Exams, possibly biopsies (in the office) and scans will be used.  Research is presently underway, looking for a blood test that might predict which patients do not need an operation after chemoradiation.

What Next?  More Like, Who Next?

Evaluating  patients with rectal cancer requires focused evaluations  by a multidisciplinary team of physicians.  At an early stage of the process, patients will see a colon and rectal surgeon with extensive experience in treating rectal cancer.  The surgeon will help determine the best course of treatment.  Either way, you should expect the most up-to-date evaluation and treatment recommendations.  If an operation is needed, you will be given a chance to understand the proposed procedure.  The operation, if needed, will be done after 6 weeks of chemoradiation and a six week rest period.  It cannot be stressed strongly enough that in this rapidly evolving field of rectal cancer therapy, experience is crucial in determining accurate preoperative tumor localization and staging, and operative treatment.

Los Angeles Colon and Rectal Surgical Associates.

The surgeons of Los Angeles Colon and Rectal Surgical Associates are board certified and knowledgeable in all aspects of diseases of the colon, rectum and anus.  Each of the surgeons is an instructor in the colon and rectal surgical fellowship at Cedars-Sinai Medical Center.  Your consultation is confidential.  You can make an appointment by calling (310)273-2310.

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