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