Rectal

Question 1

T1N0, low risk management

Answer 1

Trans-anal local excision

T1 = invades submucosa

Question 2

T1N0 high risk and T2N0 management

Answer 2

Transabdominal resection (total mesorectal excision with resection of local LNs)
If then found to have higher stage disease, give adjuvant chemoRT

T2 = invades muscularis propria

Question 3

T1 high risk characteristics

Answer 3

+LVI
Poorly differentiated
Invasion to lower third of submucosal level

Question 4

T3 Nany, T1-2 N1-2 treatment

Answer 4

Neoadjuvant chemoRT with capecitabine or 5-FU, followed by surgery and 4-6 months adjuvant FOLFOX/CAPEOX
Or

Neoadjuvant FOLFOX/CAPEOX + chemoRT (cape or 5-FU), followed by surgery

Question 5

T4 Nany treatment

Answer 5

Neoadjuvant FOLFOX/CAPEOX and chemoRT (cape or 5-FU), followed by surgery

Can give neoadjuvant chemo and chemoRT in either order (but all neoadjuvant)

Question 6

1st line metastatic treatment

Answer 6

RAS/RAF WT: FOLFOX/IRI + cetuximab/panitumumab
RAS/RAF mut: FOLFOX/IRI + bev

Treat like a left sided colon cancer