Rectal Cancer Management Flashcards
1
Q
What is the typical surgical technique for rectal cancer?
A
- gold standard
- Used to be blunt dissection
- Now sharp dissection around mesorectal fascia (fat, nodes and vessels), crm
- Clear
2
Q
When or why are alternative surgical techniques suggested?
A
- Laparoscopic can be offered
- Open surgery my be offered for locally advanced tumours
- Robotic can be considered with appropriate audited outcomes
3
Q
What is laparoscopic surgery?
A
- Keyhole
- ## MDT will discuss
4
Q
What is Transanal Total Meso Rectal Excision?
A
- Most people will have TME
- Remove fatty tissue containing lymph nodes, blood vessels meaning tumour is less likely to recur
5
Q
What is an anterior resection?
A
- Used for rectal cancers of the upper and middle part of the rectum
- Removes part of the bowel which contains the cancer
and rejoins the open ends - May result in a temporary stoma, may be reversed after a few months.
6
Q
What is colo-anal and j-pouch surgery?
A
- Cancer in low rectum
- Surgeon makes a pouch from part of colon before joining to the anus
- Pouch acts as new rectum and stores stool until it is convenient to pass them
- May use temporary stoma
7
Q
Abdomino - Perineal Resection is used when?
A
- Extremely low cancer in rectum (close to anus)
- Rectum and anus are removed
- Long wound
- Wound may be closed using muscle and skin from other part of body (flap)
- Permanent stoma bag
8
Q
What are TAE, TAMIS, TEMS?
A
- TAE = transanal excision, enter through anus and remove tumour and small amount of tissue
- TAMIS = laparoscopic procedure, sphincter sparing
- TEMS = uses endoscope, sphincter sparing
9
Q
Who is offered pre-op treatment?
A
- Not RT for early stage (T1,T2,N0,M0) as patients are low risk
- Will offer RT or chemo-RT if node positive
10
Q
When is surgery offered?
A
- T1-T2, cN1-N2, M0 or cT3-T4, any cN, M0
- Make sure patients are aware of risk of recurrence if surgery is deferred
- Anyone with a resectable tumour
11
Q
What does NICE classify as high or low risk?
A
- Margin breached or threatened, or encroaching on sphincter
- Low risk is cT1,2 or 3a
12
Q
What is Papillon and when is it used?
A
- Used when surgery is not suitable
13
Q
What if a tumour is not resectable?
A
- Pre-op RT can be used
- Ideally will shrink tumour
- Gap between
14
Q
Post-op options for treatment?
A
- Stage 3 rectal cancer, without pre-op, may be given post-op chemotherapy
15
Q
Role of XRT in rectal cancer treatment?
A
- Post-op with or without chemo
- Short course pre-op
- long course pre-op
