Colorectal Cancer Prevention (PDQ®): Prevention - Health Professional Information [NCI] - Changes to This Summary (09 / 27 / 2013)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.Editorial changes were made to this summary.This summary is written and maintained by the PDQ Screening and Prevention Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.
Rectal Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Cellular Classification and Pathology of Rectal Cancer
The World Health Organization (WHO) classification of tumors of the colon and rectum include the following:Epithelial TumorsAdenomaTubular.Villous.Tubulovillous.Serrated.Intraepithelial neoplasia (dysplasia) associated with chronic inflammatory diseasesLow-grade glandular intraepithelial neoplasia.High-grade glandular intraepithelial neoplasia.CarcinomaAdenocarcinoma.Mucinous adenocarcinoma.Signet-ring cell carcinoma.Small cell carcinoma.Adenosquamous carcinoma.Medullary carcinoma.Undifferentiated carcinoma.Carcinoid (well-differentiated neuroendocrine neoplasm)Enterochromaffin (EC)-cell, serotonin-producing neoplasm.L-cell, glucagon-like peptide and pancreatic polypeptide/peptide YY (PYY)-producing tumor.Others.Mixed carcinoma-adenocarcinomaOthers.Nonepithelial TumorsLipoma.Leiomyoma.Gastrointestinal stromal tumor.Leiomyosarcoma.Angiosarcoma.Kaposi sarcoma.Melanoma.Others.Malignant lymphomasMarginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type.Mantle cell
Rectal Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage IV and Recurrent Rectal Cancer
Treatment options for local control:Resection of locally recurrent rectal cancer may be curative in selected patients.Palliative surgical resection with either low-anterior resection (LAR) or abdominoperineal resection (APR). Palliative radiation therapy.[2,3]Palliative chemotherapy.[4,5,6,7,8,9,10]Palliative chemoradiation.[11,12]Chemotherapy alone for local control.Palliative, endoscopic-placed stents to relieve obstruction.Treatment options for systemic control:Resection of liver metastases in selected patients (5-year cure rate with resection of solitary metastases exceeds 20%).[14,15,16,17,18,19,20,21,22,23]Resection of isolated pulmonary or ovarian metastases.Systemic chemotherapy (see below).Clinical trials evaluating new drugs.Metastatic Rectal CancerTreatment of patients with recurrent or advanced colorectal cancer depends on the location of the disease. For patients with locally
Rectal Cancer Treatment (PDQ®): Treatment - Patient Information [NCI] - Recurrent Rectal Cancer
Recurrent rectal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the rectum or in other parts of the body, such as the colon, pelvis, liver, or lungs.
Rectal Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage I Rectal Cancer
Stage I tumors extend beneath the mucosa into the submucosa (T1) or into, but not through, the bowel muscle wall (T2). Because of its localized nature at presentation, stage I has a high cure rate. Treatment options:Wide surgical resection and anastomosis when an adequate low-anterior resection (LAR) can be performed with sufficient distal rectum to allow a conventional anastomosis or coloanal anastomosis.Wide surgical resection with abdominoperineal resection (APR) for lesions too distal to permit LAR.Local transanal or other resection [1,2] with or without perioperative external-beam radiation therapy (EBRT) plus fluorouracil (5-FU).There are three potential options for surgical resection in stage I rectal cancer: local excision, LAR, and APR. Local excision should be restricted to tumors confined to the rectal wall and that do not, on rectal ultrasound or magnetic resonance imaging, involve the full thickness of the rectum (i.e., not a T3 tumor). The ideal candidate for local
Colorectal Cancer Screening (PDQ®): Screening - Patient Information [NCI] - What is screening?
Screening is looking for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early,it may be easier to treat. By the time symptoms appear,cancer may have begun to spread. Scientists are trying to better understand which people are more likely to get certain types of cancer. They also study the things we do and the ...
Colorectal Cancer Prevention (PDQ®): Prevention - Health Professional Information [NCI] - Who is at Risk?
For the great majority of people,the major factor that increases a person's risk for colorectal cancer (CRC) is increasing age. Risk increases dramatically after age 50 years; 90% of all CRCs are diagnosed after this age. The history of CRC in a first-degree relative,especially if before the age of 55 years,roughly doubles the risk. Other risk factors are weaker than age and family history. ...
Rectal Cancer Treatment (PDQ®): Treatment - Patient Information [NCI] - Treatment Options by Stage
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.Stage 0 (Carcinoma in Situ)Treatment of stage 0 may include the following: Simple polypectomy.Local excision.Resection (when the tumor is too large to remove by local excision).Internal or external radiation therapy.Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage 0 rectal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.Stage I Rectal CancerTreatment of stage I rectal cancer may include the following:Local excision.Resection.Resection with radiation therapy and chemotherapy before
Colorectal Cancer Screening (PDQ®): Screening - Health Professional Information [NCI] - Evidence of Harms
Harms are associated with the various modalities used to screen for colorectal cancer (CRC).Fecal Occult Blood Testing (FOBT)A systematic review done through the Cochrane Collaboration examined all CRC screening randomized trials that involved FOBT on more than one occasion. The trials reported a low positive predictive value for the FOBT, suggesting that more than 80% of all positive tests were false-positives. A positive test can lead to further diagnostic procedures that include colonoscopy or double-contrast barium enema plus flexible sigmoidoscopy.SigmoidoscopySigmoidoscopy can be an uncomfortable or painful procedure. Women may have more pain during the procedure, which may discourage them from returning for future screening sigmoidoscopies. Sigmoidoscopy can also cause perforation and bleeding, although this is rare.ColonoscopyClinically significant complications requiring medical intervention are rare but can include the following: perforations, bleeding, cardiovascular
Rectal Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage 0 Rectal Cancer
Stage 0 rectal cancer is the most superficial of all rectal lesions and is limited to the mucosa without invasion of the lamina propria. Because of its superficial nature, surgical and other procedures may be limited. Standard treatment options:Local excision or simple polypectomy.Full-thickness rectal resection by the transanal or transcoccygeal route for large lesions not amenable to local excision.Endocavitary radiation therapy.[2,3,4]Local radiation therapy.Current Clinical TrialsCheck for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage 0 rectal cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.General information about clinical trials is also available from the NCI Web site.References: Bailey HR, Huval WV, Max E, et al.: Local excision of carcinoma of the rectum for cure. Surgery 111 (5): 555-61, 1992. Kodner IJ, Gilley MT, Shemesh EI, et al.: Radiation