Rectal Cancer Preservation: Balancing Cure and Quality of Life
Treatment of rectal cancer requires a multidisciplinary team, including surgical, radiation and medical oncologists, working together to best evaluate every patient’s individual disease. The team at Moffitt Cancer Center reviews every newly diagnosed rectal cancer within a specialized Rectal Cancer Tumor Board, which helps patients navigate the best treatment options. Balancing a cure and quality of life are two of the highest priorities that we focus on for every patient.
Over the past years, considerable advances in the management of rectal cancers have occurred. Traditionally, patients received preoperative therapies, such as chemotherapy and radiation, followed by rectal surgery. Although rectal surgery is indicated for most patients following preoperative therapies, many prefer to avoid surgery if feasible and safe, due to the associated bowel, sexual and urinary, morbidity and negative impact on quality of life.
The benefits of avoiding major rectal surgery can be substantial. This ‘tri-modality’ approach can be a long treatment process, though patients are supported throughout by dedicated rectal cancer nursing and patient “navigators.”
More recently, the possibility of avoiding (or deferring) rectal surgery has become increasingly pursued. Patients receiving preoperative treatments may respond exceptionally well, with re-staging evaluation following completion of treatments resulting in a scar without apparent residual cancer. These patients may elect to pursue a non-operative management approach to preserve the rectum, also called “watch-and-wait.”
The watch-and-wait approach may be an option for selected patients demonstrating a "complete" clinical response following preoperative treatments, reserving rectal surgery for "incomplete" responders and patients that regrow a tumor in surveillance. Surveillance is critical for these patients entering into watch-and-wait, requiring frequent endoscopic, clinical and imaging exams over the subsequent months to years in follow-up.
At Moffitt, we see a high volume of rectal cancer patients. Our multidisciplinary team, which also includes expert gastrointestinal radiologists and pathologists, has extensive clinical experience with watch-and-wait rectal cancer management. Rectal organ preservation is a highly active and promising research area, with encouraging data suggesting that highly selected patients may achieve a cure without compromising quality of life. The rectal cancer disease site continues to research all aspects of watch-and-wait, including maximizing the proportion and accuracy of patient selection and reaching a complete response.
To refer a patient with gastrointestinal cancer or a suspicious tumor finding, please complete our online form or contact a physician liaison for assistance. As part of our efforts to shorten referral times as much as possible, online referrals are typically responded to within 24 - 48 hours.