rectal cancer staging radiology

[music] the most common sign and symptom of rectal canceris rectal bleeding. and it's usuallypainless bleeding. and it can be either blood thatappears on the toilet paper or in the toilet itselfafter a bowel movement. other signs can be pain, depending on where the tumor is,diarrhea or constipation. the scary thing aboutrectal cancer is, commonly,

there are no signs or symptoms. and people can have this tumorgrowing in them for a while and not even know it. that's why it's very importantto adhere to the screening guidelines that have beenestablished, to either prevent colon and rectal cancerby removing precancerous lesions when they occur in individuals,or detect cancers early. so that everybody's chanceof survival is better. screening for rectal cancer isgenerally that people should

undergo a regular physicalexam with a digital exam, digital rectal exam, looking for blood in the stool whilstthe digital exam is done. when people get to the age of50, if they don't have any history of colon or rectalcancer in their family, and if they don't have any historyof other colonic diseases, like inflammatory bowel disease, they should undergoa screening colonoscopy. if they're not goingto have a colonoscopy,

they can have a sigmoidoscopy,which is looking at less of the colon in conjunction withradiology tests to look for either precancerous orcancerous conditions. now if people havea history of colon and rectal cancer in their family,then generally we recommend the screening start ten yearsearlier at the age of 40. and if the family member thathas colon or rectal cancer in your family has had that cancervery early, then we could potentially recommend screeningeven earlier than that.

so, screening is veryimportant because often times these cancers develop fromprecancerous lesions. and if they'redetected early and removed then you won'tdevelop the cancer. so people should considergenetic testing if they are what i wouldconsider a young person. and young we would define assomeone under the age of 40, or people who have a significantfamily history of rectal cancer. those people are individualswho have direct relatives,

either a mother, father, sister,or brother with rectal cancer. if people have many relativesin their family that have rectal cancer, so uncles, aunts,cousins, those also are people who i think should considersome sort of testing. nowadays, almost all colorectalcancers undergo some form of genetic testing. those tests that are doneare looking at specific gene defects that we thenuse to define how we treat the cancers after surgerywith chemotherapy.

so there are some defects thatwe have that will respond very well to chemotherapeutic agents. and so by defining thosedefects in all individuals, we know whether or not theyshould get certain drugs. there actually are quite a fewminimally invasive treatment options now for rectal cancer. there is the, what we callthe laparoscopic approach, which uses a camera and instrumentsthat are placed through small incisions to free the cancerup from its attachments.

free the rectum upfrom its attachments. remove the portion of colon andrectum that has the cancer and put everything back together. that can be done inconjunction with new technology that allows us tooperate through the anus freeing up the rectum indifficult places. that's something calleda tamis or a tem procedure. or it can be done withthe robot, which currently is also used to mobilize and removethe portions of the colon and

the rectum, andput things back together. technology is advancingat a very rapid pace. and so, every two orthree years, we have a new piece of equipmentthat makes it easier for us to do this withoutmaking large incisions. and i think there are multipleoptions for treating these patients with rectal cancerwith smaller incisions. now, smaller incisionsare helpful, and we think that peoplerecover quicker with them.

but they don't necessarilyreduce the complexity, or the difficultyof the operation. so that's somethingto keep in mind. i think the advances for treating recurrent rectalcancers are, again, multi-factorial and involvemultiple different teams. one of the advances is we justhave better techniques of operating, of maintainingpatients' vital signs in the operating room so thatwe can do bigger procedures.

if the cancer hasn't spreadto other places we can still perform largeresections in the pelvis and maintain patients'quality of life and indeed have low mortalityrates with these procedures. a second advancement is inthe use of intraoperative radiation therapy, which over the last 25 yearshas really also gone through tremendous improvement, and hassort of revolutionized the care. we have the capability here.

and there are certain centersin the united states to deliver the radiation to the patientduring the operation, when the abdomen is open,thereby reducing the risk of radiation side effectsto other structures. finally, the way wereconstruct either the rectum, colon, or other structuressuch as the bladder, have advanced people's qualityof life after these procedures. so all of those things togetherhave improved the likelihood of being able to removerecurrent rectal cancer, and

have also improvedpeople's survival and quality of lifeafter the procedure. well, for rectal cancer, therehave been dramatic improvements over the last 10 to 15 yearsin how we manage these tumors. and those improvements includeadvances in chemotherapy and radiation therapy. and indeed nowadaysmany rectal cancers, before we even thinkabout doing surgery, are treated with chemotherapyand radiation therapy together.

there are different formsof radiation therapy and there are differentchemotherapeutic agents. it's really very importantto have a team that looks at the entire picture with respectto the patient and the cancer to determine what is the besttherapy prior to surgery. what surgery should be done. and then, how to care for the patient afterthe surgery is completed. we feel that thatmultidisciplinary approach

really provides the highestquality care that you can achieve.

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