the Role of Radiation Therapy Before Rectal Surgery

Radiation Therapy and Surgery

I have some questions for the doctor, but I am being admitted on Monday and scheduled for surgery on Tuesday, so there doesn't seem to be much time to ask.

1.
I have come across information suggesting that for rectal cancer, radiation therapy can be administered before surgery, which may shrink the tumor and reduce the staging (from T2 to T1).
If this is the case, could the surgical approach be altered? Would it be possible to avoid resection of the bowel and instead just remove the tumor completely?
2.
Currently, the CT scan shows no signs of distant metastasis.
Are there any methods to check for lymph node involvement before the surgery? If there is no metastasis, would it still be necessary to remove a significant portion of the rectum (the tumor is located 10 cm from the anus and is approximately 3 cm in size)? Although the anus could be preserved, would this still have a considerable impact on bowel function in the future? I apologize for my concerns about the future...

Fei Cai, 40~49 year old female. Ask Date: 2019/01/05

Dr. Ke Fangxu reply Surgery

1.
For rectal cancer, administering radiation therapy before surgery can reduce the likelihood of metastasis and recurrence.
Some patients may even find that their cancer cells have completely disappeared; however, it is still recommended to undergo a rectal resection to achieve a complete cure, unless the pathological examination reveals squamous cell carcinoma, in which case radiation therapy alone may be sufficient.

2.
Prior to surgery, a CT scan or MRI can be used to check for enlarged lymph nodes, which may indicate lymph node metastasis.
However, enlarged lymph nodes do not necessarily confirm metastasis, so this should be considered as supplementary evidence.
A PET scan can also be utilized to visualize lymph nodes, but this use is not covered by insurance.
Ultimately, to definitively determine lymph node metastasis, surgical removal followed by histopathological examination is the most accurate method.

Low rectal cancer surgery will inevitably impact daily life; retaining the anal sphincter is considered a significant benefit in unfortunate circumstances.
Total rectal resection is essential; otherwise, if cancer cells are not completely eradicated, it may lead to severe consequences such as future metastasis or recurrence.

Reply Date: 2019/01/05

More Info

Understanding the role of radiation therapy before rectal surgery is crucial for patients diagnosed with rectal cancer. Your concerns are valid, especially with surgery approaching so soon. Let’s address your questions one by one.

1. Radiation Therapy and Tumor Reduction: It is indeed common practice to administer radiation therapy (often combined with chemotherapy) before surgery for rectal cancer. This approach, known as neoadjuvant therapy, aims to shrink the tumor, making it easier to remove surgically and potentially allowing for a less extensive surgical procedure. If the tumor shrinks significantly, it may indeed change the surgical plan. For instance, if the tumor downstages from T2 to T1, it might be possible to perform a local excision rather than a more extensive resection, which could spare more of the rectal tissue and possibly preserve bowel function. However, the final decision will depend on the tumor's response to the radiation, the surgeon's assessment, and the overall treatment plan.

2. Assessing Lymph Node Involvement: The absence of distant metastasis on a CT scan is a positive sign, but assessing lymph node involvement can be more complex. Typically, imaging studies like MRI or PET scans may provide additional insights into lymph node status. However, the definitive way to determine if lymph nodes are involved is through surgical pathology after lymph nodes are removed during surgery. If lymph nodes are found to be involved, it may necessitate a more extensive surgical approach, including the removal of a larger portion of the rectum.
Regarding your concern about preserving bowel function, it is important to discuss this with your surgical team. They will consider the tumor's location, size, and the extent of resection needed. While preserving the anus is a priority, it is also essential to ensure that the cancer is adequately treated.
Post-Surgery Considerations: After surgery, patients may experience changes in bowel habits, including frequency and consistency of stools. Some patients may develop a temporary or permanent change in bowel function, which can include diarrhea or incontinence. Your surgical team will provide guidance on managing these changes, including dietary modifications and potential medications.

Emotional and Psychological Support: It is completely normal to feel anxious about surgery and the potential outcomes. Consider discussing your concerns with your healthcare team, who can provide reassurance and support. They may also refer you to a counselor or support group specializing in cancer care, which can be beneficial in navigating the emotional aspects of your diagnosis and treatment.

In conclusion, radiation therapy before rectal surgery can significantly impact treatment outcomes and surgical approaches. It is essential to maintain open communication with your healthcare team to address your concerns and ensure you are well-informed about your treatment plan. Wishing you the best of luck with your surgery and recovery.

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