Treatment Options for Rectal Cancer: A Patient's Guide

Q: Treatment Options for Rectal Cancer: A Patient's Guide

Hello： 1. Why did it develop into a malignant tumor in just one year? Doesn't tumor formation take some time? A： It sounds like a portion of a benign polyp has transformed into a malignant one. Since you have check-ups every two years, it was detected early. S

Treatment options for rectal cancer?

Dear Dr.
Chen,
My wife, who is 63 years old, has been experiencing unusual frequent diarrhea.
After undergoing a colonoscopy at the gastroenterology department, five polyps were discovered, one of which is particularly large, and the biopsy report indicates a malignant tumor.
She was immediately referred to the colorectal surgery department at the hospital, and surgery for removal has been scheduled for a week later.
The diagnosis of cancer has caused great fear and confusion for our entire family, so I would like to ask Dr.
Chen the following questions:
1.
My wife has been undergoing routine colon screenings every two years.
Three years ago, one polyp was removed (benign), and last year’s routine check showed normal results.
Why did it develop into a malignant tumor in just one year? Isn’t there usually a time frame for tumor formation?
2.
The name of this surgery is "extensive resection of rectal villous adenoma or local excision of cancer." When I inquired with the lead surgeon, they mentioned that the wound from the previous polypectomy has not yet healed, and we do not need to reposition; we will just go deeper to take a look.
Is this a re-confirmation of the previous biopsy results, or is it a necessary procedure and method in the treatment process for colorectal cancer?
3.
Preoperative examinations including CT scans and CEA levels have shown normal results, and the tumor is located approximately 2.5 cm from the anal opening.
The doctor would like us to consider whether a complete resection is necessary, or if we should preserve the anus, or explore other medical plans.
They have asked us to respond at the next outpatient visit after the surgery.
Given our limited medical knowledge and the resources available for consultation, this is indeed a very difficult and overwhelming question for us.

Could you please advise us on how we should consider and choose our options? What are your personal recommendations? Thank you!

David, 60~69 year old female. Ask Date: 2022/05/18

Dr. Chen Sirong reply Oncology

Hello:
1.
Why did it develop into a malignant tumor in just one year? Doesn't tumor formation take some time?
A: It sounds like a portion of a benign polyp has transformed into a malignant one.
Since you have check-ups every two years, it was detected early.
Screening cannot prevent cancer, but it can help in early detection.
When you find out about the cancer one day, you might wonder how it developed in just one or two years.
Of course, it has been growing for more than one or two years; it just reached a size that could be detected within that timeframe.
2.1 Is this a confirmation regarding the last biopsy?
2.2 Or is it a necessary procedure and method during the treatment process for colorectal cancer?
A: First, the entire polyp will be removed.
2.1 This is not to confirm whether it is cancer; the last biopsy has already confirmed it is cancer.
This time, the entire polyp should be removed to assess its size and stage.
2.2 Of course, if you prefer, you could skip this step and proceed directly to a major surgery.
However, the physician's recommendation is to first understand the stage after the polyp removal, and then decide whether to proceed with a major surgery and the extent of it.
3.
The tumor is located about 2.5 cm from the anal opening.
The doctor wants us to consider whether to remove it entirely or to preserve the anus, or to use other treatment plans.
We are to respond during the next outpatient visit after the surgery.

A: It sounds like the process is: polyp removal --> outpatient visit --> major surgery (whether to preserve the anus).
I recommend understanding the pathological report regarding the stage after the polyp removal during the outpatient visit, and then deciding on the surgical approach, whether to preserve the anus or not.
The process appears to be: polyp removal --> outpatient visit (understanding pathological staging) --> outpatient visit (deciding on the surgical method regarding anus preservation) --> major surgery, which means an additional outpatient visit for the family to consider.
Wishing you a smooth treatment.

Dr.
Chen Si-Rong

Reply Date: 2022/05/18

More Info

Understanding treatment options for rectal cancer can be overwhelming, especially when faced with a recent diagnosis. Your concerns are valid, and it's important to approach this situation with a clear understanding of the disease and the available treatment options. Here’s a comprehensive overview based on your questions.

1. Rapid Development of Malignancy: It is indeed concerning that a benign polyp can progress to a malignant tumor in such a short time. While polyps typically take years to develop into cancer, certain factors can accelerate this process. Genetic predispositions, such as familial adenomatous polyposis (FAP) or Lynch syndrome, can lead to rapid changes in polyp pathology. Additionally, some polyps, particularly sessile serrated adenomas, have a higher risk of malignant transformation. Regular screenings are crucial, but they cannot always predict rapid changes in polyp behavior.

2. Surgical Procedure: The procedure you mentioned, "extensive resection of rectal epithelial villous adenoma or local excision of cancer," indicates that the surgeon is taking a thorough approach to ensure all cancerous tissue is removed. This may involve deeper excision to confirm the diagnosis and assess the extent of the cancer. It is a common practice to re-evaluate the tissue after initial findings, especially if there is a concern about the aggressiveness of the tumor. This step is essential in determining the appropriate treatment plan moving forward.

3. Post-Surgery Considerations: The decision regarding whether to perform a total rectal resection or to preserve the anus is complex and depends on several factors, including the tumor's size, location, and whether it has invaded surrounding tissues. The distance from the anal verge (2.5 cm in your case) is significant, as tumors closer to the anal sphincter may necessitate more extensive surgery to ensure clear margins and reduce the risk of recurrence. It’s crucial to discuss the potential outcomes of each option with your surgical team, including the implications for quality of life, potential complications, and the likelihood of recurrence.

4. Future Treatment Options: After surgery, the treatment plan may include chemotherapy or radiation therapy, especially if the cancer is found to be more aggressive or if there are concerns about lymph node involvement. The decision will be based on the final pathology report and the staging of the cancer. It's essential to have a multidisciplinary team involved in your care, including oncologists, surgeons, and possibly radiation therapists, to provide a comprehensive treatment plan tailored to your wife's specific situation.

5. Support and Resources: Given the emotional toll that a cancer diagnosis can take on a family, it’s important to seek support. Many hospitals have social workers or patient navigators who can help guide you through the process, provide resources, and connect you with support groups. Additionally, consider reaching out to organizations dedicated to cancer support, which can offer valuable information and emotional support.

In conclusion, navigating a rectal cancer diagnosis involves understanding the disease, the treatment options, and the implications of each choice. Open communication with your healthcare team is vital, as they can provide personalized recommendations based on your wife's specific case. It’s also important to take care of your emotional well-being during this challenging time.

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