Diagnosis, Treatment & Management of CA Rectum. Dr. Vandana CSMMU, Lucknow (India)

1. CA Rectum Presented By: Dr. Vandana Dept. of Radiotherapy CSMMU, Lucknow

14. TNM Classification Tis T 1 T 2 T 3 T 4 Extension to an adjacent organ Mucosa Muscularis mucosae Submucosa Muscularis propria Subserosa Serosa T X Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ: intraepithelial or invasion of lamina propria T1 Tumor invades submucosa T2 Tumor invades muscularis propria T3 Tumor invades through the muscularis propria into pericolorectal tissues T4a Tumor penetrates to the surface of the visceral peritoneum T4b Tumor directly invades or is adherent to other organs or structures

15. TNM Classification

16. Stage Grouping

18. Stage and Prognosis Stage 5-year Survival (%) 0,1 Tis,T1;No;Mo > 90 I T2;No;Mo 80-85 II T3-4;No;Mo 70-75 III T2;N1-3;Mo 70-75 III T3;N1-3;Mo 50-65 III T4;N1-2;Mo 25-45 IV M1 <3

20. Colonoscopy or barium enema Figure: C arcinoma of the rectum. Double-contrast barium enema shows a long segment of concentric luminal narrowing (arrows) along the rectum with minimal irregularity of the mucosal surface. To evaluate remainder of large bowel to rule out synchronous tumor or presence of polyp syndrome.

23. Figure: Mucinous adenocarcinoma of the rectum. CT scan shows a large heterogeneous mass (M) with areas of cystic components. Note marked luminal narrowing of the rectum (arrow) . Figure: Rectal cancer with uterine invasion. CT scan shows a large heterogeneous rectal mass (M) with compression and direct invasion into the posterior wall of the uterus (U).

44. Clinical Trials

51. Stage Rectal cancer ~5-year LF/OS III (T4/ Locally unresectable) If obstructed, diverting colostomy or stent placed  definitive treatment. 5-FU/RT  resection if possible. Consider IORT for microscopic disease (after 50 Gy EBRT, give IORT 12.5–15 Gy) or brachytherapy for macroscopic disease  adjuvant 5-FU-based therapy* IV Individualized options, including combination 5-FU-based chemo alone, or chemo ± resection ± RT Recurrent Individualized options. If no prior RT, then chemoRT  surgery ± IORT or brachytherapy. If prior RT, then chemo  surgery ± IORT or brachytherapy as appropriate.

52. Thank You !!