Non Operative Management of Rectal Cancer

Rectal cancer surgery, while often a necessary component of treatment, can have significant long term changes to quality of life. For some individuals, when there has been an excellent response to chemotherapy and radiation, surgery can be avoided.

Non operative management of rectal cancer: The holy grail in modern rectal cancer treatment treatment

There are few advancements in the management of rectal cancer that are as exciting, interesting and paradigm shifting as non operative management.  Since the 1980s, we’ve known that the use of radiation and chemotherapy can help shrink rectal cancer to facilitate its surgical removal and decrease the risk of it growing back, but with new approaches, it can completely respond sometimes making surgery not necessary.

Who is eligible?

The modern management of rectal cancer is personalized to the individual, their health, function and imaging results.  For low rectal cancers, often, we treat with a combination of radiation and chemotherapy as the initial management.  40% of individuals will have a complete clinical response, meaning that no cancer can be felt on exam, visible on colonoscopy or present on MRI.  For these individuals, we can adopt an approach of close monitoring rather than surgery

Why non operative management?

There have been multiple advancements in surgery for rectal cancer over the years.  The largest advancement has been the institution of minimally invasive surgery to aid in recovery.  Despite minimally invasive techniques, surgery for rectal cancer is still a large surgery with changes to the way the bowel works afterwards, sexual function and the need for either a temporary or permanent stoma.  Non operative management can help maintain normal function

What are the risks?

If the cancer grows back it is most likely to regrow early.  In a meta-analysis, there was an 15% risk of local regrowth, of which, 95% were able to be operated on with favorable outcomes.

Feel free to reach out to discuss further with out team at North York Colorectal to see if non operative management if an option for you.