Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

128 Anorectal Tumors

management

What to Do First

■Confirm diagnosis

specific therapy

■Rectal cancer:

➣Small, well-differentiated T1 lesions may be treated w/ local exci-

sion+/−XRT

➣Most lesions treated w/ neoadjuvant chemotherapy & XRT fol-

lowed by surgery, either low anterior resection w/ anastomosis

or abdominal-perineal resection

■Squamous cancer:

➣Chemotherapy/radiation followed by surgery if response incom-

plete or in event of recurrence

➣Earliest lesions may be treated by surgery alone, but this is un-

common

follow-up

■Rectal cancer pts at risk for metachronous adenocarcinoma of colon

should undergo periodic colonoscopy

■Digital exams, sigmoidoscopy to exclude anastomotic recurrence

■Value of surveillance for metastases not established: consider follow-

up evaluation of liver/lung w/ CT, CXR, CEA

■Local recurrence after low anterior resection may be treated w/

abdominal-perineal resection or pelvic exenteration

■Follow anal cancer pts for local recurrence or inguinal node disease

complications and prognosis

■Low anterior resection produces irregular bowel habits, occasionally

severe, esp w/ low anastomoses; changes likely greater in pts who

also receive XRT

■Minor incontinence occasional; major incontinence very rare; radi-

ation proctitis common but usually self-limited

■Impotence common after low anterior resection or abdominal-

perineal resection common; minor bladder disturbance also com-

mon, but major difficulties rare

■Surgical complications: bleeding, infection, anastomotic leak or

stricture, ureteral injury

■Rectal stricture, troublesome radiation proctitis, fissure may occur

after XRT for squamous cancer of anus