Painless masses, and anemia and anemia-hemoglobin drop have been recognized as characteristic features. There may be local or distant spread. A mass in the rectum can be the first presenting symptom and there may be delay in diagnosis or treatment. The most likely underlying cause is malignant, but inflammatory intestinal disease can produce similar appearances. It may take a long time to achieve the correct histopathologic diagnosis. The management depends on the extent and localization of the disease. Surgery in local disease is an option. Surgery is contraindicated in advanced disease as it is often ineffectively managed nonoperatively. Patients with locally advanced rectal cancer who do not undergo surgery may be offered concurrent chemoradiotherapy.
The survival in locally advanced rectal carcinoma, if treated with abdominoperineal resection, is relatively good but still is a dismal 1 year survival. A 5-year survival of 50% and a 10-year survival of 14% indicates that a large percentage of patients with locally advanced rectal carcinoma do not receive an appropriate systemic adjuvant treatment. A further analysis revealed that age at presentation affects the 10-year survival rate, with a trend towards a better prognosis in the older patients.
The most prevalent form of locally advanced RC patients in the US are between 20 and 40 years of age and female. Although most RC patients who undergo preoperative chemoradiation will have acceptable prognoses in terms of long-term survival, the number of unnecessary RC patients that die will increase if this treatment and the number of people having locally advanced RC is not managed appropriately.
There are many causes for locally advanced rectal carcinoma, but their combined effects cause rectal carcinoma with the features cited above with a high accuracy in predicting the cause of the lesion.
local pelvic and abdomino-perineal diseases due to local invasion of rectal cancer were rare in our series with the use of modern imaging techniques. However, lymph node infiltration is the most common cause of recurrent disease. Modern imaging is useful to evaluate the local extent of invasive carcinomas but should be interpreted cautiously when performing staging procedures for loco-regional disease, as the clinical significance has not been evaluated by prospective trials.
Radiotherapy is the most important treatment for rectal carcinoma, followed by CT as local treatment and preoperative radiotherapy, whereas neoadjuvant combination chemotherapy is a novel adjuvant treatment option. These approaches can be combined with either local surgical treatment, local radiation therapy, or intra-arterial or embolisation of the tumour.
A significant percentage of familial rectal cancer presents with locally advanced disease, as determined by a local stage of disease. Although the reasons for this are unknown, an aggressive approach, not just surgery and radiotherapy but also chemotherapy should be explored before the potential deleterious effect of chemotherapy on local tumor control is considered.
• • The m5a was found to be active as a cancer therapy against LARC in a recent study in Japan. But the authors found a higher therapeutic response in the placebo group, than the anti-CEa group (p<0.01), especially at 5 weeks. • • • A higher dosage than that used in the first study might be required for the treatment effect.
Clinical trials do not appear to be worthwhile for locoregional therapies of LARCs. We must reconsider our own patients with these locally advanced and metastatic/recurrent cancers.
Although there have been a number of well-designed trials for patients with pT3 rectal cancer, there are still a number of patients with locally advanced rectal carcinoma who have low survival rates. Although local radiation therapy decreases the stage after surgery and improves the survival rate, adjuvant treatment with preoperative chemotherapy is still recommended.
Results from a recent paper reveals that on average men with LARC receive a lower age at diagnosis of cancer than women, probably because of the lower use of routine colonoscopy among men in developed countries. Women, moreover, have more advanced disease at diagnosis. This means that, in a developed country, the most likely ages for men and women to have LARC have changed.
In this cohort, T3 [rectal cancer](https://www.withpower.com/clinical-trials/rectal-cancer) was associated with a slightly higher survival rate than T1-T2 cancers. In the T3 group, survival was independently influenced by lymph node and distant metastasis. To our knowledge, this is the largest series to report on the prognostic utility of this classification of rectal cancer.