| Abstract: |
Rectal cancer is the fourth most frequently diagnosed cancer in Arab countries and the third one in United States and has the second highest cancer-related mortality rate after lung cancer. Incidence of rectal cancer increases with increasing socioeconomic status. Diets high in meat and fat, low in fruit and vegetables are associated with an increased risk of rectal cancer. A number of groups have an increased risk of developing rectal cancer. At highest risk are those with either of the dominantly inherited conditions familial adenomatous polyposis (FAP) and hereditary non polyposis rectal cancer (HNPCC).Most rectal cancer arises in adenomatous polyps and their ablation arrests the development of cancer. Other groups at moderately increased risk include those with long standing ulcerative colitis or Crohn’s disease. Because of the slow growth period, regular screening tests can detect rectal cancer in its earliest phase, before any symptoms have occurred, several approaches are available for the detection of rectal neoplasia, including physical examination, digital rectal examination, fecal occult blood testing, serum carcinoembryonic antigen, standard proctosigmoidoscopy, fiber optic sigmoidoscopy, single and double contrast barium enema, CT & MRI scans or combinations of these procedure.The recent advances in surgeries pointed to excision of rectal cancer as transanal endoscopic microsurgery and low anterior resection with total mesorectal excision improve the results and decrease the morbidity and mortality; however recurrence and relapse can not be excluded.Surgical intervention is in the form of transanal excision for patients with stage I rectal cancers that meet the following criteria:Size <3 cm and within 8 cm from the anal verge, low grade, without lymphovascular invasion (LVI).Occupy <30% of the circumference. Mobile. Patients who have any of the following risk factors should either undergo low anterior resection (LAR) or abdominoperineal resection (APR), and receive adjuvant chemoradiotherapy due to a higher risk of local recurrence with transanal excision alone:Patients with stage II and III typically offered preoperative (neoadjuvant) chemoradiation therapy to downstage disease, reduce the risk of local recurrence after surgical resection, and potentially increase the odds of performing a sphincter-sparing procedure for patients with low-lying tumors.The management of stage IV patients depends on the extent of metastatic disease.Patients with limited metastatic disease involving one site (stage IVa) may be curable if their metastases are surgically resectable. Patients with large, symptomatic primary lesions amenable to surgical resection may benefit from aggressive local therapy with preoperative chemoradiation therapy, followed by surgical resection of both the primary and metastatic lesions.Liver metastases from rectal cancer are not a sign of inoperability. Up to three segments focals are still resectable by trisegmentectomy. Other modalities of treatment of these focals are cryotherapy, hepatic artery chemoemolization and radio frequency ablation. Modern cancer management is a team effort involving experts in surgery, chemotherapy, radiotherapy, and palliative care. All of these disciplines have an important contribution to the management of locally recurrent rectal cancer, recurrent rectal cancer manifests in large variety of ways, and treatments need to be tailored to each individual. The role of laparoscopic rectal cancer resection remains under trials, Advocates the technique advantages in terms of smaller wound site, early postoperative mobilization, resolution of ileus and return to normal activity.
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