Role of Systemic Chemotherapy in

Management of Rectal Cancer

Putu Niken Ayu Amrita

Introduction

• Colorectal cancer (CRC) is the third most commonly diagnosed

cancer in males and the second in females (ESMO, 2020)

• Approximately 55% of cases occur in more developed regions.

• Risk factors: age >50 years, high-fat/low-fibre diet, obesity, sedentary

lifestyle, smoking, alcohol intake, adenomas, inflammatory bowel

disease and familial history of CRC.

• Symptoms: bleeding, proctalgia, changed bowel habits with

obstructive defecation or increased frequency, abdominalpain, weight

loss, asthenia, nausea, vomiting.

Diagnostik Work Ups

Multidisciplinary Team Approach

Staging

Local and Locally Advanced

• Metastatic Rectal Cancer

Initial Assesment

• 25% of patients present with metastases at initial diagnosis and almost 50% of

patients with CRC will develop metastases,

• optimal treatment strategy for patients with mCRC, the staging include clinical

examination, blood counts, liver and renal function tests, CEA and CT scan of the

abdomen and chest (or alternatively MRI).

• The evaluation of the general condition, organ function and concomitant non-

malignant diseases determines the therapeutic strategy

Treatment strategy

Group 0 Primarily technically R0-resectable liver or lung

metastases

Group 1 Potentially resectable metastatic disease with curative

intention

Group 2 Disseminated disease, technically ‘never’/unlikely

resectable intermediate intensive treatment.

Group 3 Never-resectable metastatic disease—non-intensive/

sequential treatment.

Summary

• All rectal cancer patients should have comprehensive local and systemic staging—discussion MDT

• Role of Chemotherapy in rectal cancer neoadjuvant, adjuvant, palliation

• Personalised medicine including decision to choose biologic agents to maintain QoL and increase OS

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