Management of Rectal Cancer

Rectal cancer is an aggressive subtype of colon cancer with inferior outcomes in terms of disease-free and overall survival. Localized rectal cancer should be managed surgically. For stage II and III rectal cancer, neoadjuvant radiation, either as long-course chemoradiotherapy with a sensitizing fluoropyrimidine or short-course radiation, should be offered in all cases. Adjuvant or neoadjuvant fluoropyrimidine and oxaliplatin chemotherapy also should be given. In general, rectal cancer should be treated with a radiation-first approach, but the exact sequencing of therapy does not seem to significantly impact overall survival but rather toxicity, pathologic responses, compliance, and cost.