Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada. Department of Hematology and Oncology, CancerCare Manitoba, Winnipeg, MB, Canada. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. Department of Surgery, University of Manitoba, Winnipeg, MB, Canada. Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Am J Gastroenterol. 2018 Dec;113(12):1763-1771. doi: 10.1038/s41395-018-0180-y.
The rectum has distinctive anatomic and physiologic features, which increase the risk of local spread and recurrence among rectal cancers as compared to colon cancers. Essential to the management of rectal cancers is accurate endoscopic localization as well as preoperative imaging assessment of local and distant disease. Successful oncologic care is multidisciplinary including input from Gastroenterologists, Surgeons, Medical and Radiation Oncologists, Radiologists, and Pathologists. Extensive planning of curative intent is mandatory as failures of upfront treatment present great long‐term difficulty for patients and caregivers. Local recurrences are frequently associated with major morbidity including bowel and urinary obstruction, severe pain, and significantly diminished quality of life. Distant recurrence is associated with lower survival. Over the last two decades, there have been many advances in diagnostic imaging techniques as well as surgical techniques including transanal endoscopic microsurgery for very early stage cancers. Progress in curative management paradigms includes shorter courses of preoperative radiotherapy and chemotherapy doublet paradigms for perioperative treatment. This review describes the diagnosis, workup, and multimodality curative intent treatment of rectal cancers. It is emphasized that success begins in the hands and eyes of the gastroenterologist.
直肠具有独特的解剖和生理特征，与结肠癌相比，直肠癌更容易发生局部扩散和复发。准确的内镜定位以及对局部和远处疾病的术前影像学评估是直肠癌治疗的关键。成功的肿瘤治疗需要多学科的参与，包括胃肠病学家、外科医生、内科和放射肿瘤学家、放射科医生和病理学家的参与。必须进行广泛的治愈性意图规划，因为一线治疗的失败会给患者和护理人员带来长期的巨大困难。局部复发常伴有严重的并发症，包括肠道和尿路梗阻、严重疼痛以及生活质量显著下降。远处复发与生存率降低有关。在过去的二十年中，诊断成像技术以及手术技术（包括用于极早期癌症的经肛门内镜微创手术）都取得了许多进展。在治愈性管理模式方面的进展包括术前放疗和化疗双联方案的疗程缩短。本文描述了直肠癌的诊断、检查和多模式治愈性意图治疗。需要强调的是，成功始于胃肠病学家的手中和眼中。
