Following surgical removal of rectal cancer, the cancer is referred to as Stage II rectal cancer if the final pathology report shows that the cancer has penetrated the wall of the rectum, but does not invade any of the local lymph nodes and cannot be detected in other locations in the body.
Neoadjuvant Therapy: Neoadjuvant therapy refers to treatment given prior to surgery. Many patients with Stage II rectal cancer receive neoadjuvant chemotherapy and radiation therapy; the goals are to reduce the risk of cancer recurrence and to shrink the cancer prior to surgery. If patients are in poor health and are unable to tolerate chemotherapy and/or radiation therapy, surgery may be the initial treatment.
Surgical Treatment: The standard surgical procedures used to remove Stage II rectal cancer include low anterior resection (LAR) or an abdominoperineal resection (APR). The choice of operation depends on the location of the rectal cancer.
An LAR involves an incision across the abdomen and removal of the cancerous part of the rectum along with some surrounding tissue and lymph nodes. This is often done for cancers that are in the upper part of the rectum. Lower cancers may be treated with removal of the rectum along with extensive removal of surrounding tissues (total mesorectal excision). Depending on where the cancer was and how much of the rectum was removed, the colon may be reconnected to the remaining part of the rectum or to the anus. When possible, the surgery will allow a patient to continue to pass waste through the anus. Some patients, however, may require a temporary or permanent colostomy (an artificial opening that allows waste to pass from the colon to the outside of the body).
If the cancer is very low in the rectum (near the anus), a patient may need to have an abdominoperineal resection (APR). This involves an incision in the abdomen and an incision around the anus. Because both the rectum and the anus are removed, an APR requires a permanent colostomy.
Adjuvant Therapy: The goal of providing additional treatment after surgery (adjuvant therapy) is to reduce the risk of cancer recurrence by eliminating any remaining cancer. For patients who received neoadjuvant (before-surgery) chemotherapy and radiation therapy, additional chemotherapy is often given after surgery. If patients did not receive neoadjuvant therapy, they may be treated with both chemotherapy and radiation therapy after surgery.
Laparoscopic Surgery: Laparoscopic surgery is used for many types of surgery with the short-term advantages of less pain, fewer wound complications, quicker post-operative recovery, and shorter hospital stays. Instead of making one long incision in the abdomen, the surgeon makes several smaller incisions.
Improved Approaches to Radiation Therapy: As the technology for radiation therapy has evolved, important advances have been made in the ability of physicians to precisely target the area of the cancer. The goal is to deliver effective doses of radiation to the cancer while sparing healthy tissue to the extent possible. One newer approach to delivering radiation therapy is intensity modulated radiation therapy (IMRT). IMRT starts with a three-dimensional image of the cancer, and allows physicians to deliver different doses of radiation to different areas. The potential advantages for patients include both better tumor control and fewer side effects.
Managing Side Effects: Techniques designed to prevent or control the side effects of cancer and its treatments are called supportive care. Side effects not only cause patients discomfort, but also may prevent the delivery of therapy at its planned dose and schedule. In order to achieve optimal outcomes from treatment and improve quality of life, it is imperative that treatment is delivered as planned and that side effects resulting from cancer and its treatment are appropriately managed.