As rectal cancer treatment becomes more precise, high-resolution imaging techniques have been established to identify important tumour characteristics that help guide management. High-resolution magnetic resonance imaging scans are increasingly dictating treatment strategies by providing predictive and prognostic information related to the tumour, and are a standard part of the patient investigation pathway. Surgical management depends on patient and tumour factors with an aim to optimise function and survival with the lowest risk of recurrence. Multiple approaches are currently available for resection, including radical surgery involving excision of the rectum and associated mesentery and organsparing techniques involving local excision of the lesion or deferring surgery altogether. The pathological assessment of the resected rectal cancer specimen provides a level of quality control ensuring that surgical principles have been adhered to and that the surgery was performed in an optimal oncological manner. Multidisciplinary team presentation of imaging data, evidence-based oncological, surgical and functional recommendations, in addition to pathological assessment of surgical quality, is an essential part of formalised cancer care.
Inflammatory bowel disease (IBD)-related colorectal cancer (CRC) is responsible for approximately 2% of the annual mortality from CRC overall, but 10%-15% of the annual deaths in IBD patients. IBD-related CRC patients are also affected at a younger age than sporadic CRC, and have a 5-year survival rate of 50%. Despite optimal medical treatment, the chronic inflammatory state inherent in IBD increases the risk for highgrade dysplasia and CRC, with additional input from genetic and environmental risk factors and the microbiome. Recognizing risk factors, implementing appropriate surveillance, and identifying high-risk patients is key to managing the CRC risk in IBD patients. Chemoprevention strategies exist, and studies evaluating their efficacy are underway. Once dysplasia or invasive cancer is diagnosed, appropriate surgical resection and post-operative treatment and surveillance are necessary. Here, we discuss the current state of IBD-related CRC, prevalence, risk factors, and evidence for surveillance, prophylaxis, and treatment recommendations.
Detection of EMVI post-CRT is prognostically significant whether detected by MRI or histopathology. EMVI status after treatment may be used to counsel patients regarding ongoing risks of metastatic disease, implications for surveillance, and systemic chemotherapy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.