Rectal cancer in the year 2000

The last twenty years have seen significant advances in quality of surgery for rectal cancer. More sphincter saving procedures are being carried out. The variance in local recurrence rate between surgeons has been recognised and this has stimulated a more uniform approach to dissection involving removal of the mesorectum. The place of radiotherapy is rapidly being defined. Future developments are very likely to be based upon the present. Thus further work in screening to achieve earlier diagnosis is likely to be extended to the genetic identification of patients at risk with follow up for these selected individuals. Education of the general population is already improving and will continue to do so. Pre-operative staging by imaging will become more accurate allowing rational adoption of management policies before histological examination of any resected specimen. This will achieve refinement of treatment combinations. Finally it is likely that new and effective chemotherapeutic agents will be developed.