Management of early rectal cancer

Area of Science:

• Gastroenterology
• Surgical Oncology
• Oncology

Background:

• Early rectal cancer (ERC) is defined as a T1 tumour, invading the submucosa but not beyond.
• Local excision is curative for low-risk ERC, but its role in high-risk cases remains controversial.

Purpose of the Study:

• To review the staging and management of early rectal cancer.
• To evaluate treatment outcomes for low-risk versus high-risk ERC.

Main Methods:

• A literature review of PubMed and Cochrane databases.
• Analysis of bibliographies from extracted articles.

Main Results:

• Preoperative staging utilizes endorectal ultrasonography and MRI.
• Pathological staging employs Haggitt and Kikuchi classifications.
• Lymph node metastasis risk increases with Kikuchi level (Sm1: 1-3%, Sm2: 8%, Sm3: 23%).
• Recurrence rates are low for low-risk ERC after local surgery but increase to 29% for high-risk cancers.

Conclusions:

• Low-risk ERC can be managed endoscopically or transanally.
• High-risk ERC may necessitate transanal endoscopic microsurgery or adjuvant chemoradiotherapy.
• Management decisions should be guided by risk stratification based on staging.