Surgical Options in the Treatment of Lower Gastrointestinal Tract Cancers

Colorectal cancer is the fourth most common cancer in the USA with the second highest mortality. Early detection with screening endoscopy, in addition to improvement in treatment modalities lead to higher overall survival rates. Treatment of localized colon cancer comprises of surgical resection with en bloc lymphadenectomy. Adjuvant therapy is determined by final pathologic stage. However, treatment of rectal cancer is more complex and is determined by the clinical pathologic stage. Neoadjuvant chemoradiation therapy is an important component to treatment to decrease the risk of local recurrence. As with colon cancer, adjuvant chemotherapy is dependent on the pathologic stage. Newer technologies are being utilized in both colon and rectal cancer including minimally invasive procedures and sphincter preservation procedures. Anal squamous cell carcinoma (SCC) is the most common histologic subtype of anal canal tumors. Anal SCC is most commonly seen in patients with HPV infections. Prior to the 1970s, anal SCC was treated with abdominoperineal resection and end colostomy. Nigro and colleagues utilized chemoradiation to treat anal SCC with response rates as high as 80%. This allows majority of patients to avoid an APR with permanent colostomy.