Treatment alternatives. Localized rectal cancer

Cancers that occur in the low or mid rectum, and are superficial and freely movable on the underlying bowel wall, should be considered for local treatment provided they are not anaplastic and are technically accessible to excision. Although a variety of methods have been shown to be effective, we propose that initial local surgical excision as a "total biopsy" is the most rational approach to the management of such lesions. Factors indicating a poor prognosis, including extension through the entire thickness of the bowel wall, incomplete surgical excision, poorly differentiated histologic grading, venous or lymphatic invasion, or colloid type of tumor, can be identified, and more aggressive surgical treatment can be urged. When these factors are absent, the total biopsy then constitutes definitive treatment for this highly selected population.