Combined modality follow-up and postoperative recurrence in rectal cancer

Rectal cancer patients are at high risk for disease progression even after radical surgery for cure. Prognosis depends on a timely diagnosis for effective, curative therapies. In resected patients, an accurate follow-up especially within the first two years of surgery, is required. Clinical and radiologic follow-up is based on periodical, timed physical and instrumental exams (rectal exploration, neoplastic markers, rectoscopy, colonic enema, CT MRI, TRUS) which supply information on locoregional (liver, lymph nodes, peritoneum, chest) recurrence. Rectal exploration, endoscopy, colonic enema and TRUS enable the control of anastomosis and the identification of possible metachronous tumors. CT and MRI as liver US and chest X-ray, detect recurrence in other sites (pelvic perianastomotic recurrence, peritoneal carcinomatosis, lymph node or liver locations). A diagnostic problem is represented by the difficult differentiation of local recurrence from postoperative fibrosis. In this case, surveillance in the course of time with exams more reliable in tissue differentiation (MRI, though with some limitations) and US- or CT-guided biopsy, is required.