While surgery is one of the main rectal cancer treatment options, it has major risks. Patients up to 80 years of age have 13% to 15% mortality, and additionally, 12% won’t return home with live-in support care. The main question for doctors and patients is whether surgery is beneficial for patients or not. For many colon cancer patients, the surgery prospect is worrisome, provided that the operation impairs both bowel and sexual functions.However, according to a new study, some cancer patients fare well through forgoing surgery in favor of radiation/chemotherapy with “watchful waiting.”
The findings are from 145 rectal cancer patients’ data with stages 1, 2, or 3. All of them had radiation and chemotherapy. However, around half of these patients have undergone surgery, while others also staved off procedures for rigorous disease progression tracking, sometimes known as “watchful waiting.”
The outcomes encourage more doctors to consider the wait and watch approach in patients showing total response as an alternative to rectal surgery for a few patients. According to a surgical oncologist, most patients accept risks to defer rectal surgery to avoid treatment and preserve rectal function.
According to the study, the authors stated that the patients who go fine with rectal cancer treatment without surgery are up to 50% of stage 1 patients with general tumors following the radiation/chemotherapy rectal cancer treatment. The figure also hovers at 30% and 40% among stage 1 and 3 cancer patients.
Rectal Cancer Surgical Challenges
Surgery of rectal cancer has many difficulties. The rectum is a narrow and confined space surrounded by nerves, vessels, and muscles.
Due to anatomical restrictions, surgery is not easy to perform for rectal cancer treatment. Even when a surgery goes well, it weakens muscles and nerves already in the bowel and muscles injured by radiation, chemo, and cancer. In many cases, patients can recover quickly with the temporary opening to evacuate waste, but waiting for bowel healing with a second surgery to close the opening would mean waiting for bowel healing.
Also, there are surgical risks, including nerve damage resulting in urinary and surgical dysfunction. Also, there is a lot of rectal surgery baggage.
However, the nonsurgical rectal cancer treatment option doesn’t have guarantees even for the qualifying ones. There is a 20% chance that cancer regrows in the rectum and needs complex surgery that a patient prefers avoiding. When cancer regrows, it can also spread quickly to other organs.
The 30-day mortality from rectal cancer treatment surgery was published at 2.9% to 5.9%. The latter figure depends on the English National Cancer Intelligence Network dataset, with 20,000 restrictions. In the elderly (over 80 years), mortality increases from 13 to 15%. Thirty-day mortality is the crude method of assessing risks associated with the surgery. The European Surgical Outcomes study also suggests that the 60-day mortality following the non-cardiac surgery is at least twice the 30-day mortality. It implies that the overall estimated 60-day mortality following resection rectal cancer treatment surgery in people above 80 years is high, like 30%. Furthermore, the mortality figures don’t say anything about the quality of life after the surgery.
After resection, around 12% of the elderly patients don’t return to their preoperative accommodation (i.e., they are no longer living at the house and need residential care support), and around 69% also experience a mild loss in activities of daily living (ADLs).
A Detailed Overview
The surgery benefits are balanced against such risks. In the study of approx. 80% of elderly rectal cancer patients and around 50% of stage 1 patients survived five years. Without any surgery, the patients most likely died from cancer.
Consequently, while most colorectal cancer patients have curative surgery benefits, some, often frail, elderly patients, have high risks outweighing the benefits. The difficulty of clinicians and patients deciding any individual patient falls into the group.
Although some objective fitness or surgery measures are there, the decision is subjective with less information on non-operative management outcomes. The drive to do anything is strong among the families, clinicians, and patients alike that only frail and elderly don’t end up with surgery.
The outcome is that the potentially significant patient group resections with better quality and low mortality of life without any surgery, with less substantial healthcare cost implications.
Also, we conducted a retrospective analysis of non-operative management for colorectal cancer in elderly and frail patients. Because the design cannot provide definitive answers as to who will and will not benefit from the curative surgery, it still lets a description of patient outcomes who are not operated on for bowel cancer because of surgical perceived risk.
We also studied patients with known colorectal cancer who did not have rectal cancer surgery between October 2010 and April 2012, as they don’t deem insufficiently fit. All metastatic disease patients at diagnosis were not included.
As there was no prospective database, we identified patients with multidisciplinary team (MDT) meetings with an up to 18-month period for the comments on surgery and fitness.
Later the comments were checked against the hospital pathology system, and the ones with resected bowel specimens were excluded. More information for rectal cancer treatment was there from hospital computer systems, like endoscopy, pathology discharge summaries, and general practice medical summaries reporting.
Finally, the non-systematic database is there to identify current literature on the topic.
Outcomes
Over 18 months, around 39 patients having colorectal cancer discussed at the MDT meetings didn’t have the rectal cancer treatment operation due to not being fit for the surgery. Four patients had a little follow-up that they were not included in the analysis.
Nine patients died within 45 diagnostic days. The underlying cause of death was colorectal cancer, and it was incidentally detected, and the patient also died of another reason. Most patients were inpatients at diagnosis.
The table shows demographic tumor location and data for patients. They followed up for a minimum of 18 months, and five (20%) were alive after 36 months of follow-up. A patient was alive at analysis for three years, 240 days after the initial diagnosis. The average survival length is one year, 176 days. The mean age of diagnosis for patients was 87 years (range of 77 to 93 years).
The tumor distribution was rectum 38%, caecum 11%, sigmoid 22%, ascending 115, and transverse 8%, which is in line with general population trends.
The blood transfusion was needed after 10 (38%) patients, with around five needing a transfusion, two needing two transfusions, and three needing three transfusions. None of the patients was obstructed at presentation, but four had colonic stents later. A patient who is alive had a stent when the first was blocked.
Two patients had undergone Argon laser rectal cancer treatment. No other patients had any other type of surgery like the defunctioning stoma. Generally, rectal cancer patients also had significant symptoms. Also, they had contact with practitioners and colorectal nurse specialists, whereas people with asymptomatic colon tumors, apart from a few needing transfusions or stents.
Of the patients who died by the study period’s end, around 30% had bowel cancer as the leading death cause (recorded as Part 1 death certificate), while the remaining 70% also died from other causes.
What Does The Data Indicate?
The data indicates that the institution had 270 newly diagnosed bowel cancers yearly. Provided that we identify 39 patients without surgery-based rectal cancer treatment on frailty over 18 months, it suggests that around ten patients also fall into the non-operative group. Life expectancy among the elderly and frail patients was around one year, 176 days, compared to the average three-year expectancy and 182 among the 87-year-olds in the general population.
The study’s retrospective nature would mean that not all the comorbidities would be known. However, they would likely have more comorbidities than average patients, and the cancer diagnosis has little difference in the overall survival. It is also supported by the retrospective American Surveillance Studies, Epidemiology, Medicare databases, and End Outcomes.
Of the patients who died by the study period, around 30% had bowel cancer as the leading death cause (recorded on Part 1 death certificate), while the remaining 70% died due to other reasons.
Related Topic:- COMMON SIDE EFFECTS PATIENTS REPORT AFTER BREAST CANCER RADIATION THERAPY TREATMENT
Treating Colorectal Cancer Without Surgery
Different rectal cancer treatment approaches have similar benefits regardless of the patient’s age. However, older adults also have other treatment challenges. Let’s know about these treatment methods.
Radiation Therapy
Radiation therapy uses high energy to destroy cancer cells. It is commonly used for rectal cancer treatment as the tumor can recur near where it originally started. Any doctor who knows how to give radiation therapy to treat cancer is a radiation oncologist. A regimen of radiation therapy, or schedule, typically consists of different treatments over a specific time.
External beam radiation therapy: You use a machine to deliver x-rays to the specific cancer location with external beam radiation therapy. This rectal cancer treatment is typically provided five days a week. It is provided in the hospital or the doctor’s office.
Stereotactic Radiation Therapy: Stereotactic radiation therapy is the external-beam radiation therapy used when the tumor spreads to the lungs of the liver. The radiation therapy also delivers a precise and large radiation dose to a small area. The rectal cancer treatment also saves lung and liver tissue parts that can otherwise be removed at surgery. However, not all cancers spread to the lungs or liver can be treated through this method.
Other Radiation therapy types: For many people, special radiation therapy rectal cancer treatment like brachytherapy or intraoperative radiation therapy can help get rid of little cancer areas that can’t get removed through surgery.
Brachytherapy: The rectal cancer treatment uses radioactive seeds inside the body. According to some studies, there is little information about the approach’s effectiveness, but it slows cancer cell growth. In 1 brachytherapy type with SIR-Spheres product, doctors inject little amounts of radioactive substances like the yttrium to treat colorectal cancer spread to the liver where surgery is not considered.
Medication Therapies
These treatments are meant to destroy cancer cells. Medication is provided through the bloodstream to reach cancer cells throughout the body. When you give a drug through this manner, it is known as systemic therapy. When applying the medication directly to cancer or a single body part, medicine can also be provided. A medical oncologist, or a doctor, specializing in rectal cancer treated with medication commonly prescribed this medication.
Doctors often prescribe an IV tube into a vein through a needle, capsule, or a pill to orally swallow. If doctors suggest oral medicine, you should ask the health care team about safely handling or storing it.
Medications for colorectal cancer are:
- Targeted therapy
- Chemotherapy
- Immunotherapy
We discuss all these essential rectal cancer treatment therapies below. A patient can get one medication type or a combination of medications simultaneously. They are also provided treatment plans, including radiation therapy and surgery.
Medications to treat cancer are evaluated continually. Talking with doctors is a great way to learn about prescribed medications, their purpose, side effects, or interaction with other medications.
Targeted therapy
Targeted therapy is a rectal cancer treatment targeting cancer-specific proteins, genes, or tissue environment contributing to survival and cancer growth. The therapy also blocks the spread and development of the cancer cells and limits healthy cell damage.
Not all tumors have the same targets. Doctors can also test to identify proteins, genes, and other tumor factors for the most efficient rectal cancer treatment. It helps doctors better match the patient with the most efficient treatment forms.
Additionally, research studies also continue to find out about the specific molecule targets with new treatments. These drugs become essential in treating colorectal cancer.
According to studies, older patients can benefit from the targeted therapies, similar to young patients. Additionally, expected side effects are simple to manage in young and geriatric patients.
Final Outlook Of Treatments
Cancer recovery can either be possible or not. When you cannot control or cure cancer, the disease would be terminal or advanced. C21.8 is a specific/billable rectal cancer ICD 10 code for indicating rectal cancer diagnosis for reimbursement.
The diagnosis is stressful, and it’s difficult to hear about advanced cancer for a few people. However, it would be vital to have honest and open conversations with the health care team to express preferences, concerns, and feelings. It’s vital to ensure that the person is free from pain, physically comfortable, and emotionally supported with the best rectal cancer treatment process.
People with advanced cancer should consider hospice care. Hospice care provides advanced-stage cancer patients with a better quality of life. Special equipment and nursing care can make staying at home a great option for families. University Cancer Centers aims at providing the most intensive care facility for cancer patients regardless of their type and stage of cancer. Our awarded practitioners and surgeons emphasize rectal cancer treatment with the most suitable methods and time-proven techniques. Additionally, we utilize modern treatment technology for diagnostics, treatment, and cure. Our health care team has the special experience, skills, and knowledge for supporting patients and families and would be there for help.
