Cancers that develop in the colon and rectum parts of the large intestine, which is the last part of the digestive canal, are called colorectal cancer (large intestine cancer). Although it is defined as colorectal cancer (colon cancer) due to their similar characteristics, it is also called colon cancer and rectal cancer according to the part where the large intestine is located.
“WAIT AND SEE” METHOD
The treatment of cancers that develop in the rectum, the region of the large intestine close to the anus, presents a special study. In patients with rectal cancer, the main treatment is to surgically remove the cancerous intestine area. This is very important for full recovery. The main purpose of cancer surgeries is to remove the cancerous organ with clean boundaries (without leaving tumor tissue behind), along with the regional lymph nodes that are likely to spread. Although the main task of the doctor who performs rectum cancer surgery is to successfully remove colon cancer, another task is to ensure the continuity of the bowel and defecation functions as before, after removing the cancerous colon. In this way, it is ensured that the patient can perform the normal defecation function as before. It is possible to maintain intestinal continuity in 90% of colon cancer cases and to maintain a normal life as before.
In patients with rectum cancer that passes the intestinal wall, spreads to the surrounding tissue or spreads to the lymph nodes, it is often used together with radiation therapy (radiotherapy) and chemotherapy before surgery, depending on the stage of the cancer, the area where it is located and the patient’s characteristics. In previous scientific studies, it was determined that some patients who received radiation and chemotherapy treatment respond very well to the treatment. In a small number of patients, it was observed that there were no cancer cells left, that is, complete healing (complete pathological response was obtained).
For this reason, I wonder if rectal cancer can be treated without surgery with alternative methods today? The question has arisen. Although it is theoretically possible to get rid of defecation, sexual and urinary tract problems caused by rectal surgeries with this type of treatment, this option is suitable for a very limited patient group.
IT IS POSSIBLE FOR PATIENTS TO RECOVER THE HEALTH WITHOUT SURGERY
Nowadays, it has been shown that it is possible for patients with clinical response to receive radiation and chemotherapy treatment for rectal cancer without surgery. However, it is not known exactly which patients will benefit from treatment with radiation and chemotherapy without surgery. In this non-operated patient group, there is also the possibility of the disease occurring in the same place or spreading to a distant organ (liver, lung, etc.). Since the long-term results are not clear, these patients should be followed very closely only within the scope of scientific studies and it should be investigated whether the disease reappears.
In the light of this information, it should be kept in mind that all medical treatment methods and medications used may have a minor side effect. In other words, radiation therapy and chemotherapy drugs are not so innocent either. For example, even the most widely used aspirin in the world has side effects despite its positive aspects. To put it briefly, side effects of radiation therapy and chemotherapy drugs can also occur.
NEEDS A MULTIDISCIPLINARY TREATMENT APPROACH
The success of rectal cancer treatment requires a “multidisciplinary” treatment approach, that is, a team work. In the team that will work with a surgeon specializing in colon surgery, a medical oncologist who will determine the scheme of chemotherapy drugs, a radiation oncologist who will plan the radiation therapy program, and a radiologist who will perform the staging of the disease with imaging methods are at the forefront. With such a teamwork, the treatment of each patient should be meticulously discussed, planned and personalized.
It should not be forgotten that the team planning your treatment aims to do the best for you by considering the benefit and harm ratio at the optimum level.
In the initial phase of the treatment, we first apply radiation and chemotherapy treatment to the patient with rectal cancer according to the clinical stage. These patients, 8-12 weeks after the completion of radiation and chemotherapy treatment, evaluate the disease in detail using examination and imaging methods, and decide whether surgery is needed according to the response they give to the treatment. Generally, we can see that the disease regresses completely clinically after radiation and chemotherapy in a small number of patients in this group. However, it is not possible to understand that patients who receive this treatment have a 100% full recovery without removing the diseased intestinal part by surgery. However, we acknowledge that the patient has been fully cured after the pathological (microscopic) examination of the intestinal tissue removed by surgery and the pathologist confirms that there are no cancer cells left. It is not possible in today’s technology to get results with 100% healing accuracy with medical imaging methods.
For this reason, we can think of “rectal cancer can be followed up with non-surgical treatment” in patients who have determined that the cancer regresses, that is, disappears with radiation and chemotherapy, with only examination and imaging methods without removing the cancerous intestinal part with surgery.
To put it briefly, no healing discourse other than the “wait and see” strategy can be developed in patients who are thought to have been treated for rectal cancer with radiation and chemotherapy methods. In these patients, there is a possibility that the disease will develop again in the same place or spread to distant organs. For this reason, the patient should be explained very well that different results may arise and the patient should be enlightened about the subject. In addition, it should not be forgotten that patients who receive this treatment should be subject to a very close follow-up program.
On the other hand, in the evaluation we made in many patients 10-14 weeks after radiation and chemotherapy, if the disease has receded but has not completely disappeared, that is, if it has not responded to clinical treatment, we recommend the surgical treatment method in these patients so that the cancer can be completely cleared.
In the light of the above information, only irradiation and simultaneous chemotherapy drug administration and non-surgical treatment method have satisfactory results in a very limited number of patients, but it should be very careful. Scientific studies and research on this subject are still ongoing at the clinical level.