Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2015; 21(25): 7659-7671
Published online Jul 7, 2015. doi: 10.3748/wjg.v21.i25.7659
Rectal cancer: An evidence-based update for primary care providers
Wolfgang B Gaertner, Mary R Kwaan, Robert D Madoff, Genevieve B Melton
Wolfgang B Gaertner, Mary R Kwaan, Robert D Madoff, Genevieve B Melton, Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN 55455, United States
Author contributions: All authors equally contributed to the manuscript conception and design, acquisition of data, analysis and interpretation of data, and drafting and revision of the manuscript.
Conflict-of-interest statement: The authors have no financial disclosures to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Wolfgang B Gaertner, MSc, MD, Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 450, Minneapolis, MN 55455, United States.
Telephone: +1-612-6257992 Fax: +1-612-6254406
Received: January 14, 2015
Peer-review started: January 14, 2015
First decision: March 10, 2015
Revised: April 4, 2015
Accepted: May 21, 2015
Article in press: May 21, 2015
Published online: July 7, 2015

Rectal adenocarcinoma is an important cause of cancer-related deaths worldwide, and key anatomic differences between the rectum and the colon have significant implications for management of rectal cancer. Many advances have been made in the diagnosis and management of rectal cancer. These include clinical staging with imaging studies such as endorectal ultrasound and pelvic magnetic resonance imaging, operative approaches such as transanal endoscopic microsurgery and laparoscopic and robotic assisted proctectomy, as well as refined neoadjuvant and adjuvant therapies. For stage II and III rectal cancers, combined chemoradiotherapy offers the lowest rates of local and distant relapse, and is delivered neoadjuvantly to improve tolerability and optimize surgical outcomes, particularly when sphincter-sparing surgery is an endpoint. The goal in rectal cancer treatment is to optimize disease-free and overall survival while minimizing the risk of local recurrence and toxicity from both radiation and systemic therapy. Optimal patient outcomes depend on multidisciplinary involvement for tailored therapy. The successful management of rectal cancer requires a multidisciplinary approach, with the involvement of enterostomal nurses, gastroenterologists, medical and radiation oncologists, radiologists, pathologists and surgeons. The identification of patients who are candidates for combined modality treatment is particularly useful to optimize outcomes. This article provides an overview of the diagnosis, staging and multimodal therapy of patients with rectal cancer for primary care providers.

Keywords: Rectal cancer, Diagnosis, Treatment, Review, Primary care

Core tip: Colorectal cancer is the third most common malignant neoplasm and second most common cause of cancer-death in the United States. It is essential for primary care providers to become familiar with the modifications and updates in the diagnosis and treatment of this common malignancy. This review focuses on the advances made in the multidisciplinary approach to rectal cancer as well as minimally invasive surgical options as part of the management of rectal tumors.