Ca rectum treatment

Ca rectum treatment

# Carcinoma upper 1/3rd of rectum

@  High anterior resection includes removal growth with nodes followed by colorectal anastomosis
@ treatment of choice when growth is situated between 11 to 15cm from anal verge
@ this is sphincter saving surgery

# ca of lower 1/3 of rectum

@ growth within 7cm 4o anal verge
@ abdomino perineal resection
- pt put in Lloyd Davis position [supine with lithotomy]
- 2 surgeons operate simultaneously 1 from abd m one 4m perineum
- abdomen opened 1st growth mobilised 4m sacrum n bladder
- at this stage anus is kept close by perineal surgeon
- rectum n anal canal mobilised
- following structures removed
1 entire rectum m anal canal , 2 fascia propria with papa rectal nodes
3  2/3rd of sigmoid colon n mesocolon with lymphatic n LN
4. Muscle n peritoneum of pelvic floor
5. Wide area of perianal skin with part of ischiorectaj fossa
- this followed by permanent do colostomy by bringing out sigmoid colon outside in left iliac fossa
- it is sphincter sacrificing surgery

@ local excision

mobile tumors < 4cm, less than 40% of rectal wall involvement , located within 6cm of anal verge, lesion should be T1 or T2, no vascular or lymphatic or nodal invasion

# ca middle 1/3rd rectum

@ refers to growth between 7to 11 cm from anal verge
@ APR or low anterior resection can be done
@ in cases of well diff ca 2cm margin n in anaplastic ca 5cm margin clearance necessary

# Hartmann's operation

#Radiotherapy

@ rectal cancers r more radiosensitive  and colonic r more chemo sensitive
@ neutron beam radiation 4000-5000 cGy units
@ pre op radiotherapy when tumor extended thro wall
@ post op 2 reduce recurrence
@ Papillon's intra cavity radiation indicated 4 small localised n exophytic ca as curative therapy

# Chemotherapy

1] inj 5 FU 475mg/m2/daw IV into 5 dayp with inj leucovorhn 30mg/day for 5 days. 3 such courses
2] inj 5 FU with levamisole 150 mg BD for 3 days once in 15 days for 1 yr