Philip B. Paty, MD, surgeon, Memorial Sloan Kettering Cancer Center, discusses the high-risk period for rectal tumor regrowth in patients.

The high-risk period for regrowth of the tumor is the first 18 months following treatment, Paty explains. In this window, most practitioners who are conducting the "watch-and-wait" approach are doing so with patients in 3- to 4-month intervals. This would include a digital exam with a flexible fiberoptic sigmoidoscopy, careful examination of the rectum and tumor bed, and any scarring. The clinical examination is supplemented by cross-sectional imaging. High-resolution MRI is the optimal technique to use, especially when assessing the lymph nodes.

After the 2-year period, the risk of local cancer regrowth drops significantly, he adds, and patients are then examined at 6-month intervals. Currently, most researchers believe that patients should continue to be assessed annually for the remainder of their lives.

Videos

Dr. Paty on High-Risk Period for Rectal Tumor Regrowth

Philip B. Paty, MD, surgeon, Memorial Sloan Kettering Cancer Center, discusses patients with rectal cancer who are ineligible for a "watch and wait" approach.

Important factors to consider are tumor characteristics and the appearance of the rectal wall in the lymph nodes, Paty says. Tumors must be in a complete state of regression, which can be determined via cross-sectional imaging.

Tumors that are more difficult to eradicate are bulkier and larger in size are usually not fit for a "watch and wait" approach. Intermediate- and smaller-size tumors will likely have a higher cure rate via non-operative management; because they are smaller in size, it is easier to assess their response to treatment.

Patients with a lot of disease in the mesentery are also not appropriate candidates for "watch and wait," Paty says.

Philip B. Paty, MD, surgeon, Memorial Sloan Kettering Cancer Center, discusses patients with rectal cancer who are ineligible for a "watch and wait" approach with their surgeons.

Philip B. Paty, MD

Articles

Dr. Paty on High-Risk Period for Rectal Tumor Regrowth

Dr. Paty on Patients With Rectal Cancer Ineligible for "Watch and Wait"