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OLD APPROACH TO RECTAL CANCER

Surgical resectionPathology assessment and estimation of riskTreatment based upon classical TNM factorsPostoperative concurrent chemoradiation. OLD APPROACH TO RECTAL CANCER. NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer JAMA, Sep 1990; 264: 1444 - 1450. .

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OLD APPROACH TO RECTAL CANCER

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    2. Surgical resection Pathology assessment and estimation of risk Treatment based upon classical TNM factors Postoperative concurrent chemoradiation OLD APPROACH TO RECTAL CANCER

    3. The concept of TME surgery Optimal staging by MRI Integration of knowledge in a multidisciplinary team approach Selection of patients for preoperative therapy RECENT CHANGES IN RECTAL CANCER DIAGNOSIS AND THERAPY

    7. PREOPERATIVE STAGING OF RECTAL CANCER WITH MRI

    8. PREOPERATIVE STAGING OF RECTAL CANCER

    12. Improved coordination of care To consider each case from a variety of perspectives. Patients are more likely to be offered a range of types of treatment at appropriate times A supportive environment where professionals can share their concerns Surgeons receive feedback from pathologists and other team members on the results of their work Optimal setting for clinical research

    13. Experienced imaging specialist, particularly on MRI At least two well trained TME surgeons Pathologist able to report on specific requirements Radiation Oncologist with focused interest in rectal cancer Medical Oncologists Clinical Nurse specialist Other non core members

    14. Discussion of all new cases before surgery Discussion of MRI data Selection of patients for preoperative therapy Discussion of pathology report, stressing the assessment of the surgical plane and CRM Selection for postoperative therapy Detailed discussion of any relapse during follow up Yearly audits of all activities and results

    15. Systemic Staging: Thorax and abdominal CT Local Staging: Rectoscopy, Endorectal US, DRE MRI* has a key role in defining: Prediction of CRM involvement Tumor within 1 mm of the mesorectal fascia T3-4 arising from below the level of origin of the levator muscles Extramural spread >5mm Extramural Vein Invasion Peritoneal involvement

    20. MRI Staging MDT discussion Preoperative chemoradiation if indicated TME Surgical resection Pathology assessment and estimation of risk Postoperative chemotherapy if indicated CURRENT APPROACH TO RECTAL CANCER

    21. MULTIDISCIPLINARY TEAM FOR COLORECTAL CANCER UNIVERSITY HOSPITAL VALENCIA MRI: Salvador Campos Pathology: Samuel Navarro Surgery: Eduardo García Granero, Pedro Esclapez, Alejandro Espí, Blas Flor, Estephanie García-Botello, Tina Juan, Salvador Lledó Radiation Oncology: Ana Hernández, Pepe López Torrecilla Medical Oncology: Edith Rodríguez, Isabel Chirivella (Family Cancer Unit), Ana Bosch, Paloma Martín, Andrés Cervantes

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