• Posted February 5, 2024

New Treatment Approach Good News for People Battling Rectal Cancers

Rectal cancer often involves surgeries that can lead to a debilitating loss of bowel function for patients.

However, new research suggests that a less aggressive approach to treating the disease has helped an increasing number of patients avoid these surgeries.

That can mean everything to patients' quality of life, explained study lead author Dr. Fergal Fleming.

“You don't appreciate your bowel function until it's bad,” said Fleming, an associate professor of surgery and oncology at the University of Rochester Medical Center in New York. “For many of my patients, their bowel habit, unfortunately, dictates their lives. So, if we can avoid surgery, then that's probably much better for patients in terms of quality of life.”

His team published its findings recently in the journal JAMA Oncology.

According to the American Cancer Society, over 46,000 Americans receive a diagnosis of rectal cancer each year. It's somewhat more common among men than women.

As the Rochester team explained, surgery to remove the tumor is a necessary and potentially lifesaving procedure for the vast majority of cases. But surgery also has serious disruptive effects on a patient's bowel function and quality of life.

However, in a growing minority of cases, patients are successfully avoiding these procedures, Fleming's group reports.

Looking at outcomes for more than 175,000 rectal cancer patients recorded in a U.S. national cancer database, their study found more patients being directed to a "watch-and-wait" approach.

Such strategies are already common for other cancer types, such as prostate or breast cancers. Depending on factors such as the aggressiveness of the tumor and its response to chemotherapy, doctors may hold off on ordering surgery.

“It's somewhat similar to the evolution of breast cancer care,” Fleming explained in a university news release. “Patients used to have very extensive mastectomies and resections, whereas now breast conservation is offered wherever feasible.”

Looking over the data, his team found that the number of patients deciding to forgo rectal cancer surgeries rose to 10% between 2006 and 2020.

These patients are, of course, subjected to attentive follow-up in lieu of surgery. That typically means checking in regularly with experienced oncologists for at least five years post-diagnosis.

Fleming's group stressed that in these scenarios, doctors want to achieve a balance between seeing patients often enough that they can spot signs of cancer regrowth early, but not too often, since that can overburden patients and health care systems.

At his Rochester clinic, "we try to facilitate as much of their follow-up as possible, and coordinate with affiliate units to try and make it easier for patients to make it to appointments.”

Still, the "watch-and-wait" option to rectal cancer treatment hasn't yet gone mainstream, and clinical trials remain the only way most patients access this approach.

Fleming and his team were involved in one such trial, which found that "half of the patients who opted to watch-and-wait were able to avoid surgery long-term," according to the news release. As well, those patients who initially tried watch-and-wait and did go on to receive surgery had no worse survival than patient who got surgery right away, the trial found.

More information

Find out more about rectal cancer and its treatment at the U.S. National Cancer Institute.

SOURCE: University of Rochester, news release, Feb. 1, 2024