Management of stage IV rectal cancer: palliative options

Abstract

Approximately 30% of patients with rectal cancer present with metastatic disease. Many of these patients have symptoms of bleeding or obstruction. Several treatment options are available to deal with the various complications that may afflict these patients. Endorectal stenting, laser ablation, and operative resection are a few of the options available to the patient with a malignant large bowel obstruction. A thorough understanding of treatment options will ensure the patient is offered the most effective therapy with the least amount of associated morbidity. In this review, we describe various options for palliation of symptoms in patients with metastatic rectal cancer. Additionally, we briefly discuss treatment for asymptomatic patients with metastatic disease.

Keywords: Endorectal stenting; Laser ablation; Malignant bleeding; Malignant obstruction; Palliative therapy; Rectal cancer.

Figure 1

A young patient was diagnosed with an obstructing cancer in the upper rectum. Computed tomography demonstrated findings consistent with peritoneal metastases. She was referred for an endorectal stent to relieve the obstruction. A: Single-view plain radiography demonstrated colonic distension; B: A single-axial section with the arrow demonstrated the tumor; C: Luminal view of the tumor at time of sigmoidoscopy; D: Fluorography during stent placement demonstrated the wire across the tumor; E: Fluoroscopic view demonstrated the endoluminal stent being deployed; F, G: Fluoroscopic and endoscopic views of the stent in place.