Symptoms and diagnosis of local recurrence after rectal cancer treatment

Abstract

Aim: The prognosis for local recurrence after rectal cancer treatment is poor. A minority of patients are eligible for surgery with curative intent, which could possibly be improved by earlier detection. The aim of this study was to determine symptoms at presentation and how local recurrence was diagnosed, and to identify alarm symptoms for local recurrence as opposed to symptoms found among patients after surgery for rectal cancer in general.

Methods: In a population-based retrospective cohort (cohort A), all patients who had undergone resection surgery for rectal cancer in the region of Västra Götaland, Sweden, diagnosed 2010-2014, were identified through the Swedish ColoRectal Cancer Registry. After a follow-up period of at least five years, medical records were reviewed to identify patients diagnosed with local recurrence. Data on symptoms, diagnostic procedures and treatment of local recurrence were retrieved. A prospective cohort of patients who had undergone surgery for rectal cancer without local recurrence (the QoLiRECT-study, cohort B) was used for comparison regarding symptoms at two years after treatment.

Results: Cohort A consisted of 1208 patients, out of whom 78 (6%) were diagnosed with local recurrence. Forty-six patients were diagnosed between scheduled follow-up visits. Fifty-eight patients were symptomatic at the time of diagnosis, and the most common symptoms were pain, bleeding and urogenital symptoms. Pain was more common in patients with local recurrence when comparing cohort A with cohort B.

Conclusion: A majority of patients with local recurrence were diagnosed outside of the scheduled follow-up. Most of the patients were symptomatic at diagnosis. Symptoms were common in patients after rectal cancer surgery in general, however pain was more common in patients with local recurrence and could represent an alarm symptom.

Keywords: Rectal cancer; local recurrence; rectal neoplasm.