Oct. 12, 2023
In the U.S., the American Cancer Society estimates colorectal cancer to be the third most commonly diagnosed cancer and the third-leading cause of cancer-related death. While the overall incidence has dropped in recent years, this drop is seen primarily in older adults. For those younger than age 50, rates have increased since the mid-1990s.
Colorectal cancer includes cancers of both the colon and the rectum. Rectal cancer, specifically, can be more complicated to treat due to the smaller space and relatively close proximity to other organs.
David W. Larson, M.D., M.B.A., is a colorectal cancer surgeon at Mayo Clinic Comprehensive Cancer Center in Rochester, Minnesota. He and his colleagues are advancing surgical treatment options for patients with all types of rectal cancer — including recurrent cancers that have metastasized beyond the rectum.
"The good news is that colorectal cancer is curable," says Dr. Larson in both primary and recurrent disease. "With advancements in treatment, even metastatic disease can be treated with five-year survival up to 50%."
A multidisciplinary care team specialized in serious cancers
Dr. Larson and his colleagues have found that a unique, multidisciplinary approach to rectal cancer care provides comprehensive opportunities to both treat highly complex conditions and drive research advancements throughout the field. At Mayo Clinic, the team includes radiation oncologists, medical oncologists, gastroenterologists, colorectal surgeons, hepatobiliary surgeons, radiologists, pathologists and more.
These experts meet monthly to review the most complex patient cases, as well as several times each week to review the patients being treated in the clinic that day. Each patient is then seen by all specialties involved in the plan of care, ensuring a quick and collaborative process.
"Our approach to care centers around a multidisciplinary clinic," says Dr. Larson. "That union of forces is absolutely unique."
Complex and recurrent rectal cancer care
The same multidisciplinary care is extended into the operating room, specifically for patients with complex disease such as recurrent rectal cancer. Rectal cancer can recur both systemically and locally. Dr. Larson notes that the liver and lung are the most common recurrence locations.
Due to the complexity of recurrent disease, it's important that patients have access to specialized surgical care teams. At Mayo Clinic, surgeons from different specialty areas focus specifically on complex cancers such as recurrent rectal cancer. They can operate as a multidisciplinary team, providing all the resources a patient may need in a single surgical plan.
"We really are a three-shield center where practice, research and education work closely together," says Dr. Larson. "We have the opportunity to see a high volume of patients, develop a deep expertise in difficult cancers, conduct research in that space and educate the next generation of professionals."
In many cases, patients needing this type of complex care are initially deemed to have inoperable conditions. Consulting with a high-volume, academic medical center is imperative.
Advanced surgical options for patients with rectal cancer
Advancements are being made in the medical and surgical treatment options for rectal cancer — including research on chemotherapeutics, biological therapies and neoadjuvant therapies that help patients avoid surgery if possible. Dr. Larson notes that there are concentrated research efforts to shrink tumors, monitor patients closely and use surgical procedures as a final step in the treatment plan.
This collaborative approach has led to the advent of advanced surgical options for rectal cancer, including:
- Intraoperative radiation therapy (IORT) that brings radiation treatment into the operating room to directly target cancer cells while affecting the surrounding tissues as little as possible.
- Single-port robotic surgery that optimizes the minimally invasive approach of standard robotic surgery, utilizing a single incision by which all instruments enter the body.
- Outpatient surgical procedures that ensure patients have as simple a surgical plan as possible, avoiding hospital stays and using postoperative remote patient monitoring when possible.
Dr. Larson and his colleagues aim to work collaboratively with each patient, providing the complex care they need at Mayo Clinic and outlining detailed survivorship care plans that can be conducted with care teams at home. In many cases, patients can receive initial consultations via virtual visits — an effort designed to address barriers to access for all patients with complex rectal cancer.
For more information
Key statistics for colorectal cancer. American Cancer Society.
Refer a patient to Mayo Clinic.