The decision regarding the multiple approaches to rectal cancer can be very challenging:

Summary

The NCCN Rectal Cancer Panel believes that a multidisciplinary approach, including representation from gastroenterology, medical oncology, surgical oncology/colorectal surgery, radiation oncology, pathology, and radiology, is necessary for treating patients with rectal cancer.

Patients with very-early-stage tumours that are T1, N0 and who meet carefully defined criteria can be managed with ESD or transanal local excision. A transabdominal resection is appropriate for other rectal lesions. A TNT approach, traditionally consisting of chemoRT/short-course RT and chemotherapy, is preferred when RT is being given.

However, ongoing clinical trials for rectal cancer are particularly focused on treatment approaches that omit surgery or RT, with the goal of improving outcomes for eligible patients. Careful surveillance is necessary to detect and manage recurrences in a prompt and effective manner.

https://jnccn.org/view/journals/jnccn/22/6/article-p366.xml

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