Rectal cancer patients are at significant risk of developing metachronous colorectal cancers; thus, colonoscopy to remove metachronous benign polyps should be performed 1 year after initial diagnosis and, if normal, repeated 3 years later. Almost all patients regardless of age and comorbidities can safely tolerate such surveillance.

In general, aggressive follow up to detect recurrent cancer after curative intent therapy is restricted to patients who would tolerate a major reoperation to resect a local (pelvic) or distant (liver, lung, or abdominal) recurrence. Frequent surveillance with digital rectal examination, proctoscopy, and endorectal US may detect pelvic recurrences when still amenable to radical excision. Surveillance with regular performance of carcinoembryonic antigen (CEA) and/or CT imaging may detect metastatic disease when still amenable to resection. Although evidence for the effectiveness of such intensive follow up is weak, there is a general consensus among colorectal surgeons and a recent meta-analysis that supports using this approach (Berman et al, 2000).

Any patient who has symptoms or abnormal findings on clinical examination that suggest recurrence deserves a workup. If curative-intent reoperation is not feasible or safe, palliative therapy can be instituted. There is a separate chapter on palliative therapy for rectal cancer (see Chapter 99, "Palliative Therapy for Rectal Cancer").

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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