Oncology Referral for Resected Rectal Adenocarcinoma

Rationale for Oncology Referral

Patients with resected rectal cancer require multidisciplinary management to determine appropriate adjuvant therapy based on pathologic staging and risk factors 2
The National Comprehensive Cancer Network (NCCN) guidelines recommend adjuvant therapy for patients with stage II or III rectal cancer to reduce local recurrence and improve survival 3

For patients with T1-T2, N0 disease with favorable characteristics, observation may be appropriate 4
However, if adverse features are present, adjuvant therapy should be considered 4
Patients with T3-T4 disease or node-positive disease should receive adjuvant radiotherapy and chemotherapy (category 1 recommendation) 4
Options include infusional 5-FU/RT, capecitabine/RT, FOLFOX, or CAPEOX depending on the specific pathologic findings 3
After resection of any node-positive tumor, chemotherapy with 5-FU plus leucovorin or other appropriate regimens should be considered 5, 6

Oncology consultation facilitates appropriate surveillance planning and monitoring for recurrence 1

For patients who have undergone resection, NCCN recommends history and physical examination every 3 months for the first 2 years, then every 6 months for the next 5 years 1
CEA testing at baseline and every 3 months for 2 years, then every 6 months for the next 2-5 years for patients with T2 or greater lesions 1
Colonoscopy within 1 year of resection (or 3-6 months postoperatively) 1

All patients with resected rectal adenocarcinoma should be referred to medical oncology 1, 2, 4
Priority referrals (should be seen within 2-4 weeks): patients with node-positive disease 6, patients with T3 or T4 tumors 3, patients with adverse pathologic features 4
Standard referrals (should be seen within 4-6 weeks): patients with T1-T2, N0 disease without adverse features 4
The American College of Surgeons and the National Comprehensive Cancer Network recommend that all patients with resected rectal cancer be referred to a medical oncologist for evaluation of adjuvant therapy 1, 2