This case involves a fifty-two-year-old female that was diagnosed with stage three cervical cancer. Approximately one year after her diagnosis, the patient began to experience blood in her stool, along with painful bowel movements. The patient was sent for a colonoscopy, and the consulting physician believed there was a mass causing extrinsic pressure on the rectum with resultant obstruction. The physician also performed a biopsy of the ulcerated mass that seemed to be eroding into the anterior rectal wall. Several weeks after the colonoscopy and biopsy procedure, the patient presented back to the hospital with extreme abdominal pain. She was found to have a perforated colon that required emergency surgery with the placement of an end colostomy. The patient never recovered due to a severely infected peritoneum that spread from the bowel leak. She died of complications from sepsis two weeks after her hospital admission.
Question(s) For Expert Witness
- 1. What is the standard of care in treating rectal cancer surgically?
Expert Witness Response E-004735
Determination of an optimal treatment plan for patients with rectal cancer involves a complex decision-making process. Strong considerations should be given to the intent of surgery, possible functional outcome, and preservation of anal continence and genitourinary functions. The first step involves achievement of cure because the risk of pelvic recurrence is high in patients with rectal cancer and locally recurrent rectal cancer has a poor prognosis. Functional outcome of different treatment modalities involves restoration of bowel function with acceptable anal continence and preservation of genitourinary functions. Preservation of both anal and rectal reservoir functions in treatment of rectal cancer is highly preferred by patients. Sphincter-saving procedures for rectal cancer are now considered the standard of care.