ABSTRACT
The determination of an optimal treatment plan for an individual patient with rectal cancer is a complex process. In addition to decisions relating to the intent of rectal cancer surgery (ie, curative or palliative), consideration must also be given to the likely functional results of treatment, including the probability of maintaining or restoring normal bowel function/anal continence and preserving genitourinary functions. Particularly for patients with distal rectal cancer, finding a balance between curative-intent therapy while having minimal impact on quality of life can be challenging. Furthermore, the risk of pelvic recurrence is higher in patients with rectal cancer compared with those with colon cancer, and locally recurrent rectal cancer is associated with a poor prognosis. Careful patient selection and the use of sequenced multimodality therapy following a multidisciplinary approach is recommended. These NCCN Guidelines Insights detail recent updates to the NCCN Guidelines for Rectal Cancer, including the addition of endoscopic submucosal dissection as an option for early-stage rectal cancer, updates to the total neoadjuvant therapy approach based on the results of recent clinical trials, and the addition of a "watch-and-wait" nonoperative management approach for clinical complete responders to neoadjuvant therapy.
Subject(s)
Rectal Neoplasms , Humans , Rectal Neoplasms/therapy , Rectal Neoplasms/diagnosis , Rectal Neoplasms/pathology , Neoadjuvant Therapy/methods , Neoadjuvant Therapy/standards , Combined Modality Therapy/methods , Neoplasm Staging , Medical Oncology/standards , Medical Oncology/methodsABSTRACT
Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer and the second leading cause of cancer death in the United States. Management of disseminated metastatic CRC involves various active drugs, either in combination or as single agents. The choice of therapy is based on consideration of the goals of therapy, the type and timing of prior therapy, the mutational profile of the tumor, and the differing toxicity profiles of the constituent drugs. This manuscript summarizes the data supporting the systemic therapy options recommended for metastatic CRC in the NCCN Guidelines for Colon Cancer.
Subject(s)
Colonic Neoplasms , Humans , Colonic Neoplasms/diagnosis , Colonic Neoplasms/therapy , Colonic Neoplasms/pathology , Colonic Neoplasms/drug therapy , Medical Oncology/standards , Medical Oncology/methods , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/adverse effects , United StatesABSTRACT
Concentrations of perfluoroalkyl acids (PFAAs), polybrominated diphenyl ethers (PBDEs), and "novel" brominated flame retardants (NBFRs) were determined in lagoons processing wastewater from two high-Arctic and two sub-Arctic of Canada communities to assess the importance of local anthropogenic sources. ∑PFAAs in influent and effluent of the Arctic lagoons were within the lower end of the range of concentrations previously observed in Canadian temperate wastewater treatment plants (WWTPs). In comparison, influent and effluent concentrations of ∑PBDEs and NBFRs were significantly greater (p < 0.05) in high-Arctic lagoons compared to sub-Arctic and temperate plants. The surprisingly elevated concentrations of PBDEs and NBFRs in high-Arctic lagoons were probably related to high organic matter found in Arctic wastewater due to lower consumption of potable water leading to less dilution compared to temperate regions. Although PFAAs also sorb to solids, the wastewater samples were filtered prior to analysis of PFAAs (but not PBDEs and NBFRs), which likely reduced the impacts of solids on the results for PFAAs. Based on an extrapolation of per capita mass effluent loadings of the four Arctic lagoons, mass loadings to the Arctic of Canada via WWTP effluent were estimated as 1405 g/year and 549 g/year for ∑PFAAs and ∑PBDEs, respectively.