In populations in whom there has been a focus on the important components of rectal cancer management, 5-year survival is better in rectal cancer than in colon cancer, which was not the case in the past. Total mesorectal excision (TME) is one of many important components of current management.
As they say, “absence of evidence is not evidence of absence.” Many alternative therapies, once believed by conventional medical practitioners to be merely placebos, have now been shown to have proven therapeutic value (eg, acupuncture, numerous botanical extracts, meditation).
As we look forward, we suggest that the priority should be to further our understanding of the tumor’s interactions with its microenvironment and with the immune system. We think that such an understanding will be critical for advances in locally advanced rectal cancer therapy.
The preferred integrated treatment modality for locally advanced rectal cancer is preoperative radio(chemo)therapy followed by total mesorectal excision, though certain aspects of this standard are still debated.
It is time to develop more active treatments in the early-disease setting that actually eradicate ER-positive breast cancer before new mutations and secondary resistance have a chance to develop. In this regard, standard chemotherapy is not the answer.