New contributions to rectal tumors and therapy - an oncologist’s view

Abstract

Following the biological, clinical and imaging characterization of rectal cancer addressed in the first part of this work, this second part focuses on the principles guiding therapeutic decision- making based on staging and prognostic factors. The TNM staging system, its prognostic value and its central role in treatment strategy selection are systematically reviewed. Treatment options for localized, locally advanced and metastatic rectal cancer are discussed, including radical surgery with total mesorectal excision, neoadjuvant and adjuvant therapies, and multimodal treatment strategies. Particular attention is given to organ-preserving approaches, namely the “watch and wait” strategy and local excision after neoadjuvant chemoradiotherapy, with a critical discussion of the available evidence, functional benefits and oncological risks. Advances in the treatment of metastatic disease are also reviewed, including cytoreductive surgery combined with HIPEC and emerging therapies such as PIPAC. Finally, current controversies and future perspectives in rectal cancer management are discussed in the context of increasing therapeutic individualization and a multidisciplinary approach.