Rectal Cancer
Everything in the library about rectal cancer — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
In-Depth Reviews
4 items
Colon Cancer with Conor Delaney
Listen →
Dr. Ponsky, professor of surgery at the Cleveland Clinic Lerner College of Medicine and Department of Surgery and Dr. Colon Delaney, chairman of digestive disease and institute and professor of surgery at Cleveland Clinic Lerner College of
podcast26:50 · Dec 2020
Colorectal Cancer
Listen →
An interactive discussion about colorectal cancer between Jeffrey Ponsky, MD and Conor Delaney, MD, PhD. Dr. Delaney, is the chairman of the Digestive Disease
podcast26:42 · Jul 2026
Colorectal Cancer
Listen →
An interactive discussion about colorectal cancer between Jeffrey Ponsky, MD and Conor Delaney, MD, PhD. Dr. Delaney, is the chairman of the Digestive Disease
podcast26:42 · Jul 2026
Colorectal Cancer
Listen →
An interactive discussion about colorectal cancer between Jeffrey Ponsky, MD and Conor Delaney, MD, PhD. Dr. Delaney, is the chairman of the Digestive Disease and Surgery Institute at Cleveland Clinic, Cleveland, OH. Dr. Delaney is also a p
podcast26:42 · Jul 2026
Summaries and takeaways+ Show
The doctors in this collection+ Show
All expert statements+ Show
Every expert statement below comes from the recorded discussions, with its speaker and moment.
Colorectal Cancer
Colonoscopy is still the best test for colon cancer detection, finding the vast majority of cancers and polyps, though not perfect
clinicalConor Delaney1:15 ↗
Serrated adenomas have good evidence of genetic predisposition and may tie into many family cancer syndromes
clinicalConor Delaney2:03 ↗
Serrated polyps have a really high risk of cancer
clinicalConor Delaney2:03 ↗
Some serrated polyps are flat and difficult to see, making retroflexion in the cecum useful as they're often on the inferior or superior side of the valve
clinicalConor Delaney3:26 ↗
Historical local recurrence rates for rectal cancer from good institutions were 20 to 38 percent, with some up to 50 percent
epidemiologicalConor Delaney9:03 ↗
Current local recurrence rates should be under 10 percent, with Cleveland Clinic's last 10 years at about 3 percent
epidemiologicalConor Delaney9:03 ↗
Distal margin requirements for rectal cancer: 5 centimeters if possible, 2 centimeters if possible, and for very lowest tumors perhaps 1 centimeter as long as they're not poorly differentiated
guidelineConor Delaney4:59 ↗
MRI is probably 90 to mid-90s percent accurate at T staging and probably high 80s to 90% accurate for nodal staging
clinicalConor Delaney13:11 ↗
Ultrasound is much more operator dependent and probably only 70% accurate for predicting nodal involvement
clinicalConor Delaney13:11 ↗
The standard of care has shifted from ultrasound to MRI for rectal cancer staging
guidelineConor Delaney14:02 ↗
Historical local recurrence rates for transanally excised rectal cancers was about 18%, remarkably consistent across outcome data from several big centers
epidemiologicalConor Delaney14:19 ↗
Transanal resection is generally kept for patients who aren't fit for a rectal resection, or patients whose tumor is so close to the dentate line you'd have to give them a permanent stoma
guidelineConor Delaney14:19 ↗
If it's a rectal cancer, it needs to be a full thickness excision; you would never do an ESD type procedure
guidelineConor Delaney16:23 ↗
Neoadjuvant therapy is generally indicated for T3 or node-positive disease
guidelineConor Delaney17:25 ↗
In Europe, radiation has gone towards five times five gray given over five days, with surgery about a week to two weeks later
guidelineConor Delaney17:25 ↗
In the US, radiation is six-week, 40 to 45 gray, given with chemotherapy, staged over six weeks, then a six-week to eight-week waiting period
guidelineConor Delaney17:25 ↗
25 gray over a short period is equivalent to 40 to 45 over a longer period from a radiotherapeutic perspective
clinicalConor Delaney17:25 ↗
For colon cancer surgery, you're looking for at least a five centimeter proximal and distal margin, usually determined by blood supply, and at least 12 lymph nodes, with many hoping for at least 16
guidelineConor Delaney19:22 ↗
You should be able to do a total mesocolic excision with five mils of blood loss, in the plane between Toltz fascia and the embryological peritoneum on the mesocolon
clinicalConor Delaney19:22 ↗
Scandinavian data showed local recurrence rate for colon cancer was even higher than their rectal cancer local recurrence rate because they weren't doing adequate colon cancer surgery
epidemiologicalConor Delaney19:22 ↗
For a cecal tumor, you should take 10 centimeters of small bowel; if it's mid-ascending colon, you should take 5
guidelineConor Delaney22:44 ↗
Extracorporeal stapled anastomosis for laparoscopic right colectomy has reported leak rates of 0.8% over 1,000 cases
epidemiologicalConor Delaney23:59 ↗
The Weiss Center for Hereditary Colorectal Cancer has the biggest polyposis database in the world and probably now the biggest HNPCC database as well
clinicalConor Delaney24:32 ↗
Colonoscopy is still the best test for colon cancer detection, though not perfect, finding the vast majority of cancers and polyps
clinicalConor Delaney1:15 ↗
Serrated adenomas (previously called hyperplastic polyps in right colon) have good evidence of genetic predisposition and tie into many family cancer syndromes
clinicalConor Delaney2:03 ↗
Serrated polyps have a very high risk of cancer
clinicalConor Delaney2:03 ↗
Serrated adenomas are often flat and difficult to see, requiring retroflexion in the cecum to visualize them on the inferior or superior side of the valve or folds
clinicalConor Delaney3:26 ↗
Required distal margin for rectal cancer is 5 centimeters if achievable, 2 centimeters if achievable, and for very lowest tumors perhaps 1 centimeter as long as they are not poorly differentiated
clinicalConor Delaney4:59 ↗
Six centimeters from anal verge in an 80-year-old 90-pound female can be almost mid-rectum, while in a 6'6" 300-pound male can be top of anal canal or close to dentate line
clinicalConor Delaney4:59 ↗
Upper third rectal cancers likely will not need preoperative therapy and likely will not need a stoma
clinicalConor Delaney6:51 ↗
What's new+ Show