Surgical Pathology of Rectal Cancer in Relation to Adjuvant Radiotherapy

The general results of surgical treatment of rectal cancer at St. Mark's Hospital between 1928 and 1952 show that approximately half of all patients were cured of their disease. Among those who died of cancer about one in five had a local recurrence in the pelvis. Pelvic recurrence is most common in tumours of the lower rectum, those with lymphatic metastases and those of high-grade malignancy. Despite careful attention to technique it appears that surgery alone has little more to offer in the treatment of rectal cancer. For this reason the role of radiotherapy as an adjuvant method has been explored. The problem is to select those patients most likely to benefit from adjuvant radiotherapy. Pathological studies indicate that post-operative treatment could be given for all patients with growths of the middle and lower thirds of the rectum, other than Dukes' “A” cases. Alternatively it is suggested that pre-operative radiotherapy could be given to those patients who, prior to surgery, seem likely on clinical examination, aided by rectal biopsy, to be most at risk from pelvic recurrence.