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Colorectal Cancer — SCE Medical Oncology MCQ

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HardGI CancersColorectal CancerSCE Medical Oncology

A 65-year-old man presents with a locally advanced rectal cancer 4 cm from the anal verge. Neoadjuvant long-course chemoradiotherapy achieves a clinical complete response (no visible tumour on MRI, endoscopy or examination). What management strategy is increasingly being offered?

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Correct answer: B — Watch-and-wait (active surveillance) strategy

The watch-and-wait (organ preservation) strategy after clinical complete response to neoadjuvant chemoradiotherapy is an increasingly adopted approach based on the International Watch & Wait Database and Habr-Gama's pioneering work. Approximately 70-80% of patients with sustained cCR avoid surgery. Intensive surveillance with DRE, MRI, endoscopy and CEA is required. Salvage surgery remains curative for the majority of regrowths. NICE NG151 acknowledges this as a management option.

Reference: NICE NG151 Colorectal cancer; ESMO 2024 Rectal Cancer Guidelines; IWWD van der Valk et al Lancet 2018