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Low-risk Rectal Cancer — SCE Medical Oncology MCQ

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EasyGI CancersLow-risk Rectal CancerSCE Medical Oncology

A 70-year-old man with rectal cancer has MRI showing a cT2 N0 tumour, 8 cm from the anal verge, with no threat to the circumferential resection margin. EMVI-negative. What is the recommended treatment?

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Correct answer: D — Primary surgery without neoadjuvant therapy

Not all rectal cancers require neoadjuvant therapy. Low-risk rectal cancers (cT1-T2 N0, no CRM threat, EMVI-negative, mid-high rectum) can proceed directly to surgery (TME). Neoadjuvant CRT is reserved for: CRM-threatened/involved tumours, T3-T4, node-positive, EMVI-positive or low tumours requiring sphincter-preservation strategies. Over-treating low-risk rectal cancers with unnecessary CRT exposes patients to toxicity (sexual dysfunction, bowel dysfunction) without benefit.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer