How does the management of T3/T4 rectal cancer differ from T1/T2 rectal cancer?

In the management of rectal cancer, the differences in treatment between T3/T4 and T1/T2 stages are significant due to the extent of disease progression. T3 and T4 rectal cancers indicate that the tumor has invaded deeper layers of the rectal wall or extended beyond the rectal wall into surrounding tissues or organs. As a result, the management often requires a more aggressive approach to ensure complete removal of cancerous cells and to reduce the risk of recurrence.

In T3/T4 cases, it is common practice to utilize neoadjuvant therapy, which typically comprises chemoradiotherapy prior to surgical intervention. This approach aims to shrink the tumor, making it easier to resect completely and increasing the chances of preserving surrounding structures. After completing the chemoradiotherapy regimen, a surgical resection is generally performed to remove the affected rectal tissue and surrounding margins.

Conversely, T1/T2 rectal cancers usually indicate localized disease that has not invaded the surrounding structures to the same extent as T3/T4 cancers. In such cases, the treatment might initially focus on surgical resection without the need for extensive neoadjuvant therapy. Chemoradiotherapy can still be part of the treatment plan for certain risk factors,