“If the tumour regrew and I needed a major operation I would still have been happy with the pathway I have followed.” K.W.
Almost 1/3 of screen detected rectal cancers are limited to the bowel wall without nodal spread, yet 90% undergo major anterior resection or abdominoperineal surgery with a high associated rate of co-morbidity and economic cost. Precision staging of these cancers could stratify surgical therapy and remove the need for radical surgery and instead offer a local, endoluminal excision thus improving rates of surgical clearance of the polyp and any associated dysplasia or cancer.
The trial aims to change the current standards offered to bowel cancer screening and symptomatic patients diagnosed with a significant polyp or early rectal cancer (ERC) and promote a new pathway for ERC management and enhance current therapeutic pathways with state of art staging technologies and intelligent surgical devices.
Six areas to be investigated are:
- Identification of patients suitable for pathway through both the Bowel Cancer Screening Pathway (BCSP) and symptomatic patients
- Detailed staging and surgical roadmap to facilitate local excision
- Implementation of modern surgical innovations/techniques for real time molecular phenotyping and for precision surgery for ERC
- Histopathological verification of complete excision and biomarker capture
- Close monitoring of patients following local excision to ensure successful resection for residual/recurrent disease
- Impact on quality of life and cost effectiveness of pathway