Question

Brief note on wait and watch approach for low rectal carcinoma.

Hint:

The "wait and watch" approach is appropriate for small, localized tumors with no signs of aggression. However, careful and regular monitoring is critical to detect any progression.

Answer 1

The “wait and watch” approach, also known as active surveillance, is considered for low rectal carcinoma in select cases where the tumor is small, localized, and has a low risk of progression. This approach is used when the risks of surgery outweigh the potential benefits.
Step 1: Indications for Wait and Watch:
1. Early-Stage Tumors (T1): Patients with T1 tumors (confined to the mucosa and submucosa) who are not ideal candidates for surgery may be monitored with regular follow-up. These tumors may be treated with local excision, and if they do not exhibit adverse features (e.g., lymphovascular invasion), observation may be appropriate.
2. High Surgical Risk Patients: In elderly patients or those with significant comorbidities who may not tolerate extensive surgery, a “wait and watch” approach may be employed, especially if the tumor is small and well-defined.
Step 2: Monitoring and Follow-up:
Patients on a wait and watch protocol must undergo regular surveillance with:
1. Endoscopy and Biopsy: Regular colonoscopy or flexible sigmoidoscopy to monitor for tumor progression.
2. Imaging: Periodic imaging (e.g., CT scan or MRI) is used to detect any signs of disease progression or distant metastasis.
Step 3: Criteria for Intervention:
The wait and watch approach is abandoned if there are signs of tumor growth, local invasion, or lymph node involvement. In these cases, surgical intervention, typically with low anterior resection or a more radical approach, will be necessary.