الفهرس 
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Abstract
Colorectal carcinoma is the most common malignancy of the gastrointestinal tract and the third most common cancer in the world in both sexes constituting about 10 % of all cancers. However, its incidence in developed countries is almost double that in less developed countries. In Egypt, colorectal cancer constitutes 4.2 % and comes at 7th rank. The median age is 69 in USA and 50 years in NCI, Cairo. Colorectal cancer will account for 8% of cancer deaths in men and 9% of cancer deaths in women.
The incidence of colorectal cancer starts to increase after age 35 and rises rapidly after age 50. However, individuals of any age can develop rectal cancer, it is slightly higher in males than in females, higher in Western nations than in Asian and African countries, long-standing colitis from IBD are at increased risk for the development of colorectal cancer, Obesity and sedentary lifestyle dramatically increase cancer-related mortality, including rectal carcinoma
Local recurrence after surgical excision results in major morbidity with debilitating symptoms of pelvic pain, ureteric obstruction, intestinal and urinary tract fistulation, and poor bowel and urinary function.
More than 40% of patients who undergo curative surgery for colorectal cancer have tumor recurrences. 85% of them do so during the first 2.5 years after surgery. The remaining 15% experience recurrence during the subsequent 2.5 years.
Many factors influence the local recurrence of rectal cancer include; size and Location of the tumor and nearness to anal verge, type of first surgery, Patterns of pathology of the tumor, Nodal status, Adjuvant CRT and nCRT and CEA level pre and postoperatively.
In addition to the history and physical examination, chest radiograph, complete blood cell count, CEA, proctoscopic examination, endorectal ultrasound (ERUS), or dedicated rectal MRI, full colonoscopy, PET-CT, CT colonography and CT scan of the abdomen and pelvis should be performed to accurately stage and evaluate patients with Local recurrent rectal cancer which may influence treatment decisions.
The complex treatment of rectal cancer requires a multidisciplinary team which should include radiologists, nuclear medicine physicians, gastroenterologists, and pathologists for staging expertise, in collaboration with surgeons, medical oncologists, and radiation oncologists to represent the treatment modalities of surgery, chemotherapy, and radiation therapy, respectively. Genetic counseling involvement is appropriate.
Locally recurrent rectal cancer is characterized by isolated pelvic or anastomotic recurrence of disease, patients with disease recurrence at the anastomotic site are more likely to be cured following re-resection than those with an isolated pelvic recurrence.
Surgery for LRRC is complex and often extensive, which may result in a significant degree of postoperative mortality and complications. However, 30-day mortality is reported to be low and is mainly caused by bleeding, sepsis and thromboembolic complications. Pelvic collections, perineal wound breakdown and wound infections accounted for more than half of all complications.
Patients with unresectable lesions or unfit for operations are treated with chemotherapy with or without radiation according to their ability to tolerate therapy. Debulking that results in gross residual cancer is not recommended.
Median survival for metastatic colorectal cancer without systemic chemotherapy ranges from 6 to 9 months. The addition of 5-FU-based regimens improves survival to 10 to 12 months. The addition of irinotecan or oxaliplatin to 5-FU further improves survival to 14 to 17 months. The addition of the monoclonal antibodies have improved median survival to greater than 20 months.