Keywords
Treatment
Chemotherapy
Radiotherapy
Surgery
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Abstract
Objective: To review key advances in the diagnosis, staging, and treatment of rectal cancer (RC), emphasizing contemporary organ-preservation strategies such as total neoadjuvant therapy (TNT) and the watch and wait (WW) protocol. Literature review: RC represents a significant public health issue due to its high incidence, morbidity and mortality, and functional impact. Its carcinogenesis involves a complex interplay of genetic, epigenetic, environmental, and inflammatory factors, notably alterations in the APC, KRAS, and TP53 genes and microsatellite instability. Diagnosis relies on integrating clinical assessment, colonoscopy, histopathology, and imaging methods, with high-resolution pelvic magnetic resonance imaging (MRI) playing a pivotal role in locoregional staging. Treatment approaches have evolved to incorporate total mesorectal excision (TME), neoadjuvant chemoradiotherapy, TNT, and organ-preservation strategies. Final considerations: The WW strategy offers an alternative for carefully selected patients who achieve a complete clinical response (CCR), provided there is multimodal assessment and rigorous surveillance. Tailoring therapy and adopting a multidisciplinary approach are essential to optimizing oncological control and quality of life.
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