Palabras clave
Tratamiento
Quimioterapia
Radioterapia
Cirugía
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Resumen
Objetivo: Revisar los avances clave en el diagnóstico, la estadificación y el tratamiento del cáncer de recto (CR), haciendo hincapié en las estrategias actuales de preservación de órganos, como la terapia neoadyuvante total (TNT) y el protocolo de watch and wait (WW). Revisión de la literatura: El CR representa un problema de salud pública significativo debido a su elevada incidencia, morbimortalidad e impacto funcional. Su carcinogénesis implica una compleja interacción de factores genéticos, epigenéticos, ambientales e inflamatorios, destacando las alteraciones en los genes APC, KRAS y TP53, así como la inestabilidad de microsatélites. El diagnóstico se basa en la integración de la evaluación clínica, la colonoscopia, la histopatología y los métodos de imagen, desempeñando la resonancia magnética (RM) pélvica de alta resolución un papel fundamental en la estadificación locorregional. Los enfoques terapéuticos han incorporado la escisión total del mesorrecto (ETM), la quimiorradioterapia neoadyuvante, la TNT y estrategias de preservación de órganos. Consideraciones finales: La estrategia de WW ofrece una alternativa para pacientes cuidadosamente seleccionados que logran una respuesta clínica completa (RCC), siempre que exista una evaluación multimodal y una vigilancia rigurosa. La personalización del tratamiento y el empleo de un enfoque multidisciplinario son esenciales para optimizar el control oncológico y la calidad de vida.
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