Personalised Surgery for Cancer of the Colon and Rectum

Cancer is a complex disease with genetic, molecular and cellular components and consequences that all need attention for its cure. Cancers of the colon and rectum represent a large proportion of malignant disease in Ireland and affect over 1000 people and their families every year. One in twenty people in Ireland will develop either disease in the course of their lifetime and so it poses a considerable threat to life as well as risking difficult and unpleasant symptoms that can markedly impact on health and quality of life. Aside from the direct effects on the person, the diagnosis and disease impacts too on their family and friends. Furthermore, approximately one in five cancers of the colon and rectum are hereditary and so will affect different generations.

The treatment of colon and rectal cancer has never been better, and cure rates are now possible in up to 95% of people - especially in those in whom it is detected early, although cure still remains possible even with very advanced stage disease. There are now very many therapies that can be utilised to minimise symptoms and the disease’s other impacts, both at the time of detection and in the subsequent event of a recurrence, and also to alleviate suffering for those in whom cure is not possible. In addition, those with pre-cancer or simply heightened risk can be helped to avoid the disease altogether by having a tailored management programme. The crucial aspect is personalising the approach and treatment to the individual affected or at risk so that the therapy fits exactly the needs of the disease and the person and so that the risk of overtreatment and undertreatment is minimised. The nature of cancer means a risk of recurrence and this means tailored follow-up with an ability to directly intervene should the natural history of the cancer make this necessary, always with an understanding of the differing personal, social and professional needs of the patient and their family. This takes comprehensive expertise among the entire cancer team so that all of combined intelligence, experience and therapeutic and technological sophistication now available can be harnessed and brought to use with precision for the each and every person requiring care.

Predominantly treatment takes the form of an operation or procedure to remove the tissues affected by the disease and/or medical therapy to suppress malignant cell growth. Often these treatments are used in conjunction - either in combination or in sequence although best outcomes are achieved if the disease can be surgically removed in its entirety. Such procedures encompass focussed, pinpoint removal of diseased tissue right up to more major multiorgan resection and can be done with image and robotic-technology guidance to allow minimal access and site precision to the highest degree. The team at the Mater have recognised national and international expertise in the delivery of all useful surgical options, and utilise these techniques every day of the week as well as contribute continually to the further development of treatment through research and education. The focus is always to select the best option of the many available and to work together so that every therapy is utilised correctly at the right time for each individual person. The personalised care pathway includes individualised health optimisation and care with the singular aim of cure whenever and however possible, and always therapy of the highest personalised value. The major care components of the personalised cancer care service at the Mater are detailed here below but all work in constant concert and overlap:

 

  • Localised excision- SPEC Care “Significant Polyp, Early Cancer Care”

 

  • Regional excision- Minimally Invasive and Robotic-assisted Care

 

  • Peritoneal Cancer, Carcinomatosis and Cancer Recurrence Resection     

 

  • Multimodality multivisceral resection either synchronous or in sequence  with or without chemo and immunotherapy and radiotherapy.

 

  • Preoperative and Postoperative Fitness and Health- DCU