For patients with large, partially or nearly obstructing rectal cancers, how do you sequence TNT in order to avoid complete obstruction and surgical diversion?   

I personally favor starting with RT/chemo, but starting with chemo can work well. The more important issue is the side questions. First, there is a huge difference between a lesion that is large and one that is nearly completely obstructing. Unfortunately, many endoscopists use the term "obstructing...

Coming from the med-onc perspective, I agree with Dr. @Tepper's assessment of “obstruction” based on clinical symptoms while also trusting the discussion with the endoscopist. Personally, I prefer to start with chemotherapy. I can make individual adjustments to the regimen to prepare in ...

At our center, we treat very advanced cases routinely. CRT or chemo can yield a worsening symptomatic obstruction. If symptomatic upfront or impending symptomatic, I think a diverting ostomy is the way to go. From there, I still prefer CRT upfront than chemo (but never mind if one or two cycles of c...

Agree with the above. The obstructive symptoms will respond quickly in many patients with the institution of neoadjuvant treatment. However, it is not uncommon to have a patient who for various reasons does not seem to get started expeditiously on treatment. For those cases, referral for upfront div...