Rectal Cancer

General Information | Treatment Options | Screening
Prevention | Additional Resources

Treatment
  • Overview
  • Standard Treatment
  • Clinical Trials
  • Treatment By Stage

There are different types of treatment for patients with rectal cancer.

Different types of treatment are available for patients with rectal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Three types of standard treatment are used:

Surgery

Surgery is the most common treatment for all stages of rectal cancer. A doctor may remove the cancer using one of the following types of surgery:

  • Local excision: If the cancer is found at a very early stage, the doctor may remove it without cutting into the abdomen. If the cancer is found in a polyp (a growth that protrudes from the rectal mucous membrane), the operation is called a polypectomy.

  • Resection: If the cancer is larger, the doctor will perform a resection of the rectum (removing the cancer and a small amount of healthy tissue around it). The doctor will then perform an anastomosis (sewing the healthy parts of the rectum together, sewing the remaining rectum to the colon, or sewing the colon to the anus). The doctor will also take out lymph nodes near the rectum and examine them under a microscope to see if they contain cancer.

  • Resection and colostomy: If the doctor is not able to sew the rectum back together, a stoma (an opening) is made on the outside of the body for waste to pass through. This procedure is called a colostomy. A bag is placed around the stoma to collect the waste. Sometimes the colostomy is needed only until the rectum has healed, and then it can be reversed. If the doctor needs to remove the entire rectum, however, the colostomy may be permanent.

Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after surgery to increase the chances of a cure is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

Biologic therapy

Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

After treatment for rectal cancer, a blood test to measure amounts of carcinoembryonic antigen (a substance in the blood that may be increased when cancer is present) may be done to see if the cancer has come back.

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Stage 0 (Carcinoma in Situ)

Treatment of stage 0 may include the following:

  • Local excision (surgery to remove the tumor without cutting into the abdomen) or simple polypectomy (surgery to remove a growth that protrudes from the rectal mucous membrane).

  • Resection (surgery to remove the tumor). This is done when the tumor is too large to remove by local excision.

  • Internal or external radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage 0 rectal cancer.

Stage I Rectal Cancer

Treatment of stage I rectal cancer may include the following:

  • Surgery to remove the tumor with or without anastomosis (joining the cut ends of the rectum).

  • Surgery to remove the tumor with or without radiation therapy and chemotherapy.

  • Internal and/or external radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I rectal cancer.

Stage II Rectal Cancer

Treatment of stage II rectal cancer may include the following:

  • Resection with or without anastomosis (joining the cut ends of the rectum and colon, or the colon and anus) followed by chemotherapy and radiation therapy.

  • Partial or total pelvic exenteration (surgery to remove the organs and nearby structures of the pelvis), depending on where the cancer has spread. Surgery is followed by radiation therapy and chemotherapy.

  • Radiation therapy with or without chemotherapy followed by surgery and chemotherapy.

  • Radiation therapy during surgery followed by external-beam radiation therapy and chemotherapy.

  • A clinical trial evaluating new treatment options.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II rectal cancer.

Stage III Rectal Cancer

Treatment of stage III rectal cancer may include the following:

  • Resection with or without anastomosis (joining the cut ends of the rectum and colon, or the colon and anus) followed by chemotherapy and radiation therapy.

  • Partial or total pelvic exenteration (surgery to remove the organs and nearby structures of the pelvis), depending on where the cancer has spread. Surgery is followed by radiation therapy and chemotherapy.

  • Radiation therapy with or without chemotherapy followed by surgery and chemotherapy.

  • Radiation therapy during surgery followed by external-beam radiation therapy and chemotherapy.

  • Chemotherapy and radiation therapy to relieve symptoms caused by advanced cancer.

  • A clinical trial evaluating new treatment options.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III rectal cancer.

Stage IV Rectal Cancer

Treatment of stage IV rectal cancer may include the following:

  • Resection/anastomosis (surgery to remove the cancer and join the cut ends of the rectum and colon, or colon and anus) to relieve symptoms caused by advanced cancer.

  • Surgery to remove parts of other organs, such as the liver, lung, and ovaries, where the cancer may have spread.

  • Chemotherapy and radiation therapy to relieve symptoms caused by advanced cancer.

  • Chemotherapy following surgery.

  • Clinical trials of chemotherapy and biological therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV rectal cancer.

Treatment Options for Recurrent Rectal Cancer

Treatment of recurrent rectal cancer may include the following:

  • Surgery to remove the tumor or as palliative therapy to relieve symptoms caused by advanced cancer.

  • Surgery to remove parts of other organs, such as the liver, lungs, and ovaries, where the cancer may have spread.

  • Radiation therapy and/or chemotherapy as palliative therapy to reduce the size of the tumor and relieve symptoms caused by advanced cancer.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent rectal cancer.

Cancer information from the NCI PDQ service