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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65940_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65940_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65940_"><span class="title" itemprop="name">Rectal Cancer Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: January 31, 2020.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062959__278">This PDQ cancer information summary has current information about the treatment of rectal cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000062959__279">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.</p></div><div id="CDR0000062959__92"><h2 id="_CDR0000062959__92_">General Information About Rectal Cancer</h2><div id="CDR0000062959__92.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062959__93">Rectal cancer is a disease in which malignant (cancer) cells
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form in the tissues of the rectum. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__96">Health history affects the risk of developing rectal cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__100">Signs of rectal cancer include a change in bowel
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habits or blood in the stool.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__104">Tests that examine the rectum and colon are used to detect (find) and
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diagnose rectal cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__108">Certain factors affect prognosis
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(chance of recovery) and treatment options.</a></div></li></ul></div><div id="CDR0000062959__93"><h3>Rectal cancer is a disease in which malignant (cancer) cells
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form in the tissues of the rectum. </h3><p id="CDR0000062959__95">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> is part of
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the body’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046446/" class="def">digestive system</a>. The
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digestive system takes in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044697/" class="def">nutrients</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044744/" class="def">vitamins</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045787/" class="def">minerals</a>,
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000285960/" class="def">carbohydrates</a>, fats, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">proteins</a>, and water) from foods and helps pass waste
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material out of the body. The digestive system is made up of the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046408/" class="def">esophagus</a>,
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a>, and the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046582/" class="def">small</a> and
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045097/" class="def">large intestines</a>. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> (large <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046500/" class="def">bowel</a>) is the first part of the large intestine and is about 5 feet long. Together, the rectum and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044185/" class="def">anal</a> canal make up the last part of the large intestine and are 6-8 inches long. The anal canal ends at the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046523/" class="def">anus</a> (the opening of the large intestine to the
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outside of the body).<div id="CDR0000062959__189" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Anatomy%20of%20the%20lower%20digestive%20system%2C%20showing%20the%20colon%20and%20other%20organs&p=BOOKS&id=553342_CDR0000415499.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940.17/bin/CDR0000415499.jpg" alt="Gastrointestinal (digestive) system anatomy; shows esophagus, liver, stomach, colon, small intestine, rectum, and anus." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Anatomy of the lower digestive system, showing the colon and other organs.</p></div></div></p><p id="CDR0000062959__210">See the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summaries for more information about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000529764/" class="def">rectal cancer</a>:</p><ul id="CDR0000062959__274"><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000062878/#CDR0000062878__122">Unusual Cancers of Childhood Treatment</a> (see <a href="/books/n/pdqcis/CDR0000062878/#CDR0000062878__122">Colorectal Cancer</a> section)</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258007/">Colorectal Cancer Prevention</a></div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/CDR0000258008/"> Colorectal Cancer Screening</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000658500/">Gastrointestinal Stromal Tumors Treatment (Adult)</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000062863/">Genetics of Colorectal Cancer</a></div></li></ul></div><div id="CDR0000062959__96"><h3>Health history affects the risk of developing rectal cancer.</h3><p id="CDR0000062959__sm_CDR0000752413_5"><div class="milestone-start" id="CDR0000062959__sm_CDR0000752413_1"></div>Anything that increases your chance of getting a disease is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">risk factor</a>. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk to your doctor if you think you may be at risk for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444983/" class="def">colorectal cancer</a>.</p><p id="CDR0000062959__sm_CDR0000752413_4">Risk factors for colorectal cancer include the following:</p><ul id="CDR0000062959__sm_CDR0000752413_2"><li class="half_rhythm"><div>Having a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000302456/" class="def">family history</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044237/" class="def">colon</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000529764/" class="def">rectal cancer</a> in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000460150/" class="def">first-degree relative</a> (parent, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000616710/" class="def">sibling</a>, or child).</div></li><li class="half_rhythm"><div>Having a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642021/" class="def">personal history</a> of cancer of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a>.</div></li><li class="half_rhythm"><div>Having a personal history of high-risk <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046217/" class="def">adenomas</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046685/" class="def">colorectal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045844/" class="def">polyps</a> that are 1 centimeter or larger in size or that have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> that look <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a>).</div></li><li class="half_rhythm"><div>Having <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045098/" class="def">inherited</a> changes in certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a> that increase the risk of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045100/" class="def">familial adenomatous polyposis</a> (FAP) or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044882/" class="def">Lynch syndrome</a> (hereditary nonpolyposis colorectal cancer).</div></li><li class="half_rhythm"><div>Having a personal history of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045641/" class="def">chronic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045493/" class="def">ulcerative colitis</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045661/" class="def">Crohn disease</a> for 8 years or more.</div></li><li class="half_rhythm"><div>Having three or more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463134/" class="def">alcoholic</a> drinks per day.</div></li><li class="half_rhythm"><div>Smoking <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000748148/" class="def">cigarettes</a>.</div></li><li class="half_rhythm"><div>Being black.</div></li><li class="half_rhythm"><div>Being <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304736/" class="def">obese</a>.</div></li></ul><p id="CDR0000062959__sm_CDR0000752413_9">Older age is a main risk factor for most cancers. The chance of getting cancer increases as you get older. <div class="milestone-end"></div></p></div><div id="CDR0000062959__100"><h3>Signs of rectal cancer include a change in bowel
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habits or blood in the stool.</h3><p id="CDR0000062959__102">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by rectal cancer or by other conditions. Check with your doctor if you have any of the following:</p><ul id="CDR0000062959__103"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">Blood</a> (either bright red or very dark) in the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046605/" class="def">stool</a>.</div></li><li class="half_rhythm"><div>A change in bowel habits.<dl id="CDR0000062959__232" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000306496/" class="def">Diarrhea</a>. </p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407757/" class="def">Constipation</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">Feeling that the bowel does not
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empty completely.</p></dd><dt>-</dt><dd><p class="no_top_margin">Stools that are narrower or have a different shape than usual.</p></dd></dl></div></li><li class="half_rhythm"><div>General <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdominal</a>
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discomfort (frequent gas pains, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476585/" class="def">bloating</a>, fullness, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476584/" class="def">cramps</a>).</div></li><li class="half_rhythm"><div>Change in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454699/" class="def">appetite</a>.</div></li><li class="half_rhythm"><div>Weight loss for no known reason.</div></li><li class="half_rhythm"><div>Feeling very tired.</div></li></ul></div><div id="CDR0000062959__104"><h3>Tests that examine the rectum and colon are used to detect (find) and
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diagnose rectal cancer.</h3><p id="CDR0000062959__106">Tests used to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045959/" class="def">diagnose</a> rectal cancer include the
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following:</p><ul id="CDR0000062959__226"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045668/" class="def">Digital rectal exam</a> (DRE)</b>: An exam of the rectum. The doctor or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269445/" class="def">nurse</a> inserts a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046302/" class="def">lubricated</a>, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual. In women, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046646/" class="def">vagina</a> may also be examined.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045648/" class="def">Colonoscopy</a></b>: A procedure to look inside the rectum and colon for polyps (small pieces of bulging <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>), <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> areas, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046463/" class="def">colonoscope</a> is a thin, tube-like instrument with a light and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000572035/" class="def">lens</a> for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> for signs of cancer.<div id="CDR0000062959__276" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Colonoscopy&p=BOOKS&id=553342_CDR0000415504.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940.17/bin/CDR0000415504.jpg" alt="Colonoscopy; shows colonoscope inserted through the anus and rectum and into the colon. Inset shows patient on table having a colonoscopy." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Colonoscopy. A thin, lighted tube is inserted through the anus and rectum and into the colon to look for abnormal areas.</p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">Biopsy</a></b>: The removal
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of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> or tissues so they can be viewed under a microscope to check for signs of cancer. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">Tumor</a> tissue that is removed during the biopsy may be checked to see if the patient is likely to have the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">gene</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046063/" class="def">mutation</a> that causes HNPCC. This may help to plan treatment. The following tests may be used:<dl id="CDR0000062959__228" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><b>Reverse transcription–polymerase chain reaction (RT–PCR) test</b>: A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046590/" class="def">laboratory test</a> in which the amount of a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046391/" class="def">genetic</a> substance called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000662001/" class="def">mRNA</a> made by a specific gene is measured. An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046081/" class="def">enzyme</a> called reverse transcriptase is used to convert a specific piece of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046568/" class="def">RNA</a> into a matching piece of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045671/" class="def">DNA</a>, which can be amplified (made in large numbers) by another enzyme called DNA polymerase. The amplified DNA copies help tell whether a specific mRNA is being made by a gene. RT–PCR can be used to check the activation of certain genes that may indicate the presence of cancer cells. This test may be used to look for certain changes in a gene or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046470/" class="def">chromosome</a>, which may help diagnose cancer.</p></dd><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000653117/" class="def">Immunohistochemistry</a></b>: A laboratory test that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> to check for certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046086/" class="def">antigens</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045776/" class="def">markers</a>) in a sample of a patient’s tissue. The antibodies are usually linked to an enzyme or a fluorescent dye. After the antibodies bind to a specific antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to help diagnose cancer and to help tell one type of cancer from another type of cancer.</p></dd></dl></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046475/" class="def">Carcinoembryonic antigen (CEA) assay</a></b>: A test that measures the level of CEA in the blood. CEA is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of rectal cancer or other conditions.</div></li></ul></div><div id="CDR0000062959__108"><h3>Certain factors affect prognosis
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(chance of recovery) and treatment options.</h3><p id="CDR0000062959__187">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a> (chance of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a>) and treatment options depend on the following:</p><ul id="CDR0000062959__188"><li class="half_rhythm"><div>The
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer (whether it
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affects the inner lining of the rectum only, involves the whole rectum, or has
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spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>, nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>, or other places in the body).</div></li><li class="half_rhythm"><div>Whether the tumor has spread into or through the bowel wall.</div></li><li class="half_rhythm"><div>Where the cancer is found in the rectum.</div></li><li class="half_rhythm"><div>Whether the bowel is blocked or has a hole in it.</div></li><li class="half_rhythm"><div>Whether all of the tumor can be removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>.</div></li><li class="half_rhythm"><div> The patient’s general health. </div></li><li class="half_rhythm"><div>Whether the cancer has just been diagnosed or has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back).</div></li></ul></div></div><div id="CDR0000062959__111"><h2 id="_CDR0000062959__111_">Stages of Rectal Cancer</h2><div id="CDR0000062959__111.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062959__112"> After rectal cancer has been diagnosed, tests are done
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to find out if cancer cells have spread within the rectum or to other parts of
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the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__202">There are three ways that cancer spreads in the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__269">Cancer may spread from where it began to other parts of the body. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__116">The following stages are used for rectal cancer:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062959__118">Stage 0 (Carcinoma in Situ) </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__121">Stage I </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__124">Stage II</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__127">Stage III</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__130">Stage IV</a></div></li></ul></li></ul></div><div id="CDR0000062959__112"><h3> After rectal cancer has been diagnosed, tests are done
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to find out if cancer cells have spread within the rectum or to other parts of
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the body.</h3><p id="CDR0000062959__114">The process used to find out whether <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread within the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> or to other parts of the body
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is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. The information gathered from the
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staging process determines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the disease. It is important
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to know the stage in
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order to plan treatment.</p><p id="CDR0000062959__275">The following tests and
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procedures may be used in the staging process:</p><ul id="CDR0000062959__229"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304687/" class="def">Chest x-ray</a></b>: An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045648/" class="def">Colonoscopy</a></b>: A procedure to look inside the rectum and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045844/" class="def">polyps</a> (small pieces of bulging <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>). <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> areas, or cancer. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046463/" class="def">colonoscope</a> is a thin, tube-like instrument with a light and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000572035/" class="def">lens</a> for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> of cancer.<div id="CDR0000062959__277" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Colonoscopy&p=BOOKS&id=553342_CDR0000415504.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940.17/bin/CDR0000415504.jpg" alt="Colonoscopy; shows colonoscope inserted through the anus and rectum and into the colon. Inset shows patient on table having a colonoscopy." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Colonoscopy. A thin, lighted tube is inserted through the anus and rectum and into the colon to look for abnormal areas.</p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b>:
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A procedure that makes a series of detailed pictures of areas inside the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, or chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic
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resonance imaging)</b>: A procedure that uses a magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046140/" class="def">PET scan</a> (positron emission tomography scan)</b>: A procedure to find <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> in the body. A small amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044033/" class="def">glucose</a> (sugar) is injected into a vein. The PET <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386220/" class="def">scanner</a> rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. </div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000357580/" class="def">Endorectal ultrasound</a></b>: A procedure used to examine the rectum and nearby organs. An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000367430/" class="def">ultrasound transducer</a> (probe) is inserted into the rectum and used to bounce high-energy sound waves (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046157/" class="def">ultrasound</a>) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046587/" class="def">sonogram</a>. The doctor can identify tumors by looking at the sonogram. This procedure is also called transrectal ultrasound.</div></li></ul></div><div id="CDR0000062959__202"><h3>There are three ways that cancer spreads in the body.</h3><p id="CDR0000062959__202_69">Cancer can spread through <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>, and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>:</p><ul id="CDR0000062959__202_70"><li class="half_rhythm"><div>Tissue. The cancer spreads from where it began by growing into nearby areas.
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</div></li><li class="half_rhythm"><div>Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a> to other parts of the body.
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</div></li><li class="half_rhythm"><div>Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> to other parts of the body.
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</div></li></ul></div><div id="CDR0000062959__269"><h3>Cancer may spread from where it began to other parts of the body. </h3><p id="CDR0000062959__269_66">When cancer spreads to another part of the body, it is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046710/" class="def">metastasis</a>. Cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> break away from where they began (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>) and travel through the lymph system or blood.</p><ul id="CDR0000062959__269_67"><li class="half_rhythm"><div>Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> tumor) in another part of the body.</div></li><li class="half_rhythm"><div>Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.</div></li></ul><p id="CDR0000062959__271">The metastatic tumor is the same type of cancer as the primary tumor. For example, if rectal cancer spreads to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, the cancer cells in the lung are actually rectal cancer cells. The disease is metastatic rectal cancer, not <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445043/" class="def">lung cancer</a>.</p><div id="CDR0000062959__290" class="box"><h3><span class="title">metastasis: how cancer spreads</span></h3><div class="caption"><p>Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.</p></div><p><a href="https://www.youtube.com/watch?v=fQwar_-QdiQ" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></div><div id="CDR0000062959__116"><h3>The following stages are used for rectal cancer:</h3><div id="CDR0000062959__118"><h4>Stage 0 (Carcinoma in Situ) </h4><div id="CDR0000062959__254" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%200%20(rectal%20carcinoma%20in%20situ)&p=BOOKS&id=553342_CDR0000688354.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940.17/bin/CDR0000688354.jpg" alt="Stage 0 colorectal carcinoma in situ; drawing shows a cross-section of the colon/rectum. An inset shows the layers of the colon/rectum wall with abnormal cells in the mucosa layer. Also shown are the submucosa, muscle layers, serosa, a blood vessel, and lymph nodes." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage 0 (rectal carcinoma in situ). Abnormal cells are shown in the mucosa of the rectum wall.</p></div></div><p id="CDR0000062959__120">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000352147/" class="def">stage 0 rectal cancer</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> are found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257213/" class="def">mucosa</a> (innermost layer) of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> wall. These abnormal cells may become <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> and spread into nearby normal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>. Stage 0 is also called carcinoma in
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situ.</p></div><div id="CDR0000062959__121"><h4><div class="milestone-start" id="CDR0000062959__122"></div>Stage I <div class="milestone-end"></div></h4><div id="CDR0000062959__255" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20I%20rectal%20cancer&p=BOOKS&id=553342_CDR0000688427.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940.17/bin/CDR0000688427.jpg" alt="Stage I colorectal cancer; drawing shows a cross-section of the colon/rectum. An inset shows the layers of the colon/rectum wall with cancer in the mucosa and submucosa. Also shown are the muscle layers, serosa, a blood vessel, and lymph nodes." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage I rectal cancer. Cancer has spread from the mucosa of the rectum wall to the submucosa or to the muscle layer.</p></div></div><p id="CDR0000062959__297">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045890/" class="def">stage I rectal cancer</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has formed in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257213/" class="def">mucosa</a> (innermost layer) of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> wall and has spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454935/" class="def">submucosa</a> (layer of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> next to the mucosa) or to the muscle layer of the rectum wall.</p></div><div id="CDR0000062959__124"><h4>Stage II</h4><div id="CDR0000062959__256" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20II%20rectal%20cancer&p=BOOKS&id=553342_CDR0000688428.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940.17/bin/CDR0000688428.jpg" alt="Stage II colorectal cancer; drawing shows a cross-section of the colon/rectum and a three-panel inset. Each panel shows the layers of the colon/rectum wall: the mucosa, submucosa, muscle layers, and serosa. Also shown are a blood vessel and lymph nodes. The first panel shows stage IIA with cancer in the mucosa, submucosa, muscle layers, and serosa. The second panel shows stage IIB with cancer in all layers and spreading through the serosa to the visceral peritoneum. The third panel shows stage IIC with cancer in all layers and spreading through the serosa to nearby organs." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage II rectal cancer. In stage IIA, cancer has spread through the muscle layer of the rectum wall to the serosa. In stage IIB, cancer has spread through the serosa but has not spread to nearby organs. In stage IIC, cancer has spread through the serosa to nearby organs.</p></div></div><p id="CDR0000062959__243"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045891/" class="def">Stage II rectal cancer</a> is divided into stages IIA, IIB, and IIC.</p><ul id="CDR0000062959__244"><li class="half_rhythm"><div>Stage IIA: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> has spread through the muscle layer of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> wall to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454933/" class="def">serosa</a> (outermost layer) of the rectum wall.</div></li><li class="half_rhythm"><div>Stage IIB: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> has spread through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454933/" class="def">serosa</a> (outermost layer) of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> wall to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> that lines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> (visceral peritoneum).</div></li><li class="half_rhythm"><div>Stage IIC: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> has spread through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454933/" class="def">serosa</a> (outermost layer) of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> wall to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>.</div></li></ul></div><div id="CDR0000062959__127"><h4>Stage III</h4><p id="CDR0000062959__245">Stage III rectal cancer is divided into <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045892/" class="def">stages IIIA</a>, IIIB, and IIIC.</p><div id="CDR0000062959__257" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IIIA%20rectal%20cancer&p=BOOKS&id=553342_CDR0000688429.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940.17/bin/CDR0000688429.jpg" alt="Stage IIIA colorectal cancer; drawing shows a cross-section of the colon/rectum and a two-panel inset. Each panel shows the layers of the colon/rectum wall: the mucosa, submucosa, muscle layers, and serosa. Also shown are a blood vessel and lymph nodes. The first panel shows cancer in the mucosa, submucosa, and muscle layers and in 2 lymph nodes. The second panel shows cancer in the mucosa and submucosa and in 5 lymph nodes." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IIIA rectal cancer. Cancer has spread through the mucosa of the rectum wall to the submucosa and may have spread to the muscle layer, and has spread to one to three nearby lymph nodes or tissues near the lymph nodes. OR, cancer has spread through the mucosa to the submucosa and four to six nearby lymph nodes.</p></div></div><p id="CDR0000062959__246">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045892/" class="def">stage IIIA</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread:</p><ul id="CDR0000062959__247"><li class="half_rhythm"><div>through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257213/" class="def">mucosa</a> (innermost layer) of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> wall to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454935/" class="def">submucosa</a> (layer of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> next to the mucosa) or to the muscle layer of the rectum wall. Cancer has spread to one to three nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> or cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> have formed in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> near the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>; or </div></li><li class="half_rhythm"><div>through the mucosa (innermost layer) of the rectum wall to the submucosa (layer of tissue next to the mucosa). Cancer has spread to four to six nearby lymph nodes. </div></li></ul><div id="CDR0000062959__258" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IIIB%20rectal%20cancer&p=BOOKS&id=553342_CDR0000688430.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940.17/bin/CDR0000688430.jpg" alt="Stage IIIB colorectal cancer; drawing shows a cross-section of the colon/rectum and a three-panel inset. Each panel shows the layers of the colon/rectum wall: the mucosa, submucosa, muscle layers, and serosa. Also shown are a blood vessel and lymph nodes. The first panel shows cancer in all layers, in 3 nearby lymph nodes, and in the visceral peritoneum. The second panel shows cancer in all layers and in 5 nearby lymph nodes. The third panel shows cancer in the mucosa, submucosa, and muscle layers and in 7 nearby lymph nodes." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IIIB rectal cancer. Cancer has spread through the muscle layer of the rectum wall to the serosa or has spread through the serosa but not to nearby organs; cancer has spread to one to three nearby lymph nodes or to tissues near the lymph nodes. OR, cancer has spread to the muscle layer or to the serosa, and to four to six nearby lymph nodes. OR, cancer has spread through the mucosa to the submucosa and may have spread to the muscle layer; cancer has spread to seven or more nearby lymph nodes.</p></div></div><p id="CDR0000062959__248">In stage IIIB, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread:</p><ul id="CDR0000062959__249"><li class="half_rhythm"><div>through the muscle layer of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> wall to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454933/" class="def">serosa</a> (outermost layer) of the rectum wall or has spread through the serosa to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> that lines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> (visceral peritoneum). Cancer has spread to one to three nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> or cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> have formed in tissue near the lymph nodes; or </div></li><li class="half_rhythm"><div>to the muscle layer or to the serosa (outermost layer) of the rectum wall. Cancer has spread to four to six nearby lymph nodes; or </div></li><li class="half_rhythm"><div>through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257213/" class="def">mucosa</a> (innermost layer) of the rectum wall to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454935/" class="def">submucosa</a> (layer of tissue next to the mucosa) or to the muscle layer of the rectum wall. Cancer has spread to seven or more nearby lymph nodes. </div></li></ul><div id="CDR0000062959__259" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IIIC%20rectal%20cancer&p=BOOKS&id=553342_CDR0000688436.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940.17/bin/CDR0000688436.jpg" alt="Stage IIIC colorectal cancer; drawing shows a cross-section of the colon/rectum and a three-panel inset. Each panel shows the layers of the colon/rectum wall: the mucosa, submucosa, muscle layers, and serosa. Also shown are a blood vessel and lymph nodes. The first panel shows cancer in all layers, in 4 lymph nodes, and in the visceral peritoneum. The second panel shows cancer in all layers and in 7 lymph nodes. The third panel shows cancer in all layers, in 2 lymph nodes, and spreading to nearby organs." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IIIC rectal cancer. Cancer has spread through the serosa of the rectum wall but not to nearby organs; cancer has spread to four to six nearby lymph nodes. OR, cancer has spread through the muscle layer to the serosa or has spread through the serosa but not to nearby organs; cancer has spread to seven or more nearby lymph nodes. OR, cancer has spread through the serosa to nearby organs and to one or more nearby lymph nodes or to tissues near the lymph nodes.</p></div></div><p id="CDR0000062959__250">In stage IIIC, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread:</p><ul id="CDR0000062959__251"><li class="half_rhythm"><div>through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454933/" class="def">serosa</a> (outermost layer) of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> wall to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> that lines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> (visceral peritoneum). Cancer has spread to four to six nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>; or </div></li><li class="half_rhythm"><div>through the muscle layer of the rectum wall to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454933/" class="def">serosa</a> (outermost layer) of the rectum wall or has spread through the serosa to the tissue that lines the organs in the abdomen (visceral peritoneum). Cancer has spread to seven or more nearby lymph nodes; or </div></li><li class="half_rhythm"><div>through the serosa (outermost layer) of the rectum wall to nearby organs. Cancer has spread to one or more nearby lymph nodes or cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> have formed in tissue near the lymph nodes.</div></li></ul></div><div id="CDR0000062959__130"><h4>Stage IV</h4><p id="CDR0000062959__252"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045893/" class="def">Stage IV rectal cancer</a> is divided into stages IVA, IVB, and IVC.</p><div id="CDR0000062959__260" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IV%20rectal%20cancer&p=BOOKS&id=553342_CDR0000694405.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940.17/bin/CDR0000694405.jpg" alt="Stage IV rectal cancer; drawing shows other parts of the body where rectal cancer may spread, including the distant lymph nodes, lung, liver, abdominal wall, and ovary. An inset shows cancer cells spreading from the rectum, through the blood and lymph system, to another part of the body where metastatic cancer has formed." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IV rectal cancer. The cancer has spread through the blood and lymph nodes to other parts of the body, such as the lung, liver, abdominal wall, or ovary.</p></div></div><ul id="CDR0000062959__253"><li class="half_rhythm"><div>Stage IVA: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> has spread to one area or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a> that is not near the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a>, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a>, or a distant <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a>.</div></li><li class="half_rhythm"><div>Stage IVB: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> has spread to more than one area or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a> that is not near the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a>, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a>, or a distant <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a>. </div></li><li class="half_rhythm"><div>Stage IVC: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> has spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> that lines the wall of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> and may have spread to other areas or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>. </div></li></ul></div></div></div><div id="CDR0000062959__133"><h2 id="_CDR0000062959__133_">Recurrent Rectal Cancer</h2><p id="CDR0000062959__134"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">Recurrent</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000529764/" class="def">rectal
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cancer</a> is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> that has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a>
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(come back) after it has been treated. The cancer may come back in the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> or in other parts of the
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body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a>,
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>. </p></div><div id="CDR0000062959__135"><h2 id="_CDR0000062959__135_">Treatment Option Overview</h2><div id="CDR0000062959__135.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062959__136">There are different types of treatment for patients with rectal
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cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__140">Six types of standard treatment are used:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062959__142">Surgery</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__147">Radiation
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therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__150">Chemotherapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__286">Active surveillance</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__262">Targeted therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__298">Immunotherapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062959__154">Other types of treatment are being tested in clinical
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trials.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__291">Treatment for rectal cancer may cause side effects.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__204">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__206">Patients can enter clinical trials before, during, or after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__208">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000062959__136"><h3>There are different types of treatment for patients with rectal
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cancer.</h3><p id="CDR0000062959__138">Different types of treatment are available for patients with
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000529764/" class="def">rectal cancer</a>. Some treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> (the currently used treatment), and some
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are being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>.
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A treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to help
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improve current treatments or obtain information on new treatments for patients
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with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. When clinical trials show that a new treatment is better than the
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standard treatment, the new
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treatment may become the standard treatment.
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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.</p></div><div id="CDR0000062959__140"><h3>Six types of standard treatment are used:</h3><div id="CDR0000062959__142"><h4>Surgery</h4><p id="CDR0000062959__144"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> is the most
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common treatment for all <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stages</a> of rectal cancer. The
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cancer is removed using one of the following types of surgery:</p><ul id="CDR0000062959__145"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270865/" class="def">Polypectomy</a>: If the cancer is found in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045844/" class="def">polyp</a> (a small piece of bulging <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>), the polyp is often removed during a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045648/" class="def">colonoscopy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045755/" class="def">Local</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269459/" class="def">excision</a>: If the cancer is found on the inside surface of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> and has not spread into the wall of the rectum, the cancer and a small amount of surrounding healthy tissue is removed.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">Resection</a>: If
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the cancer has spread into the wall of the rectum, the section of the
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rectum with cancer and nearby healthy tissue is removed. Sometimes the tissue between the rectum and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdominal</a> wall is also removed. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> near the rectum are removed and checked under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> of cancer. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044865/" class="def">Radiofrequency ablation</a>: The use of a special probe with tiny <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454755/" class="def">electrodes</a> that kill cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>. Sometimes the probe is inserted directly through the skin and only <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044523/" class="def">local anesthesia</a> is needed. In other cases, the probe is inserted through an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046353/" class="def">incision</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>. This is done in the hospital with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044561/" class="def">general anesthesia</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045407/" class="def">Cryosurgery</a>: A treatment that uses an instrument to freeze and destroy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> tissue. This type of treatment is also called cryotherapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322874/" class="def">Pelvic exenteration</a>: If the cancer has spread to other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> near the rectum, the lower <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a>, rectum, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046501/" class="def">bladder</a> are removed. In women, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046133/" class="def">cervix</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046646/" class="def">vagina</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a>, and nearby lymph nodes may be removed. In men, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a> may be removed. Artificial openings (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045104/" class="def">stoma</a>) are made for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046642/" class="def">urine</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046605/" class="def">stool</a> to flow from the body to a collection bag.</div></li></ul><p id="CDR0000062959__233">After the cancer is removed, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044306/" class="def">surgeon</a> will either:</p><ul id="CDR0000062959__234"><li class="half_rhythm"><div>do an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046534/" class="def">anastomosis</a> (sew the healthy parts of the
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rectum together, sew the remaining rectum to the colon, or sew the colon to the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046523/" class="def">anus</a>);<div id="CDR0000062959__195" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Resection%20of%20the%20rectum%20with%20anastomosis&p=BOOKS&id=553342_CDR0000415508.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940.17/bin/CDR0000415508.jpg" alt="Three-panel drawing showing rectal cancer surgery with anastomosis; first panel shows area of rectum with cancer, middle panel shows cancer and nearby tissue removed, last panel shows the colon and anus joined." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Resection of the rectum with anastomosis. The rectum and part of the colon are removed, and then the colon and anus are joined.</p></div></div> or</div></li><li class="half_rhythm"><div>make a stoma (an opening) from the rectum to the outside of the body for waste to pass through. This procedure is done if the cancer is too close to the anus and is called
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a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046464/" class="def">colostomy</a>. A bag is placed around the stoma to collect the waste. Sometimes the colostomy is needed only until the rectum has
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healed, and then it can be reversed. If the entire
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rectum is removed, however, the colostomy may be permanent.</div></li></ul><p id="CDR0000062959__146"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> may be given before surgery to shrink the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>, make it easier to remove the cancer, and help with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046500/" class="def">bowel</a> control after surgery. Treatment given before surgery is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045800/" class="def">neoadjuvant therapy</a>. After all the cancer that can be seen at the
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time of the surgery is removed, some patients may be given radiation therapy and/or chemotherapy after surgery to kill any cancer
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cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045587/" class="def">adjuvant
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therapy</a>.</p></div><div id="CDR0000062959__147"><h4>Radiation
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therapy</h4><p id="CDR0000062959__149">Radiation therapy is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill cancer cells or keep them from growing. There are two types of radiation therapy:</p><ul id="CDR0000062959__284"><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a> uses a machine outside the body to send radiation toward the cancer.</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> uses a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance sealed in needles, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">seeds</a>, wires, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheters</a> that are placed directly into or near the cancer.</div></li></ul><p id="CDR0000062959__285">The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat rectal cancer. </p><p id="CDR0000062959__272">Short-course preoperative radiation therapy is used in some types of rectal cancer. This treatment uses fewer and lower <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> of radiation than standard treatment, followed by surgery several days after the last dose.</p></div><div id="CDR0000062959__150"><h4>Chemotherapy</h4><p id="CDR0000062959__152">Chemotherapy is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> 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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>). When chemotherapy is placed directly in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a>, an organ, or a body <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a> such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, the drugs mainly affect cancer cells in those areas (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046559/" class="def">regional chemotherapy</a>). </p><p id="CDR0000062959__267"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046708/" class="def">Chemoembolization</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044563/" class="def">hepatic artery</a> is a type of regional chemotherapy that may be used to treat cancer that has spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>. This is done by blocking the hepatic artery (the main <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440100/" class="def">artery</a> that supplies <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> to the liver) and injecting anticancer drugs between the blockage and the liver. The liver’s arteries then carry the drugs into the liver. Only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on what is used to block the artery. The liver continues to receive some blood from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044564/" class="def">hepatic portal vein</a>, which carries blood from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046335/" class="def">intestine</a>.</p><p id="CDR0000062959__268">The way the chemotherapy is given depends on the type and stage of the cancer being treated.</p><p id="CDR0000062959__261">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/colorectal" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Colon and Rectal Cancer</a> for more information.</p></div><div id="CDR0000062959__286"><h4>Active surveillance</h4><p id="CDR0000062959__288"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000616060/" class="def">Active surveillance</a> is closely following a patient's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests to check if the cancer is growing. When the cancer begins to grow, treatment is given to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318813/" class="def">cure</a> the cancer. Tests include the following:</p><ul id="CDR0000062959__289"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045668/" class="def">Digital rectal exam</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045678/" class="def">Endoscopy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045880/" class="def">Sigmoidoscopy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000633288/" class="def">Carcinoembryonic antigen (CEA) assay</a>.</div></li></ul></div><div id="CDR0000062959__262"><h4>Targeted therapy</h4><p id="CDR0000062959__264"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.</p><p id="CDR0000062959__280">Types of targeted therapies used in the treatment of rectal cancer include the following:</p><ul id="CDR0000062959__281"><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">Monoclonal antibodies</a>: Monoclonal antibody <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> is a type of targeted therapy being used for the treatment of rectal cancer. Monoclonal antibody therapy uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> made in the laboratory from a single type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045738/" class="def">infusion</a>. They may be used alone or to carry drugs, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046622/" class="def">toxins</a>, or radioactive material directly to cancer cells.</div><div class="half_rhythm">There are different types of monoclonal antibody therapy:<ul id="CDR0000062959__295"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044222/" class="def">Vascular endothelial growth factor</a> (VEGF) inhibitor therapy: Cancer cells make a substance called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044474/" class="def">VEGF</a>, which causes new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> to form (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046529/" class="def">angiogenesis</a>) and helps the cancer grow. VEGF inhibitors block VEGF and stop new blood vessels from forming. This may kill cancer cells because they need new blood vessels to grow. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046115/" class="def">Bevacizumab</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000648687/" class="def">ramucirumab</a> are VEGF inhibitors and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046739/" class="def">angiogenesis inhibitors</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000491507/" class="def">Epidermal growth factor receptor (EGFR) inhibitor</a> therapy: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044397/" class="def">EGFRs</a> are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">proteins</a> found on the surface of certain cells, including cancer cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000653114/" class="def">Epidermal growth factor</a> attaches to the EGFR on the surface of the cell and causes the cells to grow and divide. EGFR inhibitors block the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044958/" class="def">receptor</a> and stop the epidermal growth factor from attaching to the cancer cell. This stops the cancer cell from growing and dividing. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045467/" class="def">Cetuximab</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000397115/" class="def">panitumumab</a> are EGFR inhibitors.</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm">Angiogenesis inhibitors: Angiogenesis inhibitors stop the growth of new blood vessels that <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> need to grow. <dl id="CDR0000062959__283" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000597249/" class="def">Ziv-aflibercept</a> is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000597250/" class="def">vascular endothelial growth factor trap</a> that blocks an enzyme needed for the growth of new blood vessels in tumors.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000740896/" class="def">Regorafenib</a> is used to treat colorectal cancer that has spread to other parts of the body and has not gotten better with other treatment. It blocks the action of certain proteins, including vascular endothelial growth factor. This may help keep cancer cells from growing and may kill them. It may also prevent the growth of new blood vessels that tumors need to grow.</p></dd></dl></div></li></ul><p id="CDR0000062959__266">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/colorectal" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Colon and Rectal Cancer</a> for more information.</p></div><div id="CDR0000062959__298"><h4>Immunotherapy</h4><p id="CDR0000062959__300"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">Immunotherapy</a> 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 biologic therapy.</p><p id="CDR0000062959__301"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000772606/" class="def">Immune checkpoint inhibitor</a> therapy is a type of immunotherapy:</p><ul id="CDR0000062959__302"><li class="half_rhythm"><div>Immune checkpoint inhibitor therapy: PD-1 is a protein on the surface of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044928/" class="def">T cells</a> that helps keep the body’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045722/" class="def">immune responses</a> in check. When PD-1 attaches to another protein called PDL-1 on a cancer cell, it stops the T cell from killing the cancer cell. PD-1 inhibitors attach to PDL-1 and allow the T cells to kill cancer cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000764538/" class="def">Pembrolizumab</a> is a type of immune checkpoint inhibitor.</div></li></ul><div id="CDR0000062959__296" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Immune%20checkpoint%20inhibitor&p=BOOKS&id=553342_CDR0000774646.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940.17/bin/CDR0000774646.jpg" alt="Immune checkpoint inhibitor; the panel on the left shows the binding of proteins PD-L1 (on the tumor cell) to PD-1 (on the T cell), which keeps T cells from killing tumor cells in the body. Also shown are a tumor cell antigen and T cell receptor. The panel on the right shows immune checkpoint inhibitors (anti-PD-L1 and anti-PD-1) blocking the binding of PD-L1 to PD-1, which allows the T cells to kill tumor cells." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Immune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).</p></div></div><div id="CDR0000062959__303" class="box"><h3><span class="title">immune checkpoint inhibitors</span></h3><div class="caption"><p>Immunotherapy uses the body’s immune system to fight cancer. This animation explains one type of immunotherapy that uses immune checkpoint inhibitors to treat cancer.</p></div><p><a href="https://www.youtube.com/watch?v=GIUu239FWMg" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div><p id="CDR0000062959__304">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/colorectal" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Colon and Rectal Cancer</a> for more information.</p></div></div><div id="CDR0000062959__154"><h3>Other types of treatment are being tested in clinical
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trials.</h3><p id="CDR0000062959__201"> Information about clinical trials is available from the <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000062959__291"><h3>Treatment for rectal cancer may cause side effects.</h3><p id="CDR0000062959__291_73">For information about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> caused by treatment for cancer, see our <a href="https://www.cancer.gov/about-cancer/treatment/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Side Effects</a> page.</p></div><div id="CDR0000062959__204"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000062959__204_23">For some patients, taking part in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> 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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a>.</p><p id="CDR0000062959__204_24">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.</p><p id="CDR0000062959__204_25">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.</p></div><div id="CDR0000062959__206"><h3>Patients can enter clinical trials before, during, or after starting their cancer treatment.</h3><p id="CDR0000062959__206_29">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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurring</a> (coming back) or reduce the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of cancer treatment.</p><p id="CDR0000062959__206_30">Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trials search</a> webpage. Clinical trials supported by other organizations can be found on the <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> website.</p></div><div id="CDR0000062959__208"><h3>Follow-up tests may be needed.</h3><p id="CDR0000062959__208_33">Some of the tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> the cancer or to find out the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> 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.</p><p id="CDR0000062959__208_34">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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> has changed or if the cancer has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back). These tests are sometimes called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> tests or check-ups.</p><p id="CDR0000062959__218">After treatment for rectal cancer, a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000688783/" class="def">blood test</a> to measure amounts of
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000357558/" class="def">carcinoembryonic antigen</a> (a
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substance in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> that may be increased when cancer is present) may be
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done to see if the cancer has come back. </p></div></div><div id="CDR0000062959__161"><h2 id="_CDR0000062959__161_">Treatment Options by Stage</h2><p id="CDR0000062959__293">For information about the treatments listed below, see the <a href="#CDR0000062959__140">Treatment Option Overview</a> section.</p><div id="CDR0000062959__162"><h3>Stage 0 (Carcinoma in Situ)</h3><p id="CDR0000062959__163">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000352147/" class="def">stage 0</a> may include the following:
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</p><ul id="CDR0000062959__164"><li class="half_rhythm"><div>Simple <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270865/" class="def">polypectomy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045755/" class="def">Local</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269459/" class="def">excision</a>.
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">Resection</a> (when the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is too large to remove by local excision).
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</div></li></ul><p id="CDR0000062959__TrialSearch_162_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062959__165"><h3>Stage I Rectal Cancer</h3><p id="CDR0000062959__166">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045890/" class="def">stage I rectal
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cancer</a> may include the following:</p><ul id="CDR0000062959__167"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045755/" class="def">Local</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269459/" class="def">excision</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">Resection</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">Resection</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> and
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>.</div></li></ul><p id="CDR0000062959__TrialSearch_165_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062959__168"><h3>Stages II and III Rectal Cancer</h3><p id="CDR0000062959__169">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045891/" class="def">stage II</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045892/" class="def">stage III rectal cancer</a> may include the following:</p><ul id="CDR0000062959__170"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> combined with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>, followed by surgery.</div></li><li class="half_rhythm"><div>Short-course radiation therapy followed by surgery and chemotherapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">Resection</a> followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> combined with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>.</div></li><li class="half_rhythm"><div>Chemotherapy combined with radiation therapy, followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000616060/" class="def">active surveillance</a>. Surgery may be done if the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurs</a> (comes back).</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a>
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of a new treatment. </div></li></ul><p id="CDR0000062959__TrialSearch_168_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062959__176"><h3>Stage IV and Recurrent Rectal Cancer</h3><p id="CDR0000062959__177">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045893/" class="def">stage IV</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000529764/" class="def">rectal cancer</a> may include the following:</p><ul id="CDR0000062959__220"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">Systemic chemotherapy</a> with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046739/" class="def">angiogenesis inhibitor</a>).</div></li><li class="half_rhythm"><div>Systemic chemotherapy with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">immunotherapy</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000772606/" class="def">immune checkpoint inhibitor</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a>).</div></li><li class="half_rhythm"><div>Chemotherapy to control the growth of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>.</div></li><li class="half_rhythm"><div>Radiation therapy, chemotherapy, or a combination of both, as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">palliative therapy</a> to relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> and improve the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.</div></li><li class="half_rhythm"><div>Placement of a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044903/" class="def">stent</a> to help keep the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> open if it is partly blocked by the tumor, as palliative therapy to relieve symptoms and improve the quality of life.</div></li><li class="half_rhythm"><div>Immunotherapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">Clinical trials</a> of chemotherapy and/or targeted therapy.</div></li></ul><p id="CDR0000062959__238">Treatment of rectal cancer that has spread to other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> depends on where the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread.</p><ul id="CDR0000062959__239"><li class="half_rhythm"><div>Treatment for areas of cancer that have spread to the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> includes the following:<dl id="CDR0000062959__240" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Surgery to remove the tumor. Chemotherapy may be given before surgery, to shrink the tumor.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045407/" class="def">Cryosurgery</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044865/" class="def">radiofrequency ablation</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046708/" class="def">Chemoembolization</a> and/or systemic chemotherapy.</p></dd><dt>-</dt><dd><p class="no_top_margin">A clinical trial of chemoembolization combined with radiation therapy to the tumors in the liver.</p></dd></dl>
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</div></li></ul><p id="CDR0000062959__TrialSearch_176_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div></div><div id="CDR0000062959__196"><h2 id="_CDR0000062959__196_">To Learn More About Rectal Cancer</h2><p id="CDR0000062959__197">For more information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about rectal cancer, see the following:</p><ul id="CDR0000062959__198"><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/colorectal/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Colorectal Cancer Home Page</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258007/">Colorectal Cancer Prevention</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258008/">Colorectal Cancer Screening</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/colorectal/screening-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Tests to Detect Colorectal Cancer and Polyps</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000062878/#CDR0000062878__122">Unusual Cancers of Childhood Treatment</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/types/surgery/cryosurgery-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cryosurgery in Cancer Treatment</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/drugs/colorectal" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Colon and Rectal Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Targeted Cancer Therapies</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/causes-prevention/genetics/genetic-testing-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Genetic Testing for Inherited Cancer Susceptibility Syndromes</a></div></li></ul><p id="CDR0000062959__196_40">For general <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information and other resources from the National Cancer Institute, see the following:</p><ul id="CDR0000062959__196_41"><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">About Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Staging</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/publications/patient-education/chemo-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Chemotherapy and You: Support for People With Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/publications/patient-education/radiation-therapy-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Radiation Therapy and You: Support for People With Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a></div></li><li class="half_rhythm"><div><a href="https://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors and Caregivers</a>
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</div></li></ul></div><div id="CDR0000062959__AboutThis_1"><h2 id="_CDR0000062959__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062959__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000062959__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="https://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000062959__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000062959__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000062959__AboutThis_6">This PDQ cancer information summary has current information about the treatment of rectal cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000062959__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000062959__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
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</p><p id="CDR0000062959__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>.
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</p></div><div id="CDR0000062959__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000062959__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." 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.
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</p><p id="CDR0000062959__AboutThis_12">Clinical trials can be found online at <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. For more information, call the <a href="https://www.cancer.gov/contact/contact-center" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Information Service</a> (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000062959__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000062959__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000062959__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000062959__AboutThis_21">PDQ® Adult Treatment Editorial Board. PDQ Rectal Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/colorectal/patient/rectal-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/colorectal/patient/rectal-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389378]</p><p id="CDR0000062959__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 3,000 scientific images.
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</p></div><div id="CDR0000062959__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062959__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062959__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000062959__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK65940</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26389378" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26389378</a></span></div></div></div>
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href="/books/NBK65940.4/">NBK65940.4</a></span> February 27, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65940.3/">NBK65940.3</a></span> June 30, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65940.2/">NBK65940.2</a></span> March 21, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65940.1/">NBK65940.1</a></span> June 30, 2015</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000062959__92" ref="log$=inpage&link_id=inpage">General Information About Rectal Cancer</a></li><li><a href="#CDR0000062959__111" ref="log$=inpage&link_id=inpage">Stages of Rectal Cancer</a></li><li><a href="#CDR0000062959__133" ref="log$=inpage&link_id=inpage">Recurrent Rectal Cancer</a></li><li><a href="#CDR0000062959__135" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000062959__161" ref="log$=inpage&link_id=inpage">Treatment Options by Stage</a></li><li><a href="#CDR0000062959__196" ref="log$=inpage&link_id=inpage">To Learn More About Rectal Cancer</a></li><li><a href="#CDR0000062959__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65965/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389388" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Melanoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Melanoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389278" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Neuroblastoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Neuroblastoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389197" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Retinoblastoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span 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Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Colorectal Cancer Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=26389378" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=26389378" ref="ordinalpos=1&log$=relatedarticles_seeall&logdbfrom=pubmed">See 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<a class="text-white" href="https://www.hhs.gov/">HHS</a>
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</li>
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<li>
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<a class="text-white" href="https://www.usa.gov/">USA.gov</a>
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<noscript><img alt="statistics" src="/stat?jsdisabled=true&ncbi_db=books&ncbi_pdid=book-part&ncbi_acc=NBK65940&ncbi_domain=pdqcis&ncbi_report=record&ncbi_type=fulltext&ncbi_objectid=&ncbi_pcid=/NBK65940.17/&ncbi_pagename=Rectal Cancer Treatment (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf&ncbi_bookparttype=chapter&ncbi_app=bookshelf" /></noscript>
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