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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: February 27, 2017.</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 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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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 class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062959189" co-legend-rid="figlgndCDR0000062959189"><a href="/books/NBK65940.4/figure/CDR0000062959__189/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062959189" rid-ob="figobCDR0000062959189"><img class="small-thumb" src="/books/NBK65940.4/bin/CDR0000415499.gif" src-large="/books/NBK65940.4/bin/CDR0000415499.jpg" alt="Anatomy of the lower digestive system, showing the colon and other organs" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062959189"><h4 id="CDR0000062959__189"><a href="/books/NBK65940.4/figure/CDR0000062959__189/?report=objectonly" target="object" rid-ob="figobCDR0000062959189">Figure</a></h4><p class="float-caption no_bottom_margin">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</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 tissue), <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 signs of cancer.<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062959276" co-legend-rid="figlgndCDR0000062959276"><a href="/books/NBK65940.4/figure/CDR0000062959__276/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062959276" rid-ob="figobCDR0000062959276"><img class="small-thumb" src="/books/NBK65940.4/bin/CDR0000415504.gif" src-large="/books/NBK65940.4/bin/CDR0000415504.jpg" alt="Colonoscopy" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062959276"><h4 id="CDR0000062959__276"><a href="/books/NBK65940.4/figure/CDR0000062959__276/?report=objectonly" target="object" rid-ob="figobCDR0000062959276">Figure</a></h4><p class="float-caption no_bottom_margin">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><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000615417/" class="def">Reverse-transcription</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044798/" class="def">polymerase chain reaction</a> (RT-PCR) test</b>: A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046590/" class="def">laboratory test</a> in which cells in a sample of tissue are studied using <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643008/" class="def">chemicals</a> to look for certain changes in the structure or function of genes.</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 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> in a sample of tissue. The antibody is usually linked to a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types 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 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></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 class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062959277" co-legend-rid="figlgndCDR0000062959277"><a href="/books/NBK65940.4/figure/CDR0000062959__277/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062959277" rid-ob="figobCDR0000062959277"><img class="small-thumb" src="/books/NBK65940.4/bin/CDR0000415504.gif" src-large="/books/NBK65940.4/bin/CDR0000415504.jpg" alt="Colonoscopy" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062959277"><h4 id="CDR0000062959__277"><a href="/books/NBK65940.4/figure/CDR0000062959__277/?report=objectonly" target="object" rid-ob="figobCDR0000062959277">Figure</a></h4><p class="float-caption no_bottom_margin">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><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 class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062959254" co-legend-rid="figlgndCDR0000062959254"><a href="/books/NBK65940.4/figure/CDR0000062959__254/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062959254" rid-ob="figobCDR0000062959254"><img class="small-thumb" src="/books/NBK65940.4/bin/CDR0000688354.gif" src-large="/books/NBK65940.4/bin/CDR0000688354.jpg" alt="Stage 0 (rectal carcinoma in situ)" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062959254"><h4 id="CDR0000062959__254"><a href="/books/NBK65940.4/figure/CDR0000062959__254/?report=objectonly" target="object" rid-ob="figobCDR0000062959254">Figure</a></h4><p class="float-caption no_bottom_margin">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</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. Stage 0 is also called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046488/" class="def">carcinoma in
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situ</a>.</p></div><div id="CDR0000062959__121"><h4><div class="milestone-start" id="CDR0000062959__122"></div>Stage I <div class="milestone-end"></div></h4><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062959255" co-legend-rid="figlgndCDR0000062959255"><a href="/books/NBK65940.4/figure/CDR0000062959__255/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062959255" rid-ob="figobCDR0000062959255"><img class="small-thumb" src="/books/NBK65940.4/bin/CDR0000688427.gif" src-large="/books/NBK65940.4/bin/CDR0000688427.jpg" alt="Stage I rectal cancer" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062959255"><h4 id="CDR0000062959__255"><a href="/books/NBK65940.4/figure/CDR0000062959__255/?report=objectonly" target="object" rid-ob="figobCDR0000062959255">Figure</a></h4><p class="float-caption no_bottom_margin">Stage I rectal cancer. Cancer has spread from the mucosa of the rectum wall to the muscle layer. </p></div></div><p id="CDR0000062959__242">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045890/" class="def">stage I</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> under the mucosa). Cancer may have spread to the muscle layer of the rectum wall. </p></div><div id="CDR0000062959__124"><h4>Stage II</h4><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062959256" co-legend-rid="figlgndCDR0000062959256"><a href="/books/NBK65940.4/figure/CDR0000062959__256/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062959256" rid-ob="figobCDR0000062959256"><img class="small-thumb" src="/books/NBK65940.4/bin/CDR0000688428.gif" src-large="/books/NBK65940.4/bin/CDR0000688428.jpg" alt="Stage II rectal cancer" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062959256"><h4 id="CDR0000062959__256"><a href="/books/NBK65940.4/figure/CDR0000062959__256/?report=objectonly" target="object" rid-ob="figobCDR0000062959256">Figure</a></h4><p class="float-caption no_bottom_margin">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 <a href="/books/NBK65940.4/figure/CDR0000062959__256/?report=objectonly" target="object" rid-ob="figobCDR0000062959256">(more...)</a></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 stage IIA, stage IIB, and stage 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: Cancer 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 but has not spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>. </div></li><li class="half_rhythm"><div>Stage IIC: Cancer 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"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045892/" class="def">Stage III rectal cancer</a> is divided into stage IIIA, stage IIIB, and stage IIIC.</p><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062959257" co-legend-rid="figlgndCDR0000062959257"><a href="/books/NBK65940.4/figure/CDR0000062959__257/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062959257" rid-ob="figobCDR0000062959257"><img class="small-thumb" src="/books/NBK65940.4/bin/CDR0000688429.gif" src-large="/books/NBK65940.4/bin/CDR0000688429.jpg" alt="Stage IIIA rectal cancer" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062959257"><h4 id="CDR0000062959__257"><a href="/books/NBK65940.4/figure/CDR0000062959__257/?report=objectonly" target="object" rid-ob="figobCDR0000062959257">Figure</a></h4><p class="float-caption no_bottom_margin">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 <a href="/books/NBK65940.4/figure/CDR0000062959__257/?report=objectonly" target="object" rid-ob="figobCDR0000062959257">(more...)</a></p></div></div><p id="CDR0000062959__246">In stage IIIA:</p><ul id="CDR0000062959__247"><li class="half_rhythm"><div><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_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> under the mucosa) and may have spread to the muscle layer of the rectum wall. Cancer has spread to at least one but not more than 3 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 tissues near the lymph nodes; or</div></li><li class="half_rhythm"><div>Cancer has spread through the mucosa (innermost layer) of the rectum wall to the submucosa (layer of tissue under the mucosa). Cancer has spread to at least 4 but not more than 6 nearby lymph nodes. </div></li></ul><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062959258" co-legend-rid="figlgndCDR0000062959258"><a href="/books/NBK65940.4/figure/CDR0000062959__258/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062959258" rid-ob="figobCDR0000062959258"><img class="small-thumb" src="/books/NBK65940.4/bin/CDR0000688430.gif" src-large="/books/NBK65940.4/bin/CDR0000688430.jpg" alt="Stage IIIB rectal cancer" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062959258"><h4 id="CDR0000062959__258"><a href="/books/NBK65940.4/figure/CDR0000062959__258/?report=objectonly" target="object" rid-ob="figobCDR0000062959258">Figure</a></h4><p class="float-caption no_bottom_margin">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, <a href="/books/NBK65940.4/figure/CDR0000062959__258/?report=objectonly" target="object" rid-ob="figobCDR0000062959258">(more...)</a></p></div></div><p id="CDR0000062959__248">In stage IIIB:</p><ul id="CDR0000062959__249"><li class="half_rhythm"><div>Cancer 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 or has spread through the serosa but not to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>. Cancer has spread to at least one but not more than 3 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">tissues</a> near the lymph nodes; or </div></li><li class="half_rhythm"><div>Cancer has spread to the muscle layer of the rectum wall or to the serosa (outermost layer) of the rectum wall. Cancer has spread to at least 4 but not more than 6 nearby lymph nodes; or </div></li><li class="half_rhythm"><div>Cancer has spread 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 under the mucosa) and may have spread to the muscle layer of the rectum wall. Cancer has spread to 7 or more nearby lymph nodes.</div></li></ul><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062959259" co-legend-rid="figlgndCDR0000062959259"><a href="/books/NBK65940.4/figure/CDR0000062959__259/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062959259" rid-ob="figobCDR0000062959259"><img class="small-thumb" src="/books/NBK65940.4/bin/CDR0000688436.gif" src-large="/books/NBK65940.4/bin/CDR0000688436.jpg" alt="Stage IIIC rectal cancer" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062959259"><h4 id="CDR0000062959__259"><a href="/books/NBK65940.4/figure/CDR0000062959__259/?report=objectonly" target="object" rid-ob="figobCDR0000062959259">Figure</a></h4><p class="float-caption no_bottom_margin">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 <a href="/books/NBK65940.4/figure/CDR0000062959__259/?report=objectonly" target="object" rid-ob="figobCDR0000062959259">(more...)</a></p></div></div><p id="CDR0000062959__250">In stage IIIC:</p><ul id="CDR0000062959__251"><li class="half_rhythm"><div>Cancer 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 but has not spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>. Cancer has spread to at least 4 but not more than 6 nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>; or</div></li><li class="half_rhythm"><div>Cancer has spread through the muscle layer of the rectum wall to the serosa (outermost layer) of the rectum wall or has spread through the serosa but has not spread to nearby organs. Cancer has spread to 7 or more nearby lymph nodes; or </div></li><li class="half_rhythm"><div>Cancer has spread through the serosa (outermost layer) of the rectum wall and has spread 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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> 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 stage IVA and stage IVB.</p><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062959260" co-legend-rid="figlgndCDR0000062959260"><a href="/books/NBK65940.4/figure/CDR0000062959__260/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062959260" rid-ob="figobCDR0000062959260"><img class="small-thumb" src="/books/NBK65940.4/bin/CDR0000694405.gif" src-large="/books/NBK65940.4/bin/CDR0000694405.jpg" alt="Stage IV rectal cancer" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062959260"><h4 id="CDR0000062959__260"><a href="/books/NBK65940.4/figure/CDR0000062959__260/?report=objectonly" target="object" rid-ob="figobCDR0000062959260">Figure</a></h4><p class="float-caption no_bottom_margin">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> may have spread through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> wall and may have spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. Cancer has spread to one organ that is not near the rectum, 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>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a>, or to a distant lymph node. </div></li><li class="half_rhythm"><div>Stage IVB: Cancer may have spread through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> wall and may have spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. Cancer has spread to more than one organ that is not near the rectum or into the lining of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdominal</a> wall.</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 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">Four types of standard treatment are used:</a></div></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__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>Four 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 class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062959195" co-legend-rid="figlgndCDR0000062959195"><a href="/books/NBK65940.4/figure/CDR0000062959__195/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062959195" rid-ob="figobCDR0000062959195"><img class="small-thumb" src="/books/NBK65940.4/bin/CDR0000415508.gif" src-large="/books/NBK65940.4/bin/CDR0000415508.jpg" alt="Resection of the rectum with anastomosis" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062959195"><h4 id="CDR0000062959__195"><a href="/books/NBK65940.4/figure/CDR0000062959__195/?report=objectonly" target="object" rid-ob="figobCDR0000062959195">Figure</a></h4><p class="float-caption no_bottom_margin">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>. Even if all the cancer that can be seen at the
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time of the operation 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="http://www.cancer.gov/about-cancer/treatment/drugs/colorectal#3" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Rectal Cancer</a> for more information.</p></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><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. <dl id="CDR0000062959__282" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><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 types of monoclonal antibodies that bind to a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a> called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044222/" class="def">vascular endothelial growth factor</a> (VEGF). This may prevent the growth of new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> that tumors need to grow. </p></dd><dt>-</dt><dd><p class="no_top_margin"><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 types of monoclonal antibodies that bind to a protein called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045680/" class="def">epidermal growth factor receptor</a> (EGFR) on the surface of some types of cancer cells. This may stop cancer cells from growing and dividing.</p></dd></dl></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046739/" class="def">Angiogenesis inhibitors</a>: 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="http://www.cancer.gov/about-cancer/treatment/drugs/colorectal#3" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for 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="http://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__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. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044267/" class="def">NCI's</a> listing of clinical trials. </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><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_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43235&tt=1&format=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage 0 rectal cancer</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the <a href="http://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__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_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43286&tt=1&format=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage I rectal cancer</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the <a href="http://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__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>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_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43352&tt=1&format=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage II rectal cancer</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the <a href="http://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__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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">monoclonal antibody</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046739/" class="def">angiogenesis inhibitor</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>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of a new anticancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drug</a></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_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43422&tt=1&format=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage IV rectal cancer</a> and <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43429&tt=1&format=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">recurrent rectal cancer</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</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="http://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="http://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="http://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="http://www.cancer.gov/about-cancer/treatment/drugs/colorectal#3" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Rectal Cancer</a></div></li><li class="half_rhythm"><div><a href="http://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="http://www.cancer.gov/about-cancer/causes-prevention/genetics/genetic-testing-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Genetic Testing for Hereditary Cancer 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="http://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="http://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="http://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="http://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="http://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="http://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="http://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 ("Date Last Modified") 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="http://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 are listed in PDQ and can be found online at <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 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="http://www.cancer.gov/types/colorectal/patient/rectal-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://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="http://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 2,000 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="http://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="http://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="http://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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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" 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/NBK65940.4/?report=reader">PubReader</a></li><li><a href="/books/NBK65940.4/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65940" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65940" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Adult Treatment Editorial Board. Rectal Cancer Treatment (PDQ®): Patient Version. 2017 Feb 27. 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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" 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<p><a href="https://www.nlm.nih.gov/web_policies.html" class="text-white">Web Policies</a><br />
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