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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: September 13, 2024.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062959__278">This PDQ cancer information summary has current information about the treatment of rectal cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000062959__279">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.</p></div><div id="CDR0000062959__92"><h2 id="_CDR0000062959__92_">General Information About Rectal Cancer</h2><div id="CDR0000062959__92.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062959__93">Rectal cancer is a type of cancer that forms 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 blood in the stool or a change in bowel
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habits.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__104">Tests that examine the rectum and colon are used to diagnose rectal cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__646"> After rectal cancer has been diagnosed, imaging 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__647">Some people decide to get a second opinion.</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 type of cancer that forms 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 digestive system. The
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digestive system takes in nutrients (<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 main 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 to 8 inches long. The anal canal ends at the anus (the opening of the large intestine to the
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outside of the body).<div id="CDR0000062959__189" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Anatomy%20of%20the%20lower%20gastrointestinal%20(digestive)%20system%20showing%20the%20colon%2C%20rectum%2C%20and%20anus&p=BOOKS&id=607264_CDR0000415499.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940/bin/CDR0000415499.jpg" alt="Gastrointestinal (digestive) system anatomy; drawing shows the esophagus, liver, stomach, colon, small intestine, rectum, and anus." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Anatomy of the lower gastrointestinal (digestive) system showing the colon, rectum, and anus. Other organs that make up the digestive system are also shown.</p></div></div></p></div><div id="CDR0000062959__96"><h3>Health history affects the risk of developing rectal cancer.</h3><p id="CDR0000062959__sm_CDR0000752413_332"><div class="milestone-start" id="CDR0000062959__sm_CDR0000752413_1"></div>Colorectal cancer is caused by certain changes to the way colorectal cells function, especially how they grow and divide into new cells. There are many risk factors for colorectal cancer, but many do not directly cause cancer. Instead, they increase the chance of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045671/" class="def">DNA</a> damage in cells that may lead to colorectal cancer. To learn more about how cancer develops, see <a href="https://www.cancer.gov/about-cancer/understanding/what-is-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">What Is Cancer?</a></p><p id="CDR0000062959__sm_CDR0000752413_335">A risk factor is anything that increases the chance of getting a disease. Some risk factors for colorectal cancer, like smoking, can be changed. However, risk factors also include things you cannot change, like your genetics, getting older, and your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000302456/" class="def">family history</a>. Learning about risk factors for colorectal cancer can help you make changes that might lower your risk of getting it. </p><p id="CDR0000062959__sm_CDR0000752413_4">Risk factors for colorectal cancer include:</p><ul id="CDR0000062959__sm_CDR0000752413_2"><li class="half_rhythm"><div>having a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000460150/" class="def">first-degree relative</a> (parent, sibling, or child) with a history 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></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 colon, rectal, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445074/" class="def">ovarian cancer</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> (colorectal <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 cells that look abnormal under a microscope)</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 alcoholic drinks per day</div></li><li class="half_rhythm"><div>smoking cigarettes</div></li><li class="half_rhythm"><div>being Black</div></li><li class="half_rhythm"><div>having <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000527371/" class="def">obesity</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. </p><p id="CDR0000062959__sm_CDR0000752413_334">Having one or more of these risk factors does not mean that you will get colorectal cancer. Many people with risk factors never develop colorectal cancer, while others with no known risk factors do. Talk with your doctor if you think you might be at increased risk. <div class="milestone-end"></div></p></div><div id="CDR0000062959__100"><h3>Signs of rectal cancer include blood in the stool or a change in bowel
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habits.</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:</p><ul id="CDR0000062959__103"><li class="half_rhythm"><div>blood (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>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000321374/" class="def">fatigue</a>
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</div></li></ul></div><div id="CDR0000062959__104"><h3>Tests that examine the rectum and colon are used to diagnose rectal cancer.</h3><p id="CDR0000062959__106">In addition to asking about your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642019/" class="def">personal</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642015/" class="def">family health history</a> and doing a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">physical exam</a>, your doctor may perform the following tests and procedures:</p><ul id="CDR0000062959__226"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045668/" class="def">Digital rectal exam</a> (DRE)</b> is an exam of the rectum. The doctor or nurse 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>Colonoscopy</b> is a procedure that uses a colonoscope to look inside the rectum and colon for polyps (small pieces of bulging tissue), abnormal areas, or cancer. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.<div id="CDR0000062959__276" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Colonoscopy&p=BOOKS&id=607264_CDR0000415504.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940/bin/CDR0000415504.jpg" alt="Colonoscopy; drawing shows a colonoscope inserted through the anus and rectum and into the colon. An inset shows a patient lying on a table having a colonoscopy." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Colonoscopy. A thin, lighted tube is inserted through the anus and rectum and into the colon to look for abnormal areas.</p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">Biopsy</a></b> is the removal
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of cells or tissues so they can be viewed under a microscope to check for signs of cancer. Tumor 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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044882/" class="def">Lynch syndrome</a> (also known as hereditary nonpolyposis colorectal cancer). This may help to plan treatment. Learn about the type of information that can be found in a pathologist's report about the cells or tissue removed during a biopsy at <a href="https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/pathology-reports-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Pathology Reports</a>.</div></li><li class="half_rhythm"><div><b>Immunohistochemistry</b> is a laboratory test that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> to check for certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046086/" class="def">antigens</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045776/" class="def">markers</a>) in a sample of a patient's tissue. The antibodies are usually linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046081/" class="def">enzyme</a> or a fluorescent dye. After the antibodies bind to a specific antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to help diagnose cancer and to help tell one type of cancer from another type of cancer.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000285933/" class="def">Microsatellite instability</a> (MSI)</b> is a laboratory test in which tumor tissue is checked for cells that may have a defect in genes involved in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045671/" class="def">DNA</a> repair. The findings may indicate whether or not the patient has a type of cancer linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000339343/" class="def">inherited cancer syndrome</a> such as Lynch syndrome.</div></li></ul></div><div id="CDR0000062959__646"><h3> After rectal cancer has been diagnosed, imaging 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 cancer has spread within the
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rectum 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> is a type of radiation that can go through the body and make pictures of the organs and bones inside the chest.</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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uses a computer linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> machine to make 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. The pictures are taken from different angles and are used to create 3-D views of tissues and organs. 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 vein 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> 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 rectum. A substance called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000597153/" class="def">gadolinium</a> is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. 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> uses a small amount of radioactive sugar (also called glucose) that is injected into a vein. Then a scanner rotates around the body to make detailed, computerized pictures of areas inside the body where the glucose is taken up. Because cancer cells often take up more glucose than normal cells, the pictures can be used to find cancer cells in the body. </div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000357580/" class="def">Endorectal ultrasound</a></b> is 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><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046475/" class="def">Carcinoembryonic antigen (CEA) assay</a></b> is 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__647"><h3>Some people decide to get a second opinion.</h3><p id="CDR0000062959__649">You may want to get a second opinion to confirm your rectal cancer diagnosis and treatment plan. If you seek a second opinion, you will need to get medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans. They may agree with the first doctor, suggest changes or another treatment approach, or provide more information about your cancer.</p><p id="CDR0000062959__645">Learn more about choosing a doctor and getting a second opinion at <a href="https://www.cancer.gov/about-cancer/managing-care/finding-cancer-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Finding Cancer Care</a>. You can contact <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's Cancer Information Service</a> via chat, email, or phone (both in English and Spanish) for help finding a doctor, hospital, or getting a second opinion. For questions you might want to ask at your appointments, visit <a href="https://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor About Cancer</a>.</p></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 prognosis and treatment options depend on:</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 organs, or other places in the body)</div></li><li class="half_rhythm"><div>whether the cancer is related to a defect in genes involved in DNA repair</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 surgery</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 recurred (come back)</div></li></ul></div></div><div id="CDR0000062959__111"><h2 id="_CDR0000062959__111_">Stages of Rectal Cancer</h2><div id="CDR0000062959__111.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062959__116">The following stages are used for rectal cancer:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062959__118">Stage 0 (carcinoma in situ)</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__121">Stage I (also called stage 1) rectal cancer</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__124">Stage II (also called stage 2) rectal cancer</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__127">Stage III (also called stage 3) rectal cancer</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__130">Stage IV (also called stage 4) rectal cancer</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062959__335">Rectal cancer can recur (come back) after it has been treated.</a></div></li></ul></div><p id="CDR0000062959__640"><div class="milestone-start" id="CDR0000062959__112"></div>Cancer stage describes the extent of cancer in the body, such as the size of the tumor, whether it has spread, and how far it has spread from where it first formed.</p><p id="CDR0000062959__641">There are several staging systems for cancer that describe the extent of the cancer. Rectal cancer staging usually uses the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000672851/" class="def">TNM staging system</a>. The cancer may be described by this staging system in your pathology report. Based on the TNM results, a stage (I, II, III, or IV, also written as 1, 2, 3, or 4) is assigned to your cancer. When talking to you about your diagnosis, your doctor may describe the cancer as one of these stages.</p><p id="CDR0000062959__642">Learn about <a href="#CDR0000062959__646">tests to stage rectal cancer</a>. Learn more about <a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Staging</a>.<div class="milestone-end"></div></p><div id="CDR0000062959__116"><h3>The following stages are used for rectal cancer:</h3><div id="CDR0000062959__118"><h4>Stage 0 (carcinoma in situ)</h4><div id="CDR0000062959__254" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%200%20(rectal%20carcinoma%20in%20situ)&p=BOOKS&id=607264_CDR0000688354.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940/bin/CDR0000688354.jpg" alt="Stage 0 colorectal carcinoma in situ; drawing shows a cross-section of the colon/rectum. An inset shows the layers of the colon/rectum wall with abnormal cells in the mucosa layer. Also shown are the submucosa, muscle layers, serosa, a blood vessel, and lymph nodes." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage 0 (rectal carcinoma in situ). Abnormal cells are shown in the mucosa of the rectum wall.</p></div></div><p id="CDR0000062959__120">In stage 0 rectal cancer, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> cells are found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257213/" class="def">mucosa</a> (innermost layer) of the rectum wall. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in
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situ.</p></div><div id="CDR0000062959__121"><h4>Stage I (also called stage 1) rectal cancer</h4><div id="CDR0000062959__255" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20I%20rectal%20cancer&p=BOOKS&id=607264_CDR0000688427.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940/bin/CDR0000688427.jpg" alt="Stage I colorectal cancer; drawing shows a cross-section of the colon/rectum. An inset shows the layers of the colon/rectum wall with cancer in the mucosa and submucosa. Also shown are the muscle layers, serosa, a blood vessel, and lymph nodes." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage I rectal cancer. Cancer has spread from the mucosa of the rectum wall to the submucosa or to the muscle layer.</p></div></div><p id="CDR0000062959__297">In stage I rectal cancer, cancer has formed in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257213/" class="def">mucosa</a> (innermost layer) of the rectum wall and has spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454935/" class="def">submucosa</a> (layer of tissue next to the mucosa) or to the muscle layer of the rectum wall.</p></div><div id="CDR0000062959__124"><h4>Stage II (also called stage 2) rectal cancer</h4><div id="CDR0000062959__256" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20II%20rectal%20cancer&p=BOOKS&id=607264_CDR0000688428.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940/bin/CDR0000688428.jpg" alt="Stage II colorectal cancer; drawing shows a cross-section of the colon/rectum and a three-panel inset. Each panel shows the layers of the colon/rectum wall: the mucosa, submucosa, muscle layers, and serosa. Also shown are a blood vessel and lymph nodes. The first panel shows stage IIA with cancer in the mucosa, submucosa, muscle layers, and serosa. The second panel shows stage IIB with cancer in all layers and spreading through the serosa to the visceral peritoneum. The third panel shows stage IIC with cancer in all layers and spreading through the serosa to nearby organs." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage II rectal cancer. In stage IIA, cancer has spread through the muscle layer of the rectum wall to the serosa. In stage IIB, cancer has spread through the serosa but has not spread to nearby organs. In stage IIC, cancer has spread through the serosa to nearby organs.</p></div></div><p id="CDR0000062959__243">Stage II rectal cancer is divided into stages IIA, IIB, and IIC.</p><ul id="CDR0000062959__244"><li class="half_rhythm"><div>Stage IIA: Cancer has spread through the muscle layer of the rectum wall to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454933/" class="def">serosa</a> (outermost layer) of the rectum wall.</div></li><li class="half_rhythm"><div>Stage IIB: Cancer has spread through the serosa (outermost layer) of the rectum wall to the tissue that lines the organs in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> (visceral peritoneum).</div></li><li class="half_rhythm"><div>Stage IIC: Cancer has spread through the serosa (outermost layer) of the rectum wall to nearby organs.</div></li></ul></div><div id="CDR0000062959__127"><h4>Stage III (also called stage 3) rectal cancer</h4><p id="CDR0000062959__245">Stage III rectal cancer is divided into stages IIIA, IIIB, and IIIC.</p><div id="CDR0000062959__257" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IIIA%20rectal%20cancer&p=BOOKS&id=607264_CDR0000688429.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940/bin/CDR0000688429.jpg" alt="Stage IIIA colorectal cancer; drawing shows a cross-section of the colon/rectum and a two-panel inset. Each panel shows the layers of the colon/rectum wall: the mucosa, submucosa, muscle layers, and serosa. Also shown are a blood vessel and lymph nodes. The first panel shows cancer in the mucosa, submucosa, and muscle layers and in 2 lymph nodes. The second panel shows cancer in the mucosa and submucosa and in 5 lymph nodes." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IIIA rectal cancer. Cancer has spread through the mucosa of the rectum wall to the submucosa and may have spread to the muscle layer, and has spread to one to three nearby lymph nodes or tissues near the lymph nodes. OR, cancer has spread through the mucosa to the submucosa and four to six nearby lymph nodes.</p></div></div><p id="CDR0000062959__246">In stage IIIA, cancer has spread:</p><ul id="CDR0000062959__247"><li class="half_rhythm"><div>through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257213/" class="def">mucosa</a> (innermost layer) of the rectum wall to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454935/" class="def">submucosa</a> (layer of tissue next to the mucosa) or to the muscle layer of the rectum wall. Cancer has spread to one to three nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>, or cancer cells have formed in tissue near the lymph nodes; or</div></li><li class="half_rhythm"><div>through the mucosa (innermost layer) of the rectum wall to the submucosa (layer of tissue next to the mucosa). Cancer has spread to four to six nearby lymph nodes.</div></li></ul><div id="CDR0000062959__258" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IIIB%20rectal%20cancer&p=BOOKS&id=607264_CDR0000688430.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940/bin/CDR0000688430.jpg" alt="Stage IIIB colorectal cancer; drawing shows a cross-section of the colon/rectum and a three-panel inset. Each panel shows the layers of the colon/rectum wall: the mucosa, submucosa, muscle layers, and serosa. Also shown are a blood vessel and lymph nodes. The first panel shows cancer in all layers, in 3 nearby lymph nodes, and in the visceral peritoneum. The second panel shows cancer in all layers and in 5 nearby lymph nodes. The third panel shows cancer in the mucosa, submucosa, and muscle layers and in 7 nearby lymph nodes." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IIIB rectal cancer. Cancer has spread through the muscle layer of the rectum wall to the serosa or has spread through the serosa but not to nearby organs; cancer has spread to one to three nearby lymph nodes or to tissues near the lymph nodes. OR, cancer has spread to the muscle layer or to the serosa, and to four to six nearby lymph nodes. OR, cancer has spread through the mucosa to the submucosa and may have spread to the muscle layer; cancer has spread to seven or more nearby lymph nodes.</p></div></div><p id="CDR0000062959__248">In stage IIIB, cancer has spread:</p><ul id="CDR0000062959__249"><li class="half_rhythm"><div>through the muscle layer of the rectum wall to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454933/" class="def">serosa</a> (outermost layer) of the rectum wall or has spread through the serosa to the tissue that lines the organs in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> (visceral peritoneum). Cancer has spread to one to three nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>, or cancer cells have formed in tissue near the lymph nodes; or</div></li><li class="half_rhythm"><div>to the muscle layer or to the serosa (outermost layer) of the rectum wall. Cancer has spread to four to six nearby lymph nodes; or</div></li><li class="half_rhythm"><div>through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257213/" class="def">mucosa</a> (innermost layer) of the rectum wall to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454935/" class="def">submucosa</a> (layer of tissue next to the mucosa) or to the muscle layer of the rectum wall. Cancer has spread to seven or more nearby lymph nodes.</div></li></ul><div id="CDR0000062959__259" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IIIC%20rectal%20cancer&p=BOOKS&id=607264_CDR0000688436.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940/bin/CDR0000688436.jpg" alt="Stage IIIC colorectal cancer; drawing shows a cross-section of the colon/rectum and a three-panel inset. Each panel shows the layers of the colon/rectum wall: the mucosa, submucosa, muscle layers, and serosa. Also shown are a blood vessel and lymph nodes. The first panel shows cancer in all layers, in 4 lymph nodes, and in the visceral peritoneum. The second panel shows cancer in all layers and in 7 lymph nodes. The third panel shows cancer in all layers, in 2 lymph nodes, and spreading to nearby organs." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IIIC rectal cancer. Cancer has spread through the serosa of the rectum wall but not to nearby organs; cancer has spread to four to six nearby lymph nodes. OR, cancer has spread through the muscle layer to the serosa or has spread through the serosa but not to nearby organs; cancer has spread to seven or more nearby lymph nodes. OR, cancer has spread through the serosa to nearby organs and to one or more nearby lymph nodes or to tissues near the lymph nodes.</p></div></div><p id="CDR0000062959__250">In stage IIIC, cancer has spread:</p><ul id="CDR0000062959__251"><li class="half_rhythm"><div>through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454933/" class="def">serosa</a> (outermost layer) of the rectum wall to the tissue that lines the organs in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> (visceral peritoneum). Cancer has spread to four to six nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>; or </div></li><li class="half_rhythm"><div>through the muscle layer of the rectum wall to the serosa (outermost layer) of the rectum wall or has spread through the serosa to the tissue that lines the organs in the abdomen (visceral peritoneum). Cancer has spread to seven or more nearby lymph nodes; or </div></li><li class="half_rhythm"><div>through the serosa (outermost layer) of the rectum wall to nearby organs. Cancer has spread to one or more nearby lymph nodes, or cancer cells have formed in tissue near the lymph nodes.</div></li></ul></div><div id="CDR0000062959__130"><h4>Stage IV (also called stage 4) rectal cancer</h4><div id="CDR0000062959__260" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IV%20rectal%20cancer&p=BOOKS&id=607264_CDR0000694405.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940/bin/CDR0000694405.jpg" alt="Stage IV rectal cancer; drawing shows other parts of the body where rectal cancer may spread, including the distant lymph nodes, lung, liver, abdominal wall, and prostate. An inset shows cancer cells spreading from the rectum, through the blood and lymph system, to another part of the body where metastatic cancer has formed." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IV rectal cancer. The cancer has spread through the blood and lymph nodes to other parts of the body, such as the lung, liver, abdominal wall, or prostate.</p></div></div><p id="CDR0000062959__252">Stage IV rectal cancer is divided into stages IVA, IVB, and IVC.</p><ul id="CDR0000062959__253"><li class="half_rhythm"><div>Stage IVA: Cancer has spread to one area or 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>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a>, or a distant <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a>.</div></li><li class="half_rhythm"><div>Stage IVB: Cancer has spread to more than one area or organ that is not near the rectum, such as the liver, lung, prostate, or a distant lymph node.</div></li><li class="half_rhythm"><div>Stage IVC: Cancer has spread to the tissue that lines the wall of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> and may have spread to other areas or organs.</div></li></ul><p id="CDR0000062959__621">Stage IV rectal cancer is also called metastatic rectal cancer. Metastatic cancer happens when cancer cells travel through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymphatic system</a> or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if rectal cancer spreads to the liver, the cancer cells in the liver are actually rectal cancer cells. The disease is called metastatic rectal cancer, not liver cancer. Learn more in <a href="https://www.cancer.gov/types/metastatic-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Metastatic Cancer: When Cancer Spreads</a>.</p></div></div><div id="CDR0000062959__335"><h3>Rectal cancer can recur (come back) after it has been treated.</h3><p id="CDR0000062959__337">Recurrent rectal cancer is cancer that has come back after it has been treated. If rectal cancer comes back, it may come back in the
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rectum or in other parts of the
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body, such as the colon,
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pelvis, liver, or lungs. Tests will be done to help determine where the cancer has returned. The type of treatment for recurrent rectal cancer will depend on where it has come back.</p><p id="CDR0000062959__622">Learn more in <a href="https://www.cancer.gov/types/recurrent-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Recurrent Cancer: When Cancer Comes Back</a>. Information to help you cope and talk with your health care team can be found in the booklet <a href="https://www.cancer.gov/publications/patient-education/when-cancer-returns" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">When Cancer Returns</a>.</p></div></div><div id="CDR0000062959__135"><h2 id="_CDR0000062959__135_">Treatment Option Overview</h2><div id="CDR0000062959__135.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062959__136">There are different types of treatment for people with rectal
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cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__140">The following types of treatment are used:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062959__142">Surgery</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__147">Radiation
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therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__150">Chemotherapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__286">Chemoradiation therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__638">Active surveillance</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__262">Targeted therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__298">Immunotherapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062959__154">New types of treatment are being tested in clinical
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trials.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__291">Treatment for rectal cancer may cause side effects.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062959__208">Follow-up care may be needed.</a></div></li></ul></div><div id="CDR0000062959__136"><h3>There are different types of treatment for people with rectal
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cancer.</h3><p id="CDR0000062959__364">Different types of treatments are available for rectal cancer. You and your cancer care team will work together to decide your treatment plan, which may include more than one type of treatment. Many factors will be considered, such as the stage of the cancer, your overall health, and your preferences. Your plan will include information about your cancer, the goals of treatment, your treatment options and the possible side effects, and the expected length of treatment.</p><p id="CDR0000062959__365">Talking with your cancer care team before treatment begins about what to expect will be helpful. You'll want to learn what you need to do before treatment begins, how you'll feel while going through it, and what kind of help you will need. To learn more, visit <a href="https://www.cancer.gov/about-cancer/treatment/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor About Treatment</a>.</p></div><div id="CDR0000062959__140"><h3>The following types of treatment are used:</h3><div id="CDR0000062959__142"><h4>Surgery</h4><p id="CDR0000062959__144">Surgery 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>Polypectomy: If the cancer is found in a polyp (a small piece of bulging tissue), 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>Local excision: If the cancer is found on the inside surface of the rectum and has not spread into the wall of the rectum, the cancer and a small amount of surrounding healthy tissue are removed.</div></li><li class="half_rhythm"><div>Resection: 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 are removed. Sometimes, the tissue between the rectum and the abdominal 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 microscope for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> of cancer. </div></li><li class="half_rhythm"><div>Radiofrequency ablation: 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 cells. 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. Learn more about <a href="https://www.cancer.gov/about-cancer/treatment/types/surgery/cryosurgery" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cryosurgery to Treat Cancer</a>. </div></li><li class="half_rhythm"><div>Pelvic exenteration: If the cancer has spread to other organs 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 urine and stool to flow from the body to a collection bag.</div></li></ul><p id="CDR0000062959__233">After the cancer is removed, the surgeon will either:</p><ul id="CDR0000062959__234"><li class="half_rhythm"><div>do an anastomosis (sew the healthy parts of the
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rectum together, sew the remaining rectum to the colon, or sew the colon to the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046523/" class="def">anus</a>);<div id="CDR0000062959__195" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Resection%20of%20the%20rectum%20with%20anastomosis&p=BOOKS&id=607264_CDR0000415508.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65940/bin/CDR0000415508.jpg" alt="Three-panel drawing showing rectal cancer surgery with anastomosis; the first panel shows area of rectum with cancer, the middle panel shows cancer and nearby tissue removed, and the last panel shows the colon and anus joined." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Resection of the rectum with anastomosis. The rectum and part of the colon are removed, and then the colon and anus are joined.</p></div></div> or</div></li><li class="half_rhythm"><div>make a stoma (an opening) from the rectum to the outside of the body for waste to pass through. This procedure is done if the cancer is too close to the anus and is called
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a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046464/" class="def">colostomy</a>. A bag is placed around the stoma to collect the waste. Sometimes, the colostomy is needed only until the rectum has
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healed, and then it can be reversed. If the entire
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rectum is removed, however, the colostomy may be permanent.</div></li></ul><p id="CDR0000062959__146"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> may be given before surgery to shrink the tumor, make it easier to remove the cancer, and help with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046500/" class="def">bowel</a> control after surgery. Treatment given before surgery is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045800/" class="def">neoadjuvant therapy</a>. After all the cancer that can be seen at the
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time of the surgery is removed, some patients may be given radiation therapy and/or chemotherapy after surgery to kill any cancer
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cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045587/" class="def">adjuvant
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therapy</a>.</p><p id="CDR0000062959__650">If the cancer has spread to the liver and cannot be removed by surgery, a total hepatectomy and liver transplant after chemotherapy may be done. Total hepatectomy and liver transplant is the removal of the entire liver by surgery, followed by a transplant of a healthy liver from a donor.</p></div><div id="CDR0000062959__147"><h4>Radiation
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therapy</h4><p id="CDR0000062959__149">Radiation therapy uses high-energy x-rays 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. Rectal cancer is sometimes treated with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">external radiation therapy</a>. This type of radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.</p><p id="CDR0000062959__272">Short-course preoperative radiation therapy is used in some types of rectal cancer. This type of external radiation therapy 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><p id="CDR0000062959__620">Learn more about <a href="https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy/external-beam" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">External Beam Radiation Therapy for Cancer</a> and <a href="https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Radiation Therapy Side Effects</a>.</p></div><div id="CDR0000062959__150"><h4>Chemotherapy</h4><p id="CDR0000062959__152">Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.</p><p id="CDR0000062959__624"><b>Systemic chemotherapy</b> is when chemotherapy drugs are taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a vein or muscle. When given this way, the drugs enter the bloodstream and can reach cancer cells throughout the body. Systemic chemotherapy used to treat rectal cancer includes:</p><ul id="CDR0000062959__625"><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/capecitabine" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">capecitabine</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/fluorouracil" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">fluorouracil (5-FU)</a></div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/irinotecanhydrochloride" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">irinotecan</a>
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</div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/drugs/leucovorincalcium" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">leucovorin</a> (a vitamin that improves the effectiveness of 5-FU)</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/oxaliplatin" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">oxaliplatin</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/trifluridine-tipiracilhydrochloride" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">trifluridine and tipiracil</a>
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</div></li></ul><p id="CDR0000062959__626">Combinations of these drugs may be used. Other chemotherapy drugs not listed here may also be used.</p><p id="CDR0000062959__627">Chemotherapy may also be combined with other kinds of drugs. For example, it might be combined with the targeted therapy drug <a href="https://www.cancer.gov/about-cancer/treatment/drugs/bevacizumab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">bevacizumab</a>, <a href="https://www.cancer.gov/about-cancer/treatment/drugs/cetuximab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">cetuximab</a>, or <a href="https://www.cancer.gov/about-cancer/treatment/drugs/panitumumab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">panitumumab</a>.</p><p id="CDR0000062959__267"><b>Regional chemotherapy</b> for rectal cancer is when drugs are placed directly into the hepatic artery (the main <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440100/" class="def">artery</a> that supplies blood to the liver) in a procedure called chemoembolization. Chemoembolization of the hepatic artery 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 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__628">Learn more about how chemotherapy works, how it is given, common side effects, and more at <a href="https://www.cancer.gov/about-cancer/treatment/types/chemotherapy" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Chemotherapy to Treat Cancer</a> and <a href="https://www.cancer.gov/publications/patient-education/chemo-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Chemotherapy and You: Support for People With Cancer</a>.</p></div><div id="CDR0000062959__286"><h4>Chemoradiation therapy</h4><p id="CDR0000062959__637">Chemoradiation therapy combines chemotherapy and radiation therapy to increase the effects of both.</p></div><div id="CDR0000062959__638"><h4>Active surveillance</h4><p id="CDR0000062959__288">Active surveillance is closely following a patient's condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests to check if the cancer is growing. When the cancer begins to grow, treatment is given to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318813/" class="def">cure</a> the cancer. Tests include:</p><ul id="CDR0000062959__289"><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045668/" class="def">digital rectal exam</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045678/" class="def">endoscopy</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045880/" class="def">sigmoidoscopy</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000633288/" class="def">carcinoembryonic antigen (CEA) assay</a>
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</div></li></ul></div><div id="CDR0000062959__262"><h4>Targeted therapy</h4><p id="CDR0000062959__630">Targeted therapy uses drugs or other substances to identify and attack specific cancer cells. Your doctor may suggest <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000805418/" class="def">biomarker tests</a> to help predict your response to certain targeted therapy drugs. Learn more about <a href="https://www.cancer.gov/about-cancer/treatment/types/biomarker-testing-cancer-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Biomarker Testing for Cancer Treatment</a>.</p><p id="CDR0000062959__280">Targeted therapies used to treat rectal cancer include:</p><ul id="CDR0000062959__631"><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/bevacizumab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">bevacizumab</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/cetuximab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">cetuximab</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/encorafenib" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">encorafenib</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/fruquintinib" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">fruquintinib</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/panitumumab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">panitumumab</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/ramucirumab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ramucirumab</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/regorafenib" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">regorafenib</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/ziv-aflibercept" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ziv-aflibercept</a>
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</div></li></ul><p id="CDR0000062959__632">Learn more about <a href="https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Targeted Therapy to Treat Cancer</a>.</p></div><div id="CDR0000062959__298"><h4>Immunotherapy</h4><p id="CDR0000062959__633">Immunotherapy helps a person's immune system fight cancer. Your doctor may suggest biomarker tests to help predict your response to certain immunotherapy drugs. Learn more about <a href="https://www.cancer.gov/about-cancer/treatment/types/biomarker-testing-cancer-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Biomarker Testing for Cancer Treatment</a>.</p><p id="CDR0000062959__634">Immunotherapy drugs used to treat rectal cancer include:</p><ul id="CDR0000062959__635"><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/dostarlimab-gxly" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">dostarlimab</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/ipilimumab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ipilimumab</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/nivolumab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">nivolumab</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/pembrolizumab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">pembrolizumab</a>
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</div></li></ul><p id="CDR0000062959__636">Learn more about <a href="https://www.cancer.gov/about-cancer/treatment/types/immunotherapy" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Immunotherapy to Treat Cancer</a>.</p></div></div><div id="CDR0000062959__154"><h3>New types of treatment are being tested in clinical
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trials.</h3><p id="CDR0000062959__154_md_3">For some people, joining a clinical trial may be an option. There are different types of clinical trials for people with cancer. For example, a treatment trial tests new treatments or new ways of using current treatments. Supportive care and palliative care trials look at ways to improve quality of life, especially for those who have side effects from cancer and its treatment.</p><p id="CDR0000062959__154_md_4">You can use the <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials accepting participants. The search allows you to filter trials based on the type of cancer, your age, and where the trials are being done. Clinical trials supported by other organizations can be found on the <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> website.</p><p id="CDR0000062959__154_md_5">Learn more about clinical trials, including how to find and join one, at <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Clinical Trials Information for Patients and Caregivers</a>.</p></div><div id="CDR0000062959__291"><h3>Treatment for rectal cancer may cause side effects.</h3><p id="CDR0000062959__291_md_73">For information about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> caused by treatment for cancer, visit our <a href="https://www.cancer.gov/about-cancer/treatment/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Side Effects</a> page.</p></div><div id="CDR0000062959__208"><h3>Follow-up care may be needed.</h3><p id="CDR0000062959__208_md_33">As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> the cancer may be repeated 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_md_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 condition has changed or if the cancer has recurred (come back). </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 blood 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__341"><h2 id="_CDR0000062959__341_">Treatment of Stage 0 (carcinoma in situ)</h2><p id="CDR0000062959__343">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000352147/" class="def">stage 0</a> may include the following types of surgery:
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</p><ul id="CDR0000062959__344"><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 tumor is too large to remove by local excision)</div></li></ul><p id="CDR0000062959__360">Learn more about these treatments in the <a href="#CDR0000062959__140">Treatment Option Overview</a>.</p><p id="CDR0000062959__TrialSearch_341_19">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062959__345"><h2 id="_CDR0000062959__345_">Treatment of Stage I Rectal Cancer</h2><p id="CDR0000062959__347">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:</p><ul id="CDR0000062959__348"><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>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">resection</a>
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</div></li><li class="half_rhythm"><div>resection 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 surgery</div></li></ul><p id="CDR0000062959__361">Learn more about these treatments in the <a href="#CDR0000062959__140">Treatment Option Overview</a>.</p><p id="CDR0000062959__TrialSearch_345_19">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062959__349"><h2 id="_CDR0000062959__349_">Treatment of Stages II and III Rectal Cancer</h2><p id="CDR0000062959__351">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:</p><ul id="CDR0000062959__352"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000306495/" class="def">chemoradiation</a> followed by surgery</div></li><li class="half_rhythm"><div>chemotherapy alone followed by surgery, for people with lower-risk disease</div></li><li class="half_rhythm"><div>short-course radiation therapy followed by surgery and chemotherapy</div></li><li class="half_rhythm"><div>surgery followed by chemoradiation</div></li><li class="half_rhythm"><div>surgery</div></li><li class="half_rhythm"><div>chemoradiation followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000616060/" class="def">active surveillance</a> and possibly surgery if the cancer recurs (comes back)</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">immunotherapy</a> with <a href="https://www.cancer.gov/about-cancer/treatment/drugs/dostarlimab-gxly" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">dostarlimab</a> (for treatment of tumors that may have a defect in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a> involved in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045671/" class="def">DNA</a> repair) </div></li></ul><p id="CDR0000062959__362">Learn more about these treatments in the <a href="#CDR0000062959__140">Treatment Option Overview</a>.</p><p id="CDR0000062959__TrialSearch_349_19">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062959__353"><h2 id="_CDR0000062959__353_">Treatment of Stage IV and Recurrent Rectal Cancer</h2><p id="CDR0000062959__355">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> rectal cancer may include:</p><ul id="CDR0000062959__356"><li class="half_rhythm"><div>surgery with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a> with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a> (<a href="https://www.cancer.gov/about-cancer/treatment/drugs/bevacizumab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">bevacizumab</a>, <a href="https://www.cancer.gov/about-cancer/treatment/drugs/fruquintinib" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">fruquintinib</a>, <a href="https://www.cancer.gov/about-cancer/treatment/drugs/panitumumab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">panitumumab</a>, <a href="https://www.cancer.gov/about-cancer/treatment/drugs/ramucirumab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ramucirumab</a>, <a href="https://www.cancer.gov/about-cancer/treatment/drugs/regorafenib" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">regorafenib</a>, or <a href="https://www.cancer.gov/about-cancer/treatment/drugs/ziv-aflibercept" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ziv-aflibercept</a>)</div></li><li class="half_rhythm"><div>systemic chemotherapy with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">immunotherapy</a> with <a href="https://www.cancer.gov/about-cancer/treatment/drugs/dostarlimab-gxly" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">dostarlimab</a> (for treatment of tumors that may have a defect in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a> involved in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045671/" class="def">DNA</a> repair), <a href="https://www.cancer.gov/about-cancer/treatment/drugs/nivolumab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">nivolumab</a>, or <a href="https://www.cancer.gov/about-cancer/treatment/drugs/pembrolizumab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">pembrolizumab</a>
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</div></li><li class="half_rhythm"><div>chemotherapy to control the growth of the tumor</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 rectum 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>targeted therapy with <a href="https://www.cancer.gov/about-cancer/treatment/drugs/encorafenib" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">encorafenib</a> and <a href="https://www.cancer.gov/about-cancer/treatment/drugs/cetuximab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">cetuximab</a> in patients with a certain change in the <i><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000561325/" class="def">BRAF</a></i> gene</div></li><li class="half_rhythm"><div>immunotherapy (nivolumab or pembrolizumab, or nivolumab and <a href="https://www.cancer.gov/about-cancer/treatment/drugs/ipilimumab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ipilimumab</a> combined)</div></li></ul><p id="CDR0000062959__357">Treatment of rectal cancer that has spread to other organs depends on where the cancer has spread.</p><ul id="CDR0000062959__358"><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> may include:<dl id="CDR0000062959__359" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">chemotherapy to shrink the tumor, if needed, followed by surgery</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">liver transplant after chemotherapy for patients with liver metastases that cannot be removed by surgery</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__363">Learn more about these treatments in the <a href="#CDR0000062959__140">Treatment Option Overview</a>.</p><p id="CDR0000062959__TrialSearch_353_19">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062959__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, visit:</p><ul id="CDR0000062959__198"><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/types/colorectal/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Colorectal Cancer Home Page</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/types/colorectal/screening-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Screening Tests to Detect Colorectal Cancer and Polyps</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/colorectal" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Colon and Rectal Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/causes-prevention/genetics/genetic-testing-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Genetic Testing for Inherited Cancer Risk</a>
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</div></li></ul><p id="CDR0000062959__196_md_40">For general cancer information and other resources from the National Cancer Institute, visit:</p><ul id="CDR0000062959__196_md_41"><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">About Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Staging</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/publications/patient-education/chemo-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Chemotherapy and You: Support for People With Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/publications/patient-education/radiation-therapy-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Radiation Therapy and You: Support for People With Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors, Caregivers, and Advocates</a>
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</div></li></ul></div><div id="CDR0000062959__AboutThis_1"><h2 id="_CDR0000062959__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062959__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000062959__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="https://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000062959__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000062959__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000062959__AboutThis_6">This PDQ cancer information summary has current information about the treatment of rectal cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000062959__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000062959__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
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</p><p id="CDR0000062959__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>.
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</p></div><div id="CDR0000062959__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000062959__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000062959__AboutThis_12">Clinical trials can be found online at <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. For more information, call the <a href="https://www.cancer.gov/contact/contact-center" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Information Service</a> (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000062959__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000062959__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000062959__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000062959__AboutThis_21">PDQ® Adult Treatment Editorial Board. PDQ Rectal Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/colorectal/patient/rectal-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/colorectal/patient/rectal-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389378]</p><p id="CDR0000062959__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 3,000 scientific images.
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</p></div><div id="CDR0000062959__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062959__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062959__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000062959__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK65940</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26389378" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26389378</a></span></div></div></div>
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<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/?report=reader">PubReader</a></li><li><a href="/books/NBK65940/?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. 2024 Sep 13. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm">NBK65940.26</span> September 13, 2024 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK65940.25/">NBK65940.25</a></span> August 26, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65940.24/">NBK65940.24</a></span> April 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href="/books/NBK65940.14/">NBK65940.14</a></span> January 18, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65940.13/">NBK65940.13</a></span> January 10, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65940.12/">NBK65940.12</a></span> December 27, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65940.11/">NBK65940.11</a></span> August 17, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65940.10/">NBK65940.10</a></span> June 8, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65940.9/">NBK65940.9</a></span> May 15, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65940.8/">NBK65940.8</a></span> May 4, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65940.7/">NBK65940.7</a></span> February 16, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65940.6/">NBK65940.6</a></span> May 19, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65940.5/">NBK65940.5</a></span> March 6, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65940.4/">NBK65940.4</a></span> February 27, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65940.3/">NBK65940.3</a></span> June 30, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65940.2/">NBK65940.2</a></span> March 21, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65940.1/">NBK65940.1</a></span> June 30, 2015</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000062959__92" ref="log$=inpage&link_id=inpage">General Information About Rectal Cancer</a></li><li><a href="#CDR0000062959__111" ref="log$=inpage&link_id=inpage">Stages of Rectal Cancer</a></li><li><a href="#CDR0000062959__135" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000062959__341" ref="log$=inpage&link_id=inpage">Treatment of Stage 0 (carcinoma in situ)</a></li><li><a href="#CDR0000062959__345" ref="log$=inpage&link_id=inpage">Treatment of Stage I Rectal Cancer</a></li><li><a href="#CDR0000062959__349" ref="log$=inpage&link_id=inpage">Treatment of Stages II and III Rectal Cancer</a></li><li><a href="#CDR0000062959__353" ref="log$=inpage&link_id=inpage">Treatment of Stage IV and Recurrent Rectal Cancer</a></li><li><a href="#CDR0000062959__196" ref="log$=inpage&link_id=inpage">To Learn More About Rectal Cancer</a></li><li><a href="#CDR0000062959__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65965/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389388" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Melanoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Melanoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389278" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Neuroblastoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Neuroblastoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389197" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Retinoblastoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Retinoblastoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389322" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" 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