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Rectal Cancer Treatment by Stage

Rectal cancer is staged much the same way as is colon cancer, but because the tumor is much lower down in the large intestine, the treatment options may vary.

Surgery to remove the cancer is almost always the first treatment.

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Stage 0 Rectal Cancer

In Stage 0 rectal cancer, the tumor is located only on the inner lining of the rectum. To treat this early stage cancer, surgery can be performed to remove the tumor or a small section of the rectum where the cancer is located can be removed. Radiation treatment, given either externally (beamed in from the outside) or internally (radioactive beads are placed inside the rectum) may be considered. 

Stage I Rectal Cancer

Stage I rectal cancer is another early form or limited form of cancer. The tumor has broken through the inner lining of the rectum but has not made it past the muscular wall. Treatment usually involves:

  • Surgery to remove the tumor
  • If the tumor is small or you are very old or sick, radiation alone can be used to treat the tumor. This hasn't proven to be as effective as surgery. Chemotherapy can also be added to heighten the effect of radiation.

 

Stage II Rectal Cancer

Stage II rectal cancer is a little more advanced. The tumor has penetrated all the way through the bowel wall and may have invaded other organs, like the bladder, uterus, or prostate gland. However, lymph nodes are not involved at this stage. Treatment includes:

  • Surgery to remove all the organs involved with the cancer (wide-resection)
  • Radiation with chemotherapy is given before surgery, or after surgery; chemotherapy alone is given for 4 months after surgery.

Stage III Rectal Cancer

In Stage III rectal cancer, the tumor has spread to the lymph nodes (small structures that are found throughout the body that produce and store cells that fight infection). Treatment includes:

  • Surgery to remove the tumor
  • Radiation with chemotherapy before or after surgery
  • Chemotherapy, if elected, after surgery

 

 

Stage IV Rectal Cancer

In Stage IV rectal cancer, the tumor has spread to distant parts of the body (metastasized), often to the liver and lung. The tumor can be any size and sometimes is not that large. 

The mainstay of treatment is chemotherapy, but surgery to remove the tumor may also be recommended. Surgery, when performed, is often used to relieve or prevent blockage of the rectum or to prevent rectal bleeding. It is not generally considered a curative procedure. Surgeries of this type can also help a patient with stage IV rectal cancer live longer.

If there are only one or two liver tumors, they can be removed surgically. Other options include freezing the tumors (cryosurgery) or destroying them with microwaves or heat (radiofrequency ablation). Other nonsurgical directed therapies include giving chemotherapy directly into the liver using radioactive isotopes (radioembolization) or cutting off the blood supply to the tumor in the liver (embolization). Often, chemotherapy directly into the liver is used with embolization (chemoembolization).

 

Recurrent Rectal Cancer

Recurrent rectal cancer means the cancer has come back after treatment. The cancer can recur near the site of the original cancer in the rectum (local recurrence) or in distant organs. Treatment includes:

  • Surgery to remove local recurrences; studies show that this can help patients live longer.
  • If surgery can't remove all of the recurrences, many experts recommend chemotherapy with or without radiation. This can sometimes shrink the tumor enough to allow surgical removal of the tumor afterwards.

Patients may ask their doctors if there are clinical trials in which they can participate that are testing new treatments.

 

 

WebMD Medical Reference

Reviewed by William Blahd, MD on August 01, 2014
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