Rectal Cancer Treatment by Stage: What to Expect

Your doctor may talk about your “stage” of rectal cancer. These stages are a lot like those for colon cancer, but because the tumor is much lower in the large intestine, treatment options may vary.

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

Stage 0 Rectal Cancer

In this very early stage, the tumor is only on the inner lining of the rectum.

A surgeon can remove it or a small section of the rectum where the cancer is.

Your doctor may consider whether you can get radiation treatment, given either externally (beamed in from the outside) or internally (radioactive beads that go inside the rectum).

Stage I Rectal Cancer

This 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.

Usually, doctors use surgery to remove the tumor.

If the tumor is small or you are very old or sick, doctors treat the tumor with radiation alone. This hasn't been as effective as surgery. Your doctor may add chemotherapy to give the radiation treatment a boost.

Stage II Rectal Cancer

At this stage, the tumor has gone all the way through the bowel wall and may have invaded nearby organs, like the bladder, uterus, or prostate gland. But it’s not in any distant organs of lymph nodes, which are small structures throughout the body that store cells that fight infection and work as filters for harmful substances.

Treatment includes:

  • Surgery to remove all the organs involved with the cancer
  • Radiation with chemotherapy before or after surgery

Stage III Rectal Cancer

In this stage, the tumor has spread to the lymph nodes.

Treatment includes:

  • Surgery to remove the tumor
  • Radiation with chemotherapy before or after surgery
  • Chemotherapy, which may also be an option after surgery

Stage IV Rectal Cancer

In this stage, the cancer has spread (or “metastasized”) to distant parts of the body, often to the liver and lung. The tumor can be any size and sometimes isn’t that large.


The main treatment is chemotherapy, but your doctor may also recommend surgery to remove the tumor. Surgery is often used to relieve or avoid blockage of the rectum or to treat rectal bleeding that is hard to otherwise control. It’s not generally considered to be a cure, though it may help someone with stage IV rectal cancer live longer.

If there are only one or two liver tumors, a surgeon may be able to remove them. Other options include freezing the tumors (cryosurgery) or destroying them with microwaves or heat (radiofrequency ablation).

Other nonsurgical treatments 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, doctors give chemotherapy directly into the liver along with embolization. You may hear this called chemoembolization.

Recurrent Rectal Cancer

This means the cancer has come back after treatment, either in the same area or in a distant part of the body.

Treatment includes:

  • Surgery to remove it if it’s in the same area as the original cancer. Studies show that this can help people live longer.
  • If surgery can't remove all of the recurrences, many experts recommend chemotherapy with or without radiation. Sometimes, this shrinks the tumor enough for surgeons to remove it later.

You may also want to ask your doctor if there are clinical trials you could join. This is a way to try new treatments that aren’t yet available to everyone. Talk with your doctor about what you should consider first and how to find a clinical trial that would be a good fit for you.

WebMD Medical Reference Reviewed by Sabrina Felson, MD on October 12, 2019



American Cancer Society. "Lymph Nodes and Cancer."

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