Treatment for rectal cancer may begin with surgery to remove the cancer. If the cancer grows larger or spreads to other parts of the body, treatment might start with medicine and radiation instead. Your healthcare team considers many factors when creating a treatment plan. These factors may include your overall health, the type and stage of your cancer, and your preferences.
Surgery
Surgery to remove the cancer can be used alone or in combination with other treatments.
Procedures used for rectal cancer may include:
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Removing very small cancers from the inside of the rectum. Very small rectal cancers may be removed using a colonoscope or another specialized type of scope inserted through the anus. This procedure is called transanal local excision. Surgical tools can be passed through the scope to cut away the cancer and some of the healthy tissue around it.
This procedure might be an option if your cancer is small and not likely to spread to nearby lymph nodes. If a lab exam of your cancer cells shows that they are aggressive or more likely to spread to the lymph nodes, additional surgery may be needed.
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Removing all or part of the rectum. Larger rectal cancers that are far enough away from the anus might be removed in a procedure that removes all or part of the rectum. This procedure is called low anterior resection. Nearby tissue and lymph nodes also are removed. This procedure preserves the anus so that waste can leave the body as it usually would.
How the procedure is performed depends on the cancer's location. If cancer affects the upper portion of the rectum, that part of the rectum is removed. The colon is then attached to the remaining rectum. This is called colorectal anastomosis. All of the rectum may be removed if the cancer is in the lower portion of the rectum. Then the colon is shaped into a pouch and attached to the anus, called coloanal anastomosis.
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Removing the rectum and anus. For rectal cancers that are located near the anus, it might not be possible to remove the cancer completely without hurting the muscles that control bowel movements. In these situations, surgeons may recommend an operation called abdominoperineal resection, also known as APR. With APR, the rectum, anus and some of the colon are removed, as well as nearby tissue and lymph nodes.
The surgeon creates an opening in the abdomen and attaches the remaining colon. This is called a colostomy. Waste leaves the body through the opening and collects in a bag that attaches to the abdomen.
Chemotherapy
Chemotherapy treats cancer with strong medicines. Chemotherapy medicines are typically used before or after surgery in people with rectal cancer. Chemotherapy is often combined with radiation therapy and used before an operation to shrink a large cancer so that it's easier to remove with surgery.
In people with advanced cancer that has spread beyond the rectum, chemotherapy may be used alone to help relieve symptoms caused by the cancer.
Radiation therapy
Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. For rectal cancer, radiation therapy is most often done with a procedure called external beam radiation. During this treatment, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.
In people with rectal cancer, radiation therapy is often combined with chemotherapy. It can be used after surgery to kill any cancer cells that might remain. Or it can be used before surgery to shrink a cancer and make it easier to remove.
When surgery isn't an option, radiation therapy might be used to relieve symptoms, such as bleeding and pain.
Combined chemotherapy and radiation
Combining chemotherapy and radiation therapy may enhance the effectiveness of each treatment. Combined chemotherapy and radiation may be the only treatment you receive, or combined therapy can be used before surgery. Combining chemotherapy and radiation treatments increases the likelihood of side effects and how serious they are.
Targeted therapy
Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.
For rectal cancer, targeted therapy may be combined with chemotherapy for advanced cancers that can't be removed with surgery or for cancers that come back after treatment.
Some targeted therapies only work in people whose cancer cells have certain DNA changes. Your cancer cells may be tested in a lab to see if these medicines might help you.
Immunotherapy
Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.
For rectal cancer, immunotherapy is sometimes used before or after surgery. It also may be used for advanced cancers that have spread to other parts of the body. Immunotherapy only works for a small number of people with rectal cancer. Special testing can determine if immunotherapy might work for you.
Palliative care
Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A healthcare team that may include doctors, nurses and other specially trained health professionals provides palliative care. The care team's goal is to improve quality of life for you and your family.
Palliative care specialists work with you, your family and your care team. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time you're getting strong cancer treatments, such as surgery, chemotherapy or radiation therapy.
The use of palliative care with other proper treatments can help people with cancer feel better and live longer.