Rectal Cancer Treatments

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Rectal cancer surgery

Most stages of rectal cancer include surgery as part of the treatment plan. In the earliest stages of rectal cancer, surgery to remove the tumor from the rectum is often the only treatment needed. But as rectal cancer progresses, treatments could include a combination of both surgery and medical procedures, like chemotherapy.

The type of surgery you have for rectal cancer depends on where in the rectum the tumor is located and how far your cancer has spread. When possible, our locations offer options for minimally invasive rectal cancer surgeries, including laparoscopic and robotic-assisted surgery, which use small incisions and may help speed up recovery.

Our teams also provide surgical options that work to preserve healthy tissue and nerves, allowing us to maintain as much of your normal bowel and sexual functions as possible.

Polypectomy

Rectal cancer begins as a polyp, a small mushroom-like outgrowth of abnormal lining in the rectum. When these polyps are caught in the early stages of rectal cancer, a procedure called a polypectomy removes them. During a colonoscopy, your doctor performs a polypectomy, which uses a thin tube with a light and camera to view the polyp and remove it at its base.

Transanal excision (TAE)

A transanal excision removes a small area of cancer in the rectum and some of the tissue around it. This surgery doesn’t require an abdominal incision. Instead, tools are used during a colonoscopy to reach the tumor. TAE is most used in early-stage rectal cancer that is located near the anus.

Transanal endoscopic microsurgery (TEM)

TEM is an advanced, minimally invasive procedure that removes rectal tumors, including those higher up in the rectum, without an abdominal incision. Your physician uses a 3D microscope and microsurgical tools inserted into the rectum (through the anus) to remove the cancer. It allows for greater precision, speeds up recovery and helps minimize effects on nearby nerves related to bowel and sexual function. The same operation can be performed using instruments alongside a laparoscopic or a robotic camera through the anal canal.

Low anterior resection (LAR)

If cancer has advanced and begun to spread, a surgical procedure known as a low anterior resection may be necessary. This surgery removes the section of the rectum containing the tumor while preserving the lower part of the rectum. The colon is then connected to the preserved rectum to enable normal digestive function, known as anastomosis. This can be performed with traditional surgery or using a minimally invasive approach.

You might need a temporary ileostomy to allow the newly created connection between the colon and rectum to heal and function properly. An ileostomy connects the end of the small intestine to an opening in the abdomen that passes stool into a pouch. The temporary ileostomy is later reversed to restore normal function through the new connection.

Proctectomy with coloanal anastomosis

During the later stages of rectal cancer (rarely stage 1), the entire rectum might need to be removed, called a proctectomy. To restore bowel function without needing a permanent colostomy, your surgeon reconnects the remaining ends of your intestinal tract through anastomosis. A coloanal anastomosis attaches your colon to the top of your anal canal, where the sphincter muscles are found. This preserves the control of passing stool even though the rectum was removed.

Abdominoperineal resection (APR)

An APR procedure removes the rectum through an abdominal incision and removes the anus and its surrounding muscles through incisions around the anus. It’s often required in very low stage 3 rectal cancer that involves the muscles of the anal sphincter. Because the muscles that allow the anus to work are removed, APR requires a permanent colostomy to pass stool through an opening in the abdomen.

Diverting colostomy

Rectal cancer can grow and completely block the rectum, meaning you can no longer have bowel movements. You may need immediate surgery to divert the intestinal tract in this case. A diverting colostomy connects part of your colon to an abdomen opening, called a stoma, to pass stool into a pouch.

Radiofrequency ablation

Radiofrequency ablation is used in many body parts to destroy tissue with high-intensity heat. If rectal cancer has spread to the liver, you may have radiofrequency ablation to destroy cancer cells.

Cryosurgery

Cryosurgery is another option to destroy cancer cells when rectal cancer spreads into the liver. Cryosurgery uses a probe and cold temperatures to freeze cancer and the surrounding tissue.

Pelvic exenteration

When cancer spreads through the rectum and into nearby organs, your treatment could include a major surgery called pelvic exenteration. This surgery removes the entire rectum and organs like the bladder, prostate, uterus, ovaries and others.

In cases where the bladder is completely removed, your surgeon will also perform a urostomy. A urostomy opens outside the body, where urine can flow into a pouch. You’ll also need a permanent colostomy to pass stool out of the body.

Medical treatment

While early stages of rectal cancer may be removed with surgery, your multidisciplinary care team could recommend using medical treatments along with surgery as the rectal cancer progresses. In other cases, medical treatments are used when surgery isn’t an option to treat rectal cancer. Your team will guide you through each of your treatments so that you understand how they work and help you in your path forward.

Two of the most common medical treatments for rectal cancer are chemotherapy and radiation. These two treatments may be used together. In advanced stages of rectal cancer, you could have the option to try additional treatments such as targeted therapies or immunotherapy.

Chemotherapy

Chemotherapy uses drugs through an IV or as a pill to help slow or stop cancer cells from growing. You may have chemotherapy before rectal cancer surgery or afterward. Chemotherapy is used to achieve multiple goals, including shrinking the tumor to help with surgical removal, alleviate symptoms and reduce the risk of the cancer coming back.
Chemoradiotherapy
Chemoradiotherapy uses both chemotherapy and radiation therapy together. It may be the right option for you based on the size of your tumor or if your rectal cancer has a high chance of returning.
- Before surgery, chemoradiotherapy aims to reduce the size of your tumor so that less tissue must be removed and the need for a colostomy may be avoided.
- After surgery, this treatment helps lower the chances of rectal cancer returning but is rarely utilized if the colon has been connected to the lower part of the rectum or anal canal through anastomosis. It is only used if the surgery resulted in a permanent colostomy and was performed before chemoradiation could be used (due to bowel blockage).
- As the primary treatment, chemoradiotherapy may help slow your rectal cancer’s growth when you can’t have surgery.
Targeted drug therapy

Drug therapies target proteins or cancer cell pathways to prevent tumor growth. They’re often used with chemotherapy drugs for advanced stages of rectal cancer. One type of targeted therapy used in rectal cancer is monoclonal antibody therapy.
Immunotherapy therapy

Immunotherapy is one of the most recent innovations in care for cancer, including rectal cancer. This therapy is typically used in advanced stages of rectal cancer to help your immune system recognize and attack cancer cells. The FDA currently approves a type of therapy called checkpoint inhibitors for treating rectal cancer.

Radiation therapy

Based on the size, location and stage of your rectal cancer, our locations will often offer radiation therapy as part of your treatment plan. Many types of radiation therapy are available today, but they all work by targeting areas of rectal cancer with high-energy rays or radioactive particles that destroy the cancer cells.

Some people have radiation treatments over several weeks, while others have radiation condensed into a short time. Combining radiation therapy with surgery or chemotherapy for rectal cancer is common.

Radiation therapy might help shrink a tumor before surgery or reduce the likelihood of cancer returning to the same place in the rectum. It’s also used to help manage or reduce symptoms when you have advanced rectal cancer.

External-beam radiation therapy (EBRT)

External-beam radiation therapy is the most common type of radiation therapy used in rectal cancer treatment. This radiation therapy targets specific areas of cancer with high-energy X-ray beams delivered from a machine outside the body.

Intensity-modulated radiation therapy (IMRT) uses special computer software that provides 3D images from computed tomography (CT) to increase precision in targeting radiation therapy to specific areas of rectal cancer.
Image-guided radiation therapy (IGRT) uses markers implanted before radiation therapy and CT imaging to help guide radiation therapy.

Stereotactic radiation therapy

For people diagnosed with rectal cancer, stereotactic radiation therapy is most often used to target cancer cells that have spread to the liver or the lungs. This type of targeted radiation therapy helps doctors limit the effects of radiation on nearby healthy tissue.

Intraoperative radiation therapy (IORT)

Radiation therapy can be delivered at the same time as surgery, called intraoperative radiation therapy. During surgery, your doctor delivers one dose of radioactive material or radiation seeds directly into the rectal cancer tumor.

Brachytherapy

Brachytherapy targets cancer from inside the body by placing radioactive material into or near the tumor in the rectum. It’s sometimes used in rectal cancer, but research is still underway to understand who benefits most from this type of therapy.

Endocavitary radiation therapy: In endocavitary radiation therapy, a small, balloon-like device is inserted into the rectum near the tumor. It delivers radiation to the cancer for several minutes.
Interstitial brachytherapy: During brachytherapy for rectal cancer, small seeds or pellets of radioactive material are placed in a tube. This tube is inserted through the rectum directly into the tumor to deliver radiation therapy.

Our approach to rectal cancer treatment