Treatment overview for rectal cancer
Treatment depends on the stage of the cancer and where it is in the rectum. It also depends on your general health and personal preferences.
Treatments used for rectal cancer include surgery, radiotherapy, chemotherapy and sometimes targeted therapy. Often, a combination of treatments is used. When chemotherapy and radiotherapy are given together, it’s called chemoradiation.
It’s important you have the chance to discuss treatments with your doctor. This will help you understand why a particular plan of treatment has been suggested, and how the treatment may affect you.
Surgery to remove the cancer is one of the main treatments for rectal cancer. The operation usually involves removing part or all of the rectum, as well as nearby lymph nodes. If the cancer has grown into tissue or organs nearby, the surgeon may remove parts of these too.
Sometimes, surgery is used to relieve symptoms rather than cure the cancer. For example, if the cancer is causing a blockage in the bowel.
Occasionally, surgery may be used to remove cancer that has spread to a distant part of the body, such as the liver or lungs.
Radiotherapy or chemoradiation may be given before or after rectal surgery. These treatments help to reduce the risk of the cancer coming back in, or close to, the rectum.
Radiotherapy is also sometimes used to relieve symptoms such as pain or bleeding. This is called palliative radiotherapy.
Sometimes, chemotherapy is given after surgery to reduce the risk of the cancer coming back.
If cancer has spread to the liver or lungs (secondary cancer), chemotherapy may be the main treatment. It is given to shrink the cancer and to control it for as long as possible. Some people with secondary cancer have chemotherapy to shrink the cancer before an operation is done to remove it.
Targeted therapies are sometimes used on their own or in combination with chemotherapy to control secondary cancer.
Your cancer specialist may invite you to take part in a clinical trial.
How treatment is planned
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A team of specialists will meet to plan your treatment. This multidisciplinary team (MDT) will include a:
surgeon who specialises in bowel cancers
medical oncologist (chemotherapy specialist)
clinical oncologist (radiotherapy and chemotherapy specialist)
radiologist (specialist in x-rays and scans)
pathologist (specialist in studying tissue samples to detect diseases)
stoma care nurse.
It may also include other healthcare professionals, such as a gastroenterologist (doctor who specialises in bowel problems), dietitian, physiotherapist, occupational therapist, psychologist or counsellor.
If the cancer has spread to your liver, you may also be referred to an MDT that specialises in surgery for secondary cancer in the liver. In this situation, the two MDTs will work together to plan your treatment.
Talking about your treatment plan
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After the MDT meeting, your cancer specialist or nurse will talk to you about your treatment options.
They will explain the main aims of treatment. These may be to try to cure the cancer, to help you live longer or to relieve symptoms. They will also tell you the possible short-term and long-term side effects of the treatments.
Deciding on which treatments are right for you is usually a joint decision between you and your cancer team. Cancer specialists have expert knowledge of the treatments that can help, but you know your individual situation and your beliefs and preferences.
Usually, if there is one treatment that has been shown to work best, most people are happy to be guided by their cancer doctor. But there can be times when the decision will depend on your individual preferences. For example, if there are two or more treatments that may work equally well but cause different side effects. Or, if having an additional treatment may increase the chance of cure by a small amount, but at the cost of unpleasant side effects.
Some treatments, such as radiotherapy or chemoradiation, can reduce the chance of cancer coming back. But they may cause new side effects to develop months or years later. Your doctor will talk to you about the possible advantages and disadvantages of these treatments with you.
If a cure is not possible and the aim of treatment is to control the cancer for some time, it may be more difficult to decide what to do. You may need to discuss this in detail with your doctor. If you choose not to have the treatment, you can still be given supportive (palliative) care to control any symptoms.
When making treatment decisions, it’s important to talk things over carefully with your cancer team. It can help to make a list of the questions you want to ask them. You can take this to your next appointment. It’s also helpful to have a relative or close friend with you at appointments. You may choose to keep notes about what has been said.
Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straightaway, so they can explain again. Some cancer treatments are complex, so it’s not unusual to need repeated explanations.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You are free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.
Your multidisciplinary team (MDT) uses national treatment guidelines to decide the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion. Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information.
David Plume explains the benefits and disadvantages of getting a second opinion about your treatment.