Treatment overview for rectal cancer
Treatment depends on the stage of the cancer and where it is in the rectum.
Your doctors will have carried out various tests and investigations to help them plan your treatment. Although they may have a good idea about which treatments you’ll need, they may not be able to tell you exactly until after an operation.
It’s important to discuss the recommended treatments with your doctor, and to make sure you understand why a particular type of treatment has been suggested for you.
Most stage 1 rectal cancers are treated with surgery. Often, the cancer can be completely removed, and for most people it will never come back. People with stage 1 rectal cancer don’t usually need to have any further treatment after their surgery, although very occasionally chemotherapy or radiotherapy may be given.
Stage 2 and 3 rectal cancer
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People with stage 2 rectal cancers are also usually treated with surgery. Radiotherapy or a combination of radiotherapy and chemotherapy (chemoradiotherapy) may be given before surgery to shrink the cancer and make it easier to remove. Giving treatment before surgery is called neo-adjuvant therapy.
Chemoradiotherapy or chemotherapy can be given on their own after the operation. This is when there’s a risk that the cancer may come back in the future and treatment wasn’t given before surgery.
People with stage 3 rectal cancers may be given radiotherapy or chemoradiotherapy before surgery to shrink the cancer and make it easier to remove, as well as reducing the risk of it coming back. There’s a greater risk that the cancer will come back after surgery, so chemotherapy is usually recommended unless neo-adjuvant treatment has been given.
Advanced rectal cancer
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Advanced (stage 4) rectal cancer means that the cancer has spread from where it started in the bowel. It can spread into the area around the bowel, such as the abdomen, and this is known as local spread. If the cancer has spread to other parts of the body, such as the liver or lungs, this is known as secondary, or metastatic, cancer.
It’s not usually possible to cure stage 4 rectal cancer, but treatment may be able to control it for some time. Treatment may also be used to reduce symptoms and give a good quality of life.
However, for some people in this situation, treatment will have little effect on the cancer and they will have the side effects without many of the benefits.
The treatment that’s most appropriate for you will depend on:
the part of your body the cancer has spread to
the treatment that you’ve already had.
Chemotherapy is the most commonly used treatment for stage 4 rectal cancer. It may be given into a vein by injection, by drip, or taken as tablets or capsules.
Surgery may sometimes be used, for example to remove a cancer that’s blocking the bowel, or sometimes to remove secondary bowel cancers from the liver or lungs.
Radiotherapy may be used to shrink a cancer that’s causing pain. This is known as palliative radiotherapy. Monoclonal antibodies such as bevacizumab (Avastin®), cetuximab (Erbitux®) and panitumumab (Vectibix®) are sometimes used to control advanced rectal cancer for a time.
How treatment is planned
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In most hospitals, a team of specialists will talk to you about the treatment they think is best for your situation.
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 (an expert in evaluating the tissue taken from patients)
stoma care nurse.
It may also include other healthcare professionals, such as a dietitian, physiotherapist, occupational therapist, psychologist or counsellor.
The MDT will take a number of factors into account when advising you on the best course of action. The factors include your general health, the type and size of the tumour, and whether it has begun to spread.
If two treatments are equally effective for your type and stage of cancer, your doctor may offer you a choice of treatments. Sometimes people find it hard to make a decision. If you’re asked to make a choice, make sure that you have enough information about the different options, what’s involved and the possible side effects, so you can decide on the right treatment for you.
Remember to ask questions about anything that you don’t understand or feel worried about. It may help to discuss the benefits and disadvantages of each option with your cancer specialist, specialist nurse or with our cancer support specialists on 0808 808 00 00.
If you have any questions about your treatment, don’t be afraid to ask your doctor or nurse. It often helps to make a list of questions and to take a relative or close friend with you.
Even though a number of cancer specialists work together as a team to decide on the most suitable treatment, you may want to have another medical opinion. Most doctors will be happy to refer you to another specialist for a second opinion, if you feel that this will be helpful. Having a second opinion may mean that the start of your treatment is delayed, so you and your doctor need to be confident that it will give you useful information.
If you do go for a second opinion, it may be a good idea to have a list of questions ready so that you can make sure all your concerns are covered during the discussion.
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 benefits 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 straight away, so they can explain again. Some cancer treatments are complex, so it’s not unusual for people to need explanations repeated.
It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.
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 also 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.
The benefits and disadvantages of treatment
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Many people are frightened at the thought of having cancer treatments, because of the side effects that may occur. However, these can usually be controlled with medicines.
Some people ask what will happen if they don’t have any treatment.
Treatment can be given for different reasons, and the potential benefits will vary depending on your particular situation.
If you have early-stage rectal cancer and have been offered treatment that is intended to cure it, it may be easy to decide whether to accept the treatment. Your doctor will talk you through your treatment and any other options for you.
However, if a cure is not possible and the treatment is being given to control the cancer f
or a period of time, it may be more difficult to decide whether to go ahead.
Making decisions about treatment in these circumstances is always difficult. You may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to, you can still be given supportive (palliative) care, which often involves medicines to control any symptoms.
For more on planning your treatment, you may find it helpful to read our information on: