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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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In most hospitals, a team of specialists will discuss the treatment that is best for you. This multidisciplinary team| (MDT) will include a surgeon who specialises in bowel cancers, one or more oncologists (doctors who specialise in cancer treatments such as radiotherapy or chemotherapy) and a number of other health professionals.
Together, the MDT will be able to advise you on the best course of action and plan of treatment. They will take into account a number of factors, including your general health, age, the size of the cancer, where it is in the rectum, and whether it has begun to spread.
The stage| is very important in determining treatment.
Your doctors will have carried out various tests to help them plan your treatment. Although they will have a good idea about which treatments you need, they may not be able to tell you exactly until after an operation.
You will be asked to give your permission (consent|) for the hospital staff to give you the treatment. It’s important that you discuss with your doctor the treatments they recommend, and that you understand why a particular treatment has been suggested for you.
Often, the cancer can be completely removed with surgery, 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.
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 on its own can be given after the operation if there is 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. There is a greater risk that the cancer will come back after surgery, and chemotherapy is usually recommended unless neo-adjuvant treatment has been given.
Stage 4 (advanced) 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 isn’t 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 upon the cancer and they will have the side effects without many of the benefits.
The treatment that is most appropriate for you will depend on:
Chemotherapy is the most commonly used treatment for stage 4 rectal cancer. It may be given into a vein by injection or drip, or taken as tablets or capsules.
Surgery may sometimes be used, for example to remove a cancer that is blocking the bowel, or sometimes to remove secondary bowel cancers from the liver or lungs.
Radiotherapy may be used to shrink a cancer that is 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.
Many people are frightened at the thought of having cancer treatments because of the side effects that may occur. Some people ask what will happen if they don’t have any treatment.
Although the treatments can cause side effects, these can often be well controlled with medicines.
Treatment can be given for different reasons and the potential benefits will vary depending upon your particular situation.
If you have early-stage rectal cancer (stages 1, 2 and 3) 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 through your treatment and any other options with you.
However, if a cure is not possible and the treatment is being given to control the cancer for 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.
You can ask for a second opinion| if you feel it would be helpful.
For more on planning your treatment, you may find it helpful to read our information on:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.