How treatment is planned

A group of experts called a multidisciplinary team (MDT) will meet to discuss your treatment. After the meeting, your specialist will talk to you about the types of treatment you may be able to have. This will depend on the stage of the cancer and where it is in the rectum. It will also depend on your general health and what you may prefer.

Surgery is the most common treatment for rectal cancer but other treatments may also be used to reduce the risk of the cancer coming back. It’s important to understand why your treatment has been suggested and what side effects it may cause. It may help to make a list of questions you want to ask them. You might also want to take a relative or friend with you when the treatment is first explained.

You will need to give permission (consent) before you start your treatment, but you can also decide not to have it. Take as much time as you need to make your decision.

Your MDT

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)
  • nurse 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.

Your treatment options

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.

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.

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.

Giving your consent

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 straight away, so they can explain again. Some cancer treatments are complex, so it's not unusual to need repeated explanations.

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.

Back to Who will be involved in my treatment decision?

Getting a second opinion

There are many reasons for wanting a second opinion about your treatment. Speak to your specialist or GP.