Rectal cancer treatment by stage

Cancer of the rectum affects the last part of the bowel to the anus, and may also be referred to as bowel cancer or colorectal cancer.

Treatment for rectal cancer will usually depend on how advanced the cancer is and the person's overall health.

An operation to remove the cancer is usually the first line of treatment, but doctors will make the treatment decision based on a measure of the spread of the cancer, called staging.

Stage 0

In stage 0 rectal cancer, the tumour is confined to the inner lining of the rectum. To treat this early-stage cancer, surgery can be used to remove either the tumour or a small section of the rectum where the cancer is located. Radiotherapy, given either externally (beamed in from outside the body) or internally (radioactive beads are placed inside the rectum) may also be considered.

Stage 1

This is another early or limited form of the disease. The tumour has broken through the inner lining of the rectum and has grown into the muscular wall but not all the way through it. Treatment usually involves:

• Surgery to remove the tumour
• If the tumour is small or the patient is particularly old or sick, radiotherapy alone can be used to treat the tumour. This has not proved to be as effective as surgery.

Stage 2

This cancer is a little more advanced. The tumour has grown through the muscle layer and into the outer lining of the rectum or into organs or structures near to the bowel, such as the bladder, uterus or prostate gland, but not other parts of the body. Lymph nodes are not affected. Treatment options include:

• Surgery to remove all of the organs affected by the cancer (wide resection) may be used to control the disease.
• Some doctors will recommend using radiotherapy and/or chemotherapy before surgery to shrink the tumour and make it easier to remove. Radiotherapy and/or chemotherapy may also be used after surgery.

Stage 3

In this case the tumour has grown into the inner lining of the rectum and affects one to three lymph nodes close-by, or through the lining of the rectum or into nearby structures, and affects one to three lymph nodes, or has not broken through the lining of the rectum but affects four or more nearby lymph nodes, but has not spread other parts of the bowel.

• Surgery to remove the tumour.
• Radiotherapy and/or chemotherapy is also often used before or after surgery.

Stage 4

The cancer may or may not have grown through the wall of the rectum, and may or may not have spread to nearby lymph nodes, but has spread to other parts of the body. The liver and lung are two common destinations for metastasised rectal cancer.

The mainstay of treatment is chemotherapy, but sometimes surgery to remove the tumour or radiotherapy to shrink the tumour may also be recommended.

When surgery is used, it is often to relieve or prevent blockage of the rectum or to prevent rectal bleeding. It is not considered a curative procedure. Surgery of this type can also help a patient with stage 4 rectal cancer to live longer.

Liver metastases can also be removed surgically if there are only one or two tumours. Other options for treating metastases include freezing the tumours (cryosurgery); destroying them using a microwave procedure; photocoagulation, which involves vaporising the tumour with a laser; or other non-surgical methods.