Rectal Cancer

TREATMENT OPTIONS

Surgery

Surgery is the mainstay of rectal cancer treatment. Two different types of surgery are commonly used. For cancers that are located in the very lowest part of the rectum, the bottom two inches, the best option is usually an abdominal perineal resection. This operation means removal of the rectum and anus. The patient is left with a colostomy (bag on the abdominal wall) for evacuation of stool. The other operation, a low anterior resection, is done for tumors located higher in the rectum. This surgery removes the upper portion of the rectum while leaving the lower portion intact. The colon above the area affected by the disease is then brought down into the pelvis and attached (anastomosed) to the lower portion of the rectum. These patients can have normal bowel movements after the surgery.

Radiation Therapy

Radiation therapy is given after surgery for tumors that have extended through the wall of the rectum (stage B2 and B3) as well as for cancers that involve lymph nodes (stage C). The purpose of the radiation is to eradicate any subclinical micrometastases that may be in the pelvis after surgery. This means that on occasion a few cancer cells can remain in the pelvis after the surgery in spite of the surgeon’s best efforts. These micrometastases can be too small to detect by any current x-rays or blood tests. Postoperative radiation therapy can eliminate these cells and improve the cure rate.

Chemotherapy

Chemotherapy can also be given after the surgery as a way of decreasing the likelihood that the patient will develop recurrent disease in the pelvis and elsewhere in the body. Typical chemotherapy drugs include 5-FU and Leucovorin. These medicines are injected intravenously and are designed to eliminate micrometastatic cancer throughout the body.