Colorectal cancer
General Information(Colon Cancer)
Stages of Colon Cancer
Treatment(Colon Cancer)
General Information(Rectal Cancer)
Stages of Rectal Cancer
Treatment(Rectal Cancer)
Colorectal cancer is cancer that starts in the colon or
rectum. The colon and the rectum are parts of the large intestine,
which is the lower part of the body's digestive system. During
digestion, food moves through the stomach and small intestine into the
colon. The colon absorbs water and nutrients from the food and stores
waste matter (stool). Stool moves from the colon into the rectum before
it leaves the body.
Most colorectal cancers are adenocarcinomas (cancers that
begin in cells that make and release mucus and other fluids).
Colorectal cancer often begins as a growth called a polyp, which may
form on the inner wall of the colon or rectum. Some polyps become
cancer over time. Finding and removing polyps can prevent colorectal
cancer.
Colorectal cancer is the third most common type of cancer in
men and women in the United States. Deaths from colorectal cancer have
decreased with the use of colonoscopies and fecal occult blood tests,
which check for blood in the stool.
Colon Cancer Treatment
General Information About Colon Cancer
Key Points
- Colon cancer is a disease in which malignant (cancer) cells
form in the tissues of the colon.
- Health history can affect the risk of developing colon
cancer.
- Signs of colon cancer include blood in the stool or a
change in bowel habits.
- Tests that examine the colon and rectum are used to detect
(find) and diagnose colon cancer.
- Certain factors affect prognosis (chance of recovery) and
treatment options.
Colon
cancer is a disease in which malignant (cancer) cells form in the
tissues of the colon.
The colon is part of the body's digestive system. The
digestive system removes and processes nutrients
(vitamins, minerals, carbohydrates, fats, proteins, and water) from
foods and helps pass waste material out of the body. The digestive
system is made up of the esophagus,
stomach, and the small and large intestines. The colon
(large bowel) is
the first part of the large intestine and is about 5 feet long.
Together, the rectum
and anal canal make
up the last part of the large intestine and are about 6-8 inches long.
The anal canal ends at the anus
(the opening of the large intestine to the outside of the body).
Anatomy of the lower
digestive system, showing the colon and other organs.
Gastrointestinal stromal tumors
can occur in the colon. See the PDQ
summary on Gastrointestinal Stromal Tumors Treatment for more
information.
See the PDQ summary
about Unusual Cancers of Childhood Treatment for information about colorectal cancer in
children.
Health
history can affect the risk of developing colon cancer.
Anything that increases
your chance of getting a disease is called a risk factor. Having a risk
factor does not mean that you will get cancer;
not having risk factors doesn't mean that you will not get cancer. Talk
with your doctor if you think you may be at risk. Risk factors include
the following:
Signs
of colon cancer include blood in the stool or a change in bowel habits.
These and other signs and symptoms may be caused by
colon cancer or by other conditions. Check with your doctor if you have
any of the following:
- A change in bowel habits.
- Blood
(either bright red or very dark) in the stool.
- Diarrhea,
constipation, or
feeling that the bowel does not empty all the way.
- Stools that are narrower than usual.
- Frequent gas pains, bloating,
fullness, or cramps.
- Weight loss for no known reason.
- Feeling very tired.
- Vomiting.
Tests
that examine the colon and rectum are used to detect (find) and
diagnose colon cancer.
The following tests and
procedures may be used:
- Physical
exam and history
: An exam of the body to check general signs of
health, including checking for signs of disease, such as lumps or
anything else that seems unusual. A history of the patient's health
habits and past illnesses and treatments will also be taken.
- Digital
rectal exam : An exam of the rectum. The
doctor or nurse
inserts a lubricated,
gloved finger into the rectum to feel for lumps or anything else that
seems unusual.
- Fecal
occult blood test : A test to check stool
(solid waste) for blood that can only be seen with a microscope. Small samples of
stool are placed on special cards and returned to the doctor or
laboratory for testing.
Fecal Occult Blood Test
(FOBT) kit to check for blood in stool.
- Barium
enema : A series of x-rays of the lower gastrointestinal tract. A
liquid that contains barium (a silver-white metallic
compound) is put
into the rectum. The barium coats the lower gastrointestinal tract and
x-rays are taken. This procedure is also called a lower GI series.
Barium enema procedure.
The patient lies on an x-ray table. Barium liquid is put into the
rectum and flows through the colon. X-rays are taken to look for
abnormal areas.
- Sigmoidoscopy
: A procedure to look inside the rectum and sigmoid (lower) colon for
polyps (small areas of bulging tissue), other abnormal areas, or cancer. A
sigmoidoscope is
inserted through the rectum into the sigmoid colon. A sigmoidoscope is
a thin, tube-like instrument with a light and a lens for viewing. It may
also have a tool to remove polyps or tissue samples, which are checked
under a microscope for signs of cancer.
Sigmoidoscopy. A thin,
lighted tube is inserted through the anus and rectum and into the lower
part of the colon to look for abnormal areas.
- Colonoscopy
: A procedure to look inside the rectum and colon
for polyps, abnormal areas, or cancer. A colonoscope
is inserted through the rectum into the colon. A colonoscope is a thin,
tube-like instrument with a light and a lens for viewing. It may also
have a tool to remove polyps or tissue samples, which are checked under
a microscope for signs of cancer.
Colonoscopy. A thin,
lighted tube is inserted through the anus and rectum and into the colon
to look for abnormal areas.
- Virtual
colonoscopy : A procedure that uses a
series of x-rays called computed
tomography to make a series of pictures of the colon. A
computer puts the pictures together to create detailed images that may
show polyps and anything else that seems unusual on the inside surface
of the colon. This test is also called colonography or CT colonography.
- Biopsy
: The removal of cells
or tissues so they can be viewed under a microscope by a pathologist to check for
signs of cancer.
Certain
factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment
options depend on the following:
- The stage
of the cancer (whether the cancer is in the inner lining of the colon
only or has spread through the colon wall, or has spread to lymph nodes or other places
in the body).
- Whether the cancer has blocked or made a hole in the colon.
- Whether there are any cancer cells left after surgery.
- Whether the cancer has recurred.
- The patient's general health.
The prognosis also
depends on the blood levels of carcinoembryonic
antigen (CEA) before treatment begins. CEA is a substance
in the blood that may be increased when cancer is present.
Stages of Colon Cancer
Key Points
- After colon cancer has been diagnosed, tests are done to
find out if cancer cells have spread within the colon or to other parts
of the body.
- There are three ways that cancer spreads in the body.
- Cancer may spread from where it began to other parts of the
body.
- The following stages are used for colon cancer:
- Stage 0 (Carcinoma in Situ)
- Stage I
- Stage II
- Stage III
- Stage IV
After
colon cancer has been diagnosed, tests are done to find out if cancer
cells have spread within the colon or to other parts of the body.
The process used to find
out if cancer has
spread within the colon
or to other parts of the body is called staging.
The information gathered from the staging process determines the stage of the disease. It is important to
know the stage in order to plan treatment.
The following tests and
procedures may be used in the staging process:
- CT
scan (CAT scan): A procedure that makes a
series of detailed pictures of areas inside the body, such as the abdomen or chest, taken from
different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help
the organs or tissues show up more
clearly. This procedure is also called computed tomography,
computerized tomography, or computerized axial tomography.
- MRI
(magnetic resonance imaging): A procedure that uses a
magnet, radio waves,
and a computer to make a series of detailed pictures of areas inside
the colon. A substance called gadolinium
is injected into the patient through a vein. The gadolinium collects
around the cancer cells
so they show up brighter in the picture. This procedure is also called
nuclear magnetic resonance imaging (NMRI).
- PET
scan (positron emission tomography scan): A
procedure to find malignant
tumor cells in
the body. A small amount of radioactive
glucose (sugar)
is injected into a vein. The PET scanner
rotates around the body and makes a picture of where glucose is being
used in the body. Malignant tumor cells show up brighter in the picture
because they are more active and take up more glucose than normal cells
do.
- Chest
x-ray : An x-ray of the organs and bones
inside the chest. An x-ray is a type of energy beam that can go through
the body and onto film, making a picture of areas inside the body.
- Surgery
: A procedure to remove the tumor and see how far it
has spread through the colon.
- Lymph
node biopsy
: The removal of all or part of a lymph node. A pathologist views the tissue
under a microscope
to look for cancer cells.
- Complete
blood count (CBC): A procedure in which a
sample of blood is
drawn and checked for the following:
- The number of red
blood cells, white
blood cells, and platelets.
- The amount of hemoglobin
(the protein that
carries oxygen) in
the red blood cells.
- The portion of the blood sample made up of red blood
cells.
- Carcinoembryonic
antigen (CEA) assay : A test that measures
the level of CEA in the blood. CEA is released into the bloodstream
from both cancer cells and normal cells. When found in higher than
normal amounts, it can be a sign
of colon cancer or
other conditions.
There
are three ways that cancer spreads in the body.
Cancer can spread
through tissue, the
lymph system, and
the blood:
- Tissue. The cancer spreads from where it began by growing
into nearby areas.
- Lymph system. The cancer spreads from where it began by
getting into the lymph system. The cancer travels through the lymph vessels to other parts
of the body.
- Blood. The cancer spreads from where it began by getting
into the blood. The cancer travels through the blood vessels to other parts
of the body.
Cancer
may spread from where it began to other parts of the body.
When cancer spreads
to another part of the body, it is called metastasis.
Cancer cells break
away from where they began (the primary
tumor) and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system,
travels through the lymph vessels, and forms a tumor (metastatic tumor) in another
part of the body.
- Blood. The cancer gets into the blood, travels through the
blood vessels, and forms a tumor (metastatic tumor) in another part of
the body.
The metastatic tumor is
the same type of cancer as the primary tumor. For example, if colon
cancer spreads to the lung,
the cancer cells in the lung are actually colon cancer cells. The
disease is metastatic colon cancer, not lung
cancer.
The
following stages are used for colon cancer:
Stage
0 (Carcinoma in Situ)
Stage 0 (colon carcinoma in
situ). Abnormal cells are shown in the mucosa of the colon wall.
In stage 0, abnormal cells are found in the mucosa (innermost layer) of
the colon wall.
These abnormal cells may become cancer
and spread. Stage 0 is also called carcinoma
in situ.
Stage
I
Stage I colon cancer.
Cancer has spread from the mucosa of the colon wall to the muscle layer.
In stage I, cancer has formed in the mucosa (innermost layer) of
the colon wall and
has spread to the submucosa
(layer of tissue
under the mucosa). Cancer may have spread to the muscle layer of the
colon wall.
Stage
II
Stage II colon cancer. In
stage IIA, cancer has spread through the muscle layer of the colon wall
to the serosa. In stage IIB, cancer has spread through the serosa but
has not spread to nearby organs. In stage IIC, cancer has spread
through the serosa to nearby organs.
Stage II colon cancer is
divided into stage IIA, stage IIB, and stage IIC.
- Stage IIA: Cancer
has spread through the muscle layer of the colon
wall to the serosa
(outermost layer) of the colon wall.
- Stage IIB: Cancer has spread through the serosa (outermost layer) of
the colon wall but
has not spread to nearby organs.
- Stage IIC: Cancer has spread through the serosa (outermost layer) of
the colon wall to
nearby organs.
Stage
III
Stage III colon cancer is
divided into stage IIIA, stage IIIB, and stage IIIC.
Stage IIIA colon cancer.
Cancer has spread through the mucosa of the colon wall to the submucosa
and may have spread to the muscle layer, and has spread to one to three
nearby lymph nodes or tissues near the lymph nodes. OR, cancer has
spread through the mucosa to the submucosa and four to six nearby lymph
nodes.
In stage IIIA:
- Cancer
has spread through the mucosa
(innermost layer) of the colon
wall to the submucosa
(layer of tissue
under the mucosa) and may have spread to the muscle layer of the colon
wall. Cancer has spread to at least one but not more than 3 nearby lymph nodes or cancer cells have formed in tissues
near the lymph nodes; or
- Cancer has spread through the mucosa (innermost layer) of
the colon wall to the submucosa (layer of tissue under the mucosa).
Cancer has spread to at least 4 but not more than 6 nearby lymph nodes.
Stage IIIB colon cancer.
Cancer has spread through the muscle layer of the colon wall to the
serosa or has spread through the serosa but not to nearby organs;
cancer has spread to one to three nearby lymph nodes or to tissues near
the lymph nodes. OR, cancer has spread to the muscle layer or to the
serosa, and to four to six nearby lymph nodes. OR, cancer has spread
through the mucosa to the submucosa and may have spread to the muscle
layer; cancer has spread to seven or more nearby lymph nodes.
In stage IIIB:
- Cancer has spread through the muscle layer of the colon wall to the serosa (outermost layer) of
the colon wall or has spread through the serosa but not to nearby organs. Cancer has spread to
at least one but not more than 3 nearby lymph
nodes or cancer cells
have formed in tissues
near the lymph nodes; or
- Cancer has spread to the muscle layer of the colon wall or
to the serosa (outermost layer) of the colon wall. Cancer has spread to
at least 4 but not more than 6 nearby lymph nodes; or
- Cancer has spread through the mucosa
(innermost layer) of the colon wall to the submucosa
(layer of tissue under the mucosa) and may have spread to the muscle
layer of the colon wall. Cancer has spread to 7 or more nearby lymph
nodes.
Stage IIIC colon cancer.
Cancer has spread through the serosa of the colon wall but not to
nearby organs; cancer has spread to four to six nearby lymph nodes. OR,
cancer has spread through the muscle layer to the serosa or has spread
through the serosa but not to nearby organs; cancer has spread to seven
or more nearby lymph nodes. OR, cancer has spread through the serosa to
nearby organs and to one or more nearby lymph nodes or to tissues near
the lymph nodes.
In stage IIIC:
- Cancer has spread through the serosa
(outermost layer) of the colon
wall but has not spread to nearby organs.
Cancer has spread to at least 4 but not more than 6 nearby lymph nodes; or
- Cancer has spread through the muscle layer of the colon
wall to the serosa (outermost layer) of the colon wall or has spread
through the serosa but has not spread to nearby organs. Cancer has
spread to 7 or more nearby lymph nodes; or
- Cancer has spread through the serosa (outermost layer) of
the colon wall and has spread to nearby organs. Cancer has spread to
one or more nearby lymph nodes or cancer cells
have formed in tissues
near the lymph nodes.
Stage
IV
Stage IV colon cancer. The
cancer has spread through the blood and lymph nodes to other parts of
the body, such as the lung, liver, abdominal wall, or ovary.
Stage IV colon cancer is
divided into stage IVA and stage IVB.
- Stage IVA: Cancer may have spread through the colon wall and may have
spread to nearby organs
or lymph nodes.
Cancer has spread to one organ that is not near the colon, such as the liver, lung, or ovary, or to a distant lymph
node.
- Stage IVB: Cancer may have spread through the colon wall and may have
spread to nearby organs
or lymph nodes.
Cancer has spread to more than one organ that is not near the colon or
into the lining of the abdominal
wall.
Recurrent Colon Cancer
Recurrent colon cancer is cancer that has recurred (come back) after
it has been treated. The cancer may come back in the colon or in other parts of
the body, such as the liver,
lungs, or both.
Treatment Option Overview
Key Points
- There are different types of treatment for patients with
colon cancer.
- Six types of standard treatment are used:
- Surgery
- Radiofrequency ablation
- Cryosurgery
- Chemotherapy
- Radiation therapy
- Targeted therapy
- New types of treatment are being tested in clinical trials.
- Patients may want to think about taking part in a clinical
trial.
- Patients can enter clinical trials before, during, or after
starting their cancer treatment.
- Follow-up tests may be needed.
There
are different types of treatment for patients with colon cancer.
Different types of
treatment are available for patients with colon
cancer. Some treatments are standard
(the currently used treatment), and some are being tested in clinical trials. A treatment
clinical trial is a research
study meant to help improve current treatments or obtain
information on new treatments for patients with cancer. When clinical trials
show that a new treatment is better than the standard treatment, the
new treatment may become the standard treatment. Patients may want to
think about taking part in a clinical trial. Some clinical trials are
open only to patients who have not started treatment.
Six
types of standard treatment are used:
Surgery
Surgery (removing the cancer
in an operation) is the most common treatment for all stages of colon cancer. A
doctor may remove the cancer using one of the following types of
surgery:
- Local excision: If the cancer is
found at a very early stage, the doctor may remove it without cutting
through the abdominal
wall. Instead, the doctor may put a tube with a cutting tool through
the rectum into the
colon and cut
the cancer out. This is called a local excision. If the cancer is found
in a polyp (a small
bulging area of tissue),
the operation is called a polypectomy.
- Resection
of the colon with anastomosis:
If the cancer is larger, the doctor will perform a partial colectomy (removing the
cancer and a small amount of healthy tissue around it). The doctor may
then perform an anastomosis (sewing the healthy parts of the colon
together). The doctor will also usually remove lymph nodes near the colon
and examine them under a microscope
to see whether they contain cancer.
Resection of the colon
with anastomosis. Part of the colon containing the cancer and nearby
healthy tissue is removed, and then the cut ends of the colon are
joined.
- Resection of the colon with colostomy:
If the doctor is not able to sew the 2 ends of the colon back together,
a stoma (an
opening) is made on the outside of the body for waste to pass through.
This procedure is called a colostomy. A bag is placed around the stoma
to collect the waste. Sometimes the colostomy is needed only until the
lower colon has healed, and then it can be reversed. If the doctor
needs to remove the entire lower colon, however, the colostomy may be
permanent.
Colon cancer surgery
with colostomy. Part of the colon containing the cancer and nearby
healthy tissue is removed, a stoma is created, and a colostomy bag is
attached to the stoma.
Even if the doctor
removes all the cancer that can be seen at the time of the operation,
some patients may be given chemotherapy
or radiation therapy
after surgery to kill any cancer cells that are left. Treatment given
after the surgery, to lower the risk that the cancer will come back, is
called adjuvant therapy.
Radiofrequency
ablation
Radiofrequency ablation is
the use of a special probe with tiny electrodes
that kill cancer cells.
Sometimes the probe is inserted directly through the skin and only local anesthesia is needed.
In other cases, the probe is inserted through an incision in the abdomen. This is done in the
hospital with general anesthesia.
Cryosurgery
Cryosurgery is a treatment
that uses an instrument to freeze and destroy abnormal tissue. This type
of treatment is also called cryotherapy.
Chemotherapy
Chemotherapy is a cancer
treatment that uses drugs
to stop the growth of cancer cells, either by killing the cells or by
stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs
enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When
chemotherapy is placed directly into the cerebrospinal
fluid, an organ,
or a body cavity
such as the abdomen, the drugs mainly affect cancer cells in those
areas (regional chemotherapy).
Chemoembolization of the hepatic artery may be used
to treat cancer that has spread to the liver.
This involves blocking the hepatic artery (the main artery that supplies blood to the liver) and
injecting anticancer drugs between the blockage and the liver. The
liver's arteries then deliver the drugs throughout the liver. Only a
small amount of the drug reaches other parts of the body. The blockage
may be temporary or permanent, depending on what is used to block the
artery. The liver continues to receive some blood from the hepatic portal vein, which
carries blood from the stomach
and intestine.
The way the chemotherapy
is given depends on the type and stage of the cancer being treated.
See Drugs Approved for
Colon and Rectal Cancer for more information.
Radiation
therapy
Radiation therapy is a
cancer treatment that uses high-energy x-rays
or other types of radiation
to kill cancer cells or keep them from growing. There are two types of
radiation therapy:
- External radiation
therapy uses a machine outside the body to send radiation
toward the cancer.
- Internal radiation
therapy uses a radioactive
substance sealed in needles, seeds,
wires, or catheters
that are placed directly into or near the cancer.
The way the radiation
therapy is given depends on the type and stage of the cancer being
treated. External radiation therapy is used as palliative therapy to
relieve symptoms
and improve quality of life.
Targeted
therapy
Targeted therapy is a type
of treatment that uses drugs or other substances to identify and attack
specific cancer cells without harming normal cells.
Types of targeted
therapies used in the treatment of colon cancer include the following:
- Monoclonal
antibodies: Monoclonal antibodies are made in the
laboratory from a single type of immune
system cell. These antibodies
can identify substances on cancer cells or normal substances that may
help cancer cells grow. The antibodies attach to the substances and
kill the cancer cells, block their growth, or keep them from spreading.
Monoclonal antibodies are given by infusion.
They may be used alone or to carry drugs, toxins,
or radioactive material directly to cancer cells.
- Angiogenesis
inhibitors: Angiogenesis inhibitors stop the growth of new
blood vessels
that tumors need to
grow.
See Drugs Approved for
Colon and Rectal Cancer for more information.
New
types of treatment are being tested in clinical trials.
Information about
clinical trials is available from the NCI website.
Patients
may want to think about taking part in a clinical trial.
For some patients,
taking part in a clinical trial
may be the best treatment choice. Clinical trials are part of the
cancer research process. Clinical trials are done to find out if new
cancer treatments are safe and effective or better than the standard treatment.
Many of today's
standard treatments for cancer are based on earlier clinical trials.
Patients who take part in a clinical trial may receive the standard
treatment or be among the first to receive a new treatment.
Patients who take
part in clinical trials also help improve the way cancer will be
treated in the future. Even when clinical trials do not lead to
effective new treatments, they often answer important questions and
help move research forward.
Patients
can enter clinical trials before, during, or after starting their
cancer treatment.
Some clinical trials
only include patients who have not yet received treatment. Other trials
test treatments for patients whose cancer has not gotten better. There
are also clinical trials that test new ways to stop cancer from recurring (coming back) or
reduce the side effects
of cancer treatment.
Clinical trials are
taking place in many parts of the country. See the Treatment Options
section that follows for links to current treatment clinical trials.
These have been retrieved from NCI's
listing of clinical trials.
Follow-up
tests may be needed.
Some of the tests
that were done to diagnose
the cancer or to find out the stage
of the cancer may be repeated. Some tests will be repeated in order to
see how well the treatment is working. Decisions about whether to
continue, change, or stop treatment may be based on the results of
these tests.
Some of the tests
will continue to be done from time to time after treatment has ended.
The results of these tests can show if your condition
has changed or if the cancer has recurred
(come back). These tests are sometimes called follow-up tests or check-ups.
Treatment Options for Colon Cancer
Stage 0 (Carcinoma in Situ)
Treatment of stage 0 (carcinoma in situ) may
include the following types of surgery:
- Local excision or simple polypectomy.
- Resection
and anastomosis.
This is done when the tumor
is too large to remove by local excision.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage 0 colon cancer. For more specific results, refine
the search by using other search features, such as the location of the
trial, the type of treatment, or the name of the drug. Talk with your
doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stage I Colon Cancer
Treatment of stage I colon cancer usually
includes the following:
- Resection
and anastomosis.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage I colon cancer. For more specific results, refine
the search by using other search features, such as the location of the
trial, the type of treatment, or the name of the drug. Talk with your
doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stage II Colon Cancer
Treatment of stage II colon cancer may
include the following:
- Resection
and anastomosis.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage II colon cancer. For more specific results, refine
the search by using other search features, such as the location of the
trial, the type of treatment, or the name of the drug. Talk with your
doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stage III Colon Cancer
Treatment of stage III colon cancer may
include the following:
- Resection
and anastomosis
which may be followed by chemotherapy.
- Clinical trials
of new chemotherapy regimens
after surgery.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage III colon cancer. For more specific results, refine
the search by using other search features, such as the location of the
trial, the type of treatment, or the name of the drug. Talk with your
doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stage IV and Recurrent Colon Cancer
Treatment of stage IV and recurrent colon cancer may include the
following:
- Local excision for tumors that have recurred.
- Resection
with or without anastomosis.
- Surgery
to remove parts of other organs,
such as the liver, lungs, and ovaries, where the cancer may have recurred or
spread. Treatment of cancer that has spread to the liver may also
include the following:
- Chemotherapy
given before surgery to shrink the tumor, after surgery, or both before
and after.
- Radiofrequency
ablation or cryosurgery,
for patients who cannot have surgery.
- Chemoembolization
of the hepatic artery.
- Radiation therapy
or chemotherapy may
be offered to some patients as palliative
therapy to relieve symptoms
and improve quality of life.
- Chemotherapy and/or targeted
therapy with a monoclonal
antibody or an angiogenesis
inhibitor.
- Clinical trials
of chemotherapy and/or targeted therapy.
Rectal Cancer Treatment
General Information About Rectal Cancer
Key Points
- Rectal cancer is a disease in which malignant (cancer)
cells form in the tissues of the rectum.
- Age and family history can affect the risk of rectal cancer.
- Signs of rectal cancer include a change in bowel habits or
blood in the stool.
- Tests that examine the rectum and colon are used to detect
(find) and diagnose rectal cancer.
- Certain factors affect prognosis (chance of recovery) and
treatment options.
Rectal
cancer is a disease in which malignant (cancer) cells form in the
tissues of the rectum.
The rectum is part of the body's
digestive system.
The digestive system takes in nutrients
(vitamins, minerals, carbohydrates, fats, proteins, and water) from
foods and helps pass waste material out of the body. The digestive
system is made up of the esophagus,
stomach, and the small and large intestines. The colon (large bowel) is the first part of
the large intestine and is about 5 feet long. Together, the rectum and anal canal make up the last
part of the large intestine and are 6-8 inches long. The anal canal
ends at the anus
(the opening of the large intestine to the outside of the body).
Anatomy of the lower
digestive system, showing the colon and other organs.
See the following PDQ summaries for more
information about rectal cancer:
- Unusual Cancers of Childhood Treatment (see Colorectal
Cancer section)
- Colorectal Cancer Prevention
- Colorectal Cancer Screening
- Gastrointestinal Stromal Tumors Treatment
- Genetics of Colorectal Cancer
Age
and family history can affect the risk of rectal cancer.
Anything that increases
your chance of getting a disease is called a risk factor. Having a risk
factor does not mean that you will get cancer;
not having risk factors doesn't mean that you will not get cancer. Talk
with your doctor if you think you may be at risk. The following are
possible risk factors for rectal cancer:
- Being aged 50 or older.
- Having certain hereditary
conditions, such
as familial adenomatous polyposis
(FAP) and hereditary
nonpolyposis colon cancer (HNPCC or Lynch syndrome).
- Having a personal
history of any of the following:
- Colorectal
cancer.
- Polyps
(small pieces of bulging tissue)
in the colon or rectum.
- Cancer of the ovary,
endometrium,
or breast.
- Having a parent, brother, sister, or child with a history
of colorectal cancer or polyps.
Signs
of rectal cancer include a change in bowel habits or blood in the stool.
These and other signs and symptoms may be caused by
rectal cancer or by other conditions. Check with your doctor if you
have any of the following:
- Blood
(either bright red or very dark) in the stool.
- A change in bowel habits.
- Diarrhea.
- Constipation.
- Feeling that the bowel does not empty completely.
- Stools that are narrower or have a different shape than
usual.
- General abdominal
discomfort (frequent gas pains, bloating,
fullness, or cramps).
- Change in appetite.
- Weight loss for no known reason.
- Feeling very tired.
Tests
that examine the rectum and colon are used to detect (find) and
diagnose rectal cancer.
Tests used to diagnose rectal cancer
include the following:
Certain
factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment
options depend on the following:
- The stage
of the cancer (whether it affects the inner lining of the rectum only,
involves the whole rectum, or has spread to lymph
nodes, nearby organs,
or other places in the body).
- Whether the tumor has spread into or through the bowel wall.
- Where the cancer is found in the rectum.
- Whether the bowel is blocked or has a hole in it.
- Whether all of the tumor can be removed by surgery.
- The patient's general health.
- Whether the cancer has just been diagnosed or has recurred (come back).
Stages of Rectal Cancer
Key Points
- After rectal cancer has been diagnosed, tests are done to
find out if cancer cells have spread within the rectum or to other
parts of the body.
- There are three ways that cancer spreads in the body.
- Cancer may spread from where it began to other parts of the
body.
- The following stages are used for rectal cancer:
- Stage 0 (Carcinoma in Situ)
- Stage I
- Stage II
- Stage III
- Stage IV
After rectal cancer has been diagnosed, tests are done to find out if
cancer cells have spread within the rectum or to other parts of the
body.
The process used to find
out whether cancer
has spread within the rectum
or to other parts of the body is called staging.
The information gathered from the staging process determines the stage of the disease. It is
important to know the stage in order to plan treatment.
The following tests and
procedures may be used in the staging process:
There
are three ways that cancer spreads in the body.
Cancer can spread
through tissue, the
lymph system, and
the blood:
- Tissue. The cancer spreads from where it began by growing
into nearby areas.
- Lymph system. The cancer spreads from where it began by
getting into the lymph system. The cancer travels through the lymph vessels to other parts
of the body.
- Blood. The cancer spreads from where it began by getting
into the blood. The cancer travels through the blood vessels to other parts
of the body.
Cancer
may spread from where it began to other parts of the body.
When cancer spreads
to another part of the body, it is called metastasis.
Cancer cells break
away from where they began (the primary
tumor) and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system,
travels through the lymph vessels, and forms a tumor (metastatic tumor) in another
part of the body.
- Blood. The cancer gets into the blood, travels through the
blood vessels, and forms a tumor (metastatic tumor) in another part of
the body.
The metastatic tumor is
the same type of cancer as the primary tumor. For example, if rectal
cancer spreads to the lung,
the cancer cells in the lung are actually rectal cancer cells. The
disease is metastatic rectal cancer, not lung
cancer.
The
following stages are used for rectal cancer:
Stage
0 (Carcinoma in Situ)
Stage 0 (rectal carcinoma
in situ). Abnormal cells are shown in the mucosa of the rectum wall.
In stage 0, abnormal cells are found in the mucosa (innermost layer) of
the rectum wall.
These abnormal cells may become cancer
and spread. Stage 0 is also called carcinoma
in situ.
Stage
I
Stage I rectal cancer.
Cancer has spread from the mucosa of the rectum wall to the muscle
layer.
In stage I, cancer has formed in the mucosa (innermost layer) of
the rectum wall and
has spread to the submucosa
(layer of tissue
under the mucosa). Cancer may have spread to the muscle layer of the
rectum wall.
Stage
II
Stage II rectal cancer. In
stage IIA, cancer has spread through the muscle layer of the rectum
wall to the serosa. In stage IIB, cancer has spread through the serosa
but has not spread to nearby organs. In stage IIC, cancer has spread
through the serosa to nearby organs.
Stage II rectal cancer is
divided into stage IIA, stage IIB, and stage IIC.
- Stage IIA: Cancer
has spread through the muscle layer of the rectum
wall to the serosa
(outermost layer) of the rectum wall.
- Stage IIB: Cancer has spread through the serosa (outermost layer) of
the rectum wall but
has not spread to nearby organs.
- Stage IIC: Cancer has spread through the serosa (outermost layer) of
the rectum wall to
nearby organs.
Stage
III
Stage III rectal cancer is
divided into stage IIIA, stage IIIB, and stage IIIC.
Stage IIIA rectal cancer.
Cancer has spread through the mucosa of the rectum wall to the
submucosa and may have spread to the muscle layer, and has spread to
one to three nearby lymph nodes or tissues near the lymph nodes. OR,
cancer has spread through the mucosa to the submucosa and four to six
nearby lymph nodes.
In stage IIIA:
- Cancer
has spread through the mucosa
(innermost layer) of the rectum
wall to the submucosa
(layer of tissue
under the mucosa) and may have spread to the muscle layer of the rectum
wall. Cancer has spread to at least one but not more than 3 nearby lymph nodes or cancer cells have formed in tissues
near the lymph nodes; or
- Cancer has spread through the mucosa (innermost layer) of
the rectum wall to the submucosa (layer of tissue under the mucosa).
Cancer has spread to at least 4 but not more than 6 nearby lymph nodes.
Stage IIIB rectal cancer.
Cancer has spread through the muscle layer of the rectum wall to the
serosa or has spread through the serosa but not to nearby organs;
cancer has spread to one to three nearby lymph nodes or to tissues near
the lymph nodes. OR, cancer has spread to the muscle layer or to the
serosa, and to four to six nearby lymph nodes. OR, cancer has spread
through the mucosa to the submucosa and may have spread to the muscle
layer; cancer has spread to seven or more nearby lymph nodes.
In stage IIIB:
- Cancer has spread through the muscle layer of the rectum wall to the serosa (outermost layer) of
the rectum wall or has spread through the serosa but not to nearby organs. Cancer has spread to
at least one but not more than 3 nearby lymph
nodes or cancer cells
have formed in tissues
near the lymph nodes; or
- Cancer has spread to the muscle layer of the rectum wall or
to the serosa (outermost layer) of the rectum wall. Cancer has spread
to at least 4 but not more than 6 nearby lymph nodes; or
- Cancer has spread through the mucosa
(innermost layer) of the rectum wall to the submucosa
(layer of tissue under the mucosa) and may have spread to the muscle
layer of the rectum wall. Cancer has spread to 7 or more nearby lymph
nodes.
Stage IIIC rectal cancer.
Cancer has spread through the serosa of the rectum wall but not to
nearby organs; cancer has spread to four to six nearby lymph nodes. OR,
cancer has spread through the muscle layer to the serosa or has spread
through the serosa but not to nearby organs; cancer has spread to seven
or more nearby lymph nodes. OR, cancer has spread through the serosa to
nearby organs and to one or more nearby lymph nodes or to tissues near
the lymph nodes.
In stage IIIC:
- Cancer has spread through the serosa
(outermost layer) of the rectum
wall but has not spread to nearby organs.
Cancer has spread to at least 4 but not more than 6 nearby lymph nodes; or
- Cancer has spread through the muscle layer of the rectum
wall to the serosa (outermost layer) of the rectum wall or has spread
through the serosa but has not spread to nearby organs. Cancer has
spread to 7 or more nearby lymph nodes; or
- Cancer has spread through the serosa (outermost layer) of
the rectum wall and has spread to nearby organs. Cancer has spread to
one or more nearby lymph nodes or cancer cells
have formed in tissues
near the lymph nodes.
Stage
IV
Stage IV rectal cancer is
divided into stage IVA and stage IVB.
Stage IV rectal cancer. The
cancer has spread through the blood and lymph nodes to other parts of
the body, such as the lung, liver, abdominal wall, or ovary.
- Stage IVA: Cancer
may have spread through the rectum
wall and may have spread to nearby organs
or lymph nodes.
Cancer has spread to one organ that is not near the rectum, such as the
liver, lung, or ovary, or to a distant lymph
node.
- Stage IVB: Cancer may have spread through the rectum wall and may have
spread to nearby organs
or lymph nodes.
Cancer has spread to more than one organ that is not near the rectum or
into the lining of the abdominal
wall.
Recurrent Rectal Cancer
Recurrent rectal cancer is cancer that has recurred (come back) after
it has been treated. The cancer may come back in the rectum or in other parts of
the body, such as the colon,
pelvis, liver, or lungs.
Treatment Option Overview
Key Points
- There are different types of treatment for patients with
rectal cancer.
- Four types of standard treatment are used:
- Surgery
- Radiation therapy
- Chemotherapy
- Targeted therapy
- Other types of treatment are being tested in clinical
trials.
- Patients may want to think about taking part in a clinical
trial.
- Patients can enter clinical trials before, during, or after
starting their cancer treatment.
- Follow-up tests may be needed.
There
are different types of treatment for patients with rectal cancer.
Different types of
treatment are available for patients with rectal
cancer. Some treatments are standard
(the currently used treatment), and some are being tested in clinical trials. A treatment
clinical trial is a research
study meant to help improve current treatments or obtain
information on new treatments for patients with cancer. When clinical trials
show that a new treatment is better than the standard treatment, the
new treatment may become the standard treatment. Patients may want to
think about taking part in a clinical trial. Some clinical trials are
open only to patients who have not started treatment.
Four
types of standard treatment are used:
Surgery
Surgery is the most common
treatment for all stages
of rectal cancer. The cancer is removed using one of the following
types of surgery:
- Polypectomy:
If the cancer is found in a polyp
(a small piece of bulging tissue),
the polyp is often removed during a colonoscopy.
- Local excision: If the cancer is
found on the inside surface of the rectum
and has not spread into the wall of the rectum, the cancer and a small
amount of surrounding healthy tissue is removed.
- Resection:
If the cancer has spread into the wall of the rectum, the section of
the rectum with cancer and nearby healthy tissue is removed. Sometimes
the tissue between the rectum and the abdominal
wall is also removed. The lymph
nodes near the rectum are removed and checked under a microscope for signs of cancer.
- Radiofrequency
ablation: The use of a special probe with tiny electrodes that kill cancer cells. Sometimes the probe
is inserted directly through the skin and only local anesthesia is needed.
In other cases, the probe is inserted through an incision in the abdomen. This is done in the
hospital with general anesthesia.
- Cryosurgery:
A treatment that uses an instrument to freeze and destroy abnormal tissue. This type
of treatment is also called cryotherapy.
- Pelvic exenteration:
If the cancer has spread to other organs
near the rectum, the lower colon,
rectum, and bladder
are removed. In women, the cervix,
vagina, ovaries, and nearby lymph
nodes may be removed. In men, the prostate
may be removed. Artificial openings (stoma)
are made for urine
and stool to flow
from the body to a collection bag.
After the cancer is
removed, the surgeon
will either:
Radiation therapy and/or chemotherapy may be given
before surgery to shrink the tumor,
make it easier to remove the cancer, and help with bowel control after surgery.
Treatment given before surgery is called neoadjuvant
therapy. Even if all the cancer that can be seen at the
time of the operation is removed, some patients may be given radiation
therapy and/or chemotherapy after surgery to kill any cancer cells that
are left. Treatment given after the surgery, to lower the risk that the
cancer will come back, is called adjuvant
therapy.
Radiation
therapy
Radiation therapy is a
cancer treatment that uses high-energy x-rays
or other types of radiation
to kill cancer cells or keep them from growing. There are two types of
radiation therapy:
- External radiation
therapy uses a machine outside the body to send radiation
toward the cancer.
- Internal radiation
therapy uses a radioactive
substance sealed in needles, seeds,
wires, or catheters
that are placed directly into or near the cancer.
The way the radiation
therapy is given depends on the type and stage of the cancer being
treated. External radiation therapy is used to treat rectal cancer.
Short-course
preoperative radiation therapy is used in some types of rectal cancer.
This treatment uses fewer and lower doses
of radiation than standard treatment, followed by surgery several days
after the last dose.
Chemotherapy
Chemotherapy is a cancer
treatment that uses drugs
to stop the growth of cancer cells, either by killing the cells or by
stopping the cells from dividing. When chemotherapy is taken by mouth
or injected into a vein or muscle, the drugs
enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When
chemotherapy is placed directly in the cerebrospinal
fluid, an organ, or a body cavity
such as the abdomen,
the drugs mainly affect cancer cells in those areas (regional chemotherapy).
Chemoembolization of the hepatic artery is a type of
regional chemotherapy that may be used to treat cancer that has spread
to the liver. This
is done by blocking the hepatic artery (the main artery that supplies blood to the liver) and
injecting anticancer drugs between the blockage and the liver. The
liver's arteries then carry the drugs into the liver. Only a small
amount of the drug reaches other parts of the body. The blockage may be
temporary or permanent, depending on what is used to block the artery.
The liver continues to receive some blood from the hepatic portal vein, which
carries blood from the stomach
and intestine.
The way the chemotherapy
is given depends on the type and stage of the cancer being treated.
See Drugs Approved for
Rectal Cancer for more information.
Targeted
therapy
Targeted therapy is a type
of treatment that uses drugs or other substances to identify and attack
specific cancer cells without harming normal cells. Monoclonal antibody therapy is a type of
targeted therapy being used for the treatment of rectal cancer.
Monoclonal antibody
therapy uses antibodies
made in the laboratory from a single type of immune system cell. These
antibodies can identify substances on cancer cells or normal substances
that may help cancer cells grow. The antibodies attach to the
substances and kill the cancer cells, block their growth, or keep them
from spreading. Monoclonal antibodies are given by infusion. They may be used
alone or to carry drugs, toxins,
or radioactive material directly to cancer cells.
Bevacizumab is a monoclonal
antibody that binds to a protein
called vascular endothelial
growth factor (VEGF). This may prevent the growth of new blood vessels that tumors
need to grow. Cetuximab
and panitumumab are
types of monoclonal antibodies that bind to a protein called epidermal growth factor receptor
(EGFR) on the surface of some types of cancer cells. This may stop
cancer cells from growing and dividing.
See Drugs Approved for
Rectal Cancer for more information.
Other
types of treatment are being tested in clinical trials.
Information about
clinical trials is available from the NCI website.
Patients
may want to think about taking part in a clinical trial.
For some patients,
taking part in a clinical trial
may be the best treatment choice. Clinical trials are part of the
cancer research process. Clinical trials are done to find out if new
cancer treatments are safe and effective or better than the standard treatment.
Many of today's
standard treatments for cancer are based on earlier clinical trials.
Patients who take part in a clinical trial may receive the standard
treatment or be among the first to receive a new treatment.
Patients who take
part in clinical trials also help improve the way cancer will be
treated in the future. Even when clinical trials do not lead to
effective new treatments, they often answer important questions and
help move research forward.
Patients
can enter clinical trials before, during, or after starting their
cancer treatment.
Some clinical trials
only include patients who have not yet received treatment. Other trials
test treatments for patients whose cancer has not gotten better. There
are also clinical trials that test new ways to stop cancer from recurring (coming back) or
reduce the side effects
of cancer treatment.
Clinical trials are
taking place in many parts of the country. See the Treatment Options
section that follows for links to current treatment clinical trials.
These have been retrieved from NCI's
listing of clinical trials.
Follow-up
tests may be needed.
Some of the tests
that were done to diagnose
the cancer or to find out the stage
of the cancer may be repeated. Some tests will be repeated in order to
see how well the treatment is working. Decisions about whether to
continue, change, or stop treatment may be based on the results of
these tests.
Some of the tests
will continue to be done from time to time after treatment has ended.
The results of these tests can show if your condition
has changed or if the cancer has recurred
(come back). These tests are sometimes called follow-up tests or check-ups.
After treatment for
rectal cancer, a blood test
to measure amounts of carcinoembryonic
antigen (a substance in the blood
that may be increased when cancer is present) may be done to see if the
cancer has come back.
Treatment Options by Stage
Stage 0 (Carcinoma in Situ)
Treatment of stage 0 may include the
following:
- Simple polypectomy.
- Local excision.
- Resection
(when the tumor is
too large to remove by local excision).
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage 0 rectal cancer. For more specific results, refine
the search by using other search features, such as the location of the
trial, the type of treatment, or the name of the drug. Talk with your
doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stage I Rectal Cancer
Treatment of stage I rectal cancer may
include the following:
- Local excision.
- Resection.
- Resection
with radiation therapy
and chemotherapy
after surgery.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage I rectal cancer. For more specific results, refine
the search by using other search features, such as the location of the
trial, the type of treatment, or the name of the drug. Talk with your
doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stages II and III Rectal Cancer
Treatment of stage II and stage III rectal cancer may
include the following:
- Surgery.
- Chemotherapy
combined with radiation therapy,
followed by surgery.
- Short-course radiation therapy followed by surgery and
chemotherapy.
- Resection
followed by chemotherapy
combined with radiation therapy.
- A clinical trial
of a new treatment.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage II rectal cancer. For more specific results, refine
the search by using other search features, such as the location of the
trial, the type of treatment, or the name of the drug. Talk with your
doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stage IV and Recurrent Rectal Cancer
Treatment of stage IV and recurrent rectal cancer may include
the following:
- Surgery
with or without chemotherapy
or radiation therapy.
- Systemic
chemotherapy with or without targeted
therapy, such as bevacizumab,
cetuximab, or panitumumab.
- Chemotherapy to control the growth of the tumor.
- Radiation therapy, chemotherapy, or a combination of both,
as palliative therapy
to relieve symptoms
and improve the quality of life.
- Placement of a stent
to help keep the rectum
open if it is partly blocked by the tumor, as palliative therapy to
relieve symptoms and improve the quality of life.
- A clinical trial
of a new anticancer drug
Treatment of rectal
cancer that has spread to other organs
depends on where the cancer
has spread.
- Treatment for areas of cancer that have spread to the liver includes the following:
- Surgery to remove the tumor. Chemotherapy may be given
before surgery, to shrink the tumor.
- Cryosurgery
or radiofrequency ablation.
- Chemoembolization
and/or systemic chemotherapy.
- A clinical trial of chemoembolization combined with
radiation therapy to the tumors in the liver.
-NIH
