Stage 0 (Carcinoma in Situ)
Stage I Rectal Cancer
Stage II Rectal Cancer
Stage III Rectal Cancer
Stage IV Rectal Cancer

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Treatment of stage 0 may include the following:

• Local excision (surgery to remove the tumor without cutting into the abdomen) or simple polypectomy (surgery to remove a growth that protrudes from the rectal mucous membrane).
• Resection (surgery to remove the tumor). This is done when the tumor is too large to remove by local excision.
• Internal or external radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage 0 rectal cancer ¹.

Treatment of stage I rectal cancer may include the following:

• Surgery to remove the tumor with or without anastomosis (joining the cut ends of the rectum).
• Surgery to remove the tumor with or without radiation therapy and chemotherapy.
• Internal and/or external radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I rectal cancer ².

Treatment of stage II rectal cancer may include the following:

• Resection with or without anastomosis (joining the cut ends of the rectum and colon, or the colon and anus) followed by chemotherapy and radiation therapy.
• Partial or total pelvic exenteration (surgery to remove the organs and nearby structures of the pelvis), depending on where the cancer has spread. Surgery is followed by radiation therapy and chemotherapy.
• Radiation therapy with or without chemotherapy followed by surgery and chemotherapy.
• Radiation therapy during surgery followed by external-beam radiation therapy and chemotherapy.
• A clinical trial evaluating new treatment options.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II rectal cancer ³.

Treatment of stage III rectal cancer may include the following:

• Resection with or without anastomosis (joining the cut ends of the rectum and colon, or the colon and anus) followed by chemotherapy and radiation therapy.
• Partial or total pelvic exenteration (surgery to remove the organs and nearby structures of the pelvis), depending on where the cancer has spread. Surgery is followed by radiation therapy and chemotherapy.
• Radiation therapy with or without chemotherapy followed by surgery and chemotherapy.
• Radiation therapy during surgery followed by external-beam radiation therapy and chemotherapy.
• Chemotherapy and radiation therapy to relieve symptoms caused by advanced cancer.
• A clinical trial evaluating new treatment options.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III rectal cancer ⁴.

Treatment of stage IV rectal cancer may include the following:

• Resection /anastomosis (surgery to remove the cancer and join the cut ends of the rectum and colon, or colon and anus) to relieve symptoms caused by advanced cancer.
• Surgery to remove parts of other organs, such as the liver, lung, and ovaries, where the cancer may have spread.
• Chemotherapy and radiation therapy to relieve symptoms caused by advanced cancer.
• Chemotherapy following surgery.
• Clinical trials of chemotherapy and biological therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV rectal cancer ⁵.

Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed.

The opening of the rectum to the outside of the body.

Treatment to boost or restore the ability of the immune system to fight cancer, infections, and other diseases. Also used to lessen certain side effects that may be caused by some cancer treatments. Agents used in biological therapy include monoclonal antibodies, growth factors, and vaccines. These agents may also have a direct antitumor effect. Also called immunotherapy, biotherapy, biological response modifier therapy, and BRM therapy.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

Treatment with drugs that kill cancer cells.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called a clinical study.

The longest part of the large intestine, which is a tube-like organ connected to the small intestine at one end and the anus at the other. The colon removes water and some nutrients and electrolytes from partially digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus.

Removal by surgery.

A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.

A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external radiation therapy.

A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, radiation brachytherapy, and implant radiation therapy.

A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.

Treatment that affects cells in the tumor and the area close to it.

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

The moist, inner lining of some organs and body cavities (such as the nose, mouth, lungs, and stomach). Glands in the mucous membrane make mucus (a thick, slippery fluid). Also called mucosa.

A part of the body that performs a specific function. For example, the heart is an organ.

One of a pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus.

Surgery to remove the lower colon, rectum, and bladder, and create stomata (openings) through which urine and stool are passed out of the body. In women, the cervix, vagina, ovaries, and nearby lymph nodes are also removed.

The lower part of the abdomen, located between the hip bones.

Surgery to remove a polyp.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called radiotherapy and irradiation.

The last several inches of the large intestine closest to the anus.

A procedure that uses surgery to remove tissue or part or all of an organ.

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

Cancer has spread beyond the innermost lining of the colon and/or rectum to the second and third layers and involves the inside wall of the colon and/or rectum, but it has not spread to the outer wall or outside the colon and/or rectum. Also called Dukes A colorectal cancer.

Cancer has spread outside the colon and/or rectum to nearby tissue, but it has not gone into the lymph nodes. Also called Dukes B colorectal cancer.

Tumor cells have spread to organs and lymph nodes near the colon/rectum. Also called Dukes C colorectal cancer.

Cancer may have spread to nearby lymph nodes and has spread to other parts of the body, such as the liver or lungs. Also called Dukes D colorectal cancer.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancerous), or malignant (cancerous). Also called neoplasm.