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NCCN Guidelines for Patients



Rectal Cancer, Version 1.2017

Cancer stage

A cancer stage is a rating by your doctors of the

extent of the cancer. It is used to plan which tests

may be needed and which treatments are best

for you. The AJCC (









ancer) staging system is used to stage rectal


In the AJCC system, the letters T, N, and M describe

the areas of cancer growth. The T score describes

the growth of the primary tumor. It also describes

the level of invasion into nearby tissue. The N score

describes nearby cancer growth within nearby lymph

nodes. The M score tells if the cancer has spread to

distant sites.

Five stages

The T, N, and M scores are combined to assign

the cancer a stage. There are five stages of rectal

cancer. They are numbered 0, I (1), II (2), III (3), or IV

(4). The stages are defined as:

Stage 0

These cancers are also called carcinoma in situ of

the rectum. The cancer has not grown beyond the

first layer of the rectal wall. It is a noninvasive cancer.

More treatment may not be needed if all the cancer

was removed during an endoscopic polypectomy.

Stage I

The cancer has grown into either the second or third

layer of the rectal wall. There is no cancer in nearby

or distant sites.

Stage II

The cancer has grown outside the rectal wall. It

may have attached or grown into other structures or

organs. There is no cancer in nearby or distant sites.

Stage III

The cancer has spread from the rectum to nearby

lymph nodes or there are tumor deposits. Nearby

nodes include the presacral, perirectal, and internal

iliac nodes. Tumor deposits are small secondary

tumors within the rectal wall.

Stage IV

The rectal cancer has spread to distant organs.

Common distant sites include your liver and lungs.

Clinical vs. pathologic stage

Rating of the cancer stage is often done twice. The

first rating is based on tests before treatment. It is

called the clinical stage. Tests include a physical

exam and imaging described in Part 2.

The pathologic stage is a rating done after surgery.

The pathologic stage may be the same or differ from

the clinical stage. Sometimes the full extent of the

cancer isn’t known until after surgery.




The rectum stores stool until it is expelled from

the body.



Layers of tissue make up the rectal wall.



Rectal cancer is a cancer of cells that line the

inner rectal wall and make mucus.



Cancer cells form a tumor since they don’t grow

and die as normal cells do.



Cancer cells sometimes spread from the rectum

to other sites through lymph or blood.



Most rectal cancers start in polyps.



The cancer stage is a rating by doctors of the

extent of cancer.


Rectal cancer basics

Cancer stage