NCCN Guidelines for Patients
Rectal Cancer, Version 1.2017
In Part 3, the main treatment types
for rectal cancer are briefly described.
Knowing what a treatment is will help
you understand your treatment options
listed in Parts 4 through 6. There is more
than one treatment for rectal cancer. Not
every person will receive every treatment
described in this chapter.
Some rectal cancers grow beyond the polyp and into
the rectal wall. In many of these cases, surgery is a
key part of treatment. Your surgery may consist of
more than one type. This section describes the types
of surgery used for rectal cancer.
Before surgery, the cancer site may be marked with
a tattoo. An gastroenterologist may do the tattoo.
The tattoo allows your surgeon to find the cancer
site after the polyp has been removed. Marking isn’t
always needed. For example, marking isn’t done if
the cancer site can be easily found.
Your treatment team will tell you how to prepare for
and what to expect during surgery. You may need
to stop taking some medicines to reduce the risk of
severe bleeding. Eating less, changing to a liquid
diet, or using enemas or laxatives will empty your
rectum for surgery.
Some stage I cancers are treated with transanal
surgery. This type of surgery will not cut through your
skin. Instead, the tumor will be removed through your
Your surgeon will remove the entire rectal wall and
some fat underneath the tumor. Some normal-looking
tissue around the tumor will also be removed. This
is called the surgical margin. It is done to hopefully
remove all the cancer. Likewise, the tumor should be
removed in one piece to avoid leaving cancer cells
An advantage of this approach is that your anal
muscle will not be removed. A drawback is that you
will be watched very closely for the cancer returning.
More details on transanal surgeries are given next.
This surgery removes tumors near the anus. Pain
during surgery is often prevented by numbing the
treatment site. Otherwise, your entire pelvis may be
numbed. Another option is that you will be put in a
deep sleep-like state with general anesthesia. Before
surgery, the tumor location will be confirmed with a
Your position during surgery depends on the tumor
site. You may lie face down on a table that can be
raised in the middle like a drawbridge. When raised,
your buttocks will be higher than your head and feet.
Otherwise, you may lie on your back with your legs
raised in stirrups. This position is like sitting in a
A few tools will be used to assess the tumor. Your
buttocks will be taped apart. Your anus will be spread
open with a retractor. Another retractor will be used
to expand your rectum.
Surgery starts with marking the surgical margin. Your
surgeon will make a dotted line around the tumor
with a heated wire. Stitches may be used to bring
the tumor more into view. The tumor will be then
removed as described above. The surgical cut may
be closed with stitches. At the end, your surgeon will
perform a proctoscopic exam. This is to make sure
your rectum wasn’t closed or narrowed.
Overview of cancer treatments