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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.

Transanal 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.

Transanal excision

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

rectal exam.

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

tipped-over chair.

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