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NCCN Guidelines for Patients



Rectal Cancer, Version 1.2017


Overview of cancer treatments


Transanal endoscopic microsurgery

This surgery removes tumors in the middle or upper

rectum. It’s not like a transanal excision in a few

ways. General anesthesia with a nerve block will be

used. On the surgery table, you will be positioned

with a bean bag and taped down. Tape is used since

you will be turned during surgery. Based on the

tumor location, you may lie on your stomach, back,

or side.

A scope will be inserted into your rectum. The scope

has a light, camera, air ports, and an open channel.

Air will be pumped into your rectum to expand it.

The light and camera allow your surgeon to see the

tumor. The tumor will be removed with small tools

inserted through the open channel.

Transabdominal surgery

A transabdominal surgery removes tissue through

cuts made through your skin. This surgery requires

general anesthesia. Most people lie on their back

during the entire surgery. Some people are turned

over to lie face down.

There are two methods for accessing the insides of

your pelvis. An open surgery makes one cut into your

abdominal wall and maybe one cut between your

legs. Minimally invasive surgery makes a few smaller

cuts in your abdominal wall. There may be one cut

made between your legs. Thin tools are inserted into

the cuts that allow your surgeon to see and remove


NCCN experts advise a minimally invasive surgery

in certain conditions. Your surgeon should have

experience with this method. Your abdomen should

be thoroughly examined. Also, this surgery should

only be done on tumors that aren’t likely to return

after treatment.

There is more than one type of transabdominal

surgery. They differ in part by how much tissue is

removed. For all surgeries, at least 12 lymph nodes

should be removed. Some types of transabdominal

surgery are described next.

Total mesorectal excision







xcision) is a standard

surgery for rectal cancer. It removes your rectum with

nearby fat, lymph nodes, and the membrane in one

piece. Nerves are spared.

For me, the hardest time during

my treatments was waking

up in my hospital room after

having gone through the surgery

to remove the tumor from my

rectum, and discovering I had

a colostomy bag attached to my

body. To learn how to live with a

colostomy, while at the same time

going through cancer treatments,

was overwhelming to say the least.

I am proof, though, that you can

adjust to anything. We are all so

much stronger than we think we



Survivor, Stage III