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NCCN Guidelines for Patients



Rectal Cancer, Version 1.2017


Overview of cancer treatments





Clinical trials


Ablation destroys small tumors with little harm to

nearby tissue. It is done by either an interventional

radiologist or a surgeon. It isn’t used often for rectal


Doctors sometimes consider ablation for metastases.

Most often it is considered for rectal cancer that has

spread to the liver or lung. Ablation is only an option

if all the first sites of cancer can be treated with this

method, with or without surgery or radiation.

There is more than one way to “ablate” a tumor.

Cryoablation kills cancer cells by freezing them with

liquid nitrogen. Radiofrequency and microwave

ablation kills cancer cells with high-energy radio

waves. A probe placed into the tumor emits the

waves. The probe is guided into place with help from

an imaging test and is removed when treatment is



Embolization treats liver tumors with chemotherapy

or radioactive beads. It is done by an interventional

radiologist. He or she often teams up with a surgeon

or radiation oncologist.

A catheter will be inserted into an artery in your leg. It

will then be guided to the blood vessels that feed the

tumor. Once in place, the beads will be inserted into

the blood vessels.

The beads block blood flow to the tumor. Without

blood, the cancer cells “starve” and die. The

chemotherapy or radiation further damage the cancer

cells and cause the tumor to shrink.

This treatment is a type of arterially directed

catheter therapy. If radiation beads are used, it’s

called selective internal radiation therapy or Y-90.

Embolization is an option for some people with liver


Clinical trials

One of your treatment choices may be to join

a clinical trial. Joining a clinical trial is strongly

supported. NCCN believes that you will receive the

best management in a clinical trial.

New tests and treatments aren’t offered to the

public as soon as they’re made. They first need to

be studied. A clinical trial is a type of research that

studies a test or treatment in people.

Clinical trials study how safe and helpful tests and

treatments are for people. When found to be safe

and helpful, they may become tomorrow’s standard

treatment. Because of clinical trials, the tests and

treatments in this book are now widely used to

help people with rectal cancer. Future tests and

treatments that may have better results than today’s

treatments will depend on clinical trials.

New tests and treatments go through a series of

clinical trials. These trials aim to ensure they’re safe

and work. Without clinical trials, there is no way to

know if a test or treatment is safe or helpful. Clinical

trials have four phases. Some examples of the four

phases for treatment are:



Phase I trials

aim to find the safest and best

dose of a new drug. Another aim is to find the

best way to give the drug with the fewest side

effects. These trials often involve about 20




Phase II trials

assess if a drug works for

a specific type of cancer. These trials often

involve 20 to 100 people.