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NCCN Guidelines for Patients



Rectal Cancer, Version 1.2017

Part 4 is a treatment guide for rectal

cancer that hasn’t spread to distant sites.

The cancer is confined within the rectum,

has grown to nearby structures, or has

spread to nearby lymph nodes. Treatment

options are partly based on cancer stage.

Stage I

Stage I consists of either T1 or T2 tumors. T1 tumors

haven’t grown beyond the second layer of the rectal

wall. They are sometimes called “polyps with cancer”

because the cancer hasn’t grown far. T2 tumors

haven’t grown beyond the third layer. Stage I cancers

have not spread to lymph nodes or distant sites.

T1 tumors

Not all people with T1 tumors will need treatment.

Treatment is based on the polyp shape and if there’s

still cancer in your body. Shapes of polyps are shown


Figure 16

. Cancer is more likely present if these

high-risk features are present:



Fragmented specimen

is a tumor that was

removed in pieces.



Positive surgical margin

is cancer within the

normal-looking tissue around the tumor.



Unknown surgical margin

is unclear results of

the normal-looking tissue around the tumor.



Cancer grade 3 or 4

means cancer cells don’t

look much like normal cells.



Angiolymphatic invasion

is cancer spread

into the tumor’s lymph and blood vessels.



Tumor budding

is a group of 5 or fewer cancer

cells separate from the main tumor.


Nonmetastatic cancer

Stage I

Figure 16

Shapes of polyps

Treatment for stage I, T1 tumors

is partly based on the shape

of the polyp. A pedunculated

polyp has a stalk and round top.

A sessile polyp doesn’t have a


Illustration Copyright © 2017 Nucleus Medical Media, All rights reserved.