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NCCN Guidelines for Patients



Rectal Cancer, Version 1.2017


Nonmetastatic cancer

Stage I

Guide 4

lists the options for initial treatment.

Options are partly based on T score. If you have

surgery, a pathologist will test the removed tissue.

Follow-up care

For T1 tumors not at high risk, you may start follow-

up care. A polypectomy likely removed all the cancer.

However, sessile polyps have worse outcomes than

other polyps. Thus, surgery is also an option for

sessile polyps.

Transanal excision

This surgery removes the tumor through the anus.

Lymph nodes aren’t removed. It should only be done

under conditions that’ll likely result in a cure. These

conditions include a small T1 tumor near your anus.

There should be no signs of cancer in your lymph

nodes. Ask your doctor if this surgery is an option for


Transabdominal resection

This surgery removes the tumor through cuts made

in your abdomen. Lymph nodes are removed, too. It

is an option for many T1 tumors and T2 tumors.


A pathologist will assess how far the cancer has

grown within the rectal wall. If removed, lymph nodes

will be tested for cancer. Test results may show that

you need more treatment.

Guide 5

lists options for additional treatment

after surgery. Options are grouped by type of initial

surgery. Not all cancers need more treatment.

Additional treatment often includes chemotherapy,

chemoradiation, or both. FOLFOX or CAPEOX is

preferred for chemotherapy. Otherwise, you may

receive 5-FU/LV or capecitabine. However, there’s no

proof that FOLFOX is better than 5-FU/LV for people

70 years of age and older.

For chemoradiation, capecitabine or infusional 5-FU

is preferred. The side effects of these regimens may

be too much for you. In this case, bolus 5-FU/LV may

be received.

Your doctor will assess treatment results. CT scans

of your chest, abdomen, and pelvis are advised.

Contrast should be used.

Guide 4. Initial treatment

T score

Polyp type

Risk level

What are the options?


Pedunculated polyp

Not high

• Start follow-up care

Sessile polyp

Not high

• Start follow-up testing

• Transanal excision

• Transabdominal resection



• Transanal excision

• Transabdominal resection




• Transabdominal resection