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45

NCCN Guidelines for Patients

®

:

Rectal Cancer, Version 1.2017

4

Nonmetastatic cancer

Stage I

After transanal excision

Treatment options after transanal excision are based

on cancer stage and features. Follow-up care may

be started for T1 tumors that have likely been fully

removed. More treatment is advised for high-risk T1

tumors and all T2 tumors.

T1 tumors may have one or more high-risk features.

High-risk features include cancer in the surgical

margins, lymph vessels, or lower-third of the rectum.

Another high-risk feature is cancer cells that don’t

look much like normal cells.

Option 1

Option 1 starts with a transabdominal resection. The

removed tissue will be tested. A pathologic stage will

be assigned. CT scans are advised.

If still stage I, you don’t need more treatment. The

cancer was likely fully removed. Thus, with option 1,

you may avoid chemotherapy and radiation.

The cancer may be upstaged to stage II or III.

Chemotherapy and chemoradiation are advised.

Treatment should start as soon as possible for

best results. Six months of chemotherapy for both

treatments is preferred.

A “sandwich” treatment approach is often used. This

approach consists of receiving chemotherapy before

and after chemoradiation. The other approach is

chemoradiation followed by chemotherapy.

Guide 5. Additional treatment

After transanal excision

Option 1 for high-risk T1 and all T2 tumors

Primary

treatment

Pathologic

stage

What are the options after surgery?

• Transabdominal

resection

ª

Stage I

ª

• Start follow-up care

ª

Upstage to

stage II or III

ª

Sandwich approach

First treatment

• FOLFOX or CAPEOX

• 5-FU/LV or capecitabine

• None

Second treatment

• Capecitabine or infusional 5-FU + radiation therapy

• Bolus 5-FU/LV + radiation therapy

Third treatment

• FOLFOX or CAPEOX

• 5-FU/LV or capecitabine