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46

NCCN Guidelines for Patients

®

:

Rectal Cancer, Version 1.2017

4

Nonmetastatic cancer

Stage I

After transanal excision continued

Option 2

Option 2 starts with chemoradiation. Afterward, CT

scans are advised. You may start follow-up care if

there are no signs of cancer. Thus, with option 2,

there is a chance of avoiding surgery.

Signs or no signs of cancer, you may receive a

transabdominal resection next. Afterward, CT scans

are advised. A benefit of surgery is removing lymph

nodes that may have cancer. Also, cancer staging is

more likely to be correct. Chemotherapy may follow

surgery.

A third option after chemoradiation is chemotherapy.

It may further treat any cancer that may be in your

body. Surgery is avoided.

After transabdominal resection

Pathologic

stage

What are the options?

Stage I

• Start follow-up care

Upstaged to

stage II

• Start follow-up care

• FOLFOX or CAPEOX

• 5-FU/LV or capecitabine

• FOLFOX or CAPEOX

• 5-FU/LV or capecitabine

• None

ª

• Capecitabine or

infusional 5-FU +

radiation therapy

• Bolus 5-FU/LV +

radiation therapy

ª

• FOLFOX or

CAPEOX

• 5-FU/LV or

capecitabine

Upstaged to

stage III

• FOLFOX or CAPEOX

• 5-FU/LV or capecitabine

• None

ª

• Capecitabine or

infusional 5-FU +

radiation therapy

• Bolus 5-FU/LV +

radiation therapy

ª

• FOLFOX or

CAPEOX

• 5-FU/LV or

capecitabine

Guide 5. Additional treatment continued

After transanal excision

Option 2 for high-risk T1 and all T2 tumors

Primary treatment

What are the options after chemoradiation?

• Capecitabine or

infusional 5-FU +

radiation therapy

• Bolus 5-FU/LV +

radiation therapy

ª

• Consider starting follow-up care if no signs of cancer

ª

• Transabdominal

resection

ª

• Consider FOLFOX or CAPEOX

• Consider 5-FU/LV or capecitabine

ª

• Consider FOLFOX or CAPEOX

• Consider 5-FU/LV or capecitabine