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NCCN Guidelines for Patients



Rectal Cancer, Version 1.2017


Nonmetastatic cancer

Stage I

After transabdominal resection

After the initial resection, you should receive CT

scans. A pathologic stage will be assigned. If still

stage I, no more treatment is needed. Start follow-up


Some cancers are upstaged to stage II or III. For

stage II, you may have three options. One option

is to start follow-up care. More treatment can be

received if follow-up tests detect cancer. The second

option is chemotherapy. A third option is a “sandwich”

of chemotherapy before and after chemoradiation.

The “sandwich” approach is advised for upstaged III


Guide 6

lists follow-up care. Follow-up testing

is started when there are no signs of cancer after

treatment. It can be helpful for finding new cancer

growth early.

A transanal excision may have been your only

treatment. In this case, a proctoscopy with EUS or

MRI is advised. This test is done to assess for cancer

at the surgical site.

For all stage I cancers, routine colonoscopies are

advised. Get tested 1 year after treatment has

ended. If results are normal, the next test should be

received in 3 years and then every 5 years.

An advanced adenoma may be found during a

colonoscopy. Get your next colonoscopy within 1

year. Advanced adenomas include polyps with a

ruffled structure (villous), a polyp larger than the

width of an AAA battery (>1 cm), or a polyp with pre-

cancerous cells (high-grade dysplasia).

Guide 6. Follow-up care

Type of care

How often is this care needed?

Proctoscopy and EUS or MRI with

contrast if transanal excision only

• Every 3–6 months for up to 2 years

• If normal, then repeat every 6 months for 3 years


• At 1 year after treatment

◦◦ If no advanced adenoma, repeat in 3 years

▪ If results are normal, then repeat every 5 years

◦◦ If advanced adenoma, repeat in 1 year

When I was first diagnosed

with Stage 1 Rectal Cancer I

was absolutely terrified. The

stress on me and my family was

overwhelming because there was

a period of having a diagnosis but

not knowing the stage and disease



Survivor, Stage I