NCCN Guidelines for Patients
Rectal Cancer, Version 1.2017
Stages II and III
chemotherapy. It is given to prevent the cancer from
returning, especially in distant sites. Start adjuvant
treatment as soon as you can for the best results.
Adjuvant treatment consists of chemotherapy.
FOLFOX or CAPEOX is preferred. Otherwise, you
may receive 5-FU/LV or capecitabine. 5-FU/LV or
capecitabine may be a good choice if they worked
well for neoadjuvant treatment.
lists important follow-up care. Follow-up
care starts when there are no signs of cancer after
surgery. It is also called survivorship care. This care
should address your whole health and well-being.
Your cancer doctor and primary doctor should work
together to help you. Each doctor can have a role in
survivorship. Talk with your doctors about the care
you want and need so you get the best plan.
A medical history and physical exam are advised.
Get this care every 3 to 6 months for 2 years. If
results are normal for 2 years, repeat care every 6
months for another 3 years.
CEA blood tests are mainly used to detect the return
of cancer. CEA levels should be tested every 3 to 6
months for 2 years. If results are normal for 2 years,
get tested every 6 months for another 3 years.
CT scans may help find metastases. Thus, scans
of your chest, abdomen, and pelvis are advised.
Get these scans every 6 to 12 months for a total of
5 years. CT should be done with both IV and oral
CT images may be unclear or not possible. In this
case, MRI of the abdomen and pelvis with non-
contrast CT of the chest is an option. PET/CT is
not advised. It may only be considered if CEA rises
across more than one test.
Ongoing colonoscopies are also part of follow-up
care. You may never have had a total colonoscopy
if your rectum was blocked. If so, get a colonoscopy
within 3 to 6 months after treatment. If you had a
total colonoscopy before, get tested 1 year after
You’ll need a colonoscopy less often if results are
normal. The next test is advised in 3 years. If these
results are normal, get tested every 5 years.
If an advanced adenoma is found, another
colonoscopy within 1 year is advised. 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
Side effect care
You may still have some side effects when follow-up
care is started. Ask your cancer doctor how long they
may last. Some side effects may appear months or
years after treatment has ended. Ask your doctor
what’s your chance that you’ll get these late effects.
There may be ways to help relieve side effects.
There are medicines and other methods to decrease
diarrhea. A medicine called duloxetine may help
painful neuropathy. Fatigue may be helped with
exercise or methods to conserve energy. It may help
to get bone density tests to check for weakened
Treatment of rectal cancer may cause sexual
problems. You may also have problems with
passing urine. Your cancer doctor may refer you to a
gynecologist or urologist as needed.
It’s important to take care of other health issues
besides rectal cancer. Take steps to prevent or detect
other diseases early. Such steps can include getting