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NCCN Guidelines for Patients



Rectal Cancer, Version 1.2017


Nonmetastatic cancer

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.

Guide 8

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.

Cancer tests

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

(high-grade dysplasia).

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

pelvic bones.

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.

Other care

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