NCCN Guidelines for Patients
Rectal Cancer, Version 1.2017
Metastases at diagnosis
CT scans may help find metastases. Thus, scans
of your chest, abdomen, and pelvis are advised.
Get these scans every 3 to 6 months for 2 years.
If results are normal, then get a scan every 6 to 12
months for another 3 years. CT should be done with
both IV and oral contrast.
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 having 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
immunizations like the flu shot. Taking low-dose
aspirin may be helpful.
Cancer screening is also important. Get a skin
cancer exam. Ladies—learn how to do a breast self-
exam. A mammogram may also be needed. Men—it
may be time to get screened for prostate cancer.
Start or keep a healthy lifestyle. Limit your alcohol
use. Quit smoking. Protect yourself from the sun. Be
at a healthy weight. Eat healthfully. Healthy eating
includes eating a balanced diet, eating the right
amount of food, and drinking enough fluids.
Many people benefit from some exercise. Exercise
tones muscles, lowers stress, and improves health.
Exercise programs differ between people based on
their needs. Talk with your treatment team about
which exercises would be best for you.