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NCCN Guidelines for Patients



Rectal Cancer, Version 1.2017


Metastatic disease

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

(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 having 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

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.