Previous Page  67 / 94 Next Page
Show Menu
Previous Page 67 / 94 Next Page
Page Background


NCCN Guidelines for Patients



Rectal Cancer, Version 1.2017

Bevacizumab can be re-started 6 to 8 weeks after

surgery. Otherwise, it can slow healing.

After surgery, more chemotherapy is an option.

Observation may be an option, too. Chemotherapy

received before and after surgery should not exceed

6 months. Targeted therapy may be added but more

research is needed. Read Part 6 for options.


Instead of systemic chemotherapy after surgery, HAI

may be an option. Systemic 5-FU/LV may be added.

NCCN experts advise that this option should only be

received at treatment centers with much experience

in this method. More research is needed to learn how

well this treatment works.




Cancer in distant sites is called a metastasis.

Rectal cancer most often spreads to the liver

and sometimes the lungs.



Metastases may be present when you first

learn that you have rectal cancer. Metastases

may also occur if the cancer re-appears during

follow-up care.



Some rectal cancers with metastases can be

treated with surgery. Local treatment may be

used along with surgery or be used by itself.

Chemotherapy should also be part of treatment.



Most rectal cancers with metastases cannot

be treated with surgery. In most cases,

chemotherapy is advised. Targeted therapy

may be added.


Metastatic disease

Metastases at recurrence



Guide 14. Nonsurgical options

Chemotherapy history

What are the options?

Adjuvant FOLFOX or CAPEOX ≤12 months ago

• FOLFIRI ± bevacizumab or ziv-aflibercept or


• Irinotecan ± bevacizumab or ziv-aflibercept or


• If normal



◦◦ FOLFIRI + panitumumab or cetuximab

◦◦ Irinotecan + panitumumab or cetuximab

• If dMMR or MSI-H:

◦◦ Nivolumab

◦◦ Pembrolizumab

Adjuvant FOLFOX or CAPEOX >12 months ago • Treatments listed in Part 6

Prior 5-FU/LV or capecitabine

• Treatments listed in Part 6

Never had chemotherapy

• Treatments listed in Part 6