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Treatment Option Overview for Rectal Cancer
Source: Rectal Cancer Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: February 12, 2025 · Captured 2026-09-09.
Selected source text with whitespace normalised. This Triangle page is not an NCI PDQ summary. Independent clinical review is pending.
The management of rectal cancer varies somewhat from that of colon cancer because of the increased risk of local recurrence and a poorer overall prognosis. Differences include surgical technique, the use of radiation therapy, and the method of chemotherapy administration. In addition to determining the intent of rectal cancer surgery (i.e., curative or palliative), it is important to consider therapeutic issues related to the maintenance or restoration of normal anal sphincter, genitourinary function, and sexual function.[1,2]
The approach to the management of rectal cancer is multimodal and involves a multidisciplinary team of cancer specialists with expertise in gastroenterology, medical oncology, surgical oncology, radiation oncology, and radiology.
| Stage (TNM Definitions) | Treatment Options |
|---|---|
| FOLFOX = leucovorin, fluorouracil, and oxaliplatin. | |
| Stage 0 Rectal Cancer | Polypectomy or surgery |
| Stage I Rectal Cancer | Surgery with or without chemoradiation therapy |
| Stages II and III Rectal Cancer | Preoperative chemoradiation therapy |
| Neoadjuvant chemotherapy with FOLFOX without preoperative chemoradiation therapy (for select patients with lower-risk disease) | |
| Short-course preoperative radiation therapy followed by surgery and chemotherapy | |
| Postoperative chemoradiation therapy | |
| Surgery | |
| Primary chemoradiation therapy followed by intensive surveillance for complete clinical responders | |
| Immunotherapy (for patients with mismatch repair deficiency or high microsatellite instability) | |
| Stages IV and Recurrent Rectal Cancer | Surgery with or without chemotherapy or radiation therapy |
| Systemic therapy | |
| Second-line chemotherapy | |
| Immunotherapy | |
| Palliative therapy | |
| Liver Metastases | Surgery |
| Neoadjuvant chemotherapy for unresectable liver metastases | |
| Local ablation for unresectable liver metastases | |
| Adjuvant chemotherapy | |
| Intra-arterial chemotherapy after liver resection | |
Source links and citations
- Stage (TNM Definitions)
- Polypectomy or surgery
- Surgery with or without chemoradiation therapy
- Preoperative chemoradiation therapy
- Neoadjuvant chemotherapy with FOLFOX without preoperative chemoradiation therapy
- Short-course preoperative radiation therapy followed by surgery and chemotherapy
- Postoperative chemoradiation therapy
- Surgery
- Primary chemoradiation therapy followed by intensive surveillance for complete clinical responders
- Immunotherapy
- Surgery with or without chemotherapy or radiation therapy
- Systemic therapy
- Second-line chemotherapy
- Immunotherapy
- Palliative therapy
- Surgery
- Neoadjuvant chemotherapy for unresectable liver metastases
- Local ablation for unresectable liver metastases
- Adjuvant chemotherapy
- Intra-arterial chemotherapy after liver resection
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Preserved source evidence · Independent clinical review pending · Not medical advice