Rectal cancer

Treatment

Fred Hutchinson Cancer Center experts offer comprehensive care for rectal cancer, including advanced treatments and new options available only through clinical studies.

Many patients are seen at our Colorectal Cancer Specialty Clinic. At this clinic, all of the specialists who will be involved in your care will meet to design treatment that’s tailored to you. You will receive a multidisciplinary treatment plan in a single day — truly one-stop shopping.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Our goal is to see you within one week so you can start your treatment quickly.

A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help. 

There are many similarities between rectal cancer and colon cancer, but there are some differences in the ways they are usually treated. Learn about colon cancer treatment.

Rectal cancer expertise at Fred Hutch

Everything you need is here

We have surgeons, medical oncologists, radiation oncologists and pathologists who specialize in colorectal cancer; the most advanced diagnostic, treatment and recovery programs; and extensive support. 

Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Radiation oncologist A physician who has special training in using radiation to treat cancer.
Innovative rectal cancer therapies

Fred Hutch patients have access to innovative options, such as transanal, laparoscopic and robot-assisted surgery, as well as advanced therapies being explored in clinical studies for rectal cancer conducted here and at UW Medicine.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease.
Rectal cancer treatment tailored to you

We view treatment as a collaborative effort. Your Fred Hutch doctors will explain all your options and recommend a treatment plan to get you the best results based on the stage, size and location of your cancer and your overall health.

Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Team-based approach

Your personal team includes more than your rectal cancer doctors. Additional experts who specialize in treating people with cancer will be involved if you need them — experts like a geneticist, genetic counselor, dietitian, pharmacist, social worker or palliative care professional.

Genetic counselor A health care professional with special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. A health professional who has special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. They help patients find out their chances of having a genetic condition or of having a child or other family member with a genetic condition. They also help patients understand their options for genetic testing, including its risks and benefits. After genetic testing is done, genetic counselors help patients understand their test results, including how the results can affect other family members. They also provide counseling and support.
Ongoing care and support

During and after treatment, your team continues to provide follow-up care on a schedule tailored to you. The Fred Hutch Survivorship Clinic is also here to help you live your healthiest life as a rectal cancer survivor.

Treatment types

Treatment looks different for different people depending on your diagnosis. We tailor your treatment plan to you. Learn more about the treatment types offered at Fred Hutch. 

Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Radiation therapy

People with rectal cancer often have radiation therapy along with chemotherapy to shrink their tumor before surgery. This makes the tumor easier to remove from the small space in and around the rectum, and it decreases the chance that the cancer will return. 

If your cancer has spread to other parts of your body, radiation therapy may also be helpful for treating those specific spots.

External-beam radiation therapy (EBRT) aims high-energy X-rays or other types of radiation at your body to kill cancer cells. Three main types are used for rectal cancer: intensity-modulated radiation therapy, proton therapy and intraoperative radiation therapy.

Intensity-modulated radiation therapy (IMRT)

For rectal cancer, doctors most often use IMRT. 

  • IMRT uses a computer-controlled linear accelerator that moves around you to deliver X-ray radiation. 
  • It shapes the beams and aims them at the tumor from several angles. 
  • The intensity of the beams can be adjusted to lessen the dose that reaches sensitive normal tissue. 
  • You will most likely get chemotherapy at the same time (called chemoradiation) because chemo can make cancer more sensitive to radiation.

Learn more in our radiation oncology section.

Proton therapy

Proton therapy is a unique form of EBRT that targets protons at tumors to kill cancer cells. 

  • Proton therapy may significantly limit radiation exposure to surrounding healthy tissue near the rectum, such as the bowel and bladder. 
  • This may reduce side effects from treatment and allow for a shorter course of treatment compared with X-ray radiation therapy.
  • Proton therapy may be particularly useful if you have recurrent tumors and had radiation therapy to the same area in the past.

Fred Hutch - Proton Therapy is the only proton facility in the Pacific Northwest. Learn more about proton therapy for rectal cancer.

Intraoperative radiation therapy (IORT)

Your Fred Hutch team may recommend IORT if:

  • You have locally advanced rectal cancer that is attached to normal structures (such as nerves or blood vessels) that cannot be removed. 
  • You have recurrent tumors. 

IORT is a fast and effective form of radiation therapy that uses electron-beam radiation during surgery. 

  • Your surgeon moves normal structures out of the way to expose the area for this precise, high-dose treatment.
  • It takes only a few minutes to deliver and uses only a fraction of the total radiation given over a traditional multi-week course of external-beam radiation. 

University of Washington Medical Center (UWMC) is the only hospital in the WAMI region (Washington, Alaska, Montana and Idaho) to offer this treatment. Learn more about IORT.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.
Radiation therapy

People with rectal cancer often have radiation therapy along with chemotherapy to shrink their tumor before surgery. This makes the tumor easier to remove from the small space in and around the rectum, and it decreases the chance that the cancer will return. 

Chemotherapy

Your doctors may recommend chemotherapy:

  • Before surgery, along with radiation therapy, to help shrink your tumor so it’s easier to remove, which improves results in people with advanced disease
  • After surgery to help prevent your cancer from coming back
  • As your first treatment, instead of surgery, if your cancer has already spread to another area of your body at the time it is diagnosed

Usually chemotherapy medicines are given by infusion into a vein. Some are taken by mouth in pill form. 

Your Fred Hutch team will talk with you about the specific drugs we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and we’ll connect you with medical and support resources throughout Fred Hutch.

Learn more about chemotherapy in our medical oncology section. 

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Infusion An injection of medications or fluids into a vein over a period of time. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body.
Chemotherapy

Your doctors may recommend chemotherapy.

Surgery

Most people with rectal cancer have surgery to remove their cancer. Often they have several weeks of radiation therapy and chemotherapy first, which improves disease control.

As an Fred Hutch patient, you’ll have surgery performed by a UW Medicine surgeon specially trained and board certified in colorectal surgery. 

Your exact procedure will depend on factors like the stage and location of your cancer as well as your overall health, weight, height and preferences. You and your team will discuss your options and decide together what is best for you.

Local excisions

If your cancer was found at a very early stage, it may have been removed at the time of your colonoscopy (polypectomy). 

  • Removal during colonoscopy may be all you need, or you may need a deeper local excision of the rectal wall.
  • For early rectal cancer that’s small enough and low enough in the rectum, our surgeons are specially trained to remove a full-thickness disc of the rectal wall and sew the wall closed through the anus (called transanal surgery). This can avoid the need for larger surgery.  
  • These decisions are individualized and often very complex. Your surgeon will talk with you about what they recommend for you and why.

Mesorectal excisions

Most people need surgery to remove the cancerous segment of the rectum (proctectomy with total mesorectal excision).

  • The surgeon takes out the cancerous segment and also nearby fatty tissue and lymph nodes, which are checked for cancer. 
  • This surgery has significantly reduced the rate of recurrence of rectal cancer in the pelvis. 
  • Our surgeons typically perform the procedure laparoscopically (through small “keyhole” incisions). They may also use robotic assistance during surgery for precision movements.

After the cancerous segment of your rectum is removed, your surgeon may also perform an anastomosis or a colostomy.

Anastomosis

The surgeon sews or staples the healthy parts of your intestine together so stool can move out of your body.

It may take several operations to achieve this end result. During the process, you may temporarily need an ileostomy

  • The surgeon creates an opening (stoma) in your abdomen and attaches the open end of your small intestine (ileum) to it on the inside. 
  • A bag is attached to the skin on the outside to collect waste. This allows your new anastomosis to heal. 
  • A few months after the rectal surgery, the ileostomy can usually be reversed with a much smaller operation.

Colostomy

Sometimes in order to completely remove the cancer, surgeons cannot save the anal sphincters. 

  • Instead of an anastomosis between the colon and the rectum or anus, you may need a permanent colostomy.
  • The open end of your colon is attached to a stoma on the inside, and a bag is attached on the outside.

We can help you learn how to care for your colostomy and adjust so you can go on with normal activities comfortably. We have a specially certified wound ostomy nurse who understands the physical and emotional impact of ostomies and can work closely with you, your family and your doctors.

Reconstructive surgery

During surgery to treat rectal cancer, some patients need reconstruction of the pelvis or perineum. The type of reconstruction depends on the exact surgery being done for the cancer. If needed, our skilled reconstruction team does procedures to cover and close the perineal area or place tissue in the pelvis. This is done using tissue from another area of your body (flap reconstruction), typically the abdomen or thigh. Our colorectal and reconstructive surgeons often work together to do both resection (removal of the cancer) and reconstruction during the same surgery. 

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Colostomy An opening into the colon from the outside of the body. A colostomy provides a new path for waste material, such as urine and feces, to leave the body after part of the colon has been removed. Colonoscopy An examination of the inside of the colon using a colonoscope, which is inserted into the rectum. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. An examination of the inside of the colon using a colonoscope, which is inserted into the rectum. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. Ileostomy An opening into the ileum (part of the small intestine) from the outside of the body. This provides a new path for waste materia to leave the body after part of the intestine has been removed. An opening into the ileum (part of the small intestine) from the outside of the body. This provides a new path for waste material, such as urine and feces, to leave the body after part of the intestine has been removed. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Recurrence Cancer that has come back, usually after a period during which it could not be detected. It may come back to the same place as the original (primary) tumor or someplace else. Also called recurrent cancer. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. perineum The area of the body between the anus and the vulva in females, and between the anus and the scrotum in males.
Surgery

Most people with rectal cancer have surgery to remove their cancer. Often they have several weeks of radiation therapy and chemotherapy first, which improves disease control.

Targeted therapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. They target a gene or protein responsible for allowing cancer to grow, they seek out and damage cancer cells, or they prompt your immune system to attack particular cells (also called immunotherapy). 

Targeted biological therapies use substances, like antibodies, that come from living organisms, or versions of these substances made in a laboratory.

These medicines are important if you have colorectal cancer that has spread to other parts of your body (advanced or metastatic cancer).

Biological therapies for colorectal cancer include: 

  • Bevacizumab (Avastin) — which starves tumors by stopping growth of blood vessels that nourish tumor cells (anti-angiogenesis therapy)
  • Cetuximab (Erbitux) and panitumumab (Vectibix) — which block a normal protein (epidermal growth factor receptor) on the surface of your cells that may contribute to cancer growth (anti-EGFR therapies, or EGFR inhibitors) 

Learn more about targeted therapy in our medical oncology section. 

Antibody A protein made by immune system cells and released into the blood. Antibodies defend the body against foreign substances, such as bacteria. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.
Targeted therapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. They target a gene or protein responsible for allowing cancer to grow, they seek out and damage cancer cells, or they prompt your immune system to attack particular cells (also called immunotherapy). 

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

This treatment is for people with rectal cancer that has spread to the abdominal lining (peritoneum). Cancer that has spread here is called peritoneal carcinomatosis, or peritoneal cancer.

CRS-HIPEC may be able to control advanced disease while also giving you good quality of life. It combines two parts in one operation:

  • A surgery to remove all the cancer that surgeons can see
  • Chemotherapy, in liquid form, that is warmed and then put into your abdomen to kill any cancer cells left behind after surgery

Fred Hutch has an experienced team that provides CRS-HIPEC.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy.
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

This treatment is for people with rectal cancer that has spread to the abdominal lining (peritoneum). Cancer that has spread here is called peritoneal carcinomatosis, or peritoneal cancer.

Treating liver metastases

Over the past decade, amazing advances have been made in treating rectal cancers that have spread to the liver. If you have liver metastases, surgeons and interventional radiologists work together at UW Medicine’s Secondary Liver Tumor Clinic to determine which treatment approaches will work best for you. Treatments may include concurrent liver and rectal surgeries or catheter-based therapies, such as transarterial chemoembolization.

Radiologist A physician who has special training in creating and interpreting pictures of areas inside the body. The pictures are made with X-rays, sound waves or other types of energy. Chemoembolization A procedure in which the blood supply to a tumor is blocked after anticancer drugs are given in blood vessels near the tumor.

A procedure in which the blood supply to a tumor is blocked after anticancer drugs are given in blood vessels near the tumor. Sometimes, the anticancer drugs are attached to small beads that are injected into an artery that feeds the tumor. The beads block blood flow to the tumor as they release the drug. This allows a higher amount of drug to reach the tumor for a longer period of time, which may kill more cancer cells. It also causes fewer side effects because very little of the drug reaches other parts of the body. Chemoembolization is used to treat liver cancer. Also called TACE and transarterial chemoembolization.