Treatment for Rectal Cancer

For rectal cancer, physicians 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 about Radiation Oncology

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 Hutchinson Cancer Center - Proton Therapy is the only proton facility in the Pacific Northwest.

Learn more about Proton Therapy

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.

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.

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.

An anastomosis is a procedure where a 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.

Sometimes in order to completely remove the cancer, surgeons cannot save the anal sphincters so they need to perform a colostomy.

• 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.

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. 

Learn more abour Reconstructive Surgery