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Treating Colorectal Cancer

If you’ve been diagnosed with colorectal cancer, your cancer care team will discuss
your treatment options with you. It’s important that you think carefully about each of your
choices. Weigh the benefits of each treatment option against the possible risks and side
effects.

Local treatments

Local treatments treat the tumor without affecting the rest of the body. These treatments
are more likely to be useful for earlier stage cancers (smaller cancers that haven't
spread), but they might also be used in some other situations. Types of local treatments
used for colorectal cancer include:

● Surgery for Colon Cancer

● Surgery for Rectal Cancer
● Ablation and Embolization for Colorectal Cancer
● Radiation Therapy for Colorectal Cancer

Systemic treatments

Colorectal cancer can also be treated using drugs, which can be given by mouth or
directly into the bloodstream. These are called systemic treatments because they can
reach cancer cells throughout almost all the body. Depending on the type of colorectal
cancer, different types of drugs might be used, such as:

● Chemotherapy for Colorectal Cancer

● Targeted Therapy Drugs for Colorectal Cancer
● Immunotherapy for Colorectal Cancer

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Common treatment approaches

Depending on the stage of the cancer and other factors, different types of treatment
may be combined at the same time or used after one another.

● Treatment of Colon Cancer, by Stage

● Treatment of Rectal Cancer, by Stage

Who treats colorectal cancer?

Based on your treatment options, you might have different types of doctors on your
treatment team. These doctors could include:

● A gastroenterologist: a doctor who treats disorders of the gastrointestinal (GI or

digestive) tract
● A surgical oncologist (oncologic surgeon): a doctor who uses surgery to treat
cancer
● A colorectal surgeon: a doctor who uses surgery to treat diseases of the colon
and rectum
● A radiation oncologist: a doctor who treats cancer with radiation therapy
● A medical oncologist: a doctor who treats cancer with medicines such as
chemotherapy or targeted therapy

You might have many other specialists on your treatment team as well, including
physician assistants (PAs), nurse practitioners (NPs), nurses, psychologists,
nutritionists, social workers, and other health professionals.

● Health Professionals Who Are Part of a Cancer Care Team

Making treatment decisions

It’s important to discuss all of your treatment options, including their goals and possible
side effects, with your doctors to help make the decision that best fits your needs. It’s
also very important to ask questions if there's anything you’re not sure about.

If time permits, it is often a good idea to seek a second opinion. A second opinion can
give you more information and help you feel more confident about the treatment plan
you choose.

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● Questions to Ask About Colorectal Cancer

● Seeking a Second Opinion

Thinking about taking part in a clinical trial

Clinical trials are carefully controlled research studies that are done to get a closer look
at promising new treatments or procedures. Clinical trials are one way to get state-of-
the-art cancer treatment. In some cases they may be the only way to get access to
newer treatments. They are also the best way for doctors to learn better methods to
treat cancer.

If you would like to learn more about clinical trials that might be right for you, start by
asking your doctor if your clinic or hospital conducts clinical trials.

● Clinical Trials

Considering complementary, integrative, and alternative methods

You may hear about alternative or complementary methods to relieve symptoms or treat
your cancer that your doctors haven’t mentioned. These methods can include vitamins,
herbs, and special diets, or other methods such as acupuncture or massage, to name a
few.

Complementary methods are treatments that are used along with your regular
medical care. Alternative treatments are used instead of standard medical treatment.
Although some of these methods might be helpful in relieving symptoms or helping you
feel better, many have not been proven to work. Some might even be harmful. For
example, some supplements might interfere with chemotherapy.

Be sure to talk to your cancer care team about any method you are thinking about
using. They can help you learn what is known (or not known) about the method, which
can help you make an informed decision.

● Complementary and Integrative Medicine

Help getting through cancer treatment

People with cancer need support and information, no matter what stage of illness they
may be in. Knowing all of your options and finding the resources you need will help you
make informed decisions about your care.

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Whether you are thinking about treatment, getting treatment, or not being treated at all,
you can still get supportive care to help with pain or other symptoms. Communicating
with your cancer care team is important so you understand your diagnosis, what
treatment is recommended, and ways to maintain or improve your quality of life.

Different types of programs and support services may be helpful, and they can be an
important part of your care. These might include nursing or social work services,
financial aid, nutritional advice, rehab, or spiritual help.

The American Cancer Society also has programs and services - including rides to
treatment, lodging, and more - to help you get through treatment. Call our Cancer
Knowledge Hub at 1-800-227-2345 and speak with one of our caring, trained cancer
helpline specialists. Or, if you prefer, you can use our chat feature on cancer.org to
connect with one of our specialists.

● Palliative Care
● Programs & Services

Choosing to stop treatment or choosing no treatment at all

For some people, when treatments have been tried and are no longer controlling the
cancer, it could be time to weigh the benefits and risks of continuing to try new
treatments. Whether or not you continue treatment, there are still things you can do to
help maintain or improve your quality of life.

Some people, especially if the cancer is advanced, might not want to be treated at all.
There are many reasons you might decide not to get cancer treatment, but it’s important
to talk to your doctors as you make that decision. Remember that even if you choose
not to treat the cancer, you can still get supportive care to help with pain or other
symptoms.

People who have advanced cancer and who are expected to live less than 6 months
may want to consider hospice care. Hospice care is designed to provide the best
possible quality of life for people who are near the end of life. You and your family are
encouraged to talk with your doctor or a member of your supportive care team about
hospice care options, which include hospice care at home, a special hospice center, or
other health care locations. Nursing care and special equipment can make staying at
home a workable option for many families.

● If Cancer Treatments Stop Working

● Hospice Care

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The treatment information given here is not official policy of the American Cancer
Society and is not intended as medical advice to replace the expertise and judgment of
your cancer care team. It is intended to help you and your family make informed
decisions, together with your doctor. Your doctor may have reasons for suggesting a
treatment plan different from these general treatment options. Don't hesitate to ask your
cancer care team any questions you may have about your treatment options.

Surgery for Colon Cancer

Surgery is often the main treatment for early-stage colon cancers. The type of surgery
used depends on the stage1 (extent) of the cancer, where it is in the colon, and the goal
of the surgery.

● Polypectomy and local excision

● Colectomy
● Colostomy or ileostomy
● Surgery for colon cancer spread
● Possible side effects of colon surgery
● More information about surgery

Any type of colon surgery needs to be done on a clean and empty colon. You will be put
on a special diet before surgery and may need to use laxative drinks and/or enemas to
get all of the stool out of your colon. This bowel prep is a lot like the one used before a
colonoscopy2.

Polypectomy and local excision

Some early colon cancers (stage 0 and some early-stage I tumors) and most polyps can
be removed during a colonoscopy. This is a procedure that uses a long, flexible tube
with a small video camera on the end that’s put into the person’s rectum and eased into
the colon. These surgeries can be done during a colonoscopy:

● For a polypectomy, the cancer is removed as part of the polyp, which is cut at its
base (the part that looks like the stem of a mushroom). This is usually done by
passing a wire loop through the colonoscope to cut the polyp off the wall of the
colon with an electric current.
● A local excision is a slightly more involved procedure. Tools are used through the
colonoscope to remove small cancers on the inside lining of the colon, along with a

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small amount of surrounding healthy tissue on the wall of colon.

When cancer or polyps are taken out this way, the doctor doesn’t have to cut into the
abdomen (belly) from the outside. The goal of either of these procedures is to remove
the tumor in one piece. If some cancer is left behind or if, based on lab tests, the tumor
is thought to have a chance to spread, a type of colectomy (see below) might be the
next surgery.

Colectomy

A colectomy is surgery to remove all or part of the colon. Nearby lymph nodes3 are also
removed.

● If only part of the colon is removed, it's called a hemicolectomy, partial

colectomy, or segmental resection. The surgeon takes out the part of the colon
with the cancer and a small segment of normal colon on either side. Usually, about
one-fourth to one-third of the colon is removed, depending on the size and location
of the cancer. The remaining sections of colon are then reattached. At least 12
nearby lymph nodes are also removed so they can be checked for cancer.
● If all of the colon is removed, it's called a total colectomy. Total colectomy isn’t
often needed to remove colon cancer. It’s mostly used only if there's another
problem in the part of the colon without cancer, such as hundreds of polyps (in
someone with familial adenomatous polyposis4) or, sometimes, inflammatory bowel
disease.

How colectomy is done

A colectomy can be done in 2 ways:

● Open colectomy: The surgery is done through a single long incision (cut) in the
abdomen (belly).
● Laparoscopic-assisted colectomy: The surgery is done through many smaller
incisions and special tools. A laparoscope is a long, thin lighted tube with a small
camera and light on the end that lets the surgeon see inside the abdomen. It’s put
into one of the small cuts, and long, thin instruments are put in through the others to
remove part of the colon and lymph nodes.

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Because the incisions are smaller in a laparoscopic-assisted colectomy than in an open

colectomy, patients often recover faster and may be able to leave the hospital sooner
than they would after an open colectomy. This type of surgery requires special
expertise. If you're considering this type of surgery, be sure to look for a skilled surgeon
who has done many of these operations.

Overall survival rates and the chance of the cancer returning are much the same
between an open colectomy and a laparoscopic-assisted colectomy.

If the colon is blocked

When cancer blocks the colon, it usually happens slowly, and the person can become
very sick over time. In cases like these, if the person is strong enough to tolerate
surgery and the colon cancer is felt to be curable, it is generally recommended that they
undergo surgery to remove the tumor and treat the blockage. If the person is not strong
enough to undergo colon surgery or their colon cancer is not curable, a stent may be
placed to treat the blockage. A stent is a hollow, expandable metal tube that the doctor
can put inside the colon and through the small opening using a colonoscope. This tube
keeps the colon open and relieves the blockage.

If a stent can’t be placed in a blocked colon or if the tumor has caused a hole in the
colon, surgery may be needed right away. This usually is the same type of colectomy
that’s done to remove the cancer, but instead of reconnecting the ends of the colon, the
top end of the colon is attached to an opening (called a stoma) made in the skin of the
abdomen. Stool then comes out of this opening. This is called a colostomy and is
usually only needed for a short time. Sometimes the end of the small intestine (the
ileum) instead of the colon is connected to a stoma in the skin. This is called an
ileostomy. Either way, a bag sticks to the skin around the stoma to hold the stool.

Once the patient is healthier, another operation (known as a colostomy

reversalorileostomy reversal) can be done to put the ends of the colon back together
or to attach the ileum to the colon. It might take anywhere from 2 to 6 months after the
ostomy was first made for this reversal surgery to be done due to healing times or even
the need to treat with chemotherapy. Sometimes, if a tumor can’t be removed or a stent
placed, the colostomy or ileostomy may need to be permanent.

Colostomy or ileostomy

Some people may need a temporary or permanent colostomy (or ileostomy) after
surgery. This can take some time to get used to and might require some lifestyle
adjustments. If you have a colostomy or ileostomy, you’ll need help to learn how and

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where to order the proper supplies and how to manage it. Specially trained ostomy
nurses or enterostomal therapists can help. They’ll usually see you in the hospital
before your operation to discuss the ostomy and to mark a site for the opening. After the
operation, they may come to your home or meet with you in an outpatient setting to give
you more training. There may also be ostomy support groups you can be part of. This is
a good way to learn from people with experience in managing this part of the treatment.

For more information, see Colostomy Guide5 and Ileostomy Guide6.

Surgery for colon cancer spread

If the cancer has spread to only one or a few spots (nodules) in the lungs or liver (and
apparently nowhere else), surgery may be used to remove it. In most cases, this is only
done if the cancer in the colon is also being removed (or was already removed).
Depending on the extent of the cancer, this might help the patient live longer, or it could
even cure the cancer. Deciding if surgery is an option to remove areas of cancer spread
depends on their size, number, and location.

Possible side effects of colon surgery

Possible risks and side effects of surgery depend on several factors, including the
extent of the operation and your general health before surgery. Problems during or
shortly after the operation can include bleeding, infection, and blood clots in the legs.

When you wake up after surgery, you will have some pain and will need pain medicines
for a few days. For the first couple of days, you may not be able to eat, or you may be
allowed limited liquids, as the colon needs some time to recover. Most people are able
to eat solid food in a few days.

Sometimes after colon surgery, the bowel takes longer than normal to “wake up” and
start working again. This is called an ileus. It might be caused by the anesthesia or the
actual handling of the bowel during the operation. Sometimes, too much pain medicine
after the surgery can slow down the bowel function. If you develop an ileus, your doctor
may want to delay eating solid food or even liquids, especially if you are having nausea
and/or vomiting. More tests might also be done to make sure that the situation is not
more serious.

Rarely, the new connections between the ends of the colon may not hold together and
may leak. This can quickly cause severe pain, fever, and the belly to feel very hard. A
smaller leak may cause you to not pass stool, have no desire to eat, and not do well or
recover after surgery. A leak can lead to infection, and more surgery may be needed to

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fix it. It’s also possible that the incision (cut) in the abdomen (belly) might open up,
becoming an open wound that may need special care as it heals.

After the surgery, you might develop scar tissue in your abdomen that can cause organs
or tissues to stick together. These are called adhesions. Normally, your intestines
freely slide around inside your belly. In rare cases, adhesions can cause the bowels to
twist up and can even block the bowel. This causes pain and swelling in the belly that’s
often worse after eating. Further surgery may be needed to remove the scar tissue.

More information about surgery

For more general information about surgery as a treatment for cancer, see Cancer
Surgery7.

To learn about some of the side effects listed here and how to manage them,
see Managing Cancer-related Side Effects8.

Hyperlinks

1. www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-
staging/staged.html
2. www.cancer.org/cancer/diagnosis-staging/tests/endoscopy/colonoscopy.html
3. www.cancer.org/cancer/diagnosis-staging/lymph-nodes-and-cancer.html
4. www.cancer.org/cancer/types/colon-rectal-cancer/causes-risks-prevention/risk-
factors.html
5. www.cancer.org/cancer/managing-cancer/treatment-
types/surgery/ostomies/colostomy.html
6. www.cancer.org/cancer/managing-cancer/treatment-
types/surgery/ostomies/ileostomy.html
7. www.cancer.org/cancer/managing-cancer/treatment-types/surgery.html
8. www.cancer.org/cancer/managing-cancer/side-effects.html

References

Francone TD. Overview of surgical ostomy for fecal diversion. Weiser M and Chen W,
eds. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on
Jan 29, 2024.)

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Lawler M, Johnston B, Van Schaeybroeck S, Salto-Tellez M, Wilson R, Dunlop M, and

Johnston PG. Chapter 74 – Colorectal Cancer. In: Niederhuber JE, Armitage JO,
Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed.
Philadelphia, Pa. Elsevier: 2020.

Libutti SK, Saltz LB, Willett CG, and Levine RA. Ch 62 - Cancer of the Colon. In: DeVita
VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer:
Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams &
Wilkins; 2019.

National Cancer Institute. Physician Data Query (PDQ). Colon Cancer Treatment. 2024.
Accessed at https://www.cancer.gov/types/colorectal/hp/colon-treatment-pdq on Jan
29, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines

in Oncology: Colon Cancer. V.1.2024. Accessed at
https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf on Jan 29, 2024.

Tong G, Zhang G, Liu J, et al. A meta-analysis of short-term outcome of laparoscopic

surgery versus conventional open surgery on colorectal carcinoma. Medicine
(Baltimore). 2017;96(48):e8957.

Last Revised: January 29, 2024

Surgery for Rectal Cancer

Surgery is usually the main treatment for rectal cancer. Radiation and chemotherapy
are often given before or after surgery. The type of surgery used depends on the stage1
(extent) of the cancer, where it is, and the goal of the surgery.

● Determining surgery options

● Polypectomy and local excision
● Transanal excision (TAE)
● Transanal endoscopic microsurgery (TEM)
● Low anterior resection (LAR)
● Proctectomy with coloanal anastomosis
● Abdominoperineal resection (APR)

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● Pelvic exenteration
● Diverting colostomy
● Surgery for rectal cancer spread
● Possible side effects of rectal surgery
● Colostomy or ileostomy
● Sexual function and fertility
● More information about surgery

Determining surgery options

Before doing surgery, the doctor will need to know how close the tumor is to the anus.
This will help decide what type of surgery is done. It can also impact outcomes if the
cancer has spread to the ring-like muscles around the anus (anal sphincter) that keep
stool from coming out until they relax during a bowel movement.

Polypectomy and local excision

Some early-stage rectal cancers and most polyps can be removed during a
colonoscopy2. This is a procedure that uses a long, flexible tube with a small video
camera on the end that’s put into the person’s anus and threaded into the rectum.
These surgeries can be done during a colonoscopy:

● For a polypectomy, the cancer is removed as part of the polyp, which is cut at its
base (the part that looks like the stem of a mushroom). This is usually done by
passing a wire loop through the colonoscope to cut the polyp from the wall of the
rectum with an electric current.
● A local excision is a slightly more involved procedure. Tools are used through the
colonoscope to remove small cancers on the inside lining of the rectum, along with
a small amount of surrounding healthy tissue on the wall of rectum.

When cancer or polyps are taken out this way, the doctor doesn’t have to cut into the
abdomen (belly) from the outside. The goal of these surgeries is to remove the cancer
or polyp in one piece. If some cancer is left behind or if, based on lab tests, the tumor is
thought to have a chance to spread, a more complex type of rectal surgery (see below)
might be the next step.

Transanal excision (TAE)

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This surgery can be used to remove some early-stage I rectal cancers that are relatively
small and not too far from the anus. As with polypectomy and local excision, TAE is
done with instruments that are put into the rectum through the anus. The skin over the
abdomen (belly) isn’t cut. TAE is usually done with local anesthesia (numbing
medicine); the patient is not asleep during the operation.

In this operation, the surgeon cuts through all layers of the rectal wall to take out the
cancer, as well as some surrounding normal rectal tissue. The hole in the rectal wall is
then closed.

Lymph nodes3 are not removed during this surgery, so radiation with or without
chemotherapy might be recommended after surgery if the cancer has grown deep into
the rectum, was not removed completely, or has signs of spread into the lymph system
or blood vessels. Sometimes, instead of chemo and radiation, a more extensive
surgery, such as low anterior resection (LAR) or abdominoperineal resection (APR)
(discussed below), might be recommended and then followed with chemo and radiation.

Transanal endoscopic microsurgery (TEM)

This operation can sometimes be used for early-stage I cancers that are higher in the
rectum and can’t be reached using the standard transanal resection (see above). A
specially designed magnifying scope is put through the anus and into the rectum. This
allows the surgeon to do a transanal resection with great precision and accuracy. This
operation requires special equipment and surgeons with special training and
experience.

Low anterior resection (LAR)

For patients with a cT2-4 rectal cancer (see Colorectal Cancer Stages4) who has a
normal functioning anorectal sphincter (the muscle that keeps the anus closed and
prevents stool leakage), a low anterior resection (LAR) may be recommended, with the
goal to preserve the sphincter function.

A low anterior resection is done with general anesthesia (where the patient is put into a
deep sleep). The surgeon makes several small incisions (cuts) in the abdomen. The
cancer and a margin (edge or rim) of normal tissue around the cancer is removed, along
with nearby lymph nodes and other tissues around the rectum.

The colon is then reattached to the remaining rectum so that a permanent colostomy5 is
not needed. A colostomy is needed when, instead of reconnecting the colon and
rectum, the top end of the colon is attached to an opening made in the skin of the

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abdomen. Stool then comes out this opening.

If radiation and chemotherapy have been given before surgery, it’s common for a short-
term ileostomy6 to be made. (This is where the end of the ileum, the last part of the
small intestine, is connected to a hole in the skin of the abdomen.) This gives the
rectum time to heal before stool moves through it again. In most cases, the ileostomy
can be reversed (the intestines reconnected) about 8 weeks later.

Most patients spend several days in the hospital after the LAR, depending on how the
surgery was done and their overall health. It could take 3 to 6 weeks to recover at
home.

Proctectomy with coloanal anastomosis

Some stage I and most stage II and III rectal cancers in the middle and lower third of the
rectum require removing the entire rectum (called a proctectomy). The rectum has to
be removed so that a total mesorectal excision (TME) can be done to remove all of the
lymph nodes near the rectum. The colon is then connected to the anus (called a colo-
anal anastomosis) so that the patient will pass stool in the usual way.

Sometimes when a colo-anal anastomosis is done, a small pouch is made by doubling

back a short piece of colon (called a colonic J-pouch) or by enlarging a segment of the
colon (called coloplasty). This small reservoir or pouch of colon provides storage for
stool, like the rectum did before surgery.

When special techniques are needed to avoid a permanent colostomy, the patient may
need a short-term ileostomy (where the end of the ileum, the last part of the small
intestine, is connected to a hole in the abdominal skin) for about 8 weeks while the
bowel heals. A second operation is then done to reconnect the intestines and close the
ileostomy opening.

General anesthesia (where the patient is put into a deep sleep) is used for this
operation. Most patients spend several days in the hospital after surgery, depending on
how it was done and their overall health. It could take 3 to 6 weeks to recover at home.

Abdominoperineal resection (APR)

This operation is more involved than the LAR. For patients with a cT2-4 rectal cancer
(see Colorectal Cancer Stages7) that is unable to be fully removed without affecting the
sphincter, an APR may be recommended. It’s often needed if the cancer is growing into
the sphincter muscle (the muscle that keeps the anus closed and prevents stool

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leakage) or the nearby muscles that help control urine flow (called levator muscles).

Here, the surgeon makes a cut or incision (or several small incisions) in the skin of the
abdomen, and another in the skin around the anus. This allows the surgeon to remove
the rectum, the anus, and the tissues around it, including the sphincter muscle. Because
the anus is removed, a permanent colostomy is needed (the end of the colon is
connected to a hole in the skin over the abdomen) to allow stool to pass.

General anesthesia (where the patient is put into a deep sleep) is used for this
operation. Most people spend several days in the hospital after an APR, depending on
how the surgery is done and their overall health. Recovery time at home may be 3 to 6
weeks.

Pelvic exenteration

For patients with T4 rectal cancer (where the rectal cancer is growing into nearby
organs, see Colorectal Cancer Stages8) and no evidence of metastatic disease, a pelvic
exenteration (or multivisceral resection) may be recommended. This is a major surgery
and is not commonly done. The surgeon will remove the rectum as well as any nearby
organs that the cancer has reached, such as the bladder, prostate (in men), or uterus
(in women).

A colostomy is needed after pelvic exenteration. If the bladder is removed, a urostomy9

is needed, too. (This is an opening in skin of the abdomen where urine leaves the body
and is held in a pouch that sticks to the skin.) It can take many months to fully recover
from this complicated surgery.

Diverting colostomy

Some patients have rectal cancer that has spread and is also blocking the rectum. In
this case, surgery may be done to relieve the blockage without removing the part of the
rectum containing the cancer. Instead, the colon is cut above the cancer and attached
to a stoma (an opening in the skin of the abdomen) to allow stool to come out. This is
called a diverting colostomy. It can often help the patient recover enough to start other
treatments (such as chemotherapy).

Surgery for rectal cancer spread

If rectal cancer has spread and formed just one or a few tumors in the lungs or liver
(and nowhere else), surgery might be used to remove it. In most cases, this is only done

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if the cancer in the rectum is also being removed (or was already removed). Depending
on the extent of the cancer, this might help the patient live longer, or it could even cure
the cancer. Deciding if surgery is an option to remove areas of cancer spread depends
on their size, number, and location.

Possible side effects of rectal surgery

Possible risks and side effects of surgery depend on several factors, including the
extent of the operation and a person’s general health before surgery. Problems during
or shortly after the operation can include bleeding from the surgery, infections at the
surgery site, and blood clots in the legs.

When you wake up after surgery, you will have some pain and will need pain medicines
for a few days. For the first couple of days, you may not be able to eat, or you may be
allowed limited liquids, as the rectum needs some time to recover. Most people are able
to eat solid food again in a few days.

Rarely, the new connections between the ends of the colon may not hold together and
may leak. This can quickly cause severe belly pain, fever, and the belly to feel very
hard. A smaller leak may cause you to not pass stool, have no desire to eat, and not do
well or recover after surgery. A leak can lead to infection, and more surgery may be
needed to fix it. It’s also possible that the incision (cut) in the abdomen (belly) might
open up, becoming an open wound that may need special care as it heals.

After the surgery, you might develop scar tissue in your abdomen (belly) that can cause
organs or tissues to stick together. These are called adhesions. Normally, your
intestines freely slide around inside your belly. In rare cases, adhesions can cause the
bowels to twist up and can even block the bowel. This causes pain and swelling in the
belly that’s often worse after eating. Further surgery may be needed to remove the scar
tissue.

Colostomy or ileostomy

Some people need a temporary or permanent colostomy (or ileostomy) after surgery.
This may take some time to get used to and may require some lifestyle adjustments. If
you have a colostomy or ileostomy, you will need to learn how and where to order the
proper supplies and how to manage it. Specially trained ostomy nurses or enterostomal
therapists can help you. They’ll usually see you in the hospital before your operation to
discuss the ostomy and to mark a site for the opening. After your surgery, they may
come to your home or an outpatient setting to give you more training. There may also
be ostomy support groups you can be part of. This is a good way to learn from others

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with firsthand experience in managing this part of the treatment.

For more information, see Colostomy Guide10 and Ileostomy Guide11.

Sexual function and fertility

Rectal surgery has been linked to sexual problems and quality-of-life issues. Talk to
your doctor about how your body will look and work after surgery. Ask how surgery will
impact your sex life. You and your partner should know what you can expect. For
example:

● If you are a man, an abdominoperineal resection (APR) may stop your erections or
your ability to reach an orgasm. In other cases, your pleasure at orgasm may
become less intense. Normal aging may cause some of these changes, but they
may be made worse by the surgery. An APR can also affect fertility. Talk with your
doctor if you think you want to father a child in the future. There may still be ways to
do this.
● If you are a woman, rectal surgery (except pelvic exenteration) usually doesn’t
cause any loss of sexual function. Abdominal adhesions (scar tissue) may
sometimes cause pain or discomfort during sex. If your uterus is removed, you
won't be able to get pregnant.

If you have a colostomy, it can have an impact on body image and sexual comfort level .
While it may require some adjustments, it should not keep you from having an enjoyable
sex life.

For more about sexuality and fertility, see Fertility and Sexual Side Effects12.

More information about surgery

For more general information about surgery as a treatment for cancer, see Cancer
Surgery13.

To learn about some of the side effects listed here and how to manage them,
see Managing Cancer-related Side Effects14.

Hyperlinks

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1. www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-
staging/staged.html
2. www.cancer.org/cancer/diagnosis-staging/tests/endoscopy/colonoscopy.html
3. www.cancer.org/cancer/diagnosis-staging/lymph-nodes-and-cancer.html
4. www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-
staging/staged.html
5. www.cancer.org/cancer/managing-cancer/treatment-
types/surgery/ostomies/colostomy.html
6. www.cancer.org/cancer/managing-cancer/treatment-
types/surgery/ostomies/ileostomy.html
7. www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-
staging/staged.html
8. www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-
staging/staged.html
9. www.cancer.org/cancer/managing-cancer/treatment-
types/surgery/ostomies/urostomy.html
10. www.cancer.org/cancer/managing-cancer/treatment-
types/surgery/ostomies/colostomy.html
11. www.cancer.org/cancer/managing-cancer/treatment-
types/surgery/ostomies/ileostomy.html
12. www.cancer.org/cancer/managing-cancer/side-effects/fertility.html
13. www.cancer.org/cancer/managing-cancer/treatment-types/surgery.html
14. www.cancer.org/cancer/managing-cancer/side-effects.html

References

Kelly SR and Nelson H. Chapter 75 – Cancer of the Rectum. In: Niederhuber JE,
Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th
ed. Philadelphia, Pa. Elsevier: 2020.

Libutti SK, Willett CG, Saltz LB, and Levine RA. Ch 63 - Cancer of the Rectum. In:
DeVita VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer:
Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams &
Wilkins; 2019.

National Cancer Institute. Physician Data Query (PDQ). Rectal Cancer Treatment.
2023. Accessed at https://www.cancer.gov/types/colorectal/hp/rectal-treatment-pdq on

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Jan 29, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines

in Oncology: Rectal Cancer. V.1.2024. Accessed at
https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf on Jan 29, 2024.

Ng KS, Lee PJM. Pelvic exenteration: Pre-, intra-, and post-operative considerations.
Surg Oncol. 2021 Jun;37:101546. doi: 10.1016/j.suronc.2021.101546. Epub 2021 Mar
19. PMID: 33799076.

Solaini L, Perna F, Cavaliere D, Vaccaro C, Avanzolini A, Cucchetti A, Coratti A,

Ercolani G. Average treatment effect of robotic versus laparoscopic rectal surgery for
rectal cancer. Int J Med Robot. 2021 Apr;17(2):e2210. doi: 10.1002/rcs.2210. Epub
2020 Dec 28. PMID: 33314625.

Wang X, Cao G, Mao W, Lao W, He C. Robot-assisted versus laparoscopic surgery for

rectal cancer: A systematic review and meta-analysis. J Cancer Res Ther. 2020
Sep;16(5):979-989. doi: 10.4103/jcrt.JCRT_533_18. PMID: 33004738.

Last Revised: January 29, 2024

Ablation and Embolization for Colorectal

Cancer
Ablation and embolization are sometimes used to treat colorectal cancer that has
spread to other parts of the body, such as the liver or lungs.

● When are ablation and embolization used?

● Ablation
● Embolization

When are ablation and embolization used?

When colon or rectal cancer has spread and there are a few small tumors in the liver or
lungs, these metastases can sometimes be removed by surgery or destroyed by other
techniques, such as ablation or embolization.

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When all of the primary cancer in the colon or rectum can be removed with surgery,
ablation or embolization might be used to destroy small tumors in other places in the
body.

Ablation and embolization might also be good options for people whose metastatic
tumors come back after surgery, whose cancer can’t be cured with surgery, or who can’t
have surgery for other reasons. This might help a person live longer. It can also help
treat problems the cancer is causing, like pain.

In most cases, patients don’t need to stay in the hospital for these treatments.

Ablation

Ablation techniques are used to destroy small tumors (less than 4 cm across) instead of
removing them with surgery. There are many different types of ablation techniques.
They can be used to treat tumors in other places, too.

Radiofrequency ablation (RFA)

Radiofrequency ablation is one of the most common methods to treat cancer that has
spread to the liver. It uses high-energy radio waves to kill cancer cells. A CT scan1 or
ultrasound2 is used to guide a thin, needle-like probe through the skin and into the
tumor. An electric current is then sent to the tip of the probe, releasing high-frequency
radio waves that heat the tumor and destroy the cancer cells.

Microwave ablation (MWA)

The microwave ablation method is used to treat cancer that has spread to the liver.
Imaging tests are used to guide a needle-like probe into the tumor. Electromagnetic
microwaves are then sent through it to create high temperatures that kill the cancer
quickly. This treatment has been used to treat larger cancers (up to 6 cm across).

Percutaneous ethanol ablation (PEI) or Alcohol ablation

Percutaneous ethanol injectiondestroys the cancer cells by injectingconcentrated

alcohol into the tumor. This is usually done through the skin using a needle, which is
guided by ultrasound or CT scans. Sometimes multiple treatments of PEI may be
needed to treat the whole tumor.

Cryoablation

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Cryoablation destroys the tumor by freezing it with a thin metal probe. The probe is
guided through the skin and into the tumor using ultrasound. Then very cold gas
(usually liquid nitrogen or argon gas) is passed through the end of the probe to freeze
the tumor, killing the cancer cells. This method can treat larger tumors than the other
ablation techniques, but sometimes general anesthesia (drugs used to put the patient
into a deep sleep) is needed. Treatment can be repeated as needed to kill all the cancer
cells.

Side effects of ablation therapy

Possible side effects after ablation therapy include:

● Abdominal (belly) pain

● Infection in the liver
● Fever
● Bleeding into the chest cavity or abdomen
● Abnormal liver tests.

Serious complications are rare, but they are possible.

Embolization

Embolization is used to treat tumors in the liver. In an embolization procedure, a

substance is injected directly into an artery in the liver to block or reduce the blood flow
to the tumor.

The liver is special in that it has 2 blood supplies. Most normal liver cells get blood from
the portal vein, but cancer cells in the liver usually get their blood supply from the
hepatic artery. Blocking the part of the hepatic artery that feeds the tumor helps kill the
cancer cells, and it leaves most of the healthy liver cells unharmed because they get
their blood supply from the portal vein.

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Embolization can be used to treat tumors larger than 5 cm (about 2 inches) across that
are often too big to be treated with ablation. It can also be used along with ablation.
Embolization does reduce some of the blood supply to the normal liver tissue, so it may
not be a good option for patients with liver damage from diseases like hepatitis or
cirrhosis.

There are 3 main types of embolization procedures used to treat colon or rectal cancer
that has spread (metastasized) to the liver:

● Arterial embolization is also called trans-arterial embolization or TAE. In this

procedure, a catheter (a thin, flexible tube) is put into an artery through a small cut

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in the inner thigh and eased up into the hepatic artery in the liver. A dye is usually
injected into the blood to help the doctor watch the path of the catheter using x-ray3
pictures. Once the catheter is in the right place, small particles are injected into the
artery to plug it up, blocking oxygen and key nutrients from the cancer.
● Chemoembolization (also called trans-arterial chemoembolization or TACE)
combines arterial embolization with chemotherapy. TACE is done by giving
chemotherapy through a catheter that’s put right into the artery that feeds the
tumor, then plugging up the artery so the chemo can stay close to the tumor.
Multiple treatments may be given over 4 to 6 weeks.
● Radioembolization combines embolization and radiation therapy. This is done by
injecting tiny beads (called microspheres) coated with radioactive yttrium-90 (Y-
90) into the hepatic artery. The beads lodge in the blood vessels near the tumor
where they give off small amounts of radiation to the tumor site for several days.
The radiation travels a very short distance, so its effects are limited mainly to the
tumor.

Possible side effects of embolization

Possible side effects after embolization include:

● Abdominal (belly) pain

● Infection in the liver
● Fever
● Gallbladder inflammation
● Blood clots in the main blood vessels of the liver
● Abnormal liver tests

Because healthy liver tissue can be affected, there is a risk that liver function will get
worse after embolization. This risk is higher if a large branch of the hepatic artery is
embolized. Serious complications are not common, but they are possible.

Hyperlinks

1. www.cancer.org/cancer/diagnosis-staging/tests/imaging-tests/ct-scan-for-

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cancer.html
2. www.cancer.org/cancer/diagnosis-staging/tests/imaging-tests/ultrasound-for-
cancer.html
3. www.cancer.org/cancer/diagnosis-staging/tests/imaging-tests/x-rays-and-other-
radiographic-tests.html

References

Aykut B, Lidsky ME. Colorectal Cancer Liver Metastases: Multimodal Therapy. Surg
Oncol Clin N Am. 2023 Jan;32(1):119-141. doi: 10.1016/j.soc.2022.07.009. Epub 2022
Nov 3. PMID: 36410912.

Boas FE, Bodei L, Sofocleous CT. Radioembolization of Colorectal Liver Metastases:

Indications, Technique, and Outcomes. J Nucl Med. 2017;58(Suppl 2):104S-111S.

Kelly SR and Nelson H. Chapter 75 – Cancer of the Rectum. In: Niederhuber JE,
Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th
ed. Philadelphia, Pa. Elsevier: 2020.

Lawler M, Johnston B, Van Schaeybroeck S, Salto-Tellez M, Wilson R, Dunlop M, and

Johnston PG. Chapter 74 – Colorectal Cancer. In: Niederhuber JE, Armitage JO,
Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed.
Philadelphia, Pa. Elsevier: 2020.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines

in Oncology: Colon Cancer. V.1.2024. Accessed at
https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf on Jan 29, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines

in Oncology: Rectal Cancer. V.1.2024. Accessed at
https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf on Jan 29, 2024.

Uhlig J, Lukovic J, Dawson LA, Patel RA, Cavnar MJ, Kim HS. Locoregional Therapies
for Colorectal Cancer Liver Metastases: Options Beyond Resection. Am Soc Clin Oncol
Educ Book. 2021 Mar;41:133-146. doi: 10.1200/EDBK_320519. PMID: 34010047.

Last Revised: January 29, 2024

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Radiation Therapy for Colorectal Cancer

Radiation therapy is a treatment using high-energy rays (such as x-rays) or particles to
destroy cancer cells. It is more often used to treat rectal cancer than colon cancer. For
some colon and rectal cancers, treating with chemotherapy at the same time can make
radiation therapy work better. Using these 2 treatments together is called
chemoradiation.

● Radiation therapy for colon cancer

● Radiation therapy for rectal cancer
● Types of radiation therapy
● More information about radiation therapy

Radiation therapy for colon cancer

It's not common to use radiation therapy to treat colon cancer, but it may be used in
certain cases:

● Before surgery (along with chemo) to help shrink a tumor and make it easier to
remove.
● After surgery, if the cancer has attached to an internal organ or the lining of the
belly (abdomen). If this happens, the surgeon can’t be sure that all of the cancer
has been removed. Radiation therapy may be used to try to kill any cancer cells
that may have been left behind.
● During surgery, right to the area where the cancer was, to kill any cancer cells that
may be left behind. This is called intraoperative radiation therapy or IORT.
● Along with chemo to help control cancer if a person is not healthy enough for
surgery.
● To ease symptoms if advanced colon cancer is causing intestinal blockage,
bleeding, or pain.
● To help treat colon cancer that has spread to other areas, such as the bones,
lungs, or brain.

Radiation therapy for rectal cancer

For rectal cancer, radiation therapy is a more common treatment and may be used:

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● Either before and/or after surgery, often along with chemotherapy, to help keep the
cancer from coming back. Many doctors now favor giving radiation therapy before
surgery, as it may make it easier to remove the cancer, especially if the cancer's
size and/or location might make surgery difficult. This is called neoadjuvant
treatment. Giving chemoradiation before surgery can also help lower the chances
of damaging the sphincter muscles in the rectum when surgery is done. In either
case, nearby lymph nodes are usually treated too.
● During surgery, right to the area where the tumor was, to kill any rectal cancer cells
that may be left behind. This is called intraoperative radiation therapy or IORT.
● With or without chemo to help control rectal cancer if a person is not healthy
enough for surgery or to ease symptoms if advanced rectal cancer is causing
intestinal blockage, bleeding, or pain.
● To re-treat rectal tumors that come back in the pelvis after radiation was given.
● To help treat rectal cancer that has spread to other areas, such as the bones,
lungs, or brain.

Types of radiation therapy

Different types of radiation therapy can be used to treat colon and rectal cancers.

External-beam radiation therapy (EBRT)

EBRT is the type of radiation therapy used most often for people with colon or rectal
cancer. The radiation is focused on the cancer from a machine outside the body. It’s a
lot like getting an x-ray, but the radiation is more intense. How often and how long a
person gets radiation treatments depends on the reason the radiation is being given and
other factors. Treatments might be given over the course of a few days or several
weeks.

Newer EBRT techniques1, such as three-dimensional conformal radiation therapy (3D-

CRT), intensity modulated radiation therapy (IMRT), and stereotactic body radiation
therapy (SBRT), have been shown to help doctors treat colorectal cancers that have
spread to the lungs or liver more accurately while lowering the radiation exposure to
nearby healthy tissues. They are typically used if there are only a small number of
tumors and if the tumors are causing symptoms and surgery is not an option.

Internal radiation therapy (brachytherapy)

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Brachytherapy might be used to treat some rectal cancers, but more research is needed
to understand how to best use and when to use brachytherapy.

For this treatment, a radioactive source is put inside your rectum next to or into the
tumor. This allows the radiation to reach the rectum without passing through the skin
and other tissues of the belly (abdomen), so it’s less likely to damage nearby tissues.

Endocavitary radiation therapy: For this treatment, a small balloon-like device is

placed into the rectum to deliver high-intensity radiation for a few minutes. This is
typically done in 4 treatments (or less), with about 2 weeks between each treatment.
This can let some patients, particularly elderly patients, avoid major surgery and a
colostomy. This type of treatment is used for some small rectal cancers or in cases
where radiation was already given in the pelvic area and the rectal cancer has come
back. Sometimes external-beam radiation therapy is also given.

Interstitial brachytherapy: For this treatment, a tube is placed into the rectum and
right into the tumor. Small pellets of radioactive material are then put into the tube for
several minutes. The radiation travels only a short distance, limiting the harmful effects
on nearby healthy tissues. It’s sometimes used to treat people with rectal cancer who
are not healthy enough for surgery or have cancer that has come back in the rectum.
This can be done a few times a week for a couple of weeks, but it can also be just a
one-time procedure.

Radioembolization

Radiation can also be given during an embolization procedure. You can find more
details in Ablation and Embolization to Treat Colorectal Cancer.

Possible side effects of radiation therapy

If you’re going to get radiation therapy, it’s important to ask your doctor about the
possible short- and long-term side effects so that you know what to expect. Possible
side effects of radiation therapy for colon and rectal cancer can include:

● Skin irritation at the site where radiation beams were aimed, which can range from
redness to blistering and peeling
● Problems with wound healing if radiation was given before surgery
● Nausea
● Rectal irritation, which can cause diarrhea, painful bowel movements, or blood in
the stool
● Bowel incontinence (stool leakage)

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● Bladder irritation, which can cause problems like feeling like you have to go often
(called frequency), burning or pain while urinating, or blood in the urine
● Fatigue/tiredness
● Sexual problems (erection issues in men and vaginal irritation in women)
● Scarring, fibrosis (stiffening), and adhesions that cause the tissues in the treated
area to stick to each other

Most side effects should get better over time after treatment ends, but some problems
may not go away completely. If you notice any side effects, talk to your doctor right
away so steps can be taken to reduce or relieve them.

More information about radiation therapy

To learn more about how radiation is used to treat cancer, see Radiation Therapy2.

To learn about some of the side effects listed here and how to manage them,
see Managing Cancer-related Side Effects3.

Hyperlinks

1. www.cancer.org/cancer/managing-cancer/treatment-types/radiation/external-
beam-radiation-therapy.html
2. www.cancer.org/cancer/managing-cancer/treatment-types/radiation.html
3. www.cancer.org/cancer/managing-cancer/side-effects.html

References

Buckley H, Wilson C, Ajithkumar T. High-Dose-Rate Brachytherapy in the Management

of Operable Rectal Cancer: A Systematic Review. Int J Radiat Oncol Biol Phys.
2017;99(1):111-127.

Kelly SR and Nelson H. Chapter 75 – Cancer of the Rectum. In: Niederhuber JE,
Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th
ed. Philadelphia, Pa. Elsevier: 2020.

Lawler M, Johnston B, Van Schaeybroeck S, Salto-Tellez M, Wilson R, Dunlop M, and

Johnston PG. Chapter 74 – Colorectal Cancer. In: Niederhuber JE, Armitage JO,
Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed.

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____________________________________________________________________________________

Philadelphia, Pa. Elsevier: 2020.

Libutti SK, Saltz LB, Willett CG, and Levine RA. Ch 62 - Cancer of the Colon. In: DeVita
VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer:
Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams &
Wilkins; 2019.

Libutti SK, Willett CG, Saltz LB, and Levine RA. Ch 63 - Cancer of the Rectum. In:
DeVita VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer:
Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams &
Wilkins; 2019.

National Cancer Institute. Physician Data Query (PDQ). Colon Cancer Treatment. 2024.
Accessed at https://www.cancer.gov/types/colorectal/hp/colon-treatment-pdq on Jan 29,
2024.

National Cancer Institute. Physician Data Query (PDQ). Rectal Cancer Treatment.
2023. Accessed at https://www.cancer.gov/types/colorectal/hp/rectal-treatment-pdq on
Jan 29, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines

in Oncology: Colon Cancer. V.1.2024. Accessed at
https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf on Jan 29, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines

in Oncology: Rectal Cancer. V.6.2023. Accessed at
https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf on Jan 29, 2024.

Roeder F, Meldolesi E, Gerum S, Valentini V, Rödel C. Recent advances in (chemo-

)radiation therapy for rectal cancer: a comprehensive review. Radiat Oncol. 2020 Nov
10;15(1):262. doi: 10.1186/s13014-020-01695-0. PMID: 33172475; PMCID:
PMC7656724.

Wegner RE, Abel S, Monga D, Raj M, Finley G, Nosik S, McCormick J, Kirichenko AV.
Utilization of Adjuvant Radiotherapy for Resected Colon Cancer and Its Effect on
Outcome. Ann Surg Oncol. 2020 Mar;27(3):825-832. doi: 10.1245/s10434-019-08042-y.
Epub 2019 Nov 12. PMID: 31720934.

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Last Revised: January 29, 2024

Chemotherapy for Colorectal Cancer

Chemotherapy (chemo) is treatment with anti-cancer drugs that may be injected into a
vein or taken by mouth. These drugs travel through the bloodstream and reach most
parts of the body. Chemo is often used to treat colorectal cancer.

● When is chemotherapy used?

● How is chemotherapy given?
● Chemotherapy drugs used to treat colorectal cancer
● Possible side effects of chemo
● More information about chemotherapy

When is chemotherapy used?

Chemo may be used at different times during treatment for colorectal cancer:

● Neoadjuvant chemo is given (sometimes with radiation) before surgery to try to

shrink the cancer and make it easier to remove. This is often done for rectal cancer.
● Adjuvant chemo is given after surgery. The goal is to kill cancer cells that might
have been left behind at surgery because they were too small to see, as well as
cancer cells that might have escaped from the main colon or rectal cancer to settle
in other parts of the body but are too small to see on imaging tests. This helps
lower the chance that the cancer will come back.
● For advanced cancers that have spread to other organs like the liver, chemo can
be used to help shrink tumors and ease problems they’re causing. While it’s not
likely to cure the cancer, this often helps people feel better and live longer.

How is chemotherapy given?

You can get chemotherapy in different ways to treat colorectal cancer.

● Systemic chemotherapy: Drugs are put into your blood through a vein or you take
them by mouth. The drugs enter your bloodstream and reach almost all areas of

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your body.
● Regional chemotherapy: Drugs are put into an artery that leads to the part of the
body with the cancer. This focuses the chemo on the cancer cells in that area. It
reduces side effects by limiting the amount of drug reaching the rest of your body.
Hepatic artery infusion, or chemo given directly into the hepatic artery, is an
example of regional chemotherapy sometimes used for cancer that has spread to
the liver.

Chemo drugs for colon or rectal cancer that are given into a vein (IV), can be given
either as an injection over a few minutes or as an infusion over a longer period of time.
This can be done in a doctor’s office, infusion center, or in a hospital setting.

Often, a slightly larger and sturdier IV1 is required in the vein system to administer
chemo. These are known as central venous catheters (CVCs), central venous access
devices (CVADs), or central lines. They are used to put medicines, blood products,
nutrients, or fluids into your blood. They can also be used to take blood for testing.
There are many different kinds of CVCs. The most common types are the tunneled
central lines, ports, and peripherally inserted central catheter (PICC) lines.

Chemo is given in cycles, which include a rest period to give you time to recover from
the effects of the drugs. Each cycle is usually 2 or 3 weeks long. The schedule varies
depending on the drugs used. For example, with some drugs, the chemo is given only
on the first day of the cycle. With others, it is given for a few days in a row, or once a
week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

Adjuvant or neoadjuvant chemo is often given for a total of 3 to 6 months, depending on

the drugs used. The length of treatment for advanced colorectal cancer depends on
how well it is working and what side effects you have.

Chemotherapy drugs used to treat colorectal cancer

Some drugs commonly used for colorectal cancer include:

● 5-Fluorouracil (5-FU)
● Capecitabine (Xeloda), a pill that is changed into 5-FU once it gets to the tumor
● Irinotecan (Camptosar)
● Oxaliplatin (Eloxatin)
● Trifluridine and tipiracil (Lonsurf), a combination drug in pill form

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Most often, combinations of 2 or 3 of these drugs are used. Sometimes, chemo drugs
are given along with a targeted therapy drug.

Possible side effects of chemo

Chemo drugs attack cells that are dividing quickly, which is why they work against
cancer cells. But other cells in the body, such as those in hair follicles and in the lining
of the mouth and intestines, are also dividing quickly. These cells can be affected by
chemo too, which can lead to side effects.

The side effects of chemo depend on the type and dose of drugs given and how long
you take them. Common side effects of chemo can include:

● Hair loss
● Mouth sores
● Loss of appetite or weight loss
● Nausea and vomiting
● Diarrhea
● Nail changes
● Skin changes

Chemo can also affect the blood-forming cells of the bone marrow, which can lead to:

● Increased chance of infections (from low white blood cell counts)

● Easy bruising or bleeding (from low blood platelet counts)
● Fatigue (from low red blood cell counts and other reasons)

Other side effects are specific to certain drugs. Ask your cancer care team about the
possible side effects of the specific drugs you are getting. For example:

● Hand-foot syndrome can develop during treatment with capecitabine or 5-FU. It

can start out as redness in the hands and feet, and then might progress to pain and
sensitivity in the palms and soles. If it worsens, the skin may blister or peel,
sometimes leading to painful sores. It’s important to tell your doctor right away
about any early symptoms, such as redness or sensitivity, so that steps can be
taken to keep things from getting worse.
● Neuropathy (nerve damage) is a common side effect of oxaliplatin. Symptoms
include numbness, tingling, and even pain in the hands and feet. It can also cause

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intense sensitivity to cold in your throat, esophagus (the tube connecting the throat
to the stomach), and the palms of your hands. This can cause pain when
swallowing cold liquids or holding a cold glass. If you'll be getting oxaliplatin, talk
with your doctor about side effects beforehand, and let them know right away if you
develop numbness and tingling or other side effects.
● Allergic or sensitivity reactions can happen in some people while getting the
drug oxaliplatin. Symptoms can include skin rash; chest tightness and trouble
breathing; back pain; or feeling dizzy, lightheaded, or weakness. Be sure to tell your
nurse right away if you notice any of these symptoms while you're getting chemo.
● Diarrhea is a common side effect with many of these chemo drugs, but can be
particularly bad with irinotecan. It needs to be treated right away – at the first loose
stool – to prevent severe dehydration. This often means taking a drug like
loperamide (Imodium) or even being admitted to the hospital for intravenous
hydration. If you're getting a chemo drug that will likely cause diarrhea, your doctor
will give you instructions on what drugs to take and how often to take them to
control this problem.

Most of these side effects tend to go away over time after treatment ends. Some, such
as hand and foot numbness from oxaliplatin, may last for a long time. There are often
ways to lessen these side effects. For example, you can be given drugs to help prevent
or reduce nausea and vomiting, or you may be told to keep ice chips in your mouth
while chemo is being given to lower the chances of getting mouth sores.

Be sure to discuss any questions about side effects with your cancer care team. Also
report any side effects or changes you notice while getting chemo so that they can be
treated right away. In some cases, the doses of the chemo drugs may need to be
reduced or treatment may need to be delayed or stopped to help keep the problem from
getting worse.

More information about chemotherapy

For more general information about how chemotherapy is used to treat cancer,
see Chemotherapy2.

To learn about some of the side effects listed here and how to manage them,
see Managing Cancer-related Side Effects3.

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Hyperlinks

1. www.cancer.org/cancer/managing-cancer/making-treatment-decisions/tubes-lines-
ports-catheters.html
2. www.cancer.org/cancer/managing-cancer/treatment-types/chemotherapy.html
3. www.cancer.org/cancer/managing-cancer/side-effects.html

References

Lawler M, Johnston B, Van Schaeybroeck S, Salto-Tellez M, Wilson R, Dunlop M, and

Johnston PG. Chapter 74 – Colorectal Cancer. In: Niederhuber JE, Armitage JO,
Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed.
Philadelphia, Pa. Elsevier: 2020.

Libutti SK, Saltz LB, Willett CG, and Levine RA. Ch 62 - Cancer of the Colon. In: DeVita
VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer:
Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams &
Wilkins; 2019.

Libutti SK, Willett CG, Saltz LB, and Levine RA. Ch 63 - Cancer of the Rectum. In:
DeVita VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer:
Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams &
Wilkins; 2019.

National Cancer Institute. Physician Data Query (PDQ). Colon Cancer Treatment. 2024.
Accessed at https://www.cancer.gov/types/colorectal/hp/colon-treatment-pdq on Feb 5,
2024.

National Cancer Institute. Physician Data Query (PDQ). Rectal Cancer Treatment.
2023. Accessed at https://www.cancer.gov/types/colorectal/hp/rectal-treatment-pdq on
Feb 5, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines

in Oncology: Colon Cancer. V.1.2024. Accessed at
https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf on Feb 6, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines

in Oncology: Rectal Cancer. V.1.2024. Accessed at
https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf on Feb 5, 2024.
Last Revised: February 5, 2024

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Targeted Therapy Drugs for Colorectal

Cancer
As researchers learn more about changes in cells that cause colon or rectal cancer,
they have developed new types of drugs to specifically target these changes.

● When is targeted therapy used?

● Drugs that target blood vessel formation (VEGF)
● Drugs that target cancer cells with EGFR changes
● Drugs that target cells with BRAF gene changes
● Drugs that target cells with HER2 changes
● Drugs that target cells with NTRK gene changes
● Drugs that target cells with RET gene changes
● Drugs that target cells with KRAS gene changes
● Other targeted therapy drugs
● More information about targeted therapy

When is targeted therapy used?

Targeted drugs work differently from chemotherapy (chemo) drugs. They sometimes
work when chemo drugs don’t, and they often have different side effects. They can be
used either along with chemo, by themselves, or in combination with another targeted
therapy drug.

Like chemotherapy, these drugs enter the bloodstream and reach almost all areas of
the body, which makes them useful against cancers that have spread to distant parts of
the body.

Several types of targeted drugs might be used to treat colorectal cancer.

Drugs that target blood vessel formation (VEGF)

Vascular endothelial growth factor (VEGF) is a protein that helps tumors form new blood
vessels (a process known as angiogenesis) to get nutrients they need to grow. Drugs
that stop VEGF from working can be used to treat some colon or rectal cancers. These
include:

● Bevacizumab (Avastin, other names1)

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● Ramucirumab (Cyramza)
● Ziv-aflibercept (Zaltrap)
● Fruquintinib (Fruzaqla)

Most of these drugs are given as infusions into your vein (IV) every 2 or 3 weeks, in
most cases along with chemotherapy. Fruquintinib is given as a capsule and not
combined with chemotherapy. These drugs can often help people with advanced colon
or rectal cancers live longer.

Possible side effects of drugs that target VEGF

Common side effects of these drugs include:

● High blood pressure

● Protein in the urine
● Bleeding (from the nose or rectum)
● Headaches
● Taste changes
● Skin changes

Rare but possibly serious side effects include blood clots, severe bleeding, holes
forming in the colon (called perforations), heart problems, kidney problems, and slow
wound healing. If a hole forms in the colon, it can lead to severe infection and surgery
may be needed to fix it.

Another rare but serious side effect of these drugs is an allergic reaction during the
infusion, which could cause problems with breathing and low blood pressure.

Drugs that target cancer cells with EGFR changes

Epidermal growth factor receptor (EGFR) is a protein that helps cancer cells grow.
Drugs that target EGFR (EGFR inhibitors) can be used to treat some advanced colon
or rectal cancers. These include:

● Cetuximab (Erbitux)
● Panitumumab (Vectibix)

Both of these drugs are given by infusion into a vein (IV), either once a week or every
other week.

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These drugs typically don’t work in colorectal cancers that have mutations (defects) in
the KRAS, NRAS or BRAF gene. Doctors commonly test the tumor for these gene
changes before treatment, and only use these drugs in people whose cancer cells don’t
have these mutations.

An exception would be if an EGFR inhibitor is combined with another drug, such as with
a BRAF inhibitor (encorafenib, see below) or with a KRAS inhibitor (adagrasib or
sotorasib, see below). These two drug combinations appear to have an effect on colon
cancer that has been treated with other chemotherapy.

Possible side effects of drugs that target EGFR

The most common side effects of these drugs are skin problems such as an acne-like
rash on the face and chest during treatment, which can sometimes lead to infections.
An antibiotic and/or steroid cream may be needed to help limit the rash and related
infections. Developing this rash often means the cancer is responding to treatment.
People who develop this rash often live longer, and those who develop more severe
rashes also seem to respond better than those with a milder rash. Other side effects
can include:

● Headache
● Tiredness
● Fever
● Diarrhea

A rare but serious side effect of these drugs is an allergic reaction during the infusion,
which could cause problems with breathing and low blood pressure. You may be given
medicine before treatment to help prevent this. Other serious but rare serious side
effects include eye, heart, or lung damage.

Drugs that target cells with BRAF gene changes

A small portion of colorectal cancers have changes (mutations) in the BRAF gene.
Colorectal cancer cells with these changes make an abnormal BRAF protein that helps
them grow. Some drugs target this abnormal BRAF protein.

If you have colorectal cancer that has spread, your cancer will likely be tested to see if
the cells have a BRAF gene change known as BRAF V600E, which can cause the cell
to make an abnormal BRAF protein.

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Encorafenib (Braftovi) is a BRAF inhibitor, a drug that attacks the abnormal BRAF
protein. This drug might be given with an EGFR inhibitor such as cetuximab or
panitumumab (see above), possibly along with chemotherapy.

This drug is taken as capsules, once a day.

Possible side effects of drugs that target BRAF

Common side effects of encorafenib, in combination with an EGFR inhibitor, can include
skin thickening, diarrhea, rash, loss of appetite, abdominal pain, joint pain, fatigue, and
nausea.

Some people treated with a BRAF inhibitor might develop new squamous cell skin
cancers2. These cancers can often be treated by removing them. Still, your doctor will
want to check your skin regularly during treatment and for several months afterward.
You should also let your doctor know right away if you notice any new growths or
abnormal areas on your skin.

Drugs that target cells with HER2 changes

In a small percentage of people with colorectal cancer, the cancer cells have too much
of a growth-promoting protein called HER2 on their surface. Cancers with increased
levels of HER2 are called HER2-positive. Drugs that target the HER2 protein can often
be helpful in treating these cancers.

Drugs of this type that might be used to treat HER2-positive colorectal cancer include:

● Trastuzumab (Herceptin, other names3)

● Pertuzumab (Perjeta)
● Tucatinib (Tukysa)
● Lapatinib (Tykerb)
● Fam-trastuzumab deruxtecan (Enhertu, T-DXd)

For advanced, HER2-positive colorectal cancer that has already been treated with
chemotherapy, the most common targeted drug regimens include trastuzumab plus
either tucatinib, lapatinib, or pertuzumab. People who might be treated with this regimen
must also not have mutations in the RAS and BRAF genes.

Among these drugs, only tucatinib is FDA approved specifically to treat colorectal
cancer at this time, but the others are included in some expert treatment guidelines.

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Still, it’s important to check with your insurance provider before getting these drugs to
make sure they are covered.

Possible side effects of drugs that target HER2

The side effects of HER2-targeted drugs tend to be mild overall, but some can be
serious, and different drugs can have different possible side effects. Discuss what you
can expect with your doctor.

Some of these drugs can cause heart damage during or after treatment, which might
lead to congestive heart failure. Because of this, your doctor will likely check your heart
function (with an echocardiogram or a MUGA scan) before treatment, and regularly
while you are getting any of these drugs. Let your doctor know if you develop
symptoms, such as shortness of breath, a fast heartbeat, leg swelling, and severe
fatigue.

Some of these drugs can cause severe diarrhea, so it’s very important to let your health
care team know about any changes in bowel habits as soon as they happen.

Lapatinib and tucatinib can also cause hand-foot syndrome, in which the hands and
feet become sore and red, and may blister and peel.

Lapatinib and tucatinib can cause liver problems. Your doctor will do blood tests to
check your liver function during treatment. Let your health care team know right away if
you have possible signs or symptoms of liver problems, such as itchy skin, yellowing of
the skin or the white parts of your eyes, dark urine, or pain in the right upper belly area.

Fam-trastuzumab deruxtecan can cause serious lung disease in some people, which
might even be life threatening. It’s very important to let your doctor know right away if
you’re having symptoms such as coughing, wheezing, trouble breathing, or fever.

Drugs that target cells with NTRK gene changes

A very small number of colorectal cancers have changes in one of the NTRK genes.
This causes them to make abnormal TRK proteins, which can lead to abnormal cell
growth and cancer.

Larotrectinib (Vitrakvi), entrectinib (Rozlytrek), and repotrectinib (Augtyro) are

drugs that target the TRK proteins. These drugs can be used to treat advanced cancers
with NTRK gene changes that are still growing despite other treatments.

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These drugs are taken as pills or an oral solution, once or twice daily.

Possible side effects of TRK inhibitors

Common side effects of these drugs can include dizziness, fatigue, nausea, vomiting,
constipation, weight gain, and diarrhea.

Less common but serious side effects can include abnormal liver tests, increased risk
for fractures, heart problems, vision changes, and confusion.

Drugs that target cells with RET gene changes

A very small number of colorectal cancers have changes in one of the RET genes. This
causes them to make abnormal RET proteins, which can lead to abnormal cell growth
and cancer.

Selpercatinib (Retevmo) is a drug that targets the RET protein. These drugs can be
used to treat advanced cancers with RET gene changes that are still growing despite
other treatments.

This drug is taken as a capsule twice daily.

This drug is approved to treat other types of cancer, but doctors can prescribe it off-
label4 for colorectal cancer. Still, it’s important to check with your insurance provider
before getting these drugs to make sure they are covered.

Possible side effects of RET inhibitors

Common side effects of these drugs can include decrease in white blood cell count and
calcium, changes in liver function tests, high blood pressure, fatigue, changes in kidney
function, and increased cholesterol.

Less common but serious side effects can include abnormal heart function (QT interval
prolongation), bleed, allergic reaction, and inability to heal from a wound.

Drugs that target cells with KRAS gene changes

A very small number of colorectal cancers have the KRAS G12C gene mutation. This
causes them to make abnormal KRAS proteins, which can lead to continued cell growth
and cancer.

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Adagrasib (Krazati) and Sotorasib (Lumakras) are drugs that target the KRAS
proteins. These KRAS inhibitors can be given with an EGFR inhibitor (ie. adagrasib with
cetuximab, or sotorasib with panitumumab) to treat advanced cancers with KRAS gene
changes that are still growing despite other treatments.

These drugs are taken as tablets, once or twice daily.

Possible side effects of KRAS inhibitors

Common side effects of these drugs can include nausea, vomiting, diarrhea, muscle
and joint pain, fatigue, decreased appetite, and changes in liver and kidney function.

Less common but serious side effects can include effects to the heart (QTc interval
prolongation), liver, and lungs (interstitial lung disease).

Other targeted therapy drugs

Regorafenib (Stivarga) is a type of targeted therapy known as a multikinase

inhibitor. Kinases are proteins on or near the surface of a cell that carry important
signals to the cell’s control center. Regorafenib blocks several kinase proteins that
either help tumor cells grow or help form new blood vessels to feed the tumor. Blocking
these proteins can help stop the growth of cancer cells.

This drug can be used to treat advanced colorectal cancer, typically when other drugs
are no longer helpful. It’s taken as a pill.

Common side effects include fatigue, rash, hand-foot syndrome (redness and irritation
of the hands and feet), diarrhea, high blood pressure, weight loss, and abdominal pain.

Less common but more serious side effects can include confusion, severe bleeding, or
perforations (holes) in the stomach or intestines.

More information about targeted therapy

To learn more about how targeted drugs are used to treat cancer, see Targeted Cancer
Therapy5.

To learn about some of the side effects listed here and how to manage them,
see Managing Cancer-related Side Effects6.

Hyperlinks

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1. www.cancer.org/cancer/managing-cancer/treatment-types/biosimilar-drugs.html
2. www.cancer.org/cancer/types/basal-and-squamous-cell-skin-cancer.html
3. www.cancer.org/cancer/managing-cancer/treatment-types/biosimilar-drugs.html
4. www.cancer.org/cancer/managing-cancer/treatment-types/off-label-drug-use.html
5. www.cancer.org/cancer/managing-cancer/treatment-types/targeted-therapy.html
6. www.cancer.org/cancer/managing-cancer/side-effects.html

References

Kelly SR and Nelson H. Chapter 75 – Cancer of the Rectum. In: Niederhuber JE,
Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th
ed. Philadelphia, Pa. Elsevier: 2020.

Lawler M, Johnston B, Van Schaeybroeck S, Salto-Tellez M, Wilson R, Dunlop M, and

Johnston PG. Chapter 74 – Colorectal Cancer. In: Niederhuber JE, Armitage JO,
Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed.
Philadelphia, Pa. Elsevier: 2020.

Libutti SK, Saltz LB, Willett CG, and Levine RA. Ch 62 - Cancer of the Colon. In: DeVita
VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer:
Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams &
Wilkins; 2019.

Libutti SK, Willett CG, Saltz LB, and Levine RA. Ch 63 - Cancer of the Rectum. In:
DeVita VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer:
Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams &
Wilkins; 2019.

National Cancer Institute. Physician Data Query (PDQ). Colon Cancer Treatment. 2024.
Accessed at https://www.cancer.gov/types/colorectal/hp/colon-treatment-pdq on Feb 5,
2024.

National Cancer Institute. Physician Data Query (PDQ). Rectal Cancer Treatment.
2023. Accessed at https://www.cancer.gov/types/colorectal/hp/rectal-treatment-pdq on
Feb 5, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines

in Oncology: Colon Cancer. V.1.2024. Accessed at
https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf on Feb 6, 2024.

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National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines

in Oncology: Rectal Cancer. V.1.2024. Accessed at
https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf on Feb 5, 2024.

Ohishi T, Kaneko MK, Yoshida Y, Takashima A, Kato Y, Kawada M. Current Targeted

Therapy for Metastatic Colorectal Cancer. Int J Mol Sci. 2023 Jan 15;24(2):1702. doi:
10.3390/ijms24021702. PMID: 36675216; PMCID: PMC9864602.

Last Revised: January 28, 2025

Immunotherapy for Colorectal Cancer

Immunotherapy is the use of medicines to help a person’s own immune system better
recognize and destroy cancer cells.

● Immune checkpoint inhibitors

● Possible side effects of immunotherapy
● More information about immunotherapy

Immune checkpoint inhibitors

For people with either early- or advanced-stage colorectal cancer, immunotherapy is

now a cornerstone of treatment if the tumor has findings of dMMR (deficient mismatch
repair) or MSI-H (microsatellite instability-high).

An important part of the immune system is its ability to keep itself from attacking the
body’s normal cells. To do this, it uses “checkpoints” – proteins on immune cells that
need to be turned on (or off) to start an immune response. Colorectal cancer cells
sometimes use these checkpoints to avoid being attacked by the immune system.
Drugs that target these checkpoints help to restore the immune response against
colorectal cancer cells.

Drugs called checkpoint inhibitors can be used for people whose colorectal cancer
cells have tested positive for specific gene changes1, specifically a high level of
microsatellite instability (MSI-H), or changes in one of the mismatch repair (MMR)
genes. These drugs might be given to people before surgery for early-stage colon
cancer, or to treat people whose cancer can’t be removed with surgery, has come back

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(recurred) after treatment, or has spread to other parts of the body (metastasized).

PD-1 inhibitors

Pembrolizumab (Keytruda), nivolumab (Opdivo), and Dostarlimab (Jemperli) are

drugs that target PD-1, a protein on immune system cells called T cells that normally
help keep these cells from attacking other cells in the body. By blocking PD-1, these
drugs boost the immune response against colorectal cancer cells. They are only given if
the tumor has had findings of dMMR or MSI-H.

Pembrolizumab can be given alone. It is given as an intravenous (IV) infusion every 3 or

6 weeks.

Nivolumab can be given alone or with ipilimumab (see below). It can be given by itself
as an IV infusion every 2 or 4 weeks. If it is used along with ipilimumab, then it is
typically given every 3 weeks.

Dostarlimab can be given alone. It is given as an intravenous (IV) infusion every 3

weeks for 4 treatments, and then given at a higher dose every 6 weeks. This drug is not
approved specifically to treat colorectal cancer at this time. It is approved to treat other
types of cancer, but doctors can prescribe it off-label2 for colorectal cancer. Still, it’s
important to check with your insurance provider before getting this drug to make sure it
is covered.

CTLA-4 inhibitor

Ipilimumab (Yervoy) is another drug that boosts the immune response, but it has a
different target. It blocks CTLA-4, another protein on T cells that normally helps keep
them in check.

This drug can be used along with nivolumab (Opdivo) to treat colorectal cancer. It is
given as an intravenous (IV) infusion, usually once every 3 weeks for 4 treatments.

Possible side effects of immunotherapy

Side effects of these drugs include fatigue, cough, nausea, diarrhea, skin rash, loss of
appetite, constipation, joint pain, and itching.

Other, more serious side effects occur less often.

Infusion reactions: Some people might have an infusion reaction while getting these

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drugs. This is like an allergic reaction, and can include fever, chills, flushing of the face,
rash, itchy skin, feeling dizzy, wheezing, and trouble breathing. It’s important to tell your
doctor right away if you have any of these symptoms while getting these drugs.

Autoimmune reactions: These drugs work by basically removing one of the

safeguards on the body’s immune system. Sometimes the immune system starts
attacking other parts of the body, which can cause serious or even life-threatening
problems in the lungs, intestines, liver, hormone-making glands, nerves, skin, kidney, or
other organs.

It’s very important to report any new side effects during or after treatment with any of
these drugs to your health care team promptly. If serious side effects do occur, you may
need to stop treatment and take high doses of corticosteroids to suppress your immune
system.

More information about immunotherapy

To learn more about how drugs that work on the immune system are used to treat
cancer, see Cancer Immunotherapy3.

To learn about some of the side effects listed here and how to manage them,
see Managing Cancer-related Side Effects4.

Hyperlinks

1. www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-
staging/how-diagnosed.html
2. www.cancer.org/cancer/managing-cancer/treatment-types/off-label-drug-use.html
3. www.cancer.org/cancer/managing-cancer/treatment-types/immunotherapy.html
4. www.cancer.org/cancer/managing-cancer/side-effects.html

References

Boland PM, Ma WW. Immunotherapy for Colorectal Cancer. Cancers (Basel). 2017 May
11;9(5):50. doi: 10.3390/cancers9050050. Erratum in: Cancers (Basel). 2020 May
22;12(5): PMID: 28492495; PMCID: PMC5447960.

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Lawler M, Johnston B, Van Schaeybroeck S, Salto-Tellez M, Wilson R, Dunlop M, and

Johnston PG. Chapter 74 – Colorectal Cancer. In: Niederhuber JE, Armitage JO,
Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed.
Philadelphia, Pa. Elsevier: 2020.

Libutti SK, Saltz LB, Willett CG, and Levine RA. Ch 62 - Cancer of the Colon. In: DeVita
VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer:
Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams &
Wilkins; 2019.

National Cancer Institute. Physician Data Query (PDQ). Colon Cancer Treatment. 2024.
Accessed at https://www.cancer.gov/types/colorectal/hp/colon-treatment-pdq on Feb 5,
2024.

National Cancer Institute. Physician Data Query (PDQ). Rectal Cancer Treatment.
2023. Accessed at https://www.cancer.gov/types/colorectal/hp/rectal-treatment-pdq on
Feb 5, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines

in Oncology: Colon Cancer. V.1.2024. Accessed at
https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf on Feb 6, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines

in Oncology: Rectal Cancer. V.1.2024. Accessed at
https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf on Feb 5, 2024.

Last Revised: April 28, 2025

Treatment of Colon Cancer, by Stage

Treatment for colon cancer is based largely on the stage1 (extent) of the cancer, but
other factors can also be important.

● Treating stage 0 colon cancer

● Treating stage I colon cancer
● Treating stage II colon cancer
● Treating stage III colon cancer

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● Treating stage IV colon cancer

● Treating right-sided versus left-sided colon cancer
● Treating recurrent colon cancer

People with colon cancers that have not spread to distant sites usually have surgery as
the main or first treatment. Chemotherapy may also be used after surgery (called
adjuvant treatment). Most adjuvant treatment is given for about 3 to 6 months.

Treating stage 0 colon cancer

Since stage 0 colon cancers have not grown beyond the inner lining of the colon,
surgery to take out the cancer is often the only treatment needed. In most cases, this
can be done by removing the polyp or taking out the area with cancer through a
colonoscope (local excision). Removing part of the colon (partial colectomy) may be
needed if a cancer is too big to be removed by local excision.

Treating stage I colon cancer

Stage I colon cancers have grown deeper into the layers of the colon wall, but they have
not spread outside the colon wall itself or into the nearby lymph nodes.

Stage I includes cancers that were part of a polyp. If the polyp is removed completely
during colonoscopy, with no cancer cells at the edges (margins) of the removed piece,
no other treatment may be needed.

If the cancer in the polyp is high grade2, or there are cancer cells at the edges of the
polyp, more surgery might be recommended. You might also be advised to have more
surgery if the polyp couldn’t be removed completely or if it had to be removed in many
pieces, making it hard to see if cancer cells were at the edges.

For cancers not in a polyp, partial colectomy surgery to remove the section of colon
that has cancer and nearby lymph nodes is the standard treatment. You typically won’t
need any more treatment.

Treating stage II colon cancer

Stage II colon cancers have grown through the wall of the colon (called the muscularis
propria), and may have even invaded into nearby tissue, but they have not spread to
the lymph nodes.

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Surgery to remove the section of the colon containing the cancer (partial colectomy)
along with nearby lymph nodes may be the only treatment needed.

In certain cases, neoadjuvant therapy (therapy before surgery) may be recommended

for stage II colon cancer, especially if the tumor has invaded or is attached to
neighboring organs (T4b). This is generally considered for locally advanced colon
cancer that is not initially operable. Decisions about what type of neoadjuvant therapy to
give in these cases depends on whether the tumor has dMMR or MSI-H. If the tumor is
dMMR or MSI-H, neoadjuvant immunotherapy (either PD-1 inhibitor alone or
combination PD-1 and CTLA-4 inhibitor) is generally recommended. The type and
duration of this therapy can vary as this approach remains very new. If the tumor is not
dMMR or MSI-H, neoadjuvant chemotherapy is generally recommended.

If you did not receive neoadjuvant chemotherapy, after you recover from the colon
surgery for treatment of Stage II cancer and if the tumor is found to not have dMMR or
MSI-H, your doctor may recommend adjuvant chemo if your cancer has a higher risk of
coming back (recurring) because of certain factors, such as:

● The cancer looks very abnormal (is high grade) when viewed closely in the lab.
● The cancer has grown through the colon wall (T4).
● The cancer has grown into nearby blood or lymph vessels.
● The surgeon did not remove at least 12 lymph nodes.
● Cancer was found in or near the margin (edge) of the removed tissue, meaning that
some cancer may have been left behind.
● The cancer blocked (obstructed) the colon.
● The cancer caused a perforation (hole) in the wall of the colon.

If adjuvant chemo is given for high-risk stage II colon cancers, doctors generally
recommend 5-FU or capecitabine. At times, oxaliplatin may also be offered. Each
patient case is different and requires discussion about the risks and benefits of adjuvant
chemo, as well as which type of chemo. Not all doctors agree on when chemo should
be used for stage II colon cancers. It’s important for you to discuss the risks and
benefits of chemo with your doctor, including how much it might reduce your risk of
recurrence and what the likely side effects will be.

Treating stage III colon cancer

Stage III colon cancers have spread to nearby lymph nodes, but they have not yet
spread to other parts of the body.

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Surgery to remove the section of the colon with the cancer (partial colectomy), along
with nearby lymph nodes, followed by adjuvant chemo is the standard treatment for this
stage.

For chemo, either the FOLFOX (5-FU, leucovorin, and oxaliplatin) or CAPEOX
(capecitabine and oxaliplatin) regimens are used most often, but some patients may get
5-FU with leucovorin or capecitabine alone based on their age and health needs. In the
past, most patients received 6 months of adjuvant chemo for treatment of stage III colon
cancer. Recent research has shown that 3 months of adjuvant chemo for some stage III
colon cancers may be just as effective and is acceptable.

For some advanced colon cancers that cannot be removed completely by surgery
(either tumor has invaded through the colon wall or presence of large bulky lymph
nodes), neoadjuvant chemotherapy or neoadjuvant immunotherapy might be
recommended to shrink the cancer so it can be removed later with surgery.
Neoadjuvant chemotherapy is usually recommended if the tumor is pMMR or MSS.
Neoadjuvant immunotherapy is usually recommended if the tumor is dMMR or MSI-H.

For some advanced cancers that have been removed by surgery but were found to be
attached to a nearby organ or have positive margins (some of the cancer may have
been left behind), adjuvant radiation therapy might be recommended. Radiation therapy
and/or chemo may also be options for people who aren’t healthy enough for surgery or
for when complete resection is not possible due to tumor location.

Treating stage IV colon cancer

Stage IV colon cancers have spread from the colon to distant organs and tissues. Colon
cancer most often spreads to the liver, but it can also spread to other places like the
lungs, brain, peritoneum (the lining of the abdominal cavity), or to distant lymph nodes.

In most cases, surgery is unlikely to cure these cancers. But if there are only a few
small areas of cancer spread (metastases) in the liver or lungs and they can be
removed along with the colon cancer, surgery may help you live longer. This would
mean having surgery to remove the section of the colon containing the cancer along
with nearby lymph nodes, plus surgery to remove the areas of cancer spread. In some
cases, if the liver metastasis is not able to be surgically removed, ablation or
embolization may be an option.

Chemo may be given before and/or after surgery. If the metastases cannot be removed
because they’re too big or there are too many of them, chemo may be given before
surgery (neoadjuvant chemo). Then, if the tumors shrink, surgery may be tried to

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remove them. Chemo might be given again after surgery.

If the cancer has spread too much to try to cure it with surgery, chemo is the main
treatment. Surgery might still be needed if the cancer is blocking the colon or is likely to
do so. Sometimes, such surgery can be avoided by putting a stent (a hollow metal tube)
into the colon during a colonoscopy to keep it open. Otherwise, operations such as a
colectomy or a diverting colostomy (cutting the colon above the level of the cancer and
attaching the end to an opening in the skin on the belly to allow waste out) may be
used.

If you have stage IV cancer and your doctor recommends surgery, it’s very important to
understand the goal of the surgery whether it’s to try to cure the cancer or to prevent or
relieve symptoms of the cancer.

Most people with stage IV cancer will get chemo and/or targeted therapies to control the
cancer. Some of the most commonly used regimens include:

● FOLFOX: leucovorin, 5-FU, and oxaliplatin

● FOLFIRI: leucovorin, 5-FU, and irinotecan
● CAPEOX: capecitabine and oxaliplatin
● FOLFOXIRI: leucovorin, 5-FU, oxaliplatin, and irinotecan
● One of the above chemo combinations, plus one or more targeted drugs
● 5-FU and leucovorin, with or without a targeted drug
● Capecitabine, with or without a targeted drug
● Irinotecan, with or without a targeted drug
● Cetuximab or panitumumab
● Regorafenib, trifluridine and tipiracil (Lonsurf), alone or in combination with
bevacizumab

The choice of regimens depends on several factors, including any previous treatments
you’ve had and your overall health. For people whose cancer cells have changes in
certain genes or proteins, targeted therapy drugs might be part of treatment as well. If
one of these regimens is no longer working, another may be tried.

For people whose cancers cells have high levels of microsatellite instability (MSI) or
changes in one of the MMR genes, an immunotherapy drug, such as pembrolizumab,
nivolumab or dostarlimab, may be an option.

For advanced cancers, radiation therapy can also be used to help prevent or relieve
symptoms in the colon from the cancer such as pain. It might also be used to treat

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areas of spread such as in the lungs or bone. It may shrink tumors for a time, but it’s not
likely to cure the cancer. If your doctor recommends radiation therapy, it’s important that
you understand the goal of treatment.

Treating right-sided versus left-sided colon cancer

In recent years, research has shown that the genetic mutations found in colon cancer
can be different depending on whether it started on the right or left side of the colon.
These differences can affect how the cancer responds to certain treatments as well as a
person’s prognosis (how well they do after treatment).

Right-sided colon cancer

The right-side of the colon includes the cecum, ascending colon, and about 2/3 of the
transverse colon. Cancers that start on the right side of the colon are:

● Less common than left-sided colon cancer

● More likely to occur in older age
● More likely linked to a hereditary cancer syndrome
● More likely to be dMMR or MSI-H
● More likely to have a BRAF or KRAS gene mutation

These cancers tend to have a poorer prognosis if the cancer has advanced or spread
outside the colon, compared to advanced cancers that started on the left. They are also
unlikely to respond to anti-EGFR therapy, even if the tumor tests negative for RAS and
BRAF mutations. Right-sided colon cancer may be more responsive to immunotherapy,
compared to left-sided colon cancers.

Left-sided colon cancer

The left-side of the colon includes the rest of the colon, which includes the remaining
1/3 of the transverse colon, the descending colon, and the sigmoid colon. Cancers that
start on the left side of the colon are:

● More common than right-sided colon cancer

● More likely to occur in younger age
● More likely to be diagnosed at an earlier stage due to symptoms
● More likely to have a HER2 gene mutation

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These cancers tend to have a better prognosis if the cancer has advanced or spread
outside the colon, compared to advanced cancers that started on the right. They are
also more responsive to anti-EGFR therapy, if tests are negative for RAS and BRAF
mutations. Left-sided colon cancers may be more responsive to chemotherapy,
compared to right-sided colon cancers.

Treating recurrent colon cancer

Recurrent cancer means that the cancer has come back after treatment. The recurrence
may be local (near the area of the initial tumor), or it may be in distant organs.

Local recurrence

If the cancer comes back locally, surgery (often followed by chemo) can sometimes help
you live longer and may even cure you. If the cancer can’t be removed surgically,
chemo might be tried first. If it shrinks the tumor enough, surgery might be an option.
This might be followed by more chemo.

Distant recurrence

If the cancer comes back in a distant site, it’s most likely to appear in the liver first.
Surgery might be an option for some people. If not, chemo may be tried to shrink the
tumor(s), which may then be followed by surgery to remove them. Ablation or
embolization techniques might also be an option to treat some liver tumors.

If the cancer has spread too much to be treated with surgery, chemotherapy, targeted
therapies, and/or immunotherapy may be used. Possible treatment schedules are the
same as for stage IV disease.

Your options depend on which, if any, drugs you had before the cancer came back and
how long ago you got them, as well as your overall health. You may still need surgery at
some point to relieve or prevent blockage of the colon or other local problems. Radiation
therapy may be an option to relieve symptoms as well.

Recurrent cancers can often be hard to treat, so you might also want to ask your doctor
if clinical trials3 of newer treatments are available.

For more on recurrence, see Understanding Recurrence4.

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Hyperlinks

1. www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-
staging/staged.html
2. www.cancer.org/cancer/diagnosis-staging/tests/biopsy-and-cytology-
tests/understanding-your-pathology-report/colon-pathology/adenocarcinoma-
starting-in-a-colon-polyp.html
3. www.cancer.org/cancer/managing-cancer/making-treatment-decisions/clinical-
trials.html
4. www.cancer.org/cancer/survivorship/long-term-health-concerns/recurrence.html

References

Lawler M, Johnston B, Van Schaeybroeck S, Salto-Tellez M, Wilson R, Dunlop M, and

Johnston PG. Chapter 74 – Colorectal Cancer. In: Niederhuber JE, Armitage JO,
Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed.
Philadelphia, Pa. Elsevier: 2020.

Libutti SK, Saltz LB, Willett CG, and Levine RA. Ch 62 - Cancer of the Colon. In: DeVita
VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer:
Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams &
Wilkins; 2019.

National Cancer Institute. Physician Data Query (PDQ). Colon Cancer Treatment. 2024.
Accessed at https://www.cancer.gov/types/colorectal/hp/colon-treatment-pdq on Feb 5,
2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines

in Oncology: Colon Cancer. V.1.2024. Accessed at
https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf on Feb 6, 2024.

Last Revised: December 27, 2024

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Treatment of Rectal Cancer, by Stage

Treatment for rectal cancer is based mainly on the stage1 (extent) of the cancer, but
other factors can also be important.

● Treating stage 0 rectal cancer

● Treating stage I rectal cancer
● Treating stage II rectal cancer
● Treating stage III rectal cancer
● Treating stage IV rectal cancer
● Treating recurrent rectal cancer

People with rectal cancers that have not spread to distant sites are usually treated with
surgery. Treatment with radiation and chemotherapy (chemo) may also be given before
or after surgery.

Treating stage 0 rectal cancer

Stage 0 rectal cancers have not grown beyond the inner lining of the rectum. Removing
or destroying the cancer is typically all that’s needed. You can usually be treated with
surgery, such as a polypectomy (removing the polyp), local excision, or transanal
resection. In rare cases, a more extensive surgery might be needed.

Treating stage I rectal cancer

Stage I rectal cancers have grown into deeper layers of the rectal wall but have not
spread outside the rectum itself.

This stage includes cancers that were part of a polyp. If the polyp is removed
completely during colonoscopy, with no cancer at the edges, no other treatment may be
needed. If the cancer in the polyp was high grade (see Colorectal Cancer Stages2), or if
there were cancer cells at the edges of the polyp, you might be advised to have more
surgery. More surgery may also be advised if the polyp couldn’t be removed completely
or if it had to be removed in many pieces, making it hard to see if there were cancer
cells at the edges (margins).

For other stage I cancers, surgery is usually the main treatment. Some small stage I
cancers can be removed through the anus without cutting the abdomen (belly), using
transanal resection or transanal endoscopic microsurgery (TEM). For some, a low

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anterior resection (LAR), proctectomy with coloanal anastomosis, or an

abdominoperineal resection (APR) may be needed, depending on exactly where the
cancer is located within the rectum.

Additional treatment typically isn’t needed after these operations, unless the surgeon
finds the cancer is more advanced than was thought before surgery. If it is more
advanced, a combination of chemo and radiation therapy is usually given. 5-FU and
capecitabine are the chemo drugs most often used.

If you’re not healthy enough to have surgery, you may be treated with chemotherapy
given with radiation therapy.

Treating stage II rectal cancer

Many stage II rectal cancers have grown through the wall of the rectum and might
extend into nearby tissues. They have not spread to the lymph nodes.

For treatment of stage II rectal cancer that is pMMR or MSS, chemotherapy, radiation
therapy, and surgery are usually given, although the order of these treatments might be
different for some people. Recent studies have shown that an approach called total
neoadjuvant therapy (TNT) may be effective and potentially allow people from having to
undergo transabdominal surgery. TNT is when a patient is treated with both
chemotherapy and radiation before surgery. Here is a common approach to treating
these cancers:

● Many people get both chemo and radiation therapy (called chemoradiation) as
their first treatment. The chemo given with radiation is usually either 5-FU or
capecitabine .
● This may be followed by more chemotherapy (without radiation) for several months.
The chemo may be the FOLFOX regimen (oxaliplatin, 5-FU, and leucovorin) or
CAPEOX (capecitabine plus oxaliplatin) based on what’s best suited to your health
needs.
● Afterward, surgery, such as a low anterior resection (LAR), proctectomy with
coloanal anastomosis, or abdominoperineal resection (APR), may be done,
depending on where the cancer is in the rectum. If the chemo and radiation therapy
shrink the tumor enough, sometimes a transanal resection can be done instead of a
more invasive LAR or APR. This might help you avoid having a colostomy. But not
all doctors agree with this method, because it doesn’t let the surgeon check the
nearby lymph nodes for cancer.
● Another option might be to get chemotherapy alone, followed by chemoradiation

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followed by surgery.

For treatment of stage II rectal cancer that is dMMR or MSI-H, immunotherapy is

preferred, but chemotherapy combined with radiation (TNT) is also an option. If you and
your doctor choose to be treated with immunotherapy, it is usually given for 6 months. If
there are no findings of cancer after the immunotherapy treatment by imaging and
scope, no further therapy is given. If there are finding of persistent cancer after the
immunotherapy treatment, combined chemo and radiation may then be given, followed
by surgery.

Treating stage III rectal cancer

Stage III rectal cancers have spread to nearby lymph nodes but not to other parts of the
body.

Treatment for stage III rectal cancer is very similar to that of stage II rectal cancer (see
above).

Treating stage IV rectal cancer

Stage IV rectal cancers have spread to distant organs and tissues, such as the liver or
lungs. Treatment options for stage IV rectal cancer is very similar to that of Stage IV
colon cancer. For more details, refer to Treatment of Colon Cancer, by Stage. For
rectal cancers that don’t shrink with chemo and widespread cancers that are causing
symptoms, treatment is done to relieve symptoms and avoid long-term problems, such
as bleeding or blockage of the intestines. Treatments may include one or more of these:

● Removing the rectal cancer with surgery

● Surgery to create a colostomy and bypass the rectal cancer (a diverting colostomy)
● Using a special laser to destroy the cancer within the rectum
● Placing a stent (hollow metal tube) within the rectum to keep it open; this does not
require surgery
● Chemoradiation therapy
● Chemo alone

Treating recurrent rectal cancer

Recurrent cancer means that the cancer has come back after treatment. It may come

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back near the area of the initial rectal cancer (locally) or in distant organs, like the lungs
or liver. If the cancer does recur, it’s usually in the first 2 to 3 years after surgery, but it
can also recur much later.

Local recurrence

If the cancer comes back in the pelvis (locally), it’s treated with surgery to remove the
cancer, if possible. This surgery is often more extensive than the initial surgery. In some
cases, radiation therapy may be given during the surgery (this is called intraoperative
radiotherapy) or afterward. Chemo may also be given after surgery. Radiation therapy
might be used as well if it was not used before.

Distant recurrence

If the cancer comes back in a distant part of the body, the treatment will depend on
whether it can be removed by surgery.

If the cancer can be removed, surgery is done. Chemo may be given before or after
surgery, too. When the cancer has spread to the liver, chemo may be given through the
hepatic artery leading to the liver.

If the cancer can’t be removed by surgery, chemo and/or targeted therapy drugs may be
used. For people with certain gene changes in their cancer cells, another option might
be treatment with immunotherapy. The drugs used will depend on what drugs a person
has received previously and on their overall health. If the cancer doesn’t shrink, a
different drug combination may be tried.

As with stage IV rectal cancer, surgery, radiation therapy, or other approaches may be
used at some point to relieve symptoms and avoid long-term problems, such as
bleeding or blockage of the intestines.

These cancers can often be hard to treat, so you might also want to ask your doctor if
there are any clinical trials3 of newer treatments that might be right for you.

For more on recurrence, see Understanding Recurrence4.

Hyperlinks

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1. www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-
staging/staged.html
2. www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-
staging/staged.html
3. www.cancer.org/cancer/managing-cancer/making-treatment-decisions/clinical-
trials.html
4. www.cancer.org/cancer/survivorship/long-term-health-concerns/recurrence/coping-
with-cancer-recurrence.html

References

Kelly SR and Nelson H. Chapter 75 – Cancer of the Rectum. In: Niederhuber JE,
Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th
ed. Philadelphia, Pa. Elsevier: 2020.

Libutti SK, Willett CG, Saltz LB, and Levine RA. Ch 63 - Cancer of the Rectum. In:
DeVita VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer:
Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams &
Wilkins; 2019.

National Cancer Institute. Physician Data Query (PDQ). Rectal Cancer Treatment.
2023. Accessed at https://www.cancer.gov/types/colorectal/hp/rectal-treatment-pdq on
Feb 5, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines

in Oncology: Rectal Cancer. V.1.2024. Accessed at
https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf on Feb 5, 2024.

Last Revised: February 5, 2024

Written by

The American Cancer Society medical and editorial content team

(https://www.cancer.org/cancer/acs-medical-content-and-news-staff.html)

Our team is made up of doctors and oncology certified nurses with deep knowledge of
cancer care as well as editors and translators with extensive experience in medical

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writing.

American Cancer Society medical information is copyrighted material. For reprint

requests, please see our Content Usage Policy (www.cancer.org/about-
us/policies/content-usage.html).

cancer.org | 1.800.227.2345

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