Rectal Cancer Treatment

Rectal cancer and colon cancer are technically the same disease. But because the rectum is embedded deeply in the pelvis, it can be more difficult to remove rectal tumors surgically. Washington University Physicians at Siteman use a number of techniques, including radiation and chemotherapy, to treat rectal cancer without surgery or to better ensure that surgery will be a success.

How is rectal cancer treated?

Depending on the stage and location of the tumor, some rectal cancer patients will be treated with surgery alone. Other rectal cancer patients will receive a combination of chemotherapy and radiation therapy known as total neoadjuvant therapy, which shrinks tumors so they can be removed more easily. Combinations of chemotherapy and radiation, or chemoradiation, can also be used to treat patients who aren’t eligible for surgery.

Chemotherapy is one type of a class of treatments known as systemic therapies. These are medicines that kill or deactivate cancer cells. In addition to chemotherapy, the other systemic therapies available for rectal cancer are immunotherapy and molecularly targeted therapy. However, these treatments are only given to patients with advanced rectal cancers that have certain genetic features.

If the stage and characteristics of your cancer meet the criteria, you may be treated with immunotherapy or targeted therapy. There are also ongoing clinical trials at Siteman seeking to apply these drugs to other groups of patients. Ask your physicians if a clinical trial might be helpful to you.

What surgeries are done for rectal cancer?

Surgery for rectal cancer involves a delicate balance between getting rid of the cancer and optimizing bowel function. That requires doctors who collaborate as ours do. The colorectal surgeons at Siteman strive to preserve bowel function as much as possible with innovative, “sphincter sparing” procedures.

Learn more about surgery for rectal cancer.

What is total neoadjuvant therapy for rectal cancer?

The purpose of total neoadjuvant therapy, or TNT, is to shrink rectal tumors so they can be removed surgically. Patients first undergo a course of radiation therapy, and then receive chemotherapy for a period of weeks.

Total neoadjuvant therapy can take as long as six months. Radiation oncologists at Siteman, however, have shortened TNT by nine to 14 weeks. They have achieved this, in large part, by significantly reducing the length of radiation therapy from six weeks to just five days. This new approach to radiation, also called short-course pre-operative radiation, can improve the overall outcomes of total neoadjuvant therapy, such that some patients don’t even need surgery afterwards.

Siteman is the only treatment center in the United States to offer short-course pre-operative radiation as a component of TNT.

Learn more about radiation therapy for rectal cancer