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.

Treatment for rectal cancer

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 (TNT), 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.

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 for rectal cancer at Siteman seeking to apply these drugs to other groups of patients. Ask your physician if a clinical trial might be right for you.

Chemotherapy

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.

Other systemic therapies

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 for rectal cancer at Siteman seeking to apply these drugs to other groups of patients. Ask your physician if a clinical trial might be right for you.

Surgery for rectal cancer

Rectal cancer surgery involves a delicate balance between getting rid of the cancer and optimizing bowel function. Washington University colorectal surgeons at Siteman are leaders in their field and strive to preserve bowel function as much as possible with innovative “sphincter-sparing” procedures.

Total neoadjuvant therapy (TNT) for rectal cancer

TNT is an approach where both chemotherapy and radiotherapy are delivered prior to surgery to shrink tumors and ideally spare patients from a permanent colostomy.

How long does TNT take?

TNT can take as long as six months. However, Washington University radiation oncologists at Siteman have shortened TNT by nine to 14 weeks. A big reason for this was that our experts significantly reduced 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 TNT. Some patients don’t even need surgery afterwards!

What sets Siteman apart when it comes to TNT?

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