Rectal Cancer

Rectal Cancer

MSK surgeon, Emmanuel Pappou, smiles at the camera while dressed in his scrubs.

Martin Weiser and other MSK surgeons have special expertise in minimally invasive techniques that help people preserve their ability to use the bathroom normally as well as their sexual health and quality of life after surgery for rectal cancer.

You may be reading this because you or someone you care about has been diagnosed with rectal cancer. Or you may be having symptoms that make you concerned you may have colon or rectal cancer. Learning as much as you can about the disease can help you feel better prepared to speak with a doctor about your condition and options for screening and treatment.

You may feel worried and overwhelmed. This is a good place to begin to look for help. From here you can visit other sections of this guide for more in-depth information.

We are here to help you every step of the way.


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What is rectal cancer?

Rectal cancer forms inside a portion of the large intestine, which is roughly five and a half feet long. The first five feet of the large intestine is called the colon. The colon absorbs water from stool. The rectum makes up the last six inches of the large intestine. The rectum is where the body stores stool until you have a bowel movement. Cancers found in the two organs are often grouped together as colorectal cancer.

Rectal cancer often develops slowly over several years. It typically starts as a small abnormal growth on the inner lining of the rectum. This is called a polyp. Some polyps can eventually grow into cancer.

Rectal cancer is often contained within the rectum. But if left untreated, it can spread to other organs, most often the liver and lungs.

A small percentage of rectal cancer is due to genetic causes that may be passed from parents to children.

Learn more about colon cancer.

Learn more about the genetic causes of rectal cancer.

Is rectal cancer different from colon cancer?

Both are cancers of the large intestine. They can cause the same symptoms and are diagnosed the same way, usually by a colonoscopy.

However, colon and rectal cancer may be treated differently. Surgery is the most common treatment for colon cancer, which develops in the first five feet of the large intestine and is located in the belly. The belly is a relatively large and open space for a surgeon to operate in.

Surgery is also commonly used to treat rectal cancer, often in combination with other therapies. However, the rectum can be more challenging for surgery. It is surrounded by the bones of the pelvis, and the area around the rectum is more crowded. The rectum is very close to the bladder, and to the vagina and uterus for women and to the prostate for men.

Tumors in the lower rectum may also be close to the anal sphincter muscle, which is important for using the bathroom normally. All of these factors can affect treatment options for rectal cancer.

Learn more about treatments for rectal cancer.
Learn more about treatments for colon cancer.

What are the signs and symptoms of rectal cancer?

Rectal cancer often does not cause symptoms in the early stages. That’s why we recommend that you get regular screenings for colorectal cancer depending on your age, medical history, and other risk factors.

There are some signs of rectal cancer that you should not ignore, including changes in your bowel habits that are significant or last longer than a few days.

If you are younger than 45 and have not been screened for colorectal cancer, it’s particularly important that you do not ignore any symptoms. The typical age to begin screening for colorectal cancer is now 45 years old. But recently there has been a troubling rise in colorectal cancer among people as young as their 20s and 30s who have no family history or risk factors for colorectal cancer.

Learn more about the signs and symptoms of rectal cancer.

Learn more about colon and rectal cancer before 50.

Am I at risk for getting rectal cancer?

Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. About 145,000 people are newly diagnosed with colorectal cancer each year, and 44,000 of them have rectal cancer.

Your risk of rectal cancer depends on many factors. You can control some of them but others you can’t, including:

  • age – the older you are, the more likely you are to develop rectal cancer
  • diet, exercise, and tobacco and alcohol use
  • a personal history of polyps and inflammatory bowel diseases, including ulcerative colitis and Crohn’s colitis
  • a family history of colorectal and related cancers and inherited disorders, including Lynch syndrome and familial adenomatous polyposis
  • genetics— about 5 to 10 percent of colorectal cancer is due to genetic causes passed from parents to children.

Learn more about the risk factors for rectal cancer.

Learn more about genetic testing for rectal cancer.

Should I get screened for colorectal cancer?

Colorectal cancer can usually be cured if found early enough.
Memorial Sloan Kettering’s guidelines recommend that you get screened for colorectal cancer every ten years beginning at age 45, if you have an average risk and no symptoms. If you are at a higher risk, you should have screenings more often, depending on your age as well as your personal and family medical history.

At MSK, a colonoscopy is the preferred colorectal cancer screening method. This procedure detects polyps. These abnormal growths of tissue inside the colon and rectum can grow into cancer. A colonoscopy can also remove polyps before they become cancerous.

Learn more about a colonoscopy and other screening tests for colorectal cancer.

How is rectal cancer diagnosed?

If rectal cancer is suspected, a specialist will do a colonoscopy. This is a test in which a small piece of tissue is removed to look for signs of cancer. This sample is examined under a microscope by a pathologist (a doctor who specializes in diagnosing disease).

If you are diagnosed with rectal cancer, the next step is determining how advanced the disease is. This is called staging. Your care team may recommend CT and MRI scans and other tests to see if the cancer has spread outside the rectum to other organs.

What are the types of rectal cancer?

The vast majority of rectal cancer is a type called adenocarcinoma. This is a cancer of the cells that line the inside surface of the rectum. Rarer tumor types include:

  • carcinoid tumors, which start in hormone-producing cells in the intestines
  • gastrointestinal stromal tumors (a type of soft tissue sarcoma that can be found anywhere in the gastrointestinal tract but is rare in the rectum) or other types of sarcoma that start in the blood vessels or connective tissue of the rectum
  • lymphoma, which is a cancer of the immune system that more commonly starts in the lymph nodes but can start in the rectum

Learn more about the types of rectal cancer.

What are the stages of rectal cancer?

Stages describe how widespread the cancer is in the rectum and whether it has spread (metastasized) to other organs. This is crucial information for MSK doctors when tailoring a care plan for you.
There are five stages of rectal cancer.

  • Stage 0: This very early cancer is found only in the innermost lining of the rectum wall.
  • Stage I: The tumor has spread beyond the inner lining but remains within the rectum wall and has not spread to the lymph nodes (small organs that are part of the immune system).
  • Stage II: The cancer extends through the thick outer muscle layer of the rectum but has not spread to the lymph nodes.
  • Stage III: The cancer has spread outside the rectum to one or more lymph nodes.
  • Stage IV: The cancer has spread to other parts of the body, such as the liver or lungs. The cancer may be in the lymph nodes.

Learn more about the stages of rectal cancer.

Rectal Cancer Treatment Without Radiation: A New Option
Learn about a clinical trial at Memorial Sloan Kettering that gives people with rectal cancer a new option to be treated without radiation.

What are the treatments for rectal cancer?

If you are diagnosed with rectal cancer, your doctors will discuss treatment options with you. To make an informed choice, ask about the pros and cons of each option, potential side effects, and how effective the treatment is likely to be.

We understand how important quality of life is. We always try to preserve your ability to use the bathroom normally as well as your sexual health. There are several ways to treat rectal cancer depending on the stage and location of the disease. These methods are often used in combination, including:

  • Surgery to remove the cancer. Early-stage rectal cancer can often be treated with a minimally invasive procedure, which uses a smaller incision (cut) than traditional surgery. This includes robot-assisted surgery. With some procedures, doctors use special tools so that they can avoid an incision. For more advanced cancer, surgery may still be appropriate, usually with chemotherapy or radiation before, during, or after surgery.
  • Chemotherapy with drugs that shrink or kill cancer cells. This can be done before, during, or after surgery.
  • Radiation using high-energy rays or radioactive seeds to shrink or kill cancer cells. These therapies use sophisticated, highly precise imaging tools to deliver powerful doses of radiation directly to a tumor while avoiding damage to normal cells.
  • Watch-and-wait therapy (nonoperative management). MSK doctors have helped pioneer rectal cancer treatments with a combination of chemotherapy and radiation for people with stage II and III cancer that spare them from surgery.
  • Targeted therapy that attacks genetic weaknesses in cancer cells. This treatment spares normal cells.
  • Immunotherapy. This helps unleash your body’s own immune system to fight cancer.

Learn more about rectal cancer treatments.

What are the treatments for rectal cancer that has spread (metastatic cancer)?

If the cancer has spread (metastasized) beyond the rectum, there are many options for treatment.

  • Surgery can remove tumors that have spread from the rectum to other organs, such as the liver or lungs.
  • Chemotherapy and radiation therapy can shrink or kill cancer cells. They are often used together.
  • MSK is a leader in the development of total neoadjuvant therapy (TNT) for rectal cancer. This uses chemotherapy combined with radiation before surgery. Research suggests that TNT helps kill cancer cells that can go undetected.
  • Therapies are available that target portions of cancer cell DNA (targeted therapies) or boost your body’s immune system to fight cancer (immunotherapy). These are effective for a relatively small number of people.

Learn more about treatments for metastatic rectal cancer.

How will rectal cancer treatment affect my quality of life?

After the shock of a rectal cancer diagnosis, you may have many questions about how treatment will affect you, including your ability to use the bathroom normally as well as your sexual health.

At MSK, preserving these functions is one of our key goals. Your care team will focus on your quality of life from the very beginning of treatment. We will tailor a personalized plan for you. Because we care for many people with rectal cancer, we have unparalleled expertise in protecting what’s most important to you.

Learn more about rectal cancer treatment and how we preserve your quality of life.

Why should I choose Memorial Sloan Kettering for rectal cancer treatment?

If you are facing rectal cancer, we understand how much you want to regain a sense of control over your life. Deciding where to be treated is a crucial step.

MSK is recognized around the world as a leader in pioneering new ways to treat rectal cancer, so we can tailor a treatment specifically for you. Each year we care for more than 1,200 people with colon and rectal cancer. We cure or control the disease for people facing every form of colorectal cancer, from the earliest stages to the rarest and most complex.

Many of the most advanced treatments available today were developed or first studied by our colorectal cancer team. That means the people we care for may have access to clinical trials with new therapy options that may not be available at other hospitals.

We believe you should choose MSK because we offer:

  • Compassionate care from a team of experts. Our staff includes more than 70 colorectal cancer specialists from diverse fields, including surgery, chemotherapy, radiology, pathology, and symptom management. Many of them are nationally or internationally recognized.
  • The most-advanced rectal cancer treatments, including minimally invasive surgeries, which use smaller incisions (cuts) than traditional surgeries. MSK’s surgeons are particularly skilled at methods that use a robotic system so they can be even more precise. MSK doctors perform more of these kinds of surgeries than doctors at any other institution in the country. This gives us a high level of expertise that reduces recovery time and leads to fewer complications.
  • Leadership in developing the next generation of rectal cancer treatments. At MSK, we helped pioneer total neoadjuvant therapy. This treatment uses precisely calibrated chemotherapy and radiation therapy before surgery for advanced cancer. We also helped lead the way with watch-and-wait therapy, which can spare people the risks of surgery.
  • A commitment to your quality of life. Our specialists take every measure to preserve your ability to use the bathroom normally as well as your sexual health. We can help you not just survive but thrive.
  • Expertise in diagnosing and treating hereditary, rare, or complex rectal cancer. As the world’s largest nonprofit cancer center, we have extensive experience in curing or controlling all forms of the disease.
  • Personalized treatment. We use state-of-the-art genetic testing and other methods to predict which treatments are most likely to be effective for our patients.
  • The first clinic in the world for people under 50 with colorectal cancer. The Center for Young Onset Colorectal and Gastrointestinal Cancer was created to address a troubling rise in colorectal and GI cancer among people as young as their 20s and 30s. The specialists at the center help younger patients with the specific challenges they face while advancing research into the causes of this disturbing new trend.
  • Personalized screening and monitoring after treatment to keep you healthy. This includes the Hereditary Colorectal Cancer Family Registry for families who are affected by genetic colorectal cancer syndromes and may be at an elevated risk.
  • A dedication to giving you the best outcome possible and ensuring that you are happy with your care. We track patient satisfaction and use your feedback to continually improve.
  • Flexibility in how and where to receive treatment. Our specialists are conveniently located in Manhattan and at our regional outpatient locations in New Jersey, on Long Island, and in Westchester County. This provides our patients with the same outstanding care from MSK doctors closer to home.
  • Emotional support at MSK’s Counseling Center and wellness therapies from integrative medicine specialists if you need help relieving symptoms after treatment.
  • A personalized survivorship care plan with the medical guidance you’ll need to go back to a healthy life after rectal cancer treatmentWatch a video to learn more about MSK’s Adult Survivorship Program.