Many persons with early-stage cancer of the rectum for which all visible cancer can be removed by surgery can be cured. Radiation therapy may be used before or after surgery to help prevent a recurrence (return) of cancer and increase the chance for cure. However, there has been some debate about whether radiation therapy given before surgery increases the risk for complications related to the subsequent surgery. Recently, researchers found that, in fact, radiation therapy given before surgery for stage I to III rectal cancer reduced recurrences and improved survival.

Cancer of the rectum is characterized by the presence of cancer cells in the rectum, the last 10 inches or so of the colon (or large bowel), a part of the body’s digestive system.

Stage I rectal cancer is cancer that involves the top lining, second and third layers, and the inside wall of the rectum, but has not spread to the outer wall or outside of the the rectum (also called stage Dukes A).

Stage II rectal cancer is cancer that has originated in and has spread outside the rectum, but not to the nearby lymph nodes (also called stage Dukes B).

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Stage III rectal cancer has spread outside the rectum and to the nearby lymph nodes, but not to other parts of the body (also called stage Dukes C). Persons who have stage I to III rectal cancer that can be removed by surgery can sometimes be cured with surgery alone. However, radiation therapy is sometimes used before or after surgery to help prevent recurrence (return) of the cancer in the rectum or in distant parts of the body. Researchers in Sweden sought to determine whether radiation therapy before surgery would indeed prevent recurrences and improve survival for persons with rectal cancer.

Swedish researchers assigned 1168 persons with stage I to III rectal cancer to receive either A) surgery alone or B) radiation therapy followed by surgery. The results showed that 908 persons were able to have all visible cancer removed by surgery. Of these persons, 38% of those who received surgery alone had a recurrence of cancer, compared with only 28% of those who also had radiation therapy. Overall, the 5-year survival rates were 58% in the group that received radiation and 48% in the group that underwent surgery only. For those who had successful surgical removal of all visible cancer, the 9-year survival rates were 74% in those receiving radiation therapy and 65% in those having surgery alone.

The researchers concluded that radiation therapy before surgery may reduce cancer recurrences and improve survival for persons with stage I to III rectal cancer. Individuals with this type of disease may wish to talk with their doctor about the risks and benefits of receiving radiation therapy before surgery or of participating in a clinical trial in which other new treatments approaches are being studied. Sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute (cancer.gov) and the Clinical Trials section and service offered by Cancer Consultants.com (www.411cancer.com). (New England Journal of Medicine, Vol 336, No 14, pp 980-987, 1997)

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