Rectal Cancer Treatments

About Rectal Cancer

At Penn Medicine, patients with rectal cancer receive their care from a multidisciplinary team of nationally recognized experts in the diagnosis, treatment and research of rectal cancer.

The rectum is a 5-inch structure located at the end of the colon. The rectum is usually empty except when stool is propelled by the upper colon into the rectum just prior to a bowel movement.

Rectal cancer is cancerous tissue that grows along and invades the wall of the rectum. Rectal cancer and colon cancer are very similar and share many common features.  The difference in location creates important differences in how each is treated.   Rectal cancer, like colon cancer, may start as a polyp that becomes cancerous.

Penn Medicine’s multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more About Rectal Cancer

Diagnosing Rectal Cancer

An accurate cancer diagnosis from trusted cancer specialists is the first step in getting personalized treatment options to treat rectal cancer.

Patients who choose Penn’s Abramson Cancer Center benefit from a multidisciplinary team of cancer specialists including gastroenterologists, radiologists, pathologists and surgeons who work together to provide a diagnosis and treatment plan custom designed for each patient with rectal cancer.

Cancer specialists at Penn Medicine are highly experienced in using the most advanced techniques for diagnosing rectal cancer and are actively researching better and more precise ways to detect rectal cancer.

Because an accurate diagnosis is a critical step in planning cancer treatment, it’s important patients know that when they come to the Abramson Cancer Center, they are taking an important step in getting the best cancer treatment.

Navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right person. Penn Medicine’s contact center has experienced cancer nurses available and ready to guide patients in finding the cancer specialist right for them.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more Diagnosing Rectal Cancer

Rectal Cancer Treatments

Following the diagnosis and staging of rectal cancer, cancer specialists at Penn’s Abramson Cancer Center develop a personalized treatment plan. Penn’s treatment options for rectal cancer include:

  • Surgery
    • Local excision via the anus through transanal endoscopic microsurgery (TEM) or endoscopic mucosal resection (EMR)
    • Laparoscopic, robotic-assisted or open excision
    • Pelvic exenteration (removal of other affected organs in the pelvis)
  • Radiation therapy
    • Three-dimensional conformal radiation
    • Intensity-modulated radiation therapy (IMRT)
    • Proton therapy
    • Volumetric-modulated arc therapy
  • Chemotherapy and biologic therapies
    • Chemotherapy
    • Monocolonal antibiody therapy
  • Clinical trials
    • Monoclonal antibody therapy
  • Other treatments
    • Integrative medicine and wellness
    • Palliative care
    • Penn Home Care and Hospice Services

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).


Surgery for Rectal Cancer

Surgery is the most common treatment for all stages of rectal cancer. Unlike colon cancer, the rectum resides within the bony pelvis. Because of this, the treatment of rectal cancer differs from colon cancer substantially. The type of procedure recommended, and the addition of chemotherapy and radiation may be possible depending on the stage of the rectal cancer. It is very important to correctly stage, determine both local and distant spread, of rectal cancer before proceeding with surgery or other treatments.

Rectal cancer is divided into early and late or “advanced” stage.  Early stage rectal cancers are those that have not spread to the lymph nodes and are confined to the inner layer of the rectal wall.  Late stage rectal cancers have either spread through the wall of the rectum into the fat surrounding the rectum (mesorectum) or involve lymph nodes in the mesorectum. 

Early rectal cancer

If a rectal cancer is early, then several options may be open to the patient.  Some very small early rectal cancers can be removed through the anus through:

  • Traditional open approach.
  • Transanal endoscopic microsurgery (TEM)
  • Endoscopic mucosal resection (EMR) 

This is called “local excision.” Typically, these cancers must be removed entirely with no tumor left behind. They must be “good risk” nonaggressive cancers to be treated with local excision and they may need additional chemotherapy and radiation added to the surgery to ensure optimal results. 

Small early stage rectal cancers that are located higher in the rectum must be taken out along with part or all of the rectum through an abdominal incision, either laparoscopically or in an open fashion. Consultation between the surgeon or gastroenterologist, the oncologist, and the radiation oncologist is typically made prior to making a final decision on treatment.

Late rectal cancer

Late or advanced stage rectal cancer simply refers to the fact that the tumor invades through the rectal wall or involves perirectal lymph nodes. Surgeons almost always pre-treat advanced rectal cancer with a combination of chemotherapy and radiation given simultaneously in order to reduce the size of the tumor and help prevent recurrence of the cancer in the area of the pelvis. 

Following radiation and chemotherapy, surgery to remove both the rectum and the surrounding lymph nodes is required. This can be done either laparoscopically or in an open fashion, and typically requires an abdominal incision.  The type of gastrointestinal reconstruction and need for a colostomy or ileostomy bag is based on the distance of the tumor from the anal sphincter muscle as well as individual patient characteristics.  

Resection

“Resection” refers to the removal of tissue.  If the cancer has spread into the wall of the rectum, the section of the rectum with the cancer and nearby healthy tissue is removed. Sometimes, the tissue between the rectum and the abdominal wall is also removed. The lymph nodes near the rectum are removed and checked under a microscope for signs of cancer.

Pelvic Exenteration

If the cancer has spread to other organs near the rectum, removal of the lower colon, rectum and bladder is possible. In addition, in women the uterus, cervix, vagina, ovaries and nearby lymph nodes may require removal. In men, the prostate may be removed. Colostomy or ileostomy for stool and urostomy for urine are created for urine and stool to flow from the body into a collection bag.

Radiation Therapy for Rectal Cancer

Radiation oncologists at Penn Medicine are recognized for techniques that target radiation precisely to the disease site while sparing nearby tissue.

Radiation therapy may be given to patients with rectal cancer before surgery to shrink the tumor and make it easier to remove.

Proton therapy is currently used to treat recurrent tumors in the digestive tract. Penn Medicine is the only facility in the country treating gastrointestinal cancers in this way.

Radiation therapy uses high-energy radiation to kill cancer cells. A radiation therapy schedule usually consists of a specific number of treatments given over an extended period of time. In many cases, radiation therapy is capable of killing all of the cancer cells.

Three-dimensional Conformal Radiation Therapy

The imaging technology used by radiation oncologists at Penn Medicine helps shape the radiation treatment beam to the shape of the tumor. Conformal radiation therapy gives doctors more control when treating tumors.

Special computers use CT imaging scans to create 3D maps of the location of the cancer in the body. The system permits the delivery of radiation from several directions, and the beams can then be shaped, or conformed, to match the shape of the cancer. Conformal radiation therapy limits radiation exposure to nearby healthy tissue as well as the tissue in the beam's path.

Intensity-modulated Radiation Therapy (IMRT)

This advanced type of radiation therapy uses a computer-controlled device, called a linear accelerator, to deliver precise doses of radiation to tumors or specific areas within the tumors. Radiation therapy, including IMRT, stops cancer cells from dividing and growing, thus slowing or stopping tumor growth. In many cases, radiation therapy is capable of killing all of the cancer cells.

Using 3-D computed tomography (CT) images of the gallbladder along with computerized dose calculations, IMRT allows for the radiation dose to conform more precisely to the shape of the tumor by controlling, or modulating, the intensity of the radiation beam. The therapy allows higher radiation doses to be delivered to areas within the tumor while minimizing the dose to the surrounding area.

Volumetric-modulated Arc Therapy (VMAT)

Volumetric-modulated arc therapy (VMAT) is a type of specialized intensity modulated radiation therapy, or IMRT. VMAT delivers radiation by rotating the radiation machine, through one or more arcs while radiation is continuously delivered.

VMAT allows Penn radiation oncologists to treat complex cancers while minimizing exposure to surrounding healthy tissue. VMAT shortens radiation delivery time, and offers patient more comfort because it does not require patients to lie completely still for long periods of time.

Penn radiation oncologists use RapidArc™ radiotherapy technology to treat hard to reach tumors.

Proton Therapy

Penn Medicine is the only health care facility in the country that is using proton therapy to treat recurrent gastrointestinal tumors in clinical trials.

Penn Medicine's Roberts Proton Therapy Center is the largest and most advanced facility in the world for this precise form of cancer radiation. Patients have access to one of the most sophisticated weapons against cancer, seamlessly integrated with the full range of oncology services available at Penn Medicine. Proton therapy is external beam radiotherapy in which protons are directed at a tumor.

The radiation dose that is given through protons is very precise, and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation. The result is a better chance for curing cancer with fewer harmful side effects.

Proton therapy, like all forms of radiation therapy, works by aiming the energized particles, in this case protons, onto the target tumor. The particles damage the DNA of cells, ultimately causing their death. Unlike X-rays, protons can be manipulated to release most of their energy only when they reach their target. With more energy reaching the cancerous cells, more damage is administered by each burst of radiation.

Chemotherapy and Biologic Therapies for Rectal Cancer

Penn Medicine specializes in a team approach to treatment with interdisciplinary care and innovative approaches that use chemotherapy to target tumors prior to and after surgery.

Chemotherapy may be given to patients with rectal cancer before surgery to shrink the tumor and make it easier to remove.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is usually delivered intravenously through a catheter, or orally by pill.

Clinical Trials for Rectal Cancer

Today, more and more people are surviving cancer. Clinical trials benefit patients with access to breakthrough therapies and treatments. These new advances in cancer treatment are occurring every day at Penn Medicine, giving patients hope that even greater discoveries lie ahead. Through clinical trials:

  • Diagnosing cancer has become more precise.
  • Radiation and surgical techniques have advanced.
  • Medications are more successful.
  • Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes.
  • Strategies to address the late effects of cancer and its treatment are improving quality of life.

Other Treatments for Rectal Cancer

In addition to standard treatments and clinical trials, patients at Penn Medicine may wish to add additional therapies and treatments such as massage therapy, acupuncture and art therapy. These therapies do not have curative intent, and are designed to complement standard treatments, not take their place.

Integrative Medicine and Wellness Programs

At Penn Medicine, integrative medicine and wellness services can supplement traditional cancer treatments such as chemotherapy, surgery and radiation therapy. While conventional medicine plays a critical role in eradicating cancer, integrative medicine and wellness programs offer patients and their families ways to enhance the quality of their lives, minimize or reduce the side effects of cancer and cancer treatment, and promote healing and recovery.

The physicians at Penn Medicine are knowledgeable and supportive of complementary cancer treatments. The cancer team works with patients and families to integrate these supportive programs into the overall care plan, while ensuring the safety and health of patients.

The Abramson Cancer Center’s range of integrative supportive services is designed to help patients cope with the cancer experience and improve their overall sense of well-being. Services include:

The Abramson Cancer Center at Pennsylvania Hospital at Pennsylvania Hospital offers a variety of supportive care programs for patients and families, from diagnosis through survivorship. These programs are available at no cost to the patients treated at Pennsylvania Hospital, and some are open to patients treated elsewhere. These services include social work counseling, nutrition counseling, psychological counseling and spiritual counseling.

The Cancer Appetite and Rehabilitation Clinic focuses on patients with loss of appetite and weight as well as deconditioning.

The Supportive Care Clinic helps to manage cancer related symptoms and goals of care.

Integrative support programs include:

Support groups and educational programs are available at Pennsylvania Hospital throughout the year.

Palliative Care

Palliative care provides medical and non-medical interventions to ease the symptoms of cancer and its treatment. Palliative care includes physicial, emotional and spiritual care that can enhance the quality of life for cancer patients.

Palliative care can be used to complement traditional cancer therapies, or to improve quality of life when curative therapies are no longer an option.

Palliative care is an approach to patient care that can be integrated with curative therapies at any point from diagnosis to survivorship or end-of-life care.

Palliative care services include palliative chemotherapy, radiation therapy and surgery as well as psychological counseling, art therapy and support groups for patients and families. The goals of palliative care are to enhance the quality of life for cancer patients and their families, and provide emotional and spiritual support to enhance personal growth.

Palliative care services are offered at Pennsylvania Hospital, and at the Hospital of the University of Pennsylvania.  

Penn Home Care and Hospice Services

Penn Home Care and Hospice Services offer a full range of home health care needs by partnering three top-level home health care services under one roof:

Penn Home Care and Hospice Services offer an array of specialized therapies and medications for patients with cancer and cancer-related conditions.

Rectal Cancer Survivorship

Survivorship programs at Penn Medicine are a distinct phase of cancer care and are designed to help patients' transition from their cancer treatment routine to a post-cancer care lifestyle.

There are more than 12 million cancer survivors living and thriving today as a result of advances in cancer treatment. However, cancer treatments can result in physical, emotional and financial complications long after the therapy is complete.

Read more Rectal Cancer Survivorship


Nicholas Martell

Nicholas Martell was first diagnosed with prostate cancer more than ten years ago. He was healthy for many years after being treated with radiation therapy. Nick recently experienced a recurrence of his cancer. Physicians at Penn tailored his treatment

Stand Up to Cancer

Peter O'Dwyer, MD, professor of Hematology-Oncology and program director of Development Therapeutics in the Abramson Cancer Center, was interviewed on NBC10's 10! Show about Penn's work as part of the Stand Up to Cancer Dream Team... Read more

Clinical Trials

Clinical trials are studies to find new ways to prevent, detect and treat cancer. The purpose of each clinical trial is to answer a specific question. Our physicians carefully design these studies to find new ways to improve care and quality of life ...


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