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Colorectal Cancer

Duke’s colorectal cancer specialists use the latest medical and surgical advances to detect and treat colorectal cancer at the earliest-possible stage. If you need surgery, our surgeons are skilled at performing sphincter-sparing procedures that may reduce your chance of needing a permanent colostomy bag. Not every patient is eligible for this type of procedure and the team will determine the best surgery for your cancer and outline a plan to maximize your quality of life and your colon health.

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Colorectal Cancer Treatments

Colorectal cancer starts in the digestive system. It can begin in the colon (the longest part of the large intestine) or the rectum (the last several inches of the large intestine). Understanding where your cancer originated is important for determining the best treatment options. Depending on the location and characteristics of your tumor, you may benefit from surgery, radiation, immunotherapy, chemotherapy, or a combination of these treatments.

Colonoscopies are used for the detection of early colorectal cancers. If caught early, colorectal cancer can be cured.

Our Locations

Duke Cancer Centers are located in Cary, Raleigh, Durham, and throughout the Triangle.

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Surgery for Colorectal Cancer

While surgery is the most common treatment for colorectal cancer, the type of surgery you need depends on the location and size of the tumor and whether cancer has spread. Whenever possible, our surgeons use a minimally invasive surgical approach that results in less scarring, reduced pain and infection risk, shorter hospital stays, and quicker recovery.

Polypectomy

Colonoscopies can detect polyps at a precancerous stage, and removing them during a colonoscopy can prevent cancer from developing at all.

Endoscopic Mucosal Resection

Endoscopic procedures are performed through an endoscope, a flexible tube used to reach your gastrointestinal (GI) tract. An electrical device is passed through the tube to remove early-stage cancers, precancerous growths, and surrounding tissue from the GI lining. Tumors that have penetrated deeper layers of the GI wall can be removed through different but similar procedures called endoscopic submucosal dissection or endoscopic full-thickness resection.

Transanal Endoscopic Microsurgery

We are one of the few centers in the region experienced in performing this minimally invasive approach to remove less-invasive rectal cancers and large rectal polyps that cannot be removed through an endoscopic procedure. Surgeons use a proctoscope to perform microsurgery inside the rectum. There are no visible scars, and you recover faster and experience minimal pain.

Partial Proctectomy or Colectomy, Total Proctectomy

A partial colectomy or proctectomy may be performed to remove the area of the colon or rectum where the cancer is located as well as associated lymph nodes. The procedure is often performed laparoscopically or robotically for faster recovery. In select cases, a total proctocolectomy, which removes the entire colon and rectum, may be required for hereditary cancers or when there are multiple sites of cancer. For each of these operations, there are reconstructive options available. Surgery to remove the entire anus, requiring a permanent waste bag, is only needed if the cancer is at the very end of the bowel, where it exits the body.

Pelvic Exenteration

If the tumor has spread to organs near the rectum, it may be necessary to remove the rectum and bladder. In some women, the cervix, vagina, ovaries, and nearby lymph nodes may be removed. In men, the prostate may be removed. Our teams work together to remove the cancer and create artificial openings that allow body waste to empty into bags.

Stent Placement

An expanding metal scaffolding device called an endoluminal stent may be inserted into the colon through a small, lighted endoscope to clear a blockage created by a tumor. A stent can also be used to keep the colon or rectum open if it has been blocked by a tumor. This type of stent relieves painful symptoms and improves quality of life.

Radiation Therapy, Chemotherapy, and Other Treatments

Cancer that starts in the colon is generally treated with surgery, which may or may not be followed by chemotherapy. Rectal cancer surgery is often preceded by chemotherapy and radiation therapy, separately or together.

Intraoperative Radiotherapy (IORT)

When a tumor has spread, sometimes it requires a variety of approaches to achieve the best chance for cure. Intraoperative radiation at Duke University Hospital allows your care team to deliver a highly specialized, high-dose form of radiation to the region of the tumor in the operating room while limiting the amount of radiation to nearby normal tissues.

Chemotherapy

Chemotherapy can slow or kill tumor growth. It is sometimes recommended after surgery if recurrence risk is high and if colorectal cancer has spread to lymph nodes or beyond.

Targeted Therapy or Immunotherapy

Our doctors are leaders in testing new drugs for colorectal cancer. We now use systemic treatments -- those that affect the whole body -- other than chemotherapy. Some of these drugs target specific pathways known to promote tumor growth and spread. Immunotherapy, which uses medication to help your immune system better recognize and destroy cancer cells, can treat some advanced colorectal cancers. Your medical oncology team will help you understand which medications might be effective against your cancer.

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Tests for Colorectal Cancer

Finding colorectal cancer early and getting an accurate diagnosis can significantly improve outcomes. Several methods are used to detect and diagnose these cancers.

Digital Rectal Exam

During this physical exam, your doctor will check for abnormal growths.

Procotoscopy

This clinic exam allows the surgeon to examine the entire rectum and get a precise measurement of a rectal lesion. These measurements help surgical and treatment planning.

Colonoscopy

A camera at the tip of a flexible tube is inserted in the rectum to allow the doctor to evaluate the entire colon. We routinely use high-resolution colonoscopy to create clearer images that offer better detection of polyps and cancer not seen with standard colonoscopy.

Stool DNA

A stool DNA test looks for abnormal DNA from cancer or polyp cells in your stool. This can be an early sign of cancer or, in some cases, large polyps. This test is usually ordered by your primary care doctor. A kit is mailed to your home with instructions on how to collect and return the stool to be tested. Since some insurance companies do not pay for this test, you should talk to your insurer and your primary care doctor first. If you have a positive stool DNA test, a colonoscopy is recommended for further evaluation of your colon.

Advanced Imaging

Noninvasive imaging techniques -- including MRI, PET, and CT scans -- check for metastatic disease away from the primary tumor and may be used to look at rectal cancers and the surrounding lymph nodes.

Molecular Testing

This test uses a sample of tissue, blood, or other body fluid to check for certain genes, proteins, or other signs of colorectal cancer. Molecular testing -- also called tumor profiling -- can help doctors understand more about your specific colorectal cancer.

Best Cancer Hospital in North Carolina

Where you receive your cancer care is important. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our cancer program is nationally ranked, and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2025–2026.

Why Choose Duke

A Nationally Ranked Program

We are a National Cancer Institute-designated Comprehensive Cancer Center and are part of the National Comprehensive Cancer Network, an alliance of the nation’s leading cancer centers dedicated to improving care for our patients. We offer a level of expertise found only in the top cancer centers across the country. The skills and experience of our specialists come from working with people with colorectal cancer every day.

A Team of Specialists

We have a range of board-certified colorectal cancer specialists, including medical and radiation oncologists, colorectal surgeons, gastroenterologists, radiologists, and pathologists. They hold weekly group meetings called “tumor boards” to ensure that the most appropriate treatment recommendations are made for each patient. Our experts also work with geneticists, specially trained nurses, nutritionists, wound care providers, and social workers to regularly discuss your care.

Leaders in Robotic Surgery

Duke surgeons perform thousands of robotic surgeries each year, including surgeries for GI cancers. Robotic surgery leads to fewer complications, shorter hospital stays, and faster recovery times—meaning that you move on to the next phase of treatment or return to your activities more quickly. Our surgeons also advise industry engineers as they develop robotic surgical platforms that translate to better outcomes.

Enhanced Recovery Reduces Hospital Stays and Readmissions

Our enhanced recovery program minimizes pre-operative fasting, encourages immediate post-operative physical rehabilitation, and incorporates specialized pain management to reduce the stress of colorectal cancer surgery. Duke research shows that this enhanced recovery approach decreases post-operative complication rates and reduces the length of hospital stays.

Research to Improve Care

Our specialists also test new approaches in clinical trials. For example, we are exploring why some colorectal cancers that spread to the liver respond well to chemotherapy while others do not. We also study genes, how they function, and their impact on health so we can provide you with more personalized treatment options.

Genetic Counseling and Screening for Inherited Cancer Syndromes

If you are at high risk for or have a family history of colorectal cancer, you may work with our genetic counselors to identify and reduce your risk.

Support for You and Your Family

Our comprehensive support services range from helping patients minimize the side effects of cancer treatment to coping with the emotional and psychological effects of diagnosis and treatment. View all of our cancer support groups in our event calendar.

Access to Clinical Trials

As a patient at Duke, you may be able to participate in our ongoing clinical trials, which test new anti-cancer targeted therapies, new surgical approaches, and new ways to minimize patient concerns and cancer-related symptoms. Participating in a clinical trial may afford you access to new treatment approaches before they become widely available.

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This page was medically reviewed on 03/04/2026 by

Hope E. Uronis, MD, MHS | Medical Oncologist