Colorectal Cancer

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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. They 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 your diagnosis, you may benefit from surgery, radiation, 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.

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. 


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 proctectomy or partial colectomy may be performed to remove the area of the rectum or colon 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 proctectomy may be required for hereditary cancers, cancer recurrence, or cancers deep in the body. This removes the entire rectum and anus and requires a permanent colostomy.

Pelvic Exenteration

If the tumor has spread to organs near the rectum, it may be necessary to remove the lower colon, 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 skilled surgeons create artificial openings that allow body waste to empty into a permanent colostomy bag.

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. After surgery, more chemotherapy may be needed.

Three-Dimensional Conformal Radiation Therapy (3D-CRT)

Imaging and special computer software map the location of your rectal cancer. Eternal radiation beams are then shaped and aimed at the tumor from several directions. This minimizes the amount of radiation to your healthy tissue. Radiation may be combined with chemotherapy before or after surgery to stop or slow rectal tumor growth in people who are at high risk for cancer recurrence.

Intraoperative Radiotherapy (IORT)

An intraoperative radiation facility at Duke University Hospital allows your care team to deliver a highly specialized form of radiation directly to the colorectal tumor without interfering with other sensitive organs.


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.

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.


A camera at the tip of a flexible plastic 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 colonography (also known as virtual colonoscopy) -- may be used to look inside the rectum to identify and assess tumors and polyps. 

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 colorectal cancer.

Consistently Ranked Among the Nation’s Best Hospitals

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2023–2024.

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 providers, 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, and social workers to regularly discuss your care. 

High-Definition Colonoscopies
We routinely use high-resolution imaging scopes to create clearer colonoscopy images that better detect and allow for removal of polyps and cancer not seen with standard colonoscopy equipment.

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 were involved in the development of the targeted therapy Avastin, which shrinks tumors and extends survival in patients when colorectal cancer has spread. 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.

This page was medically reviewed on 04/25/2023 by