Rectal Cancer

Surgery

Surgery is the most common treatment for rectal cancer. The type of surgery is based on the location and size of the tumor, and whether cancer has spread. Whenever possible, our surgeons use a minimally invasive approach to surgery that results in less scarring, reduced pain and infection risk, shorter hospital stays, and quicker recovery. Our extensive training and expertise let us perform surgeries that minimize the need for a permanent colostomy. Sometimes a temporary stoma, or opening, is needed to allow for the removal of waste from the body.

Polypectomy

Removal of polyps during a colonoscopy.

Partial Proctectomy

Removes the area of the rectum where the cancer is located as well as surrounding healthy tissue. If appropriate, lymph nodes may be removed to determine if cancer has spread. The procedure is often performed laparoscopically with robotic tools, which makes it possible for your surgeon to reach more areas. We are currently investigating whether robotic surgery will improve sexual function compared with other treatment options.

Whole Proctectomy

Removes the entire rectum and anus and results in a permanent colostomy. It may be performed in patients with hereditary cancers, multiple polyps, or cancer recurrence.

Transanal Endoscopic Microsurgery

We are one of few centers in the region experienced in performing this minimally invasive approach on 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.

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 created artificial openings that allow body waste to empty into a permanent colostomy bag.

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

Imaging and special computer software map the location of your cancer. A treatment plan is developed involving external radiation beams, which are 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 tumor growth in people who are at high risk for cancer recurrence.

Intraoperative Radiotherapy (IORT)

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

Brachytherapy

Shrinks the size of the tumor before surgery. Radioactive seeds are surgically placed in or near the tumor, and release radiation over time.

Endoscopic Mucosal Resection

Performed by a gastroenterologist on less invasive cancers and large polyps that are not cancerous. The mass is removed through a proctoscope inserted in the rectum. An electrified needle cuts and removes the suspicious area and surrounding healthy tissue.

Endoluminal Stent Placement

A minimally invasive endoscopic procedure performed by surgeons and gastroenterologists. Expanding metal stents are placed in the rectum when a tumor is blocking the intestine.

Chemotherapy

Kills tumor cells or slows their growth. Sometimes recommended before surgery to shrink the tumor, after surgery if recurrence risk is high, and if cancer has spread to lymph nodes or beyond.

Targeted Therapies

Our doctors are leaders in testing new drugs for rectal cancer, including the development of bevacizumab (Avastin). These intravenous (IV) drugs work on certain rectal cancers by targeting a protein called vascular endothelial growth factor (VEGF) and cutting off the supply of blood and nutrients that help tumors continue to grow and survive. You may also be able to participate in clinical trials studying additional targeted therapies for rectal cancer.

Palliative Stenting

A small metal cylindrical device is inserted to keep the rectum open if it has been blocked by a tumor. The stent relieves painful symptoms and improves quality of life.