Management of Rectal Cancer

A cancer-specific history should be obtained eliciting disease-specific symptoms, associated symptoms, family history, and perioperative medical risk. Routine laboratory values, including CEA level, should also be evaluated, as indicated. (1B)

As a part of a complete physical examination, the distance of the distal extent of the cancer from the anal verge and the cancer’s relation to the sphincter complex should typically be assessed. (1C)

Before elective treatment, the histological diagnosis of invasive adenocarcinoma should be confirmed, and patients should typically undergo a full colonic evaluation so the treatment plan can address synchronous pathology, as needed. (1B)

Rectal cancer should typically be staged according to the American Joint Committee on Cancer TNM system before initiating treatment. (1B)

Rectal cancer protocol pelvic MRI is the preferred modality for locoregional clinical staging. Endorectal ultrasound (EUS) may be considered when differentiating between early T stages (ie, T1 versus T2 tumors) or when MRI is contraindicated. (1B)

Clinical staging for metastatic disease should typically be conducted in patients with rectal cancer. (1B)

Restaging evaluation should be considered after neoadjuvant therapy in patients with locally advanced rectal cancer. (1C)

The treatment of patients with rectal cancer should typically incorporate a multidisciplinary team tumor board discussion. (1C)

If either a temporary or permanent ostomy is being considered, preoperative education and stoma site marking should typically be performed. (1B)