Treatment for Stage III Rectal Cancer

Surgery

For rectal cancer, abdominal surgery is often required to remove tumors. You may be treated with radiation and chemotherapy before surgery.

Low anterior resection (LAR)

The tumor and part of the rectum is removed without affecting the anus. The colon is then attached to the remaining part of the rectum so that after the surgery, your bowels can be used in the usual way.

Abdominoperineal resection (APR)

One incision is made in the abdomen and another in the perineal area to remove the anus and the tissues surrounding it, including the sphincter muscle. This is a more invasive surgery than the LAR because the anus is removed. With an APR you will need a permanent colostomy to allow stool a path out of the body.


Chemotherapy Combinations

For stage III rectal cancer patients who are medically fit and can tolerate combined methods of therapy, treatment can consist of chemoradiation (chemotherapy and radiation) before surgery, abdominal surgery, and/or adjuvant chemotherapy after surgery.

Patients who cannot tolerate chemoradiation at first, may go directly to surgery with no additional treatment, and then onto adjuvant chemotherapy and/or chemoradiation after surgery.


Chemoradiation options:

  • Continuous infusion 5-FU and external beam radiation (EBRT). Treatment usually lasts several weeks. The chemotherapy drug is delivered intravenously through a pump carried in a fanny pack to provide a continuous infusion of 5-FU.
  • Bolus 5-FU and external beam radiation. Less often recommended
  • Oral capecitabine (Xeloda®) and radiation
  • Clinical trial

Adjuvant chemotherapy options:

  • 5-FU and leucovorin
  • FOLFOX (oxaliplatin, leucovorin, continuous infusion 5-FU)
  • Oral capecitabine (Xeloda®)
  • Clinical trial

Adjuvant chemoradiation options
(a “sandwich” of chemo-chemoradiation-chemo):

  • 5-FU with leucovorin or FOLFOX or capecitabine (Xeloda®)
  • Radiotherapy with either continuous infusion 5-FU or capecitabine (Xeloda®)
  • Additional 5-FU with leucovorin or FOLFOX or capecitabine (Xeloda®)

Content medically-reviewed by members of the Fight Colorectal Cancer Medical Advisory Board, February 2014