Treatment For Stage IV and Metastatic Rectal Cancer


There are different ways to treat stage IV rectal cancer that has metastasized (spread beyond the colon or rectum). Treatment depends on variables like the location of the metastatic tumors, the number of metastatic tumors, the patient’s overall health, and the patient’s treatment goals. Thus, patients should, if possible, work with a multidisciplinary team to determine an appropriate treatment plan.

Over time, one person’s treatment for metastatic colorectal cancer might include combinations of:

  • Chemotherapy using a variety of chemo drugs and biologic agents
  • Surgery to remove colon or rectal tumors
  • Surgery to remove metastatic tumors that have spread into other areas of the body
  • Radiofrequency ablation to destroy tumors with heat from radio waves
  • Several approaches to radiation therapy to shrink or destroy both primary and metastatic tumors
  • Chemotherapy directly applied to the liver or to the abdominal cavity
  • Treatment with radioactive beads
  • One or more clinical trials


Even though you may be terrified when you are first told that your cancer has spread beyond your colon or rectum and is metastatic, taking time to get the very best information and advice you can from a multidisciplinary team is vitally important.

With your team, you’ll consider whether:

  • Your metastatic tumors are limited enough to be removed surgically (resectable) and might be curable
  • Your tumors are not resectable now, but with treatment might become resectable and converted to a curable situation.
  • Your cancer is widespread and unlikely to become resectable and should be treated palliatively with the goal of extending your life, while giving you a good quality of life

Talk to your doctor about getting a second opinion. You may worry that asking your doctor about a second opinion may hurt your relationship with your doctor. Don’t worry about that! Good doctors are very supportive, and may even be able to help you schedule an appointment at a different cancer center.

Major cancer centers, such as NCI-designated cancer centers or centers that are part of the National Comprehensive Cancer Network, can help define a treatment plan. Sometimes getting a second opinion may take extra time. In that case, work with your doctor to determine how to best integrate your treatment needs with getting a second opinion.


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