Stage I Rectal Cancer
Surgery
There are a variety of different colorectal cancer surgeries used to treat stage 1 rectal cancer:
- Local excision through the anus.
- Low anterior resection (LAR) for tumors that are high enough in the rectum to permit reconnecting the colon or rectum to the anus (anastomosis).
- Abdominoperineal resection with permanent colostomy when the distance between tumor and anus is too short to allow safe anastomosis (reconnection).
Tumor Imaging
Endorectal ultrasound (a procedure where an ultrasound probe is inserted into the rectum), MRI scans, or CT scans are commonly used to make images of rectal tumors to assess the depth of tumor invasion and whether there are signs of lymph node invasion by the tumor. If the tumor has invaded through the rectal wall or has spread to lymph nodes it is not a Stage I tumor and its treatment is covered elsewhere.
Possible Chemotherapy
If the tumor has gone through the outer layer of the rectum (T3) or there are cancer cells in lymph nodes (N1 or N2), then preoperative chemotherapy and chemoradiation may be recommended to reduce the size of the tumor and increase the likelihood of avoiding a permanent colostomy.
In some cases, chemotherapy and/or chemoradiotherapy (if no radiation was administered before surgery) may be recommended after surgery as well. This is generally done when the tumor is felt to have progressed beyond Stage I based on examination and tumor imaging.
Possible Watch and Wait
For some stage I rectal cancers, there may be the option to watch and wait after removal of the tumor via a polypectomy or after a surgical procedure where the tumor is removed through the anus when that is possible.
In all cases surveillance for local or distant tumor recurrence is critical so that any recurrence can be addressed quickly and examinations and/or imaging is often done every 3-6 months for several years.
