Stage I Rectal Cancer
Surgery
Surgery is the main treatment for Stage I rectal cancer. The type of surgery recommended depends on where the tumor is located, how deep it has grown, and whether it has any high-risk features. Your care team will help determine which option is right for you.
- Endoscopic submucosal dissection (ESD) for small, early-stage tumors that can be removed through a scope with no incisions needed.
- Transanal local excision for small tumors located close to the anal opening that can be removed 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 (APR) with permanent colostomy when the distance between the tumor and anus is too short to allow safe reconnection.
Tumor Imaging
Before surgery, your care team will use imaging to learn as much as possible about your tumor — how deep it has grown, and whether any nearby lymph nodes are involved.
- MRI of the pelvis is the preferred imaging test for rectal cancer. It gives a detailed picture of the tumor and nearby lymph nodes and is recommended if surgery is being considered.
- Endorectal ultrasound (EUS) may be used instead of MRI in some cases. A small probe is inserted into the rectum to create images using sound waves.
- CT scan of the chest and abdomen is recommended as part of initial testing to check whether the cancer has spread to other areas of the body, like the liver or lungs.
If imaging shows the tumor has grown through the rectal wall or spread to nearby lymph nodes, it is no longer considered Stage I and a different treatment plan will be recommended.
After Surgery
For most people with Stage I rectal cancer, surgery is the only treatment needed. No chemotherapy or radiation is typically required when the cancer is confirmed as Stage I after surgery.
In some cases, the tumor may turn out to be more advanced than expected once it is removed and examined in a lab. If the cancer is found to be Stage II or III after surgery, your care team will discuss whether chemotherapy — with or without radiation — is recommended for you. This is not a reflection of anything that went wrong, just a natural part of making sure your treatment plan fits what the cancer actually looks like.
Watch and Wait
For some Stage I rectal cancer patients, watch and wait may be an option after the tumor has been removed through a polypectomy or local excision. Rather than moving straight to additional surgery, your care team monitors you closely to make sure the cancer has not come back.
Watch and wait is not the same as doing nothing — it requires a committed follow-up schedule. If there are any signs of recurrence, your care team can act quickly.
