Stage II & III Rectal Cancer
Chemotherapy
Your doctor may prescribe chemotherapy right away. You may receive multiple rounds of chemotherapy first, followed by radiation + chemotherapy (chemoradiation), followed by additional chemotherapy.
Often, treatment will begin with a combination of radiation and chemotherapy. When this is the case, the chemotherapy given will most likely be 5-FU or capecitabine (an oral form of 5-FU).
This regimen may then be followed, without radiation, by FOLFOX or CAPEOX for several months, depending on your unique circumstances.
Some of the most common chemotherapy drugs to receive include:
- Folfox
- Capeox
- 5-FU (fluorouracil)
- Capecitabine
- Any patient receiving chemotherapy containing 5-FU or capecitabine should undergo DPD testing prior to beginning treatment.
Immunotherapy
If you have a specific type of rectal cancer, known as dMMR or MSI-H (deficient mismatch repair or microsatellite instability-high) you may be eligible for immunotherapy. Immunotherapy is different from chemotherapy in that it helps the person’s own immune system recognize and destroy cancer cells. Immunotherapy may be administered for around 6 months. If there is not cancer detectable at the end of this regimen, therapy is discontinued. If the cancer is persistent, then a combination of radiation, chemotherapy, and surgery may be given.
The Prospect Study
The PROSPECT study was a unique type of trial called a “de-escalation” study, which means a standard of care treatment was removed to see if it was necessary.
The study found that, depending on tumor location, some patients with stage II or III rectal cancer may not benefit from radiation.
Radiation
If you’re receiving radiation therapy for rectal cancer, it’s likely in one of these two intervals:
- Daily (M-F) for 5-6 weeks (smaller doses)
- 5 days total (higher doses)
Ask your radiation oncologist what’s recommended for you and why. Lower dose radiation spread out over several weeks may give tumors time to shrink and save bowel function.
While you’re receiving radiation, it’s also possible to receive continuous chemotherapy through a pump. This is called chemoradiation.
Chemotherapy Combinations
In other cases, chemotherapy may be recommended without radiation, and radiation may be reserved for after surgery in cases with high-risk features in their tumors noted when the pathologist examines the surgical specimen.
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.
Surgery
For rectal cancer, abdominal surgery is often required to remove tumors. You may be treated with radiation and/or chemotherapy before surgery.
Colectomy (resection)
Removal of all or part of your colon through an incision or incisions (laparoscopic surgeries often require several small incisions while open surgery is usually done using a single, larger incision).
Laparoscopic colectomy
When a surgeon makes a few small incisions in your abdomen through which they pass a tiny camera and tools to access your colon.
