Rectal Cancer Stages and its Surgery

Rectal Cancer Stages

Stage I: The tumor involves only the first or second layer of the rectal wall, and no lymph nodes are involved.

Stage II: The tumor penetrates into the mesorectum, but no lymph nodes are involved.

Stage III: Regardless of how deeply the tumor penetrates, the lymph nodes are involved with the cancer.

Stage IV: Convincing evidence of the cancer exists in other parts of the body, outside of the rectal area.

Rectal Cancer Surgery

The type of surgical method used to treat rectal cancer depends on the stage and location of the tumor which include as following:


Suspicious or cancerous polyps on the inside surface of the rectum usually can be removed during a colonoscopy. A colonoscope, which is a long tube with a camera in the end, is inserted into the rectum. The doctor guides it to the area needing treatment. A tiny, scissor-like tool or wire loop removes the polyp.

Local excision

Cancers that can be reached through the anal opening and that have not spread too deeply may be removed by a surgical procedure called local excision or transanal resection. These approaches do not need an incision in the stomach.


Proctectomy is a surgical operation to remove all or part of the rectum. The most common reason for proctectomy is rectal cancer, but ulcerative colitis or crohn’s disease may also be treated with proctectomy. All rectal cancers—stages I though IV—may be treated with some type of proctectomy.


Cancers that are higher and deeper in the rectum may need to be removed by taking a larger section of the rectum out through an incision that goes through the lower stomach. This is called a low anterior resection (LAR).


If rectal cancer has not spread and there is enough tissue on either side of the cancer, the ends of the nondiseased intestinal tissues can be reconnected. This is called anastomosis. After proctectomy with anastomosis, a person can have normal bowel movements through the anus. The pattern of bowel movements (frequency or looseness) often changes after the procedure.


If rectal cancer is too large and close to the anal opening, it may not be possible to spare the rectal area. In these cases, a procedure called abdominoperineal resection (APR) may be needed. In APR surgery, the rectum is removed, the anal opening is closed, and the other end of the colon is attached to an opening (stoma) on the outside of the lower stomach. This is called a colostomy. Bowel movements are collected in a special bag attached to the colostomy.


Rarely, a more extensive operation known as a pelvic exenteration might be needed, in which nearby organs, such as the bladder, prostate, or uterus, are removed. A colostomy is usually needed after this operation.


A technique called minimally invasive laparoscopic surgery may be used during some types of proctectomy. With this procedure, the surgeons operate through several small incisions with special instruments while watching the procedure on a television monitor.


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