Rectal cancer begins as a polyp, a small mushroom-like outgrowth of abnormal lining in the rectum. When these polyps are caught in the early stages of rectal cancer, a procedure called a polypectomy removes them. During a colonoscopy, your doctor performs a polypectomy, which uses a thin tube with a light and camera to view the polyp and remove it at its base.
Transanal excision (TAE)
A transanal excision removes a small area of cancer in the rectum and some of the tissue around it. This surgery doesn’t require an abdominal incision. Instead, tools are used during a colonoscopy to reach the tumor. TAE is most used in early-stage rectal cancer that is located near the anus.
Transanal endoscopic microsurgery (TEM)
TEM is an advanced, minimally invasive procedure that removes rectal tumors, including those higher up in the rectum, without an abdominal incision. Your physician uses a 3D microscope and microsurgical tools inserted into the rectum (through the anus) to remove the cancer. It allows for greater precision, speeds up recovery and helps minimize effects on nearby nerves related to bowel and sexual function. The same operation can be performed using instruments alongside a laparoscopic or a robotic camera through the anal canal.
Low anterior resection (LAR)
If cancer has advanced and begun to spread, a surgical procedure known as a low anterior resection may be necessary. This surgery removes the section of the rectum containing the tumor while preserving the lower part of the rectum. The colon is then connected to the preserved rectum to enable normal digestive function, known as anastomosis. This can be performed with traditional surgery or using a minimally invasive approach.
You might need a temporary ileostomy to allow the newly created connection between the colon and rectum to heal and function properly. An ileostomy connects the end of the small intestine to an opening in the abdomen that passes stool into a pouch. The temporary ileostomy is later reversed to restore normal function through the new connection.
Proctectomy with coloanal anastomosis
During the later stages of rectal cancer (rarely stage 1), the entire rectum might need to be removed, called a proctectomy. To restore bowel function without needing a permanent colostomy, your surgeon reconnects the remaining ends of your intestinal tract through anastomosis. A coloanal anastomosis attaches your colon to the top of your anal canal, where the sphincter muscles are found. This preserves the control of passing stool even though the rectum was removed.
Abdominoperineal resection (APR)
An APR procedure removes the rectum through an abdominal incision and removes the anus and its surrounding muscles through incisions around the anus. It’s often required in very low stage 3 rectal cancer that involves the muscles of the anal sphincter. Because the muscles that allow the anus to work are removed, APR requires a permanent colostomy to pass stool through an opening in the abdomen.
Rectal cancer can grow and completely block the rectum, meaning you can no longer have bowel movements. You may need immediate surgery to divert the intestinal tract in this case. A diverting colostomy connects part of your colon to an abdomen opening, called a stoma, to pass stool into a pouch.
Radiofrequency ablation is used in many body parts to destroy tissue with high-intensity heat. If rectal cancer has spread to the liver, you may have radiofrequency ablation to destroy cancer cells.
Cryosurgery is another option to destroy cancer cells when rectal cancer spreads into the liver. Cryosurgery uses a probe and cold temperatures to freeze cancer and the surrounding tissue.
When cancer spreads through the rectum and into nearby organs, your treatment could include a major surgery called pelvic exenteration. This surgery removes the entire rectum and organs like the bladder, prostate, uterus, ovaries and others.
In cases where the bladder is completely removed, your surgeon will also perform a urostomy. A urostomy opens outside the body, where urine can flow into a pouch. You’ll also need a permanent colostomy to pass stool out of the body.