What is the first treatment for rectal cancer?

Rectal cancer sits in the lower bowel, close to the bladder, reproductive organs and muscles that control bowel function. Scans and biopsy findings help the team judge how far the tumour extends through the bowel wall, whether nearby lymph nodes are involved and how close it is to the anal muscles.

Chemotherapy before surgery is called neoadjuvant chemotherapy. It can treat cancer cells throughout the body while also working on the rectal tumour. Radiotherapy may be added when local control is a concern. After this initial treatment, the team reassesses the tumour and plans rectal cancer surgery when appropriate. Some operations require temporary or permanent stoma surgery to divert stool through an opening on the abdomen.

Ask the multidisciplinary team to explain your stage, the aim of treatment before surgery and how response will be assessed. Discuss bowel habits, diet, hydration, work and travel during treatment. Tell the team about numbness, previous abdominal surgery, diabetes, heart problems and all medicines.

Before an operation, ask where the tumour is, whether the anal muscles can be preserved, what type of rectal resection is planned and whether a stoma is likely. A stoma nurse can explain appliances, skin care and practical support before surgery.

Call the treatment team for fever, repeated vomiting, severe diarrhoea, inability to drink, increasing abdominal swelling, worsening rectal bleeding or new severe pain. Seek urgent care for severe abdominal pain with vomiting, fainting, confusion or inability to pass stool and gas, because bowel obstruction, dehydration or infection may need immediate treatment.

Why is treatment before surgery recommended for me? Will I receive chemotherapy, radiotherapy or both? How will response be measured? What operation is planned? Could I need a stoma, and would it be temporary?