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Rectal cancer: early, locally advanced and metastatic

Rectal cancer treatment has changed a lot, and some people can now avoid surgery altogether. Here's how the options fit together for you and your family.

ℹ️ General information to help you and your loved ones talk with your care team, not medical advice. Read our disclaimer.

The quick guide

What it means: Cancer in the last part of the large intestine. NCCN separates early, locally advanced and metastatic rectal cancer.

How it's found: Exam, colonoscopy and biopsy, pelvic MRI, CT scans, CEA, and MMR/MSI testing.

How common it is: Rectal cancer makes up about 3 in 10 colorectal cancers.

How treatment works

🌱 Early-stage

Early: surgery, sometimes a local removal.
Locally advanced: often total neoadjuvant therapy (chemo plus chemoradiation or radiation before surgery).
If the tumor disappears, some people choose close 'watch and wait' monitoring instead of surgery.
dMMR tumors: immunotherapy first may make surgery and radiation unnecessary for some.

🔁 Advanced or metastatic

Treated much like metastatic colon cancer, based on MMR status and tumor genes; radiation or surgery to the rectum may be added.

Approvals depend on stage and prior treatment. Your care team will decide what fits you.

Drug guides

Biomarker tests that matter

Side effects you may notice

❓ Questions you and your loved ones can ask

Am I a candidate for total neoadjuvant therapy or watch-and-wait?
Is my tumor dMMR?
How will treatment affect bowel, bladder and sexual function?

Back to Colorectal cancer overview. Other types: Colon cancer: non-metastatic and metastatic, MSI-high / dMMR colorectal cancer, HER2-positive (HER2-amplified) colorectal cancer, KRAS G12C colorectal cancer (RAS-mutant), RAS wild-type colorectal cancer (KRAS/NRAS normal), BRAF V600E colorectal cancer.

Written by the Cancer Side Effects Guide team from FDA labels and leading cancer centers. Not medical advice. · Last updated: October 15, 2026 · How we write

Not medical advice. This page is general information to help you talk with your care team. It can't replace advice from your doctor or nurse. If you have a fever of 100.4°F (38°C) or higher during treatment, or any symptom that worries you, call your care team now. In an emergency, call 911.