Treatment of Stage IV and Recurrent Rectal Cancer

Treatment of stage IV and recurrent rectal cancer may include:

• surgery with or without chemotherapy or radiation therapy
• systemic chemotherapy with or without targeted therapy (, , , , , or )
• systemic chemotherapy with or without immunotherapy with (for treatment of tumors that may have a defect in genes involved in DNA repair), , or
• chemotherapy to control the growth of the tumor
• radiation therapy, chemotherapy, or a combination of both, as palliative therapy to relieve symptoms and improve the quality of life
• placement of a stent to help keep the rectum open if it is partly blocked by the tumor, as palliative therapy to relieve symptoms and improve the quality of life
• targeted therapy with and in patients with a certain change in the BRAF gene
• immunotherapy (nivolumab or pembrolizumab, or nivolumab and combined)

Treatment of rectal cancer that has spread to other organs depends on where the cancer has spread.

• Treatment for areas of cancer that have spread to the liver may include:
  • chemotherapy to shrink the tumor, if needed, followed by surgery
  • cryosurgery or radiofrequency ablation
  • chemoembolization and/or systemic chemotherapy
  • liver transplant after chemotherapy for patients with liver metastases that cannot be removed by surgery
  • a clinical trial of chemoembolization combined with radiation therapy to the tumors in the liver

Learn more about these treatments in the Treatment Option Overview.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.