Rectal cancer

Rectal cancer is the third most common cancer in men and the second most common cancer in women in the UK. In the UK, about 44,100 people get cancer in the colon or rectum each year. Bowel cancer is more common in older people. But the number of younger people (those 50 years old and under) diagnosed with it is increasing.

We hope this leaflet answers some of the questions you may have. If you have any further questions or concerns, please speak to a member of your healthcare team.

What is rectal cancer?

Rectal cancer is a cancer that starts in the rectum. It is also called cancer of the rectum.

The rectum (back passage) is part of the large bowel, which is part of the digestive system. The large bowel is made up of the colon, rectum and anus. 

Cancer that starts in the colon or rectum might be called bowel cancer or sometimes colorectal cancer.

What are the symptoms?

Common symptoms

• Bleeding from the back passage.

• A change in the number of times you empty your bowels (have a poo).

• The passage of mucous or slime.

• Weight loss and poor appetite.

However, these symptoms are very common and are usually not due to rectal cancer.

How is the diagnosis made?

To make a diagnosis of rectal cancer we must examine the colon and rectum, either with:

• a flexible telescope (flexible sigmoidoscope or colonoscope); or

• a special test called a CT colonography.

During a colonoscopy we take a tiny piece of tissue (a biopsy) from the cancer for laboratory examination. In addition to a colonoscopy, we will arrange a CT scan to examine the lungs and liver. This is to check that the cancer has not spread. Patients also need an MRI scan to help plan the most appropriate treatment.

How can it be treated?

The best chance of curing rectal cancer is with an operation. The operation aims to remove the part of the rectum with the cancer in it, along with the blood supply and lymph nodes (glands) that supply it.

The operation is done using either:

• a single large incision (cut) (called open surgery); or

• multiple small incisions (called keyhole or laparoscopic surgery).

The exact type of operation you have will depend on where the cancer is.

• Anterior resection removes the upper rectum and some of the colon on the left of the body. The surgeon then joins the colon back up to the rectum, so the bowel works normally.

• Abdominoperineal resection (APR). If the cancer is very low in the rectum, it is not possible to remove the cancer without damaging the muscles which control the bowel (sphincters). This would lead to faecal incontinence (you are not able to control your bowel (poo) movements). In these cases, it is better to remove the rectum and anus and form a colostomy. A colostomy is an artificial opening of the colon on the abdominal wall.

• Transanal Endoscopic Micro Surgery (TEMS) uses a specially designed microscope and instruments. It allows the surgeon to perform surgery through the anus (back passage) inside the rectum. It needs no cuts on the outside of the anus or abdomen (tummy). Surgeons sometimes use TEMS:

  • to remove small early cancers from the rectum, avoiding major surgery; or

  • when they consider TEMS safer than major surgery.

  Where necessary, your surgeon will explain these choices to you.

Above are the most common types of operations. There are others, which you will discuss with your surgeon.

Is a stoma necessary?

A stoma is not always needed in these operations. A stoma (colostomy or ileostomy) is an artificial opening of the colon / small bowel on to the abdominal wall.

Sometimes it is necessary to have a temporary stoma (for 3 months or so) to allow the bowel join to heal. Your surgeon will discuss whether you may need a stoma before your surgery. If you do need a stoma you will get all the support you need.

Are there any other forms of treatment?

• Radiotherapy. Some rectal cancers respond to a course of radiotherapy before surgery. This may make surgery easier and possibly prevent the cancer coming back at the same place. If we recommend radiotherapy, you can discuss this with a specialist in this field (oncologist).

• You can have chemotherapy together with radiotherapy before surgery or on its own. We may recommend a course of chemotherapy once:

  • you have recovered from your surgery

  • the cancer has been thoroughly examined by the pathologist

  This will depend on your general state of health and the stage of the disease. The stage of disease gives a sign of whether the cancer has spread to other organs (usually the glands close to the bowel, liver, or lungs). We assess the stage of disease using a combination of:

  • the tests that you had before your operation (CT, MRI); and

  • the pathologist’s opinion when they examined the cancer under the microscope.

  If we recommend chemotherapy, you can discuss it further with a specialist in this field (oncologist).

• Liver surgery. If the cancer has spread to your liver, it may still be possible to try to cure the cancer. We do this by removing a piece of your liver with an operation. If we recommend this, you can discuss it further with a specialist in this field (hepatobiliary surgeon).

We will discuss all the available treatment options with you and the people important to you (with your permission). No decisions are made before we have had these discussions.

What are the chances of a cure?

Appropriate surgery offers the best chance of a cure, possibly with chemotherapy and radiotherapy. The earlier we diagnose the cancer and treat it, the more likely the cure.

In early cancers, the cure rate is greater than 90% (9 in 10 people). In cancers at a more advanced stage, the chances of cure are less than 50% (less than 5 in 10 people).

Will I need to be seen again?

Yes. We will check you regularly following your treatment. How often we see you will depend on the stage of your cancer, and tailored to your own particular needs. This will usually include visits to the clinic, CT scans, and a colonoscopy.

Produced with grateful acknowledgement to The Association of Coloproctology of Great Britain and Ireland (ACPGBI).

References

• Macmillan Cancer Support. Rectal cancer

[Web sites last accessed 1 September 2026]

Ask 3 Questions

There may be choices to make about your healthcare. Before making any decisions, make sure you get the answers to these three questions:

• What are my choices?

• What is good and bad about each choice?

• How do I get support to help me make a decision that is right for me?

Your healthcare team needs you to tell them what is important to you. It’s all about shared decision making.

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