Treatment of rectal cancer

Yes. Complete resection of the tumor together with the mesorectum and the corresponding lymph nodes is a treatment with curative intent. The quality of that resection, measured by the integrity of the mesorectum and the circumferential margin, is what most influences the risk of the tumor coming back in the pelvis.

Not always. It depends on the stage, the height of the tumor and its relationship with the mesorectum. In locally advanced tumors it is usually indicated to shrink the tumor and allow a resection with a sufficient margin. Early tumors are operated on directly, without prior treatment.

In many cases, yes, thanks to sphincter-preserving techniques. It depends on the distance from the tumor to the anus, its extent and the response to prior treatment. When the tumor invades the sphincter itself, a permanent colostomy cannot be avoided, but this situation is becoming less and less common.

As with any major surgery: bleeding, infection and leakage at the bowel join, which is the most feared complication in the rectum. In addition there may be urinary and sexual problems because of the proximity of the pelvic nerves. At specialized centers these risks are significantly reduced.

With ERAS enhanced recovery protocols, between 5 and 7 days after an uncomplicated operation. If a protective ileostomy has been created, the time needed to learn to manage it before discharge is added. Discharge is decided by progress, not by a fixed timeline.

Full functional recovery usually takes 6 to 8 weeks, although it varies with age, prior condition and the extent of surgery. Bowel function takes longer to settle: after low resections it can take several months and, in some patients, pelvic floor rehabilitation.

Yes. Most patients return to a normal life. Bowel habits change during the first months, with more frequent or fragmented stools and some urgency. This is low anterior resection syndrome, and it usually improves with time, dietary adjustments and rehabilitation when needed.

In selected cases with a complete clinical response, the watch and wait strategy, which avoids immediate surgery, may be considered. It requires very frequent check-ups with MRI and endoscopy, and surgery if the tumor comes back. It is not an option for everyone: selection requires high-resolution tests and specialized interpretation.

Check-ups with tumor markers, CT, pelvic MRI and colonoscopy, according to established protocols and for at least five years. Pelvic MRI is key in the rectum because it detects local recurrence while it can still be operated on, which is when salvage surgery makes sense.

At centers with proven experience in rectal surgery and enough case volume. In this tumor, the quality of total mesorectal excision determines the prognosis, and that quality depends on the team. It is worth asking how many rectal resections they perform each year and whether they have a multidisciplinary board.