Surgery

Cancer of the rectum may be found incurable before or at the time of operation. If the primary tumour is not resectable and the patient develops obstruction, a diverting colostomy, if feasible, is preferred. In some incurable patients a Hartmann resection provides good palliation. Other local measures such as laser fulguration, endoluminal radiation, and internal stent placement may be of benefit in reducing the risk of obstruction and reduce bleeding. These local measures may also be helpful in managing patients who are unfit for surgery. Occasional very carefully selected patients with disease confined to the pelvis are candidates for radical resection by a multidisciplinary team of surgeons.

Non-resectable liver lesions are sometimes appropriate for other local therapies, such as radiofrequency ablation (RFA).

Radiation

Palliative pelvic radiotherapy can then be considered to help control pain or bleeding. Radiotherapy does not help obstruction and is contraindicated in the intact, obstructed bowel. Radiotherapy is particularly useful for perineal or pelvic pain from local recurrence of rectal cancer.

Chemotherapy

See palliative treatment for colon cancer.