Rectal Cancer | Symptoms & Treatments | MedStar Health

Individualized rectal cancer care based on the latest research and advanced surgical techniques

When you’re cared for at MedStar Health, you can expect comprehensive care that starts with a full range of advanced diagnostic options and continues with groundbreaking treatments that eliminate your cancer—and minimize the likelihood it will return. Our team approach involves a variety of specialists who are focused on customizing your treatment plan using the most effective surgical techniques. Through innovative clinical trials and complex procedures only available at a few cancer centers in the nation, we can reduce your chances of needing a colostomy through sphincter preservation.

This type of cancer begins in the rectum, the last six inches of the large intestine. It's similar to colon cancer because the colon and rectum are both parts of the digestive system. In fact, the two kinds of cancer are often grouped and called “colorectal cancer.” However, the diseases require different treatment approaches. This sort of cancer can be more challenging to treat because of its proximity to other organs, bones, and tissue.

Symptoms and risk factors

Most people don't have symptoms of rectal cancer.

Like colon cancer, most people with early-stage rectal cancer don’t experience any symptoms. By the time signs appear, it’s already progressing to a more advanced stage. And when cancer is advancing, it may be spreading and harder to treat.

Once this cancer has advanced, you may experience symptoms, such as:

  • Bloating, cramping, and/or frequent gas pains
  • Bloody stool
  • Constipation or diarrhea
  • Persistent fatigue
  • Unexplained, sudden weight loss
  • Vomiting

Many of these symptoms could be related to other health conditions, including colon cancer. However, if symptoms continue for more than two weeks, be sure to check in with your doctor to rule out cancer.

Knowing your risk can help you minimize your chances of developing rectal cancer.

Knowing your risk ahead of time can help you take action to stay healthy and minimize the likelihood of a diagnosis.

Risk factors may include:

  • Age: Men and women over 45 have a higher risk of developing this type of cancer.

  • Race/Ethnicity: If you are African-American or Jewish with an Eastern European background, you are at an increased risk.

  • Medical history: Certain health conditions raise your risk, including ulcerative colitis, Crohn’s disease, Type 2 diabetes, or other types of cancer. And, if your doctor found polyps during a colonoscopy, you are also at an elevated risk.

  • Family history: If you have family members with this type of cancer, you are at a higher risk. Our genetic counselors can help you determine how much you are at risk and take action to reduce your chances.

  • High-fat diet: Lifestyle choices significantly impact your risk. Studies show that you have an increased risk if you eat a diet high in fatty calories, such as those in red meat. You may also have a higher risk if you don’t eat enough food with fiber, such as fruits and vegetables.

  • Not enough exercise: If you aren’t active, you may have a higher risk of cancer development.

  • Tobacco and alcohol use: Poor lifestyle choices such as smoking cigarettes and drinking too much alcohol can increase your risk.

If one or more risk factors apply to you, that doesn’t mean that you will get this cancer. But, it’s a good idea to talk to your doctor about ways to minimize your risk.

At MedStar Health, you’ll benefit from genetic counselors who are experts in evaluating your family history and risk for inherited cancers. Through our High-Risk Gastrointestinal Cancer Prevention program, we can help you proactively manage your risk through earlier screening and lifestyle changes.

Screening and prevention

A colonoscopy can help prevent rectal cancer—or find it early when it’s treatable.

Unlike some other forms of cancer, this cancer is preventable. Most of them develop from polyps, which are unusual growths that develop on the rectum wall. A doctor can spot and remove polyps during rectal screenings called colonoscopies. If something unusual is found, our specialists move quickly to find out if it is or isn’t cancer.

You shouldn’t wait for symptoms to appear before seeing a doctor. Getting regular colonoscopies is the best prevention because your doctor can remove polyps in the rectum before they turn into cancer.

That's why we recommend patients with an average risk of colorectal cancer begin colonoscopy screening at the age of 45. There are other cancer screening tests available, but a colonoscopy is the only test that allows a doctor to remove polyps in the rectum as soon as they're spotted.

A healthy lifestyle can lower your risk of rectal cancer.

Some studies suggest that a healthy lifestyle helps to prevent this cancer. Consider taking the following steps to lower your risk:

  • Get screened every ten years, starting at age 45
  • Maintain a healthy weight
  • Exercise regularly
  • Eat a low-fat diet and less red meat
  • Consume more fruits and vegetables
  • Avoid smoking and excessive alcohol consumption

If you are considered at a high risk of developing this type of cancer, talk to your doctor about screening guidelines, as you may need to be screened earlier or more frequently. A genetic counselor can also help you manage your risk, if this type of cancer runs in your family.


An accurate diagnosis leads to more effective treatment.

At MedStar Health, our colorectal specialists are experts in diagnosing and treating because we see a high number of patients every year. Research shows that patients experience better outcomes, like higher survival rates and a lower risk of needing a colostomy when they seek care from a care team who treats a high volume of patients.

We believe an accurate diagnosis is the most important step to getting treatment that will give you the best results and the highest quality of life. There are a variety of tests that your doctor may use to confirm your diagnosis and understand the size and location of your rectal tumor, as well as if it has spread, or metastasized. These may include:

  • Physical exam: Your doctor will review your medical history and symptoms. They’ll also examine your body for anything abnormal. This may include a digital rectal exam (DRE), where your doctor will use a gloved finger to feel for anything unusual in the rectum.
  • Colonoscopy: A colonoscopy may be used as both a screening and a diagnostic procedure. It allows your doctor to evaluate the inside of your rectum for polyps or other signs that cancer is developing.
  • Biopsy: Your doctor will take a small sampling of suspicious tissue from your rectum using a procedure called a biopsy. This is the most definitive way to determine if your tumor is cancerous or not.
  • Proctoscopy: If your doctor suspects cancer, they may use a proctoscope to look inside the rectum. During a proctoscopy, your doctor will insert a thin, lighted tube with a camera into the rectum. This allows them to identify the location and size of your tumor.
  • Imaging: Your doctor may use a combination of x-ray, computed tomography scans (CT scans), or ultrasound to take pictures of the inside of your body. This allows them to see if the tumor has spread to other parts of the body.
  • Blood tests: Your doctor may use various blood tests to:
    • Look for blood in your stool that may not be otherwise visible
    • Measure the types of cells in your blood
    • Identify tumor markers found in blood
    • Check your liver function
    • Inform treatment options

Rectal cancer stages

As part of your diagnosis, your doctors will evaluate the stage of your cancer, or how much it has grown and spread. Your stage will determine what kind of treatment is necessary to remove your cancerous tumor and prevent it from coming back.

The staging system is complex and indicates:

  • The tumor size
  • How much it is affecting the lymph nodes
  • How far it has spread to other parts of the body

Your doctor will consider all three factors to describe your cancer on a scaled stage of zero to four. The higher the number, the more your cancer has progressed and the harder it is to treat.

  • Stage 0: There are abnormal cells in the innermost rectum lining. This is the earliest possible sign of cancer and is highly treatable.
  • Stage I: The tumor has grown beyond the inner lining of the rectum. However, it’s still contained in the rectum and has not spread to nearby lymph nodes.
  • Stage II: Cancer has expanded to the outer layer of the rectum but has not spread to the lymph nodes.
  • Stage III: Cancer has grown through the rectum wall and has reached one or more lymph nodes.
  • Stage IV: Cancer has spread to other vital organs in the body, such as the lungs. There may also be cancer in the lymph nodes.

Types of cancer

The most common type of rectal cancer is an adenocarcinoma, which develops from a polyp in the lining of the rectum. Other rare types may include:

  • Gastrointestinal stromal tumors, which rarely develop in the lining of the gastrointestinal tract and can form in the rectum

  • Rectal leiomyosarcoma, in which the tumor begins in the layers of muscle in the rectum
  • Colorectal lymphoma, which commonly develop in the lymph nodes but can begin in the rectum
  • Familial adenomatous polyposis (FAP), which is an inherited syndrome that can cause hundreds-to-thousands of polyps in the rectum or colon


Unmatched expertise and experience that leads to your best possible outcome

Your treatment plan will be designed by a variety of medical, surgical, and radiation oncologists, as well as other specialists, including interventional radiologists, gastroenterologists and gynecologists. Involving experts across various disciplines allows us to customize a comprehensive treatment plan that considers your most promising options. Your treatment plan will be based on several factors, including:

  • Where cancer is located in the rectum
  • How far cancer has spread
  • If the bowel is blocked
  • If there is a hole in the bowel
  • If it’s a new tumor or a recurring tumor
  • Your overall health condition


When cancer is contained in the rectum, surgery is the most common treatment. During surgery, a specialist removes the tumor by entering through the opening of the rectum or the abdomen. This may be performed as open surgery or a minimally invasive procedure, like robotic surgery, which results in fewer risks, less pain, and faster recovery than traditional surgery.

Your surgery type will vary based on the stage and location of your tumor.

  • If you have a polyp: When a polyp appears suspicious or is confirmed to be cancerous, a surgeon can remove it during colonoscopy using a procedure called a polypectomy.
  • If you have a small tumor: Small tumors may be removed through a local excision, which means a surgeon will remove only the cancerous area.
  • If you have a large tumor: For larger tumors, your surgeon may need to remove the tumor and the tissues surrounding it in a procedure called resection.

Because the rectum is a small body part, it’s important to select a highly trained surgeon with experience in reconnecting the colon to the rectum using a sphincter-preserving procedure. Choosing someone who specializes in sphincter-preserving procedures can significantly lower your risk of needing a permanent colostomy. Many patients are relieved to know that while some need a temporary colostomy, most patients can resume normal bathroom activity after recovery. Thanks to advances in surgical technique, very few patients need a permanent colostomy.


Chemotherapy uses drugs to destroy cancerous cells and prevent them from growing. There are a variety of chemotherapy options that can be useful in shrinking the tumor before surgery and minimizing your risk of cancer returning after surgery, especially if cancer spreads to your lymph nodes.

Chemotherapy is considered a systemic treatment, which means that it affects your entire body. When you need chemotherapy, our oncologists work hard to minimize your side effects so you can maintain a high quality of life. Your team of oncologists and specialists will carefully calculate a dosage that may be given in several ways, including:

  • Intravenously through a needle
  • Orally as a pill

Immunotherapy and targeted therapy

Immunotherapy harnesses the power of the body's immune system to attack and kill cancer cells. This type of therapy may be used to treat certain patients with a specific gene makeup, although this doesn't work universally.

Targeted therapies may be used for patients with certain proteins or genes. This advanced treatment option relies on approved or emerging drugs that can be used alone or in combination with chemotherapy to control the growth of the tumor.

Radiation therapy

When you have a rectal tumor that is growing or has spread, we may give radiation therapy before surgery to help increase the effectiveness of surgery. When radiation and/or chemotherapy treatments are used as a supplement to surgery, the cancer recurrence is less than 10%, compared to historical rates of 20% to 30%.

At MedStar Health, each patient benefits from a personalized plan based on what will most effectively treat their cancer. There are several types of radiation therapy that may be used, including:

  • External-beam radiation therapy, including Intensity-Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IMRT)
  • Internal radiation therapy (brachytherapy)

  • Proton beam therapy


Looking for expert cancer care?

With multiple locations throughout the region, patients have access to many of the nation’s renowned cancer specialists offering high quality care, second opinions and a chance for better outcomes close to where they live and work. Georgetown Lombardi Comprehensive Cancer Center, one of the nation’s comprehensive cancer centers designated by the National Cancer Institute (NCI), serves as the research engine allowing patients access to clinical trials that often lead to breakthroughs in cancer care.

Our locations

Distance from Change locationEnter your location

MedStar Franklin Square Cancer Center at Loch Raven Campus

5601 Loch Raven Blvd.
Russell Morgan Building
First Floor
Baltimore, MD 21239

MedStar Georgetown Cancer Institute at MedStar Franklin Square Medical Center

9103 Franklin Square Dr.
The Harry and Jeanette Weinberg Cancer Institute
Suite 220
Baltimore, MD 21237

MedStar Georgetown Cancer Institute at MedStar St. Mary’s Hospital

25500 Point Lookout Rd.
First Fl.
Leonardtown, MD 20650

Why choose us

Studies prove that outcomes are better at high-volume centers like MedStar Health. When you receive rectal cancer treatment here, you can expect the highest quality of care from specialists who have more experience treating this disease than most cancer centers in the region. Because we have extensive experience treating patients with this specific cancer, our surgeries are more successful in:

  • Removing cancer
  • Preventing cancer from returning
  • Preserving the sphincter
  • Lowering the risk of a colostomy

Your care team includes several specialists who work together in regular tumor boards. Multidisciplinary care leads to exceptional results because it ensures you receive comprehensive treatment that addresses all of your physical and emotional needs. Here, your team may involve surgical, radiation, and medical oncologists, interventional radiologists, gastrointestinal specialists, therapists, and nurses who collaborate in your care. Your team may also involve genetic counselors, psychologists, dietitians, and others who can help you manage your health throughout your cancer journey.

We translate the latest research into novel therapies and surgeries that help preserve your quality of life. We partner with the only comprehensive cancer center in the region, Georgetown Lombardi Comprehensive Cancer Center, to conduct research paving the way for a cure for gastrointestinal cancers. Because our oncologists and researchers are investigating the latest treatment options, we can quickly put new methods for diagnosing and treating the disease into practice. In addition, our surgeons are experts in complex, minimally invasive, and robotic procedures that result in less pain, fewer risks, and shorter recovery times than traditional surgery. Our goal is to preserve your quality of life while minimizing the chances of your disease returning.

Awards and recognition

Recipient of an Accreditation with Commendation, the highest level of approval, from the American College of Surgeons’ Commission on Cancer (CoC)

Numerous colorectal surgeons, medical oncologists, radiation oncologists, and gastroenterologists recognized as "Top Doctors" by both Baltimore Magazine and the Washingtonian

Magnet® designation from the American Nurses Credentialing Center (ANCC)

Clinical trials and research

Clinical trials

Through clinical trials, patients gain access to breakthrough treatments that may offer new therapies or new combinations of therapies. We regularly have clinical trials open for enrollment and will recommend any that may benefit you directly as part of your comprehensive treatment plan


With a dedicated team at the Ruesch Center for the Cure of Gastrointestinal Cancers, our doctors and researchers are actively investigating new, less invasive ways to treat. One of our primary areas of focus is understanding why more men and women are developing this kind of cancer at a younger age.

Patient stories

Support services

We're experts in treating your cancer, but we're also experts in treating you like a person. We know a cancer diagnosis can be challenging and we're here to help you navigate that journey, whatever it looks like for you. Our patients benefit from access to comprehensive support services designed to address any physical or emotional need that may arise as part of treatment.

Genetic counseling

Colorectal cancer is increasingly affecting adults younger than 40, and some people are predisposed to rectal cancer because of any inherited genes or syndromes, such as Lynch syndrome. At MedStar Health, our genetic counselors can help you understand your hereditary risk of developing this cancer, even if you're under the recommended screening age. We'll help you understand if you'd benefit from genetic testing and what you can do to manage your risk of the disease—and your family's risk.

Personalized rehabilitation

Chemotherapy, surgery, and other treatments can affect your strength and mobility. That's why we offer comprehensive rehabilitation services to help you move the way you did before your diagnosis. Our therapists and specialists are trained to help address the unique challenges associated with cancer so you can live and feel well at home, work, and activities you enjoy.


Through our Survivorship program, you can expect your care team to help you navigate life after treatment. Your individualized survivorship plan may include:

  • Regular check-ins and preventative screenings
  • Therapies to address any long-term or late effects of your cancer treatment
  • Recommendations for lifestyle modifications related to diet, exercise, alcohol, and tobacco use
  • Emotional support to help you deal with any stress or worry about recurrence
  • Care coordination with any other specialty care you may need