Treatment of Rectal Cancer — Clinical Stage T1, N0 Appropriate for Resection

Clinical scenario

This protocol applies to patients with rectal cancer that is appropriate for resection, confirmed at clinical stage T1, N0. Staging is based on assessment by pelvic MRI (preferred) or endorectal ultrasound. Transanal local excision is considered only for carefully selected T1, N0 early-stage cases.

Approach

Management is guided by pathologic findings after initial surgery. The approach distinguishes between cases without high-risk features — where surveillance may be appropriate — and those with high-risk features or more advanced pathologic stage, where a combination of surgical and adjuvant systemic and/or radiation-based treatment is considered.

Full treatment algorithm, sequencing, and regimen options available in the complete protocol →

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References

Rectal cancer appropriate for resection
T1, N0 staging should be based on assessment of pelvic MRI (preferred) or endorectal ultrasound.
Transanal local excision is only appropriate for selected T1, N0 early-stage cancers.
pT1, NX without high-risk features: Observe.
pT1, NX with high-risk features or pT2, NX: Transabdominal resection (preferred).
High-risk features include positive margins, lymphovascular invasion, poorly differentiated tumors, or sm3 invasion (submucosal invasion to the lower third of the submucosal level).
Bolus 5-FU/leucovorin/RT is an option for patients not able to tolerate capecitabine or infusional 5-FU.

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