STAGES OF RECTAL CANCER

Key Points for This Section

After rectal cancer has been diagnosed, tests are done to find out if cancer cells have spread within
the rectum or to other parts of the body.
The following stages are used for rectal cancer:

Stage 0 (carcinoma in situ)

Stage I
Stage II
Stage III
Stage IV

After rectal cancer has been diagnosed, tests are done to find out if cancer cells have
spread within the rectum or to other parts of the body.
The process used to find out whether cancer has spread within the rectum or to other parts of the body is
called staging. The information gathered from the staging process determines the stage of the disease. It is
important to know the stage in order to plan treatment. The following tests and procedures may be used in the
staging process:

Digital rectal exam: An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into
the rectum to feel for lumps or abnormal areas.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body,
taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may
be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure
is also called computed tomography, computerized tomography, or computerized axial tomography.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to
make a series of detailed pictures of areas inside the body. This procedure is also called nuclear
magnetic resonance imaging (NMRI).
Sigmoidoscopy or colonoscopy and biopsy: A procedure to look inside the rectum and colon for
polyps, abnormal areas, or cancer. A sigmoidoscope or colonoscope is inserted through the rectum into
the colon. Polyps or tissue samples may be taken for biopsy.
Endoscopic ultrasound (EUS): A procedure in which an endoscope (a thin, lighted tube) is inserted
into the body. The endoscope is used to bounce high-energy sound waves (ultrasound) off internal
tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This
procedure is also called endosonography.

The following stages are used for rectal cancer:

As rectal cancer progresses from Stage 0 to Stage IV, the cancer cells grow through the layers of the rectum wall
and spread to lymph nodes and other organs.

Stage 0 (carcinoma in situ)

In stage 0, cancer is found in the innermost lining of the rectum only. Stage 0 cancer is also called carcinoma
in situ.

Stage I
In stage I, cancer has spread beyond the innermost lining of the rectum to the second and third layers and
involves the inside wall of the rectum, but it has not spread to the outer wall of the rectum or outside the
rectum. Stage I rectal cancer is sometimes called Dukes A rectal cancer.

Stage II
In stage II, cancer has spread outside the rectum to nearby tissue, but it has not gone into the lymph nodes
(small, bean-shaped structures found throughout the body that filter substances in a fluid called lymph and
help fight infection and disease). Stage II rectal cancer is sometimes called Dukes B rectal cancer.

Stage III
In stage III, cancer has spread to nearby lymph nodes, but it has not spread to other parts of the body. Stage III
rectal cancer is sometimes called Dukes C rectal cancer.

Stage IV
In stage IV, cancer has spread to other parts of the body, such as the liver, lungs, or ovaries. Stage IV rectal
cancer is sometimes called Dukes D rectal cancer.