• Survival rates may be increased by 10 to 15 percent with new adjuvant chemotherapy programs such as 5-FU +
leucovorin and/or radiation therapy .
• Intraoperative radiation therapy (IORT) is being evaluated in patients with locally advanced disease.
• 5-FU + levamisole and 5-FU + PALA are being evaluated.
Stage IV (Dukes' D)
TNM Any T, any N, M1
The cancer has spread outside the rectum to distant areas, including organs such as the liver or lungs.
Standard Treatment This stage of cancer is largely incurable. Treatment is directed basically toward palliation, although there can be long-term disease-free survival if isolated metastases in the liver or lung can be removed.
Treatment options include:
• Palliative removal of the primary tumor in some cases, with radiation therapy for local disease that can't be
removed.
• Removal of isolated liver, ovary or lung metastases for possible cure. Liver metastases (if there are three or
fewer) can be removed at the same surgery to remove the rectal cancer in selected cases.
