Rectal Cancer Stage III

Stage III rectal cancer means the disease has spread to nearby lymph nodes but has not yet reached distant parts of the body. Understanding this stage and the available treatment options is an important step in facing this diagnosis.

Table of contents

• What is stage III rectal cancer?
• Understanding stage III subdivisions
• Treatment approaches
• Living with the diagnosis

What is stage III rectal cancer?

Stage III rectal cancer is a condition where cancer has grown beyond the inner layers of the rectum and has spread into nearby lymph nodes – small bean-shaped structures that help your body fight infections. At this stage, the cancer has not yet traveled to other distant areas of the body^[1][2].

The rectum is the last several inches of your large intestine, located just before the anus. When doctors find cancer cells in the lymph nodes near the rectum, they classify the disease as stage III^[2][3].

Understanding stage III subdivisions

Stage III rectal cancer is divided into three smaller categories – IIIA, IIIB, and IIIC – based on how deeply the cancer has grown into the wall of the rectum and how many lymph nodes contain cancer cells^[6][12].

Stage IIIA means one of the following: the cancer is still in the inner or muscle layer of the bowel wall and has spread to between 1 to 3 nearby lymph nodes or to areas of tissue close to the lymph nodes. It can also mean the cancer is in the inner layer of the bowel wall and has spread to between 4 and 6 nearby lymph nodes^[6][12].

Stage IIIB means the cancer has grown into the outer lining of the bowel wall or into the tissue layer covering the organs in the abdomen, and it has spread to between 1 and 3 nearby lymph nodes or to areas of fat close to the lymph nodes. It can also describe cancer that has grown into the muscle or outer lining of the bowel wall with 4 to 6 nearby lymph nodes containing cancer, or cancer that is still in the inner or muscle layer of the bowel wall but has spread to 7 or more nearby lymph nodes^[6][12].

Stage IIIC describes more extensive spread. This includes cancer that has grown through the outer lining of the bowel wall into the tissue layer covering the organs in the abdomen with between 4 to 6 nearby lymph nodes containing cancer, or cancer that has grown into the outer lining of the bowel wall with 7 or more nearby lymph nodes affected. It can also mean the cancer has grown through the bowel wall into other nearby organs and has spread to at least one nearby lymph node or to areas of fat close to the lymph nodes^[6][12].

Treatment approaches

The main treatments for stage III rectal cancer include surgery, radiation therapy (treatment that uses high-energy rays to destroy cancer cells), chemotherapy (medicines that kill cancer cells), or a combination of chemotherapy and radiation therapy called chemoradiation^[12][15].

Many patients receive treatment before surgery to shrink the tumor. This is called neoadjuvant therapy. You might have a short course of radiation therapy followed by surgery, a longer course of chemoradiation followed by surgery, a course of chemotherapy followed by surgery, or what doctors call total neoadjuvant therapy (TNT), which might include chemoradiation and a course of chemotherapy all before surgery^[11][12][16].

Surgery to remove the cancer is typically the main treatment. The type of surgery depends on where the tumor is located in the rectum. After surgery, some patients need a colostomy, which creates an opening from the colon to the outside of the body through the abdominal wall. This creates a new path for stool to leave the body. The colostomy may be temporary or permanent^[15].

If you did not receive chemotherapy or radiation therapy before surgery, your doctor might offer you chemotherapy after surgery. This can help lower the chance of the cancer coming back. Chemotherapy after surgery typically lasts for several months^[12][15].

Chemoradiation may be given before surgery, usually as 25 to 30 treatments of radiation combined with chemotherapy medicines such as 5-fluorouracil or capecitabine over a period of 5 to 6 weeks. Sometimes chemoradiation is given after surgery^[15].

Living with the diagnosis

Receiving a diagnosis of stage III rectal cancer can feel overwhelming. Many people find it helpful to fully understand their diagnosis and treatment plan by asking their healthcare team questions. Preparing a list of questions before appointments can help ensure you don’t forget anything important^[18].

Support groups can be valuable resources for people facing rectal cancer. Speaking with others who are in similar situations can help you find new ways to cope with your condition and provide emotional support^[18].

After treatment, regular follow-up appointments with your doctor are important. These visits help monitor for any signs that the cancer might return and allow your healthcare team to address any side effects from treatment^[17].

While dealing with treatment, it’s important to continue living your life and doing things you enjoy. Spending time with family members, pursuing hobbies, and making meaningful moments count can help maintain quality of life during this challenging time^[18].