Rectal Cancer Stage II
Stage II rectal cancer means the cancer has grown into or through the outer layers of the rectum wall, but it has not yet spread to nearby lymph nodes or distant parts of the body. Understanding your stage helps your healthcare team plan the most effective treatment approach.
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What is Stage II Rectal Cancer?
In stage II rectal cancer, the cancer has spread into the outer layers of the rectum (the last several inches of your large intestine) or into tissue surrounding the rectum, but it has not spread to any nearby lymph nodes (small bean-shaped organs that are part of the immune system) or to other organs in the body.[1][2]
After a rectal cancer diagnosis, additional tests are needed to find out how far the cancer has spread. This process is called staging, and knowing the stage of cancer is important because it helps your healthcare team create the most effective treatment plan. Staging tests often include blood tests and imaging scans of the abdomen, pelvis, and chest to show the location and size of the cancer.[3]
Healthcare professionals commonly use the TNM system to describe each stage in detail. This system looks at three key factors: T (the size of the primary tumor), N (whether the cancer has spread to nearby lymph nodes), and M (whether the cancer has spread to other parts of the body, called metastasis). In stage II rectal cancer, the cancer has not spread to lymph nodes or distant organs.[4]
Understanding Stage II Substages
Stage II rectal cancer is divided into three categories based on how deeply the cancer has grown into or through the rectal wall.[5]
Stage IIA means the cancer has spread into the muscularis propria layer (the outer muscle layer) of the rectum but has not grown beyond it. It has not spread to any other organs or lymph nodes.[6]
Stage IIB means the cancer has spread through to the outermost layer of the rectal wall, which is called the serosa (the outer lining), or into the tissue layer covering the organs in the abdomen. It has not spread to any other organs or lymph nodes.[7]
Stage IIC means the cancer has grown through the wall of the rectum and into nearby tissue or organs next to it. It has not spread to any other organs or lymph nodes.[8]
Treatment Options
The main treatments for stage II rectal cancer include surgery, radiation therapy (treatment using high-energy rays to destroy cancer cells), chemotherapy (drugs that kill cancer cells), or a combination of these approaches. The treatment you receive depends on several factors that your healthcare team will discuss with you.[9]
Surgery is a key treatment for stage II rectal cancer. A bowel resection is the surgery typically performed, where the section of the rectum containing the cancer is removed. The type of bowel resection depends on where the tumor is located in the rectum. Depending on the type of surgery done, you may need a temporary or permanent colostomy, which creates an opening from the colon to the outside of the body through the abdominal wall to allow waste to leave the body.[10]
Many patients with stage II rectal cancer receive treatment before surgery. Chemoradiation combines radiation therapy with chemotherapy given at the same time. This may be given before surgery and is usually delivered as 25 to 30 treatments over a period of 5 to 6 weeks. The chemotherapy drugs commonly used include 5-fluorouracil or capecitabine. Sometimes a short course of radiation therapy alone may be given before surgery, typically five treatments.[11]
Some treatment approaches for stage II rectal cancer include surgery as the only treatment, a short course of radiation therapy followed by surgery, a course of chemoradiation followed by surgery, a course of chemotherapy followed by surgery, or total neoadjuvant therapy (which might include chemoradiation and chemotherapy all given before surgery).[12]
After surgery, some patients may be offered additional chemotherapy, especially if they haven’t received this treatment before surgery. This additional treatment aims to lower the chance of cancer coming back after surgery.[13]
Patients with stage II rectal cancer and certain high-risk features may benefit more from additional treatments beyond surgery. Your healthcare team will work with you to develop a treatment plan based on your specific situation and needs.[14]
