Foreword: Dear patients and family members, the treatment recommendations and guidelines posted on this website are all word-for-word knocked out by me, not simply copied or reposted. Patients and families are asked to believe that reading the articles I post is the same as talking to me face-to-face. I am responsible to tell you that all the contents are from real clinical practice, without any fiction or exaggeration. They are all from the latest treatment guidelines and recommendations, from my experience in actual clinical work, from the experience of high-level academic exchanges, and from the anxiety of patients and their family members who can really feel the helplessness and how to choose treatment when they have rectal cancer. If you can read this article before treatment, I think it will bring you some guidance and help. I. Rectal cancer is not scary. Rectal cancer is a highly prevalent cancer in China, and its incidence rate is increasing year by year. The characteristics of rectal cancer in China are higher than those in western countries, with high proportion, location close to the anus and more young patients. Overall, rectal cancer is the mildest cancer among GI tumors in nature and the disease develops slowly. For patients with early and middle stage rectal cancer, if they can receive reasonable and correct treatment, long-term survival is an easy task, and many patients are eventually cured. Even in advanced stage with liver and lung metastasis, as long as they receive timely and correct comprehensive treatment, their survival rate is far more optimistic than other advanced solid tumors. Therefore, rectal cancer is not an incurable disease. After quieting down and stabilizing emotion first, choosing professional doctors and cooperating with them with a positive attitude, defeating rectal cancer is just around the corner. How to correctly diagnose rectal cancer The correct diagnosis of malignant tumor is accurate “characterization” and “staging”. Colonoscopy is a necessary item for qualitative diagnosis: if you have clinical suspicion of rectal cancer, you must perform full colonoscopy to clarify the location, size, shape, upper and lower margin of rectal tumor, and take biopsy to clarify the pathological type, which is the accurate qualitative diagnosis; meanwhile, full colonoscopy is necessary to understand the situation of all large intestine, and there are many colorectal multiple cancer foci in the clinic. Pelvic enhanced MRI: It is the preferred imaging examination. MRI, compared with CT examination, is more accurate in determining the level of rectal cancer lesions invading the intestinal wall and peri-intestinal lymph node metastasis. Enhanced CT of chest and abdomen: must be perfected. This is a powerful tool for rectal cancer staging examination. The common metastatic sites of rectal cancer are liver and lung. In the clinic, we often encounter patients who have liver or lung metastases found while diagnosing rectal cancer; some patients even have metastases found first and then have colonoscopy to discover the primary rectal lesions. Transrectal ultrasonography: It is another powerful tool to understand the depth of tumor invasion into the rectum, which is to extend the ultrasound probe into the rectum through the anus and observe directly on the surface of the lesion. If MRI examination can determine the depth of invasion very clearly, this examination can be left out. Whole-body PET/CT examination: It is good for excluding systemic metastasis, and it is very sensitive to determine whether there is metastasis or not, as it can understand the situation of the whole body organs after one dose. The disadvantage is that the cost is high, which limits the wide application in clinical practice. How to treat rectal cancer correctly The treatment of rectal cancer is not uniform. Depending on the location and stage, the treatment plan will be different. Transanal local excision: It is the local excision of cancer lesions through the anus. It is generally suitable for some patients with early rectal cancer. Indications: early cancer within 8 cm from the anus, invading less than 1/3 week of the intestinal circumference, well differentiated pathological type, and depth in the mucosa or submucosa layer. The rest of early rectal cancers would be suitable for radical resection. High rectal cancer, treated more than 8cm from the anus: if there is no distant metastasis, low anterior resection of rectal cancer (i.e. anal preservation surgery) is generally performed. Middle and low rectal cancer: if the tumor invades deeper than the intrinsic muscular layer or has lymph node metastasis, preoperative radiotherapy treatment is recommended. That is, neoadjuvant therapy, the purpose: to reduce the local recurrence rate after surgery; to increase the chance of anal preservation. Generally, after 6-8 weeks of rest after radiotherapy, surgical treatment is performed. If the tumor does not invade the intrinsic muscle layer or there is no lymph node metastasis, TME surgery (standard radical surgery) is performed directly. For the issue of anal preservation: leave it to professional colorectal cancer doctors, who will synthesize all aspects and will definitely preserve the anus as long as the anal function can be preserved; however, when anal preservation and curative radical treatment conflict, I suggest listening to the advice and guidance of professional doctors. For traditional open and laparoscopic minimally invasive treatment: the two surgical methods do not conflict, minimally invasive treatment is the direction of development, and medicine always keeps advancing. Following the same principles of tumor treatment, but laparoscopic minimally invasive surgery for rectal cancer has advantages that open surgery does not have: the pelvic space is small, so open surgery is difficult to operate with direct vision, which is unfavorable for nerve protection, while laparoscopic surgery, with lens magnification, can clearly show the vascular nerves in the deep pelvic cavity, which is a more refined operation and preserves the protection of patients’ defecation, urination and sexual function. Adjuvant treatment and follow-up after rectal cancer surgery According to the postoperative pathological results, it is better to follow the professional doctor’s advice and adjuvant treatment. Follow-up is important. 2 years after surgery, review every 3-6 months, review: gastrointestinal tumor markers; chest X-ray or chest CT; abdominal ultrasound or CT; pelvic MRI or CT. 2-5 years after surgery, every 6 months; 5 years after surgery, every 1-2 years.