# Care pathway for rectal cancer On this page you will find information about the different stages of examinations and treatment of rectal cancer at HUS. ## [ From symptoms to diagnosis ](#from-symptoms-to-diagnosis) ## [ Getting a diagnosis ](#getting-a-diagnosis) ## [ Treatments ](#treatments) ## [ After treatments ](#after-treatments) ## From symptoms to diagnosis Primary health care ### A symptom appears or an abnormal finding is made --- Bowel cancer may be suspected on the basis of, for example, altered bowel function, anemia, weight loss, or other abnormal abdominal symptoms. ### Required additional examinations in primary health care and a physician’s assessment --- You may undergo colonoscopy in primary healthcare. Biopsies are taken of any suspicious lesions. ### A physician writes a referral --- When you have received a diagnosis of colon cancer or rectal cancer, or there is a strong suspicion of cancer, a physician will refer you to a gastrointestinal surgeon at HUS. ## Getting a diagnosis Comprehensive Cancer Center and other specialized medical care ### The referral arrives at specialized medical care and an invitation is sent to the patient --- When the referral arrives at HUS, a specialist reviews it, assesses the urgency of the referral and plans any additional examinations, such as various imaging examinations and blood sampling. You will be notified of your appointment and of your X-ray and laboratory examinations by letter. Along with the letter, you will receive a preliminary information form, which we hope you will fill in and take with you to your visit at the HUS surgery outpatient clinic reserved for planning treatment. The nurse coordinating your treatment will schedule your outpatient clinic appointments and the required examinations, and will contact you by phone. At the appointment, we usually perform a sigmoidoscopy to examine the rectum and the descending colon. It is a good idea to reserve plenty of time for the appointment day, as you will meet with a surgeon and nurse and, if necessary, an anesthesiologist. You can bring a loved one with you to your appointment. [ See the average treatment wait times for bowel cancer here ](/en/patient/treatments-and-examinations/cancer/access-cancer-treatment) ### If necessary, additional examinations can be carried out --- Based on the endoscopic examination, the surgeon can specify the location and size of the tumor and plan the surgical procedure. For the endoscopy, you will need to perform bowel cleansing with the help of a drinkable bowel cleansing solution. We will take a biopsy of the tumor if necessary during the sigmoidoscopy. ### Appointment with a physician and a nurse --- Planning your treatment begins with an appointment with a surgeon. At the appointment, we will go through your examination results, the diagnosed disease, and the pros and cons of the various treatment options. Your physician will plan the necessary further examinations and the treatment you have opted for together. If necessary, we will also make a referral for other support measures, such as nutritional therapy, physiotherapy, or services at the Palliative Care Center or Psychosocial Support Unit. After the surgeon’s appointment, you will meet with a nurse with whom you will discuss your treatment plan and who will give you instructions on how to prepare for surgery. The nurse will go through with you the information on the preliminary information form and the supportive treatments: your medication, height, weight, blood pressure, use of compression stockings, and instructions related to anesthesia. You will receive instructions on how to prepare for surgery and possible bowel cleansing. The nurse will also give you information on postoperative recovery. ## Treatments Specialized medical care ### Treatment begins --- The choice of treatment depends on the type of tumor, local spreading, and possible metastases. Radiation therapy or a combination of radiation therapy and chemotherapy may be administered before the operation, if necessary. [ Read more about the treatment of localized rectal cancer ](/en/patient/treatments-and-examinations/cancer/care-pathway-rectal-cancer/treatment-local-rectal-cancer) ### Healing and follow-up --- The follow-up of rectal cancer at HUS usually continues for the first two years, after which follow-up is transferred to primary health care. In order to detect a possible recurrence of rectal cancer as early as possible, we examine the seam area of the intestinal anastomosis two years after surgery. We plan your follow-up program in accordance with your tumor type and general physical condition. If necessary, your follow-up will continue based on the oncologist's assessment at the Comprehensive Cancer Center. The follow-up includes symptom surveys, clinical examinations, blood tests, endoscopic examination, and in some cases imaging examinations. ### If the disease recurs or treatments do not help --- Bowel cancer may metastasize. Depending on the disease situation, we treat metastatic cancer by combining different chemotherapy. [At the Clinical Trial Unit](/en/patient/hospitals-and-other-units/comprehensive-cancer-center/clinical-pharmaceutical-research-unit "Clinical Trial Unit, Comprehensive Cancer Center") we offer an increasing number of patients the opportunity to be among the first to receive new research treatments. [ Read more about the treatment of metastatic rectal cancer ](/en/patient/treatments-and-examinations/cancer/care-pathway-rectal-cancer/treatment-metastatic-rectal) ### Palliative care and psychosocial support --- The majority of surgically treated bowel cancer patients are permanently cured. With some patients, the cancer recurs or is found to be metastasized early on. A metastatic cancer is one that has caused remote tumors to appear in other internal organs or in the bones. Palliative care to alleviate the symptoms will be given alongside chemotherapy and will be continued once the chemotherapy is discontinued and symptomatic therapy is introduced. Symptomatic treatment aims to alleviate symptoms and, as far as possible, to ensure a good and active life with the illness until death. Typically, at this stage, your care responsibility is transferred to the Palliative Care Center or to the palliative outpatient clinic or a hospital-at-home unit in your area. Good palliative care and psychosocial support are an integral part of cancer treatment. The Palliative Care Center provides help in the stressful life situation caused by the cancer treatments, assistance in treating the difficult symptoms, and conversational support. [ Read more about the Palliative Care Center ](/en/patient/hospitals-and-other-units/comprehensive-cancer-center/palliative-center-comprehensive) ## After treatments ### Follow-up in specialized medical care ends --- We plan the duration of your follow-up individually, taking into account the disease situation and the cancer treatments administered. We monitor your condition with various examinations. If you have received adjuvant therapy at the Comprehensive Cancer Center after surgery with the goal of reducing the risk of recurrence, we will perform a CT scan of your body at the end of your treatment. If, after the adjuvant therapy, no findings suggestive of recurrence of the disease are detected, your follow-up will be transferred to HUS surgery. If you have been operated on for rectal cancer metastasis with a curative goal, your follow-up will be carried out at the Comprehensive Cancer Center. Often you will also be offered adjuvant therapy. After postoperative follow-up by a surgeon, your follow-up will be transferred to primary health care. We treat and monitor metastatic, non-curable rectal cancer at the Comprehensive Cancer Center. In between follow-up visits, you can contact the unit that treated you if you have any questions. Updated: 14.04.2026