Optimizing Primary Tumor Management in Stage IV Rectal Cancer

Stage IV rectal cancer is defined by the presence of distant metastatic disease on presentation with the primary rectal lesion. Historically, the outcomes for patients with stage IV rectal cancer had been poor. However, with improved survival rates due to modern-day chemotherapy and increased indications for surgical metastasectomy, the management of such patients has become more nuanced and complex. The management of the primary tumor should be considered in the context of the patient as a whole. Patients may be approached differently depending on the ultimate goals of therapy (i.e., curative versus palliative) and on whether the primary tumor is symptomatic on presentation. Furthermore, there are several different options for managing the symptomatic primary rectal lesion. Such management decisions should be made in a multidisciplinary fashion, incorporating the disciplines of surgery, medical oncology, and radiation oncology.