Current controversies and trends in stage IV rectal cancer

Almost one-third of patients with rectal cancer present with stage IV disease, with the liver being the most common site of distant metastasis. Long-term survival depends on the ability to safely resect all disease (primary and secondary) with negative margins in a multidisciplinary management setting. Unlike stage IV colon cancer where chemotherapy and surgery are the only two options for management, patients with stage IV rectal cancer are candidates for chemoradiotherapy for optimum local control of the primary, in addition to surgery and chemotherapy. There are no standard guidelines for the exact sequence of management in stage IV rectal cancer. While there are still questions regarding proper treatment, for the best results treatment plans should be individualized and formulated in a comprehensive multidisciplinary setting.