1. LCC REC-1 Φ π π π Φ Φ See Primary and Adjuvant Treatment (LCC REC-3) Observe or See Primary Treatment (LCC REC-3) Rectal Cancer

2. LCC REC-2 See Primary Treatment (LCC REC-3) See Primary Treatment (LCC REC-4) See Primary Treatment (LCC REC-5) See Primary Treatment (LCC REC-6) Rectal Cancer

3. LCC REC-3 Chemoradiotherapy Surveillance (See LCC REC-7) High risk features include positive margins, lymphovascular invasion and poorly differentiated tumors. Φ Φ Rectal Cancer

4. LCC REC-4 Surveillance (See LCC REC-7) Preoperative chemoradiation (Neoadjuvant Chemoradiotherapy) Chemotherapy Reconsider adjuvant Chemoradiotherapy Chemoradiotherapy Chemotherapy Φ Φ π π Rectal Cancer

5. LCC REC-5 Surveillance (See LCC REC-7) Chemoradiotherapy Chemotherapy Chemoradiotherapy Φ Φ Rectal Cancer

6. LCC REC-6 Chemotherapy Chemoradiotherapy or Resection of involved rectal segment or Diverting colostomy or Chemotherapy alone Rectal Cancer

7. LCC REC-7 See Workup and Treatment (LCC REC-8) If patient is a potential candidate for resection of isolated metastasis. High risk for recurrence (eg, lymphatic or venous invasion by tumor, or poorly differentiated tumors). Villous polyp, polyp > 1 cm, or high grade dysplasia. Φ π † Φ π † Rectal Cancer

8. LCC REC-8 Reevaluate chest/abdominal/ pelvic CT in 3-6 months See treatment for Documented metachronous metastases (LCC COL-8) See treatment for Documented metachronous metastases (LCC REC-9) Preoperative chemoradiotherapy Resection, if feasible Radiation, if not given previously. Φ Φ Rectal Cancer

9. LCC REC-9 See Primary Treatment (LCC REC-10) Chemotherapy π Therapy may be considered for a maximum of 6 months. π π Rectal Cancer

10. LCC REC-10 Chemotherapy π π π π π Therapy may be considered for a maximum of 6 months. Rectal Cancer