While it shares many risk factors, screening paradigms, and presenting symptoms with colon adenocarcinoma, rectal adenocarcinoma has a unique treatment paradigm that involves multi-modality therapy, including surgery, radiation, and chemotherapy for most tumors. The exact treatment is determined based on the depth of invasion of the tumor, the nodal involvement, and the location within the rectum, as well as patient preferences. The distance of the tumor from the anal sphincters dictates the surgical options available to the patient. Some patients may be eligible for non-operative management (omission of surgery entirely) if they have a complete clinical response to neoadjuvant treatment. Regardless of approach, patients are followed closely after treatment to watch for recurrences.