Rectal cancer is often presented with a dizzying array of treatment recommendations. This article clarifies and simplifies this common clinical problem from the surgical perspective. Treatment of rectal cancer requires an understanding of presenting stage (early or advanced) and location (high or low) to provide oncologic sound treatment decisions. Surgical treatment requires a minimum of 1 cm distal margin, careful clearance of the mesorectum and radial margin using total mesorectal excision technique, and 12 or more regional lymph nodes harvested and analyzed. Appropriate and effective multimodality treatments exist and must be used based on sound guidelines as outlined.