Patients with rectal cancer are evaluated with digital examination, endoscopy and imaging of the liver and lungs, including biopsies of the primary tumour and suspected secondary spread. On the basis of a precise tumour staging by MRI scan and/or transrectal ultrasound scan, the combined surgical-oncological treatment is discussed at a multidisciplinary treatment conference. Preoperative oncological treatment is offered depending on the tumour stage and for selected patients may include radiotherapy and chemotherapy. Radiotherapy may be offered as a short-term adjuvant treatment or a long-term course with the aim of downstaging. The surgical treatment for selected patients includes total mesorectal excision or local tumour resection. The prognosis has improved over the last decade.