| Summary: | <p><strong>Purpose: </strong>Palliative treatment techniques for advanced stage rectal cancer should be designed according to the patients’ major symptoms. Combined chemo-radiation therapy is effective choice for symptomatic patients with good performance status. In this study, we reviewed our patients' stage IV rectal carcinoma in regard to most common presentation, outcome and possible prognostic features.</p><p><strong>Methods</strong> Medical chart of twenty patients who were diagnosed with stage IV rectal carcinoma, were reviewed based on the hospital database information, which included images, radiotherapy charts, and their follow up notes. <strong></strong></p><p><strong>Results: </strong>All patients were young with age less than 40 years. Bleeding per rectum, pain, and symptoms of obstruction were the most common presentation. Seven patients had solitary lesion and 13 patients had multiple lesions. Eleven patients with multiple metastases were treated with palliative chemotherapy and radiotherapy. Patients who had solitary metastases to liver had a median survival time of 49 months versus 13.5 months for other patients (p = 0.001). <strong></strong></p><p><strong>Conclusion</strong>: Patients who presented with solitary liver metastases could be treated with a course of neoadjuvant chemo-radiotherapy similar to the curative one.</p><p>-----------------------------------</p><p align="left"><strong>Cite this article as:</strong> Aboziada MA, Attia AM, Alhamad AA. Presentation and outcome of twenty patients with synchronous stage IV rectal carcinoma. <em>Int J Cancer Ther Oncol </em>2014; <strong>2</strong>(3):020313. <strong>DOI</strong>:<a href="http://dx.doi.org/10.14319/ijcto.0203.13" target="_blank"><strong>10.14319/ijcto.0203.13</strong></a></p>
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