Abstract Locally advanced rectal cancer represents a challenge requiring integration between specialized care and Primary Health Care. This letter reflects on the role of PHC in prevention, early detection, timely referral, follow-up, rehabilitation, and continuity of care for these patients. Proposed actions include strengthening healthcare personnel training, organizing post-treatment surveillance, incorporating psychosocial support, promoting multidisciplinary coordination, and reducing inequalities in access to care. Shared decision-making is also highlighted as an essential component of patient-centered care, together with the need for local research to adapt these strategies to the characteristics, resources, and specific needs of each community.