Endoscopic treatment for early rectal cancer was investigated. The characteristics of early rectal cancer were compared with those of early colon cancer, and the advantages of endoscopic treatment were evaluated. The indications for endoscopic resection are mucosal cancer, slight submucosal invasion without vessel or lymphatic involvement, poorly differentiated adenocarcinoma, and sprouting. The presence of other characteristics indicates the need for surgical resection. Early rectal cancers in the form of laterally spreading tumors of the non-granular, pseudodepressed type should be treated with endoscopic submucosal dissection due to the high incidence of submucosal invasion. The decision on the procedure for the treatment of early rectal cancer may be complicated because of the anatomic character and function of the ano-rectal area, complications of anal dysfunction, and incidence of leakage from the anastomosis after surgery. A precise diagnosis after endoscopic examination based on the pit pattern with magnifying endoscopy may be an effective aid in selecting the most appropriate endoscopic treatment for early rectal cancer.