Colorectal cancer

Colorectal cancer treatment will be developed for a sick person by a healthcare team. It will be according to patient health and specific cancer information. When the healthcare team decides which treatments to offer, they take the following into consideration:

  • Location of the tumor or where the cancer reappear (recurrence)
  • The stage of cancer
  • The general state of health
  • What the patient prefers or want

Several or only one colorectal cancer treatment may be offered.

1. Surgery

Surgery is the main treatment for most colorectal cancers. Depending on the stage and location of the tumor, one of the following types of surgery may be performed.

- Local excision (local resection): is a surgery to remove abnormal tissue, such as a polyp or tumor, and a margin of healthy tissue all around. They usually use this technique to remove a stage 0 colorectal tumor, some stage 1 rectal tumors, or a local recurrence of rectal cancer. The types of local excision are polypectomy, local transanal excision, and transanal endoscopic microsurgery.

- Bowel resection is the most common type of colorectal cancer surgery. It involves the removal of a part of the intestine and the nearby lymph nodes. Depending on the location of the tumor, one of the following types of bowel resection is performed:

  • Right hemicolectomy to remove the right side of the colon.
  • Transverse colectomy to remove the central part of the colon.
  • Left hemicolectomy to remove the left side of the colon.
  • Sigmoid colectomy to remove the last part of the colon.
  • Low anterior resection to remove the last part of the colon and part of the rectum.
  • Proctocolectomy to remove the rectum and part of the sigmoid colon (last part of the colon).
  • Abdominoperineal resection to remove the rectum, anal canal, and neighboring muscles.
  • Partial colectomy to remove most of the colon.
  • Total colectomy to remove the entire colon.

A colostomy or an ileostomy can be done after a bowel resection. These surgeries can also help bypass or prevent a blockage in the intestine, or intestinal obstruction. An ostomy (artificial opening) is created in the colon or ileum to the outside of the body through the wall of the abdomen. Colostomy and ileostomy are temporary or permanent.

Lymph node dissection is surgery to remove the lymph nodes near the tumor, and it is done during resection of the intestine.

Pelvic exenteration used to treat stage 4 or recurrent rectal cancer that has spread to nearby organs. The reproductive organs and the lymph nodes in the pelvis are removed. We usually remove part of the colon and the rectum or both. Sometimes the bladder is also removed.

Surgery is done to remove metastatic tumors when there is only one or a few in the liver or lungs.

Related: What are the colorectal cancer symptoms?

2. Chemotherapy

Chemotherapy is sometimes used as a colorectal cancer treatment. The following chemotherapy drugs can be used alone or in combination to treat colorectal cancer:

  • 5-fluorouracil (Adrucil, 5-FU)
  • Capecitabine (Xeloda)
  • Oxaliplatin (Eloxatin)
  • Irinotecan (Camptosar)
  • Raltitrexed (Tomudex)
  • Trifluridine and tipiracil (Lonsurf)

Leucovorin (folinic acid) is commonly used as a colorectal cancer treatment. It is not a chemotherapeutic agent, but it makes 5-fluorouracil more effective.

3. Chemoradiotherapy

Chemotherapy is often used in combination with radiation therapy to treat cancer of the rectum. This is called chemoradiotherapy. Specialists administrate treatments during the same period. The commonly used chemotherapeutic agents are 5-fluorouracil or capecitabine.

4. Radiotherapy

Radiotherapy mostly used to treat cancer of the rectum. It can be administered alone or combined with chemotherapy as part of chemoradiotherapy.

External radiation therapy is the most common type of radiation therapy. Brachytherapy can be used in some cases.

5. Targeted therapy

Targeted therapy sometimes performed to treat advanced colorectal cancer. It is usually combined with chemotherapy, but it can be given alone.

The following targeted drugs can be used as colorectal cancer treatment:

  • bevacizumab (Avastin, Mvasi)
  • cetuximab (Erbitux)
  • panitumumab (Vectibix)
  • regorafenib (Stivarga)

6. If you cannot or do not want cancer treatment

You might want to consider care that makes you feel better without treating cancer itself, perhaps because cancer treatments are no longer working, or are likely to improve your condition or their effects are difficult to tolerate. There are other reasons why you cannot or do not want cancer treatment.

Talk to the members of your healthcare team. They can help you choose the care and treatment for advanced cancer.

7. Follow-up

Post-treatment follow-up is an essential part of caring for people with cancer. You will need to have regular follow-up visits, especially in the first five years after treatment. These follow-up visits allow the healthcare team to control your progress and how you are recovering from treatment.

Originally published on Live Positively.