Treatment of Colorectal Cancer

May 15th, 2013 by Eduardo Krajewski, MD, FACS, FASCRS

If you have been diagnosed with colon or rectal cancer then you certainly have many questions. Many of the questions most likely deal with treatment options. The treatment of colorectal cancer is not the same for everyone, and many factors must be considered.

Staging comes first

Cancer staging is the first step your doctor takes in deciding upon the treatment. This means defining exactly how far the disease has advanced in your body. Some questions to answer in order to stage colorectal cancer are:

  • How deep has the cancer penetrated the intestinal wall?
  • Has the cancer grown into any organs nearby?
  • Is there any sign of cancer in the lymph nodes near the colon?
  • Has the cancer spread to other organs such as the liver or the lungs?

This staging process is completed by analyzing information obtained from tissue biopsies and CT scanning of the abdomen, pelvis and lungs.

Another test that comes with the pre-treatment evaluation is the CEA or carcinoembryonic antigen blood test. This test does not affect the staging of the disease, but it does allow your physician to follow how well your body responds to treatment.

Treatment of localized colorectal cancer

About 80% of cancers are limited to the wall of the colon with or without affecting the lymph nodes. Surgery is used here to cut out the cancerous area, the accompanying blood vessels and lymphatic vessels. The size and location of the cancer will determine if you will need a colostomy bag after the surgery. In some cases, a less invasive laparoscopic surgery can be performed.

In Stage I cancer, where the cancer is limited to the wall of the colon, surgery alone can be curative. Even if your cancer has grown into nearby organs, surgery may be recommended.

Chemotherapy

Chemotherapeutic agents are special drugs whose aim is to kill cancer cells. In some cases chemotherapy can be considered before surgery. This is called neoadjuvant chemotherapy. This type of treatment is typically reserved if your cancer has grown through the intestinal wall and into other nearby organs. However, current research data is unclear on the benefits of the neoadjuvant approach.

When given after surgery, the goal of chemotherapy is to eradicate any left-over tumor cells that might have been missed by surgery. The benefit of chemotherapy has been most clearly established if you have a cancer that has spread to the lymph nodes. This is called Stage III, node positive disease. In this case, chemotherapy reduces your risk of disease recurrence by 30% and reduces your risk of death by 22 to 32%. The benefit of chemotherapy is controversial when it comes to cancers free of lymph node involvement (Stage II disease).

Most chemotherapeutic regimens use a combination of drugs which are administered intravenously over a period of six months. One of the most commonly used drugs is oxaliplatin. The potential side effects of chemotherapy are:

  • Inflammation/ulceration of the lining of the mouth and intestinal tract
  • Vomiting and diarrhea
  • Low white blood cell count and fever
  • Fatigue
  • Hair loss
  • Soreness, redness and peeling of the skin of the palms and soles of the feet (Hand-foot syndrome)
  • Heart toxicity
  • Nerve damage

These side effects are serious and must be taken into consideration when deciding on treatment. In general, the benefits outweigh the risks, and the side effects normally go away when treatment stops.

Radiation therapy

Radiation therapy is the use of ionizing radiation to kill cancer cells. This therapy is not typically used if a cancer has been completely removed from the colon. However, if the cancer is in the rectum then radiation therapy is commonly used. This is because the anatomy of the rectum makes it difficult to remove all of the cancer making recurrence more common.

Treatment of metastatic disease

If your cancer has spread to other parts of the body like the liver or lungs, then you and your doctor must decide if surgery is an option. In some cases, the surgeons will remove not only the cancer in your colon, but sites of cancer that are in other organs. This approach can be done with the goal of curing the cancer or relieving symptoms. In the majority of cases, chemotherapy is used also.

Follow up after treatment

After you have been treated for your cancer, you will have to keep in close contact with your doctor for regular checkups and exams. He or she will check your CEA, and if it is elevated it could mean the cancer has reoccurred. You should also have a CT scan and colonoscopy yearly to look for disease reoccurrence. However, for Stage I cancer (limited to the wall of the colon) you will only need a yearly colonoscopy.

Conclusion

Colon cancer is one of the most common cancers diagnosed around the world. It is a treatable and sometimes curable disease. The treatment depends on the stage of the cancer at the time of diagnosis.

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Have an outstanding day.

 

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