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What Are My Treatment Options?
There are a number of treatment options
for Colorectal Cancer. Your physician will develop a treatment
plan to fit your needs based on the location of the tumor
and the stage of the disease. Treatment for colon cancer may
involve radiation therapy or chemotherapy, but the primary
treatment in nearly all cases is surgery.
Surgery for Colon Cancer
Surgery is the main treatment for colon
cancer. Usually, the cancer and a length of normal tissue
on either side of the cancer (as well as nearby lymph nodes)
are removed. In addition, the surgeon checks the intestine
and liver to see if the cancer has spread. The two ends of
the colon are then sewn back together. For colon cancer, a
colostomy (an opening in the abdomen for getting rid of body
wastes) is not usually needed, although sometimes a temporary
colostomy may be done.
Sometimes very early colon cancer can be removed through
a colonoscope. When this is done, the doctor does not have
to cut into the abdomen. For some very advanced cancers and
for some patients in poor health, a different operation might
be done to relieve symptoms such as blockages and bleeding.
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Surgical Techniques
"Laparoscopic" and "open" colon
surgery simply describe the techniques a surgeon uses to gain
access to the internal surgery site. Advancing technology
and research have transformed surgery for the treatment of
colon cancer in recent years. In the past, most patients underwent
“open” surgery for colon cancer. However, patients
now have a second surgery option, laparoscopic or minimally
invasive surgery. The technique known as minimally invasive
laparoscopic colon surgery allows surgeons to perform many
common colon procedures through small incisions. Depending
on the type of procedure, patients may leave the hospital
in a few days and return to normal activities more quickly
than patients recovering from open surgery.
Open Surgery: During traditional
“open surgery,” the surgeon makes an incision
up to 16 inches long from the upper to lower abdomen to view
the colon and remove the diseased portions. Because of the
nature of this highly invasive procedure, patients often face
a long and difficult healing process that results in a hospital
stay of at least a week, with recovery time ranging from six
to eight weeks.
Laparoscopic or Minimally Invasive
Surgery: In most laparoscopic colon surgeries, surgeons
operate through 4 or 5 small openings (each about a ½ inch).
A small video camera or “scope” is placed in one
of the incisions, providing the surgeon with a magnified view
of the patient’s internal organs on a television monitor.
In some cases, one of the small openings may be lengthened
to 2 or 3 inches to complete the procedure. Surgical instruments
are placed in the other incisions allowing the surgeon to
work inside and remove portions of the diseased colon. This
surgical technique also can be used to treat other diseases
of the colon such as Crohn’s disease and diverticulitis.
Laparoscopic colon surgery offers many benefits
over traditional “open” surgery. These benefits
include:
- Less pain and scarring.
- Quicker recovery time.
- Shorter hospital stay.
- Better cosmetic results.
Patients considering “minimally invasive”
surgery should consult with a surgeon experienced in laparoscopic
techniques and has performed at least 20 laparoscopic colon
resections.
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Surgical Treatments
Surgery for Colon/Rectal Cancer:
There are several types of surgery for rectal cancer:
- Polypectomy is a method
used to remove mushroom-like growths that contain stage
0 cancer. The cancer is cut out across the base of the stalk.
- Local excision removes
superficial cancers and a small amount of nearby tissue
from the inner layer of the rectum. Instead, the doctor
may put a tube through the rectum into the colon and cut
the cancer out. This is called a local excision.
 Resection:
If the cancer is larger, the doctor will perform a partial
colectomy (removing the cancer and a small amount of healthy
tissue around it). The doctor may then perform an anastomosis
(sewing the healthy parts of the colon together). The doctor
will also usually remove lymph nodes near the colon and
examine them under a microscope to see whether they contain
cancer. Resection and colostomy: If the doctor is not able
to sew the 2 ends of the colon back together, a stoma (an
opening) is made on the outside of the body for waste to
pass through. This procedure is called a colostomy. A bag
is placed around the stoma to collect the waste. Sometimes
the colostomy is needed only until the lower colon has healed,
and then it can be reversed. If the doctor needs to remove
the entire lower colon, however, the colostomy may be permanent.
- Radiofrequency ablation:
The use of a special probe with tiny electrodes that kill
cancer cells. Sometimes the probe is inserted directly through
the skin and only local anesthesia is needed. In other cases,
the probe is inserted through an incision in the abdomen.
This is done in the hospital with general anesthesia.
- Cryosurgery: A treatment
that uses an instrument to freeze and destroy abnormal tissue,
such as carcinoma in situ. This type of treatment is also
called cryotherapy.
Even if the doctor removes all the cancer
that can be seen at the time of the operation, some patients
may be given chemotherapy or radiation therapy after surgery
to kill any cancer cells that are left. Treatment given after
the surgery, to increase the chances of a cure, is called
adjuvant therapy.
For more advanced stages of rectal cancer,
other types of surgery may be done. If you are having surgery,
ask your doctor if you will need a colostomy. A colostomy
is used much more often in the surgical treatment of rectal
cancer than for colon cancer. If you have a colostomy, follow-up
care is important. There are nurses who have special training
in ostomy care. Ask your cancer care team if this help is
available. Also, there are groups that can put you in touch
with others who have had an ostomy.
Radiation Therapy for Colon and
Rectal Cancer: Radiation therapy uses high-energy
radiation to kill cancer cells. External beam radiation therapy
uses radiation from outside the body to focus on the cancer.
Local radiation therapy or brachytherapy uses a small pellet
of radioactive material placed directly into the cancer. Having
radiation treatment does not make you radioactive.
After surgery, radiation can kill small
areas of cancer that may not be seen during surgery. If the
size or location of a tumor makes surgery hard, radiation
may be used before the surgery to shrink the tumor. Radiation
also may be used to ease (palliate) symptoms of advanced cancer
such as intestinal blockage, bleeding, or pain.
Side effects of radiation therapy for colon
or rectal cancer include mild skin irritation, nausea, diarrhea,
or tiredness. These often go away after a while. If you have
these or other side effects, talk to your doctor. There are
ways to lessen many of these problems.
Chemotherapy for Colon and Rectal
Cancer: Chemotherapy refers to the use of anti-cancer
drugs to kill cancer cells. The drugs are given through an
IV or in the form of pills. They enter the bloodstream and
reach all areas of the body. Studies have shown that chemotherapy
after surgery can increase the survival rate for patients
with some stages of colorectal cancer. Chemotherapy can also
help relieve symptoms of advanced cancer.
Chemotherapy can have some side effects.
These side effects will depend on the type of drug, how much
you have, and how long you take it. Most of the side effects
go away when treatment is over. For example, hair will grow
back after treatment ends, though it may look different. Anyone
who has problems with side effects should talk with their
doctor or nurse as there are remedies for many of these.
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Other types of treatment
are being tested in clinical trials. These include the following:
Biologic therapy is a treatment
that uses the patient’s immune system to fight cancer.
Substances made by the body or made in a laboratory are used
to boost, direct, or restore the body’s natural defenses
against cancer. This type of cancer treatment is also called
biotherapy or immunotherapy.
This summary section refers to specific
treatments under study in clinical trials, but it may not
mention every new treatment being studied. For information
about ongoing clinical trials ask your Doctor.
What happens after
the treatment for Colorectal Cancer?
There are some important follow-up
activities after treatment for colorectal cancer that can
help you to deal with your situation.
Follow-up Care: For years
after treatment ends, regular follow-up exams will be very
important for you. These can detect recurrence, that is, the
cancer coming back. Be sure to report any new or persistent
symptoms to your doctor right away. Follow-up tests usually
includes a careful general physical exam and rectal exam,
colonoscopy, and blood tests for tumor markers such as carcinoembryonic
antigen (CEA). Other imaging studies such as chest x-rays,
CT scans, and MRI scans may also be done if symptoms or other
test results suggest a recurrence.
Tumor markers: Carcinoembryonic
antigen (CEA). is a substance in the blood of some people
with colon cancer. The CEA blood test is most often used with
other tests for follow-up of patients who already have had
cancer and have been treated. CEA may be useful to provide
an early warning of a cancer that has returned. CEA may be
present in the blood of some people without colon cancer.
Often these people have ulcerative colitis, noncancerous tumors
of the intestines, or some types of liver disease or chronic
lung disease. Smoking can also cause an increase in CEA levels.
Because the CEA level in the blood can be high for reasons
other than cancer, it is not a specific test for cancer. It
is not a method for finding cancer in people who have never
had a cancer and appear to be healthy.
For patients with colostomies:
Few permanent colostomies are needed now in the treatment
of colon cancer. Most colostomies are done for cancers that
are near the outer or lower end of the rectum. If you have
a colostomy, follow-up is an important concern. You may feel
worried or isolated from normal activities. Whether your ostomy
is temporary or permanent, an enterostomal therapist (a health
care professional trained to help people with their colostomies)
can teach you about the care of your colostomy.
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