Treatment for colorectal cancer

Most colorectal cancer is treated with a combination of one or more of the following treatments:

• Surgery
• Chemotherapy
• Radiation
• Targeted therapy
• Immunotherapy

Surgery for colorectal cancer

Surgery for early stage colorectal cancer may include the following:

• Polypectomy (polyp removal) is used to completely remove small cancers contained within a polyp during a colonoscopy.
• Endoscopic mucosal resection (removing polyps and surrounding tissue) allows doctors to remove larger polyps and a small amount of lining of the colon during a colonoscopy.
• Minimally invasive or laparoscopic surgery is used to remove polyps that cannot be removed during a colonoscopy. During laparoscopic surgery, small incisions are made in the abdominal wall so that the surgeone can insert cameras to help see the colon and instruments to help remove the cancer. Polyps are removed as well as a part the part of the colon that contains the polyp, and nearby lymph nodes through these incisions.

Surgery for more advanced colon cancer may include the following:

• Partial colectomy removes the part of the colon that contains the cancer and normal tissue on either side of the cancer. A partial colectomy can often be done using a laparoscope, but sometimes open abdominal surgery is required.
  • Often, after removing the cancer, the surgeon can reconnect the healthy portions of the colon.
  • When it is not possible to reconnect the healthy portions of the colon, the surgeon creates a hole in the wall of the abdomen called an ostomy. Ostomies allow stool to be removed from the body into a bag that fits securely over the opening.
    • Sometimes the ostomy is only temporary, and after time the ostomy can be reversed.  However, in some cases it may be permanent.

Surgery for very advanced cancer may include:

• For people in otherwise good health, if the cancer has spread only to the liver or lung, doctors may recommend surgery in combination with other treatments such as chemotherapy.
• For people with very advanced cancer or overall poor health, surgery may be used only to relieve a blockage of the colon or to improve symptoms such as bleeding or pain.

For people who have an inherited mutation linked to very high risk for colorectal cancer, more extensive colectomy surgery may be recommended to treat their cancer and prevent new cancers from developing. These surgeries include: 

• Total proctocolectomy with Ileal Pouch and Anal Anastomosis (TPC IPAA) involves removal of the colon and rectum but spares the anal sphincter. People who have this surgery may remain continent and are able to control bowel movements. The surgeon uses a portion of the small intestine to create an internal pouch, which stores waste until a bowel movement. 
• Total abdominal colectomy with ileorectal anastomosis (TAC IRA) involves removal of the entire colon but spares the rectum. Not all people are candidates for this surgery, which leaves the risk for rectal cancers. 
• Total proctocolectomy with permanent end ileostomy (TPC EI) removes the entire colon, rectum  and anus and creates an ostomy opening at the end of the small intestine. 

Surgical risks and recovery

Every surgery has potential risks; some are more serious than others. Some possible risks include:

• Infection
• Fluid build-up at the surgical site (seroma or hematoma)
• Delayed healing
• Blood loss
• Blood clots
• Leakage of bowel contents into the abdomen
• Bowel blockage

• Damage to organs

Recovery times after colectomy varies depending on several factors including the extent of surgery. Average recovery time is

Chemotherapy

Chemotherapy for colon cancer is usually given after surgery if the cancer is has spread to deeper layers of the colon wall or has spread to the lymph nodes. Neoadjuvant chemotherapy may also be used before surgery to shrink a large cancer so that it is easier to remove with surgery.

Chemotherapy for colon cancer is usually a combination of two or three chemotherapy drugs.  The most common chemotherapies are:

• 5-FU: 5-flourouracil
• Capecitabine, also known as Xeloda, an oral form of 5-fluoruracil
• Irinotecan (Camptosar)
• Oxaliplatin (Eloxatin)

Common chemotherapy combinations include:

• 5-FU/LV:  5-fluorouracil and leucovorin (leucovorin is not a chemotherapy, but it used to improve the effectiveness of chemotherapy)
• CAPEOX: Capecitabine (Xeloda) and oxaliplatin (Eloxatin)
• FOLFIRI: 5-fluoruracil, leucovorin, and irinotecan (Camptosar)
• FOLFOX:  5-fluoruracil, leucovorin and oxaliplatin (Eloxatin)
• FOLFOXIRI: 5-fluoruracil, leucovorin, oxaliplatin (Eloxatin) and irinotecan (Camptosar)
• Trifluridine and tipiracil (Lonsurf) 

Radiation therapy

Radiation therapy is not often used to treat colon cancer. However, it may be used in some clinical trials.