Colorectal Cancer: Standard Therapy

Treatment for Colorectal Cancer

Doctors base treatment recommendations for colorectal cancer on several factors, including:

• Stage of cancer
• Subtype based on pathology
• Additional testing, including biomarkers and other tests
• How fast the cancer is growing or how likely it is to spread
• Whether the cancer is newly-diagnosed or has recurred after one or more treatments

Most colorectal cancer is treated with one or more of the following treatments. Every treatment has potential risks and side effects. Before any new treatment or surgery, make sure your healthcare team tells you about what to expect.

Surgery

Surgery for early stage colorectal cancer may include:

• 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:

• 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:

• 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.

Surgery considerations for people with gene mutations

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. 

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)

Radiation therapy

Radiation therapy is used more often to treat rectal and anal cancers than colon cancer. It also may be used as part of some clinical trials.

Treatment side effects

Your healthcare team should explain what you should expect from all treatments, including:

• all of the possible risks and side effects of each treatment.
• which side effects may be serious and how to tell. 
• when and who you should call if you experience a side effect.
• what can be done to treat or alleviate each side effect. 

Make sure you let your healthcare team know if you experience any side effects of your treatment. For more information about possible treatment side effects, see our section on Cancer Treatment by Treatment Type. 

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