Treatment Options for Colorectal Cancer

The treatment depends on the staging of the cancer. When colorectal cancer is

caught at early stages (with little spread) it can be curable. However when it is

detected at later stages (when distant [[metastasis|metastases]] are present) it is

less likely to be curable.

Surgery remains the primary treatment while chemotherapy and/or radiotherapy

may be recommended depending on the individual patient’s staging and other

medical factors.

Surgery

Surgical treatment is by far the most likely to result in a cure of colon cancer if the

tumor is localized. Very early cancer that develops within a polyp can often be cured

by removing the polyp at the time of colonoscopy. More advanced cancers typically

require surgical removal of the section of colon containing the tumor leaving

sufficient margins to reduce likelihood of re-growth. If possible, the remaining parts

of colon are anastomosed together to create a functioning colon. In cases when

anastomosis is not possible, a stoma (artificial orifice) is created. While surgery is

not usually offered if significant metastasis is present, surgical removal of isolated

liver metastases is common. Improved chemotherapy has increased the number of

patients who are offered surgical removal of isolated liver metastases.

Laparoscopic assist resection of the colon for tumour can reduce the size of painful

incision and minimize the risk of infection.

As with any surgical procedure, colorectal surgery can in rare cases result in

complications. These may include infection, abscess, fistula or bowel obstruction.

Chemotherapy

Chemotherapy is used to reduce the likelihood of metastasis developing, shrink

tumour size, or slow tumor growth. Chemotherapy is often applied after surgery

(adjuvant), before surgery (neo-adjuvant), or as the primary therapy if surgery is not

indicated (palliative). The treatments listed here have been shown in clinical trials to

improve survival and/or reduce mortality and have been approved for use by the US

Food and Drug Administration.

Adjuvant (after surgery) chemotherapy. One regimen involves the combination of

infusional 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX)

5-fluorouracil (5-FU)

Leucovorin (LV)

Oxaliplatin (Eloxatin®)

Capecitabine (Xeloda®)

Chemotherapy for metastatic disease. Commonly used first line regimens involve

the combination of infusional 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX)

with bevacizumab or infusional 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI)

with bevacizumab

5-fluorouracil (5-FU)

Leucovorin

Irinotecan

Oxaliplatin

Bevacizumab

Cetuximab

Radiation Therapy

Radiation therapy is used to kill tumor tissue before or after surgery or when

surgery is not indicated. Sometimes chemotherapy agents are used to increase the

effectiveness of radiation by sensitizing tumor cells if present. Radiotherapy is not

used routinely in colorectal cancer, as it could lead to radiation enteritis, and is

difficult to target specific portions of the colon, but may be used on metastatic

tumor deposits if they compress vital structures and/or cause pain. There may be a

role for post-operative adjuvant radiation in the case where a tumor perforates the

colon as judged by the surgeon or the pathologist. However, as the area of the prior

tumor site can be difficult (if not impossible) to ascertain by imaging, surgical clips

need to be left in the colon to direct the radiotherapist to the area of risk.

Immunotherapy

Bacillus Calmette-Guérin (BCG) is gaining prominence as a complementary

theraputic agent in the treatment of colorectal cancer. A review of results from

recent clinical trials is given in Mosolits et al.

Support Therapies

Cancer diagnosis very often results in an enormous change in the patient’s

psychological wellbeing. Various support resources are available from, hospitals and

other agencies which provide counseling, social service support, cancer support

groups, and other services. These services help to mitigate some of the difficulties

of integrating a patient’s medical complications into other parts of their life.