You just found out you have colorectal cancer, and now it’s time to consider treatment options. The first thing you should know is that CRC is one of the most treatable types of cancer when you catch it at an early stage.
Although there are six standard treatments for colon cancer, the most widely used are surgery, chemotherapy and radiation therapy. Surgery removes tumors and, sometimes, a portion of the surrounding tissue. Your surgeon may also remove some of your lymph nodes. Chemotherapy uses powerful drugs and radiation therapy uses high-energy radiation to kill cancer cells or stop them from growing. Your treatment will depend upon the stage of your cancer at diagnosis and other factors, such as your overall health.
“[Colon cancer treatment] is done in a multi-disciplinary fashion,” says Dr. Matilda Hagan, an inflammatory bowel disease specialist at Mercy Medical Center in Baltimore. “We get input from the surgeon, radiation and medical oncologists and usually the pathologist regarding staging the tumor. [Together we discuss] what needs to happen.”
[See: 8 Questions to Ask Your Doctor About Colon Cancer.]
Treatment by Stage
“Patients with stage I or stage II cancer are treated primarily with surgery,” Hagan says. “Stage II patients may need additional treatment. Stage III and stage IV patients generally undergo a combination of treatments.”
The standard of care (or best practice) for all stages of CRC is to surgically remove as much of the cancer as possible. If you have early stage cancer, your surgeon may be able to remove the tumor without making an incision in your abdomen, instead using a surgical tool inserted into the rectum. Larger tumors generally require a more complex surgery. Your surgeon will remove the tumor (this is called a resection) and a small amount of healthy tissue surrounding the tumor. By removing the tissue flanking the tumor, your surgeon will be more confident she got the entire tumor. After the resection, she will sew the healthy ends of your colon back together ( anastomosis).
Your surgeon may also remove one or more lymph nodes to see if the cancer has spread. Lymph nodes are part of the immune system. Once cancer cells get into the lymph nodes, they can travel to another part of the body and begin to grow again (metastasize).
“In stage I, surgery is very effective,” says Dr. Hanna Sanoff, an oncologist at at UNC Lineberger Comprehensive Cancer Center in Chapel Hill, North Carolina. “About 90 percent of patients are cured with surgery alone. For stages II and III, surgery alone is less curative.”
[See: 10 Seemingly Innocent Symptoms You Shouldn’t Ignore.]
Patients with stages III and stage IV cancer, and sometimes stage II, often receive chemotherapy. There are different points of view on whether chemotherapy is appropriate for stage II CRC, which oncologists further divide into three subcategories to describe how far the tumor has spread into the colon wall (stages IIa and IIb) or into nearby organs (stage IIc). Sanoff says the treatment for stage II depends on whether the tumor has high risk factors. For example, if the tumor grows up against the nearby bladder, it has a high risk of recurrence.
“If [a patient has] stage III cancer, there are a lot of lymph nodes involved,” Sanoff says. The standard for these patients is to also remove one or more lymph nodes and add chemotherapy after the surgery to kill any remaining cancer cells.
Patients who have stage IV colon cancer are not curable, Sanoff says. “Chemotherapy is geared to reduce the burden of disease and help the patient live longer.”
Radiation therapy is generally reserved for palliative care (treatment for relief of symptoms, not to cure) when patients have advanced stage colon cancer. However, in addition to surgery, it is a standard part of treatment for stage II and III rectal cancer. Because the rectum is a narrow tube, Sanoff says, it bumps up against other organs, so the risk of recurrence is high.
Oncologists are slowly starting to use immunotherapy (using your own immune system to find and destroy cancer cells) and targeted therapies, and these treatments are an active area of cancer research. Understanding the biology of colon and rectal cancers will also help oncologists predict how well patients will respond to treatment.
[See: 6 Options for People Who Don’t Want a Colonoscopy.]
What Happens After Treatment?
Regular follow up after CRC treatment is important. If you’ve had polyps or colon cancer, your risk of new or recurrent cancer is higher. In fact, according to the American Society of Colon and Rectal Surgeons, if you’ve had surgery for a polyp or colon cancer, you have about double the risk of developing new polyps. Your specific follow up routine will depend on the stage of your cancer, but your oncologist will want to see and screen you regularly for the next five years.
More from U.S. News
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How Is Colon Cancer Treated? originally appeared on usnews.com
