Surgery, medical oncology and radiation oncology are treatments for colon and rectal cancer
No one wants to hear they or someone they know has colon cancer or rectal cancer. It is common to feel anxious and scared after a colorectal cancer diagnosis. You might also feel overwhelmed about what to expect next and treatment options.
Here are three common treatments to help you feel empowered with facts if you or someone you care about has been recently diagnosed with colorectal cancer.
What type of colorectal cancer treatment is right for me?
Treatment for colorectal cancer depends on many factors, including type, location and stage of the cancer. For example, is it an adenocarcinoma, the most common type of colorectal cancer? Is the tumor located in the colon or rectum? Did your doctor find the cancer early before it spread, or has it spread to other parts of the body? Age and other health conditions may also affect a treatment plan, as well as an individual’s personal preferences.
At Nuvance Health, the colorectal cancer care team will consider these factors and develop a treatment plan that is best for each individual.
What is surgery for colorectal cancer?
Surgery is the most common treatment for colorectal cancer. A colorectal surgeon will remove the cancerous tumor during the cancer surgery.
Individuals with colon or rectal cancer will first undergo staging to determine the extent of the disease. They will have imaging, such as CT scans, MRIs, ultrasounds or PET scans to see if the cancer has spread.
“Surgery is usually the first line of treatment for colon cancer if there is no evidence the cancer has spread to other parts of the body,” explains Dr. James McClane, chief of colorectal surgery at Norwalk Hospital, part of Nuvance Health. “Rectal cancer management is somewhat different. Depending on the staging, we may treat it with chemotherapy and/or radiation therapy before proceeding with surgery.”
“We usually perform a colectomy to treat colon cancer,” Dr. McClane says. “During the operation, we remove the segment of the colon with the cancer as well as its adjacent lymph nodes. Then, if possible, we reconnect the colon to restore normal bowl function.”
Surgeons use a variety of techniques to perform a colectomy. The technique used depends on the location and size of the tumor and other individual factors.
“During an open colectomy, we make a single incision along the abdomen. With minimally invasive surgery, we perform the operation through small incisions and use a scope with a video camera at the end of it to see inside the body,” Dr. McClane explains. “We always aim to perform the least invasive surgery possible in order for patients to have less pain and recover faster.”
Laparoscopic and robotic-assisted colorectal surgery (RACS) are two types of minimally invasive procedures. During a laparoscopic procedure, the surgeon places a long, thin tube with a camera on the end called a laparoscope inside the abdomen. RACS is similar to a laparoscopic surgery except more advanced because the surgeon uses a robot to control the surgical instruments.
During the colectomy, the surgeon may need to perform a colostomy if it is not possible to reconnect the colon or if they need to remove the entire colon. During the procedure, the surgeon connects a colostomy bag to the outside of the abdomen through a stoma. The colon is part of the large intestine at the end of the digestive tract. A colostomy is a way for the body to remove waste from the digestive tract as the colon heals from surgery or if the entire colon is removed. The colostomy may be temporary or permanent depending on the individual.
Patients usually stay in the hospital for a short while after colorectal surgery. How long they are in the hospital depends on the extent of the surgery.
“Your care team will develop a pain management plan to alleviate your discomfort as much as possible after colorectal surgery. We also encourage early mobility such as walking soon after surgery because moving helps with the healing process,” Dr. McClane says.
At Nuvance Health, registered dietitians and oncology nutrition specialists are an important part of the care team.
“Most patients usually follow a modified diet until their intestines recover,” Dr. McClane says. “Patients can usually start eating solid foods a few days after colorectal surgery.”
What is medical oncology for colorectal cancer?
Medical oncology is a type of systemic therapy. The goal of medical oncology is to attack and eliminate cancer cells wherever they are in the body, and in turn, increase the chances of curing the cancer and lowering the risk of it from coming back.
Over the past 20 years, there have been substantial advances in treatment for colorectal cancer. There is now a wide range of systemic treatment options including chemotherapy, immunotherapy, targeted therapy and more.
Not all colorectal cancer patients need systemic therapy. Surgery alone can usually treat early stage cancer. We usually recommend chemotherapy after surgery for patients with local spread (cancer that has spread from the primary tumor to nearby tissue or lymph nodes) to destroy micrometastases.
“For people with later-stage or metastatic colon cancer, chemotherapy can prevent the cancer from spreading even further and improve their quality of life,” explains Dr. Radhika Rachamalla, medical oncologist and medical director at the Dyson Center for Cancer Care. ”While chemotherapy has remained a standard treatment for many years, expanded therapeutic options including biologic therapy, immunotherapy and targeted therapy have improved average survival from less than one year in the single-agent fluoropyrimidine era (a type of chemotherapy for solid tumors) to more than 2.5 years.”
Immunotherapy is a newer treatment option that uses the body’s own immune system to fight cancer. Recent immunotherapy studies have shown significant improvements in outcomes for people with genetically driven cancer. Learn more about immunotherapy.
Another type of medical oncology is targeted therapy. Unlike chemotherapy that attacks cancer cells as a whole, targeted therapy disables specific molecular features that allow cancer cells to divide and spread. Learn more about targeted therapy.
What is radiation therapy for colorectal cancer?
Radiation therapy is one of the main possible treatment options for people with colorectal cancer. Many colon cancer patients will not need radiation therapy. It is more common for rectal cancer patients to have radiation therapy. The location and stage of the tumor will help your care team determine whether radiation therapy will be part of your treatment plan.
Your care team may recommend radiation therapy before surgery to shrink the tumor. They may also recommend it after surgery to eliminate residual disease.
Radiation treatment uses beams of energy that destroy cancer cells and shrink tumors. Radiation oncologists target the cancer and areas at risk of microscopic tumor spread while avoiding healthy tissue as much as possible.
You will not feel or see the radiation during treatments. Treatments are usually quick, and you are not radioactive after a treatment. The number of treatments recommended depends on the location and stage of the cancer.
“We carefully consider each individual’s cancer and the potential benefits and side effects of radiation therapy to determine when and how to deliver it,” says Dr. Maryann Mikucki, radiation oncology, Vassar Brothers Medical Center, part of Nuvance Health. “If you or a loved one needs radiation therapy, it may be helpful to know that we create a personalized radiation plan for each patient based on their own anatomy which helps us reduce the risk of side effects during treatment.”
Your care team will help you manage possible side effects from radiation therapy for colorectal cancer. Side effects may include pain or skin changes that feel like a sunburn in the treated area, discomfort during bowel movements, diarrhea, and fatigue.
The bottom line: If you or someone you know has colorectal cancer, your care team may recommend surgery as the initial treatment, depending on the type, location and stage of the cancer. Your treatment plan may include medical oncology such as chemotherapy, and radiation therapy either before or after surgery depending on the extent of the cancer. At Nuvance Health, your care team will develop a treatment plan based on your individual circumstances while also following the latest guidelines and standards of care.