Johns Hopkins Health Alerts | Colon Cancer | Choosing a Treatment for Colorectal Cancer

Johns Hopkins gastroenterologist Sergey V. Kantsevoy, M.D. explains what you should expect if you are diagnosed with colorectal cancer.

The best way to “treat” colorectal cancer is to prevent it, through regular colonoscopy screenings during which any suspicious polyps can be removed. However, if your doctor does find evidence of colorectal cancer, your treatment options include surgery, chemotherapy, and radiation. When the disease is caught and treated in its early stages, the five-year survival rate is greater than 90%.

Surgery for Colorectal Cancer -- Colorectal cancers are typically performed using open surgery, in which one large incision is made in the abdomen to gain access to the colon or rectum. In recent years, there has been interest in performing colorectal surgery laparoscopically, which involves insertion of small surgical instruments with cameras through a few small keyhole-like incisions made in the abdomen.

With either the open or laparoscopic procedures for colorectal cancer, surgeons remove not only the part of the colon or rectum that contains the cancer but also some of the healthy tissue that surrounds it. Surgeons also remove any lymph nodes near the colorectal cancer for later study under a microscope to see if the colorectal cancer has spread to the lymphatic system. Afterward, the surgeon sews together the remaining healthy parts of the colon or rectum.

However, if the colorectal cancer is located low in the rectum close to the anal sphincter, the surgeon may not be able to reconnect the healthy tissue. In such cases, a permanent colostomy will be necessary to pass stool. A colostomy connects the remaining colon or rectum to an opening in the abdomen to allow waste to pass into a colostomy bag.

Chemotherapy for Colorectal Cancer -- Chemotherapy uses medications to attack cancerous cells throughout the body. It sometimes follows surgery to increase the chance that all cancer cells have been eliminated. When used in this way, patients generally begin chemotherapy about one month after surgery and continue for about six months. Chemotherapy may also be administered before surgery to help shrink a tumor.

When cancer has spread to the lymph nodes or beyond the colon or rectum, physicians may use chemotherapy to slow progression of the cancer and to relieve the symptoms of colorectal cancer without expecting to achieve a cure. Because chemotherapy drugs are given intravenously and travel through the bloodstream, they can affect the entire body and produce a range of possible side effects, including nausea, vomiting, fatigue, diarrhea, mouth sores, hair loss, and bone marrow suppression.

Radiation Therapy for Colorectal Cancer -- Radiation therapy involves the use of x-rays to target cancer cells. This approach is used for rectal--but not colon--cancer. As with chemotherapy, physicians may use radiation to destroy any cancer cells that remain after surgery, to decrease the size of a cancer before surgery, or for symptom relief. Unlike chemotherapy, which affects the entire body, radiation therapy is designed to target cancer cells while minimizing damage to healthy tissues.

Physicians often recommend a combination of chemotherapy and radiation after surgery if the colorectal cancer has spread to areas outside the rectum. There are two types of radiation; they can be used alone or together.

• Internal radiation therapy involves the placement of a radioactive implant or “seeds” in or adjacent to the cancer cells.
• External radiation is delivered from an x-ray machine that directs the radiation toward the cancerous cells.
For more Alerts and Special Reports, please visit the Colon Cancer Topic page.

Johns Hopkins Health Alerts | Colon Cancer | Choosing a Treatment for Colorectal Cancer