Johns Hopkins Health Alert
Choosing a Treatment for Colorectal Cancer
In this Health Alert, Johns Hopkins experts explain 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 90 percent.
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. Chemotherapy drugs 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.
In the last few years, chemotherapy for cancer that has spread beyond the colon or rectum has significantly improved with the availability of a number of new medications, including the "targeted" antibody therapies like bevacizumab (Avastin), cetuximab (Erbitux) and panitumumab (Vectibix). On average, these improvements to chemotherapy medications have lengthened survival time for patients with advanced disease from roughly one year to nearly two years. Because some tumors are not responsive to Erbutux or Vectibix, a test will be conducted to determine if the tumor has a type of gene that will benefit from these treatments.
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. Radiation treatments choices include: brachytherapy, intensity-modulated radiation therapy, intraoperative radiation therapy, TheraSphere and cyberknife.
Posted in Colon Cancer on June 12, 2007
Reviewed June 2011
Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer
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Very interesting commentary. Thanks.
Posted by: apadron | June 16, 2007 7:30 AM