7 Colorectal Cancer Treatments

Colon and rectal cancers—known collectively as colorectal cancer (CRC)—are cancers that start in the colon (large intestine) or rectum, which sits at the end of the digestive tract. Globally, CRC is the third most common type of cancer. It's also the second leading cause of death related to cancer, and it's on the rise in the United States among people under 50 years old.

Colorectal cancer has a five-year survival rate of about 90% if caught early and treated with surgery. Surgery is the first-line treatment. Other options include chemotherapy and radiation therapy (radiotherapy). The goal is to remove all cancer cells and lower the risk of the cancer recurring.

Colorectal treatment typically includes working with a team of specialists, including the following:

• Gastroenterologist: Treats digestive tract conditions
• Colorectal surgeon: Treats colon and rectal conditions surgically
• Surgical oncologist: Treats cancer surgically
  
• Medical oncologist: Treats cancer with medications
• Radiation oncologist: Treats cancer with radiotherapy
  

1. Surgery

Surgery is the primary treatment option for all stages of colorectal cancer. It's often all that's needed for stage 0 CRC. Surgical options include:

• Excision: The surgeon removes the tumor by placing an endoscope (a tube with a light and a cutting tool on the end) into the rectum. This surgical approach might be used in very early cancer stages.
• Resection with anastomosis: The surgeon removes the tumor and surrounding tissue, then sews healthy colon parts back together. The remaining colon makes up for what was removed. Anastomosis might be used for cancer stages 1-4.
• Resection with colostomy: With this type of surgical resection, the surgeon makes an opening (stoma) on the outside of the body for waste to pass through the hole. The waste collects in a bag that surrounds the stoma. A colostomy is performed if the surgeon can't connect the two colon pieces after removing the tumor. The colostomy bag may be temporary or permanent depending on how much of the colon is removed.

Side Effects

Possible side effects of colon or rectal surgery include:

• Bleeding
• Infection
• Blood clots
• Abdominal pain or swelling due to leaks or scar tissue adhesions (which cause tissue and organs to stick together)
• Colostomy (temporary or permanent)

2. Radiation Therapy (Radiotherapy)

Radiation therapy is another local treatment option. Like surgery, it focuses specifically on tumors rather than cancer throughout the body. Radiation therapy uses high-energy waves to destroy cancer cells. It's more commonly used in rectal cancer, and using it in combination with chemotherapy (chemoradiation) might increase its effectiveness.

Internal radiation is given through a radioactive substance concealed inside needles, seeds, wires, or catheters that a doctor will place directly into or near the cancer. External radiation uses a machine to send X-rays or other radiation toward the cancerous area of the body.

Radiotherapy might be used:

• Before surgery (neoadjuvent therapy), to reduce the size of the tumor and make surgery easier
• After surgery (adjuvant therapy), to remove any cancer left behind
• During surgery, to kill cancer cells that might be missed
• To control the spread of cancer if you're not healthy enough for surgery
• To ease CRC cancer symptoms
• To treat cancer that spreads to other areas

Side Effects

Possible side effects of radiotherapy include:

• Skin irritation at the site
• Nausea
• Rectal or bladder irritation
• Fatigue
• Bowel incontinence
• Scarring

3. Ablation or Embolization

Ablation and embolization are other local treatment options. These procedures can help treat tumors that spread to areas like the lungs or liver. Medical imaging tests like computed tomography (CT) scans or ultrasounds help guide very thin probes to the tumor through the skin.

Ablation targets tumors less than four centimeters in diameter. Types of ablation used to kill cancer cells include:

• Radiofrequency ablation (RFA): Uses high-energy radio waves
• Microwave ablation (MWA): Uses electromagnetic microwaves
• Ethanol (alcohol) ablation: Uses concentrated alcohol
• Cryosurgery (cryotherapy or cryoablation): Freezes the tumor with a cold gas, like liquid nitrogen

Embolization is a procedure used for liver tumors larger than five centimeters. A substance is inserted into a liver artery to cut off blood flow to the tumor. Types of embolization include:

• Arterial embolization: A surgeon inserts a small tube (catheter) into the hepatic artery in the liver via a cut in the upper thigh. Tiny particles are inserted to plug the artery.
• Chemoembolization: A surgeon inserts a chemotherapy drug into the hepatic artery via a catheter, then plugs up the artery so the medication stays there.
• Radioembolization: A surgeon inserts tiny radioactive beads into the hepatic artery via a catheter.

Side Effects

Possible side effects of ablation or embolization include:

• Abdominal pain
• Fever
• Liver infection
• Abnormal liver tests
• Bleeding or blood clots

4. Chemotherapy

Chemotherapy is a common treatment for colorectal cancer. It's a systemic treatment, meaning it can target cancer cells throughout the body. Chemotherapy uses drugs to stop cancer cells from growing, either by killing them or by stopping them from dividing. Like radiation therapy, it might be used:

• Before surgery (neoadjuvant chemo), sometimes with radiation
• After surgery (adjuvant chemo)
• For advanced or metastatic cancer (cancer that has spread to other areas)

With systemic chemotherapy, the medication is injected into a vein (intravenous, or IV) or taken by mouth and spreads through the body via the bloodstream. With regional chemotherapy, the medication is injected into the artery that leads to the tumor.

Chemotherapy involves treatment cycles of 2-3 weeks, with rest between treatments. The total length of time varies depending on the diagnosis and how your body responds to treatment.

Side Effects

Possible side effects of chemotherapy include:

• Hair loss
• Nausea
• Diarrhea
• Loss of appetite
• Skin and nail changes
• Increased risk of infections
• Fatigue

5. Targeted Therapy

Targeted therapy uses newer drugs that target specific cell changes. This treatment option might be used with chemotherapy or if chemo doesn't work. Like chemo, the medication travels throughout the bloodstream.

There are two types of targeted therapies used to treat colon cancer:

• Anti-epidermal growth factor drugs (EFGR inhibitors): These target proteins that help cancer grow. They're given every 1-2 weeks via an IV. Erbitux (cetuximab) is one example.
• Anti-angiogenesis drugs: These prevent new blood vessels from growing in the tumor, which stops tumor growth. They're given every 2-3 weeks via an IV. Avastin (bevacizumab) is one example.

Side Effects

Possible side effects and complications of targeted therapy drugs depend on the type of drug used. They might include:

• Fatigue
• Nausea
• Diarrhea
• Loss of appetite
• Headache
• Heart damage
• Liver problems
• Lung disease

6. Immunotherapy

Immunotherapy uses the person's immune system to destroy cancer cells. Oncologists will use substances like certain proteins—made either in the body or in the lab—to improve, direct, or restore the body's immune system in hopes that it will target the invading cancer cells. Keytruda (pembrolizumab) and Opdivo (nivolumab) are two examples.

Immunotherapy might be used for advanced or metastatic cancer, as it can prolong survival.

Side Effects

Side effects of immunotherapy include:

• Fatigue
• Nausea
• Diarrhea
• Loss of appetite
• Joint pain
• Infusion reaction (similar to an allergic reaction)
• Autoimmune reactions (in which the body starts attacking its own healthy cells)

7. Palliative Care

Palliative care is treatment and support for people with serious conditions, including advanced cancer. It can help improve quality of life and relieve symptoms and stress. Palliative care for colorectal cancer might include:

• Nutritional monitoring and counseling
• Pain relief
• Exercise to maintain mobility and reduce fatigue
• Avoid additional hospital admissions
• Psychosocial support
• Chemotherapy
  

Colorectal Cancer Treatment by Stage

Treatment varies depending on the cancer stage, your general health, and how you respond to treatment. It might also vary between colon and rectal cancer.

Colon Cancer

Here are general treatment approaches for each stage.

Rectal Cancer

Here are general treatment approaches for each stage.

Recurrent Colorectal Cancer Treatment

Cancer can return after treatment. Options at that point typically depend on whether or not it can removed surgically:

• If colon cancer returns locally (to the same site as the original cancer), the approach is usually surgery with chemotherapy before and/or after.
• If rectal cancer returns locally, the approach is usually surgery with radiation therapy before and chemotherapy or radiation therapy after.

Here are the general treatment approaches for both colon cancer and rectal cancer if the cancer returns in a different part of the body:

• Surgery, with possible chemotherapy before and/or after
• Chemotherapy or targeted therapy drugs if the cancer has spread too much for surgery
• Immunotherapy if cancer cells have gene changes
• Radiation therapy to relieve symptoms
  

Living With and Managing Colon Cancer

You will be continually evaluated by your healthcare provider or team to monitor for colorectal cancer recurrence. However, survival rates for recurrent CRC are relatively low. The prognosis depends on several factors, including:

• The extent to which the tumor grew beyond the bowel wall
• Whether or not the lymph nodes are affected, which can be a sign that the cancer is spreading or will spread to other areas
• Distant metastases (if the cancer spreads to other areas)
• Bowel obstruction
• Elevated blood levels of a protein called carcinoembryonic antigen (CEA)

There are many potential side effects and complications from various treatment options. You'll want to make sure you fully understand different treatments and get continual support as needed.

A Quick Review

Colorectal cancer (CRC) is generally treated with surgery first, if possible. Other treatment options include chemotherapy, radiation therapy, immunotherapy, and targeted therapy drugs. These treatment options can improve your quality of life and improve your odds of beating cancer.

Getting the recommended colorectal cancer screenings can help reduce your risk of developing cancer and improve your odds of catching it early. Detecting CRC in its earliest stages is also a significant factor in survival rates. Current recommendations include having a colonoscopy every 10 years beginning at age 45 if you don't have an increased risk of CRC.

Discussing all treatment options with healthcare providers helps you understand the potential benefits, risks, and short-term and long-term side effects and complications.