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 Colon Cancer Treatment Options

What Are My Treatment Options?

There are a number of treatment options for Colorectal Cancer. Your physician will develop a treatment plan to fit your needs based on the location of the tumor and the stage of the disease. Treatment for colon cancer may involve radiation therapy or chemotherapy, but the primary treatment in nearly all cases is surgery.

Surgery for Colon Cancer
Surgery is the main treatment for colon cancer. Usually, the cancer and a length of normal tissue on either side of the cancer (as well as nearby lymph nodes) are removed. In addition, the surgeon checks the intestine and liver to see if the cancer has spread. The two ends of the colon are then sewn back together. For colon cancer, a colostomy (an opening in the abdomen for getting rid of body wastes) is not usually needed, although sometimes a temporary colostomy may be done.

Sometimes very early colon cancer can be removed through a colonoscope. When this is done, the doctor does not have to cut into the abdomen. For some very advanced cancers and for some patients in poor health, a different operation might be done to relieve symptoms such as blockages and bleeding.

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Surgical Techniques
"Laparoscopic" and "open" colon surgery simply describe the techniques a surgeon uses to gain access to the internal surgery site. Advancing technology and research have transformed surgery for the treatment of colon cancer in recent years. In the past, most patients underwent “open” surgery for colon cancer. However, patients now have a second surgery option, laparoscopic or minimally invasive surgery. The technique known as minimally invasive laparoscopic colon surgery allows surgeons to perform many common colon procedures through small incisions. Depending on the type of procedure, patients may leave the hospital in a few days and return to normal activities more quickly than patients recovering from open surgery.

Open Surgery: During traditional “open surgery,” the surgeon makes an incision up to 16 inches long from the upper to lower abdomen to view the colon and remove the diseased portions. Because of the nature of this highly invasive procedure, patients often face a long and difficult healing process that results in a hospital stay of at least a week, with recovery time ranging from six to eight weeks.

Laparoscopic or Minimally Invasive Surgery: In most laparoscopic colon surgeries, surgeons operate through 4 or 5 small openings (each about a inch). A small video camera or “scope” is placed in one of the incisions, providing the surgeon with a magnified view of the patient’s internal organs on a television monitor. In some cases, one of the small openings may be lengthened to 2 or 3 inches to complete the procedure. Surgical instruments are placed in the other incisions allowing the surgeon to work inside and remove portions of the diseased colon. This surgical technique also can be used to treat other diseases of the colon such as Crohn’s disease and diverticulitis.

Laparoscopic colon surgery offers many benefits over traditional “open” surgery. These benefits include:

  • Less pain and scarring.
  • Quicker recovery time.
  • Shorter hospital stay.
  • Better cosmetic results.

Patients considering “minimally invasive” surgery should consult with a surgeon experienced in laparoscopic techniques and has performed at least 20 laparoscopic colon resections.

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Surgical Treatments
Surgery for Colon/Rectal Cancer: There are several types of surgery for rectal cancer:

  • Polypectomy is a method used to remove mushroom-like growths that contain stage 0 cancer. The cancer is cut out across the base of the stalk.

  • Local excision removes superficial cancers and a small amount of nearby tissue from the inner layer of the rectum. Instead, the doctor may put a tube through the rectum into the colon and cut the cancer out. This is called a local excision.

  • Resection: If the cancer is larger, the doctor will perform a partial colectomy (removing the cancer and a small amount of healthy tissue around it). The doctor may then perform an anastomosis (sewing the healthy parts of the colon together). The doctor will also usually remove lymph nodes near the colon and examine them under a microscope to see whether they contain cancer. Resection and colostomy: If the doctor is not able to sew the 2 ends of the colon back together, a stoma (an opening) is made on the outside of the body for waste to pass through. This procedure is called a colostomy. A bag is placed around the stoma to collect the waste. Sometimes the colostomy is needed only until the lower colon has healed, and then it can be reversed. If the doctor needs to remove the entire lower colon, however, the colostomy may be permanent.

  • Radiofrequency ablation: The use of a special probe with tiny electrodes that kill cancer cells. Sometimes the probe is inserted directly through the skin and only local anesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen. This is done in the hospital with general anesthesia.

  • Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy.

Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

For more advanced stages of rectal cancer, other types of surgery may be done. If you are having surgery, ask your doctor if you will need a colostomy. A colostomy is used much more often in the surgical treatment of rectal cancer than for colon cancer. If you have a colostomy, follow-up care is important. There are nurses who have special training in ostomy care. Ask your cancer care team if this help is available. Also, there are groups that can put you in touch with others who have had an ostomy.

Radiation Therapy for Colon and Rectal Cancer: Radiation therapy uses high-energy radiation to kill cancer cells. External beam radiation therapy uses radiation from outside the body to focus on the cancer. Local radiation therapy or brachytherapy uses a small pellet of radioactive material placed directly into the cancer. Having radiation treatment does not make you radioactive.

After surgery, radiation can kill small areas of cancer that may not be seen during surgery. If the size or location of a tumor makes surgery hard, radiation may be used before the surgery to shrink the tumor. Radiation also may be used to ease (palliate) symptoms of advanced cancer such as intestinal blockage, bleeding, or pain.

Side effects of radiation therapy for colon or rectal cancer include mild skin irritation, nausea, diarrhea, or tiredness. These often go away after a while. If you have these or other side effects, talk to your doctor. There are ways to lessen many of these problems.

Chemotherapy for Colon and Rectal Cancer: Chemotherapy refers to the use of anti-cancer drugs to kill cancer cells. The drugs are given through an IV or in the form of pills. They enter the bloodstream and reach all areas of the body. Studies have shown that chemotherapy after surgery can increase the survival rate for patients with some stages of colorectal cancer. Chemotherapy can also help relieve symptoms of advanced cancer.

Chemotherapy can have some side effects. These side effects will depend on the type of drug, how much you have, and how long you take it. Most of the side effects go away when treatment is over. For example, hair will grow back after treatment ends, though it may look different. Anyone who has problems with side effects should talk with their doctor or nurse as there are remedies for many of these.

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Other types of treatment are being tested in clinical trials. These include the following:

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. For information about ongoing clinical trials ask your Doctor.

What happens after the treatment for Colorectal Cancer?
There are some important follow-up activities after treatment for colorectal cancer that can help you to deal with your situation.

Follow-up Care: For years after treatment ends, regular follow-up exams will be very important for you. These can detect recurrence, that is, the cancer coming back. Be sure to report any new or persistent symptoms to your doctor right away. Follow-up tests usually includes a careful general physical exam and rectal exam, colonoscopy, and blood tests for tumor markers such as carcinoembryonic antigen (CEA). Other imaging studies such as chest x-rays, CT scans, and MRI scans may also be done if symptoms or other test results suggest a recurrence.

Tumor markers: Carcinoembryonic antigen (CEA). is a substance in the blood of some people with colon cancer. The CEA blood test is most often used with other tests for follow-up of patients who already have had cancer and have been treated. CEA may be useful to provide an early warning of a cancer that has returned. CEA may be present in the blood of some people without colon cancer. Often these people have ulcerative colitis, noncancerous tumors of the intestines, or some types of liver disease or chronic lung disease. Smoking can also cause an increase in CEA levels. Because the CEA level in the blood can be high for reasons other than cancer, it is not a specific test for cancer. It is not a method for finding cancer in people who have never had a cancer and appear to be healthy.

For patients with colostomies: Few permanent colostomies are needed now in the treatment of colon cancer. Most colostomies are done for cancers that are near the outer or lower end of the rectum. If you have a colostomy, follow-up is an important concern. You may feel worried or isolated from normal activities. Whether your ostomy is temporary or permanent, an enterostomal therapist (a health care professional trained to help people with their colostomies) can teach you about the care of your colostomy.

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This information is not intended to take the place of your discussion with your surgeon about your need for colon surgery. If you have questions about your need for a colon operation, your alternatives, the cost of the procedure, billing or insurance, or your surgeon's training and experience, do not hesitate to ask your surgeon or his/her office staff about it. If you have questions about the operation or subsequent follow-up, please discuss them with your surgeon before or after the operation. Terms of Use