Colon and Rectal Cancer: Treatment Options

How is it treated?

There are a number of treatment options for Colorectal Cancer. These vary depending on the individual case and stage of the cancer. Some of the more common treatment choices are as follows:

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. 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.

Surgery for 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.
  
  
• Local full thickness resection involves cutting through all layers of the rectum to remove invasive cancers as well as some surrounding normal rectal tissue.
  
  
• Electrofulgeration destroys a cancer by burning it with electrical current.
  

All four of the above methods can be done without cutting through the abdomen.

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. There is an ostomy visitor program in RI.

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.

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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