Colorectal Cancer

Treatment Options

Your treatment plan will be based on many factors: diagnostic test results, including imaging, bloodwork, genetic tests and biopsies; your age and general health; and tumor size and biomarkers. Learn about each treatment’s risks and benefits to help you decide which one is best for you. As you discuss the available options with your doctor, it is very important that you share your expectations for your quality of life.

Surgery is the most common treatment for early-stage colorectal cancer. Different procedures are used to remove the part of the colon or rectum containing the tumor and to reattach the ends. Removing the entire colon is called a colectomy, and removing the entire rectum is a proctectomy. Nearby lymph nodes may also be removed (lymphadenectomy) to allow a pathologist to determine whether the cancer has spread, and if so, how far. Types of surgery include the following:

  • Open surgery involves a large incision in the abdomen.
  • Laparoscopic surgery uses a special lighted instrument with a tiny video camera attached that is inserted into a few small incisions in the abdomen.
  • Robotic-assisted laparoscopic surgery uses robotic arms that operate surgical tools controlled by a surgeon who has specialized training.

Your surgeon will try to preserve normal bowel function whenever possible. However, sometimes a different pathway for bowel function must be created. The surgeon attaches one end of the small intestine or colon to an opening created in the abdomen called a stoma. A pouch is attached to the stoma to collect waste. This procedure is called a colostomy, ileostomy or simply an ostomy, depending on the part of the intestine used to form the stoma. An ostomy can be temporary or permanent. Working with a trained ostomy nurse can help make the transition easier.

Chemotherapy may include two or more drugs that are used alone or combined with targeted therapies. Chemotherapy can be given before surgery (neoadjuvant) to shrink a tumor for easier removal and/or after surgery (adjuvant) to kill any remaining cancer cells. It may also be given for metastatic disease.

Hepatic arterial infusion (HAI) may be used when colon or rectal cancer has spread to the liver. It is chemotherapy delivered directly into the liver through its main blood vessel, the hepatic artery.

Targeted therapy may be used. Many are oral medications, and some may be given in combination with other drug therapies.

To determine whether certain targeted therapy drugs will be effective, testing is performed on a biopsy sample of tissue. A pathologist will examine the tissue under a microscope and perform other genomic tests to determine if mutations are present in the tumor.

Immunotherapy uses the immune system to attack cancer. Immune checkpoint inhibitors, a type of immunotherapy, known as monoclonal antibodies, are approved for colorectal cancer. They work by blocking specific proteins and receptors that can trigger an immune system slowdown. Single immunotherapy drugs or a combination of two immune checkpoint inhibitors are approved for people who have microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) colorectal tumors.

Radiation therapy is typically given to treat rectal cancer and cancer that has metastasized to a localized area of the body, such as a liver lesion or bone lesion. It may be delivered as neoadjuvant therapy to shrink tumors before surgery and as adjuvant therapy to kill remaining cancer cells after surgery. It is frequently given with chemotherapy (chemoradiation).

Radiofrequency ablation (RFA), microwave ablation (MWA) or cryoablation may be used to treat colorectal cancer that has spread to the liver or lungs. RFA uses radiofrequency waves to heat the tumor; MWA uses microwave energy to heat the tumor; and cryoablation freezes the tumor.

Clinical trials may be an option. Ask your doctor if you should consider a clinical trial.

 
Commonly Used Medications
Chemotherapy
capecitabine (Xeloda)
fluorouracil – also known as 5-FU
irinotecan (Camptosar)
trifluridine/tipiracil (Lonsurf)
Immunotherapy
ipilimumab (Yervoy)
nivolumab (Opdivo)
pembrolizumab (Keytruda)
Targeted Therapy
cetuximab (Erbitux)
entrectinib (Rozlytrek)
larotrectinib sulfate (Vitrakvi)
panitumumab (Vectibix)
regorafenib (Stivarga)
Some Possible Combinations
bevacizumab (Avastin) with fluorouracil (5-FU)
bevacizumab (Avastin) with fluoropy- rimidine and irinotecan (Camptosar)
bevacizumab (Avastin) with fluoropy- rimidine and oxaliplatin (Eloxatin)
bevacizumab-awwb (Mvasi) with fluorouracil (5-FU)
bevacizumab-awwb (Mvasi) with fluoropyrimidine and irinotecan (Camptosar)
bevacizumab-awwb (Mvasi) with fluoropyrimidine and oxaliplatin (Eloxatin)
bevacizumab-bvzr (Zirabev) with fluorouracil (5-FU)
bevacizumab-bvzr (Zirabev) with fluoropyrimidine and irinotecan (Camptosar)
bevacizumab-bvzr (Zirabev) with fluoropyrimidine and oxaliplatin (Eloxatin)
cetuximab (Erbitux) with irinotecan (Camptosar)
cetuximab (Erbitux) with leucovorin calcium, fluorouracil (5-FU) and irinotecan (Camptosar)
encorafenib (Braftovi) with cetuximab (Erbitux)
ipilimumab (Yervoy) with nivolumab (Opdivo)
irinotecan (Camptosar) with fluorouracil (5-FU) and leucovorin
levoleucovorin (Fusilev, Khapzory) with fluorouracil (5-FU)
oxaliplatin (Eloxatin) with fluorouracil (5-FU) and leucovorin
panitumumab (Vectibix) with leucovorin, fluorouracil (5-FU) and oxaliplatin (Eloxatin)
ramucirumab (Cyramza) with leucovorin, fluorouracil (5-FU) and irinotecan (Camptosar)
ziv-aflibercept (Zaltrap) with fluorouracil (5-FU), leucovorin and irinotecan (Camptosar)

As of 5/12/21