Colorectal Cancer

Types of Treatment

Your doctor will create a treatment plan tailored specifically to you. It 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. Each treatment type has risks and benefits; learning about them can help you decide which treatment 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

Surgery is the most common treatment for early-stage colorectal cancer. Depending on the tumor’s size, stage and location, 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 if the cancer has spread, and if so, how far.

Open surgery involves operating through a large incision in the abdomen. Laparoscopic surgery allows the surgeon to operate through a few small incisions in the abdomen, guided by a special lighted instrument with a tiny video camera attached (laparoscope). The smaller incisions result in shorter recovery time. In robotic-assisted laparoscopic surgery, a surgeon with specific training and experience controls robotic arms that operate the surgical tools.

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. With a temporary ostomy, the intestine can be reconnected after healing. Having an ostomy can be a physically and emotionally challenging adjustment. Working with a trained ostomy nurse can help make the transition easier.

Chemotherapy

Chemotherapy is often combined with two or more chemotherapy drugs with or without targeted therapies to treat colorectal cancer. 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.

Targeted Therapy

Targeted therapy drugs approved to treat colorectal cancer either shut down the vascular endothelial growth factor (VEGF) essential for creating blood vessels, target the neurotrophic receptor tyrosine kinase (NTRK) gene fusion, inhibit the BRAF mutation or block the epidermal growth factor receptor (EGFR). Before recommending an EGFR inhibitor, your doctor should test your tumor for KRAS and NRAS gene mutations, which may prevent the drug from working.

Immunotherapy

Immunotherapy is approved to treat metastatic colorectal cancer for patients in the form of immune checkpoint inhibitors, which are a type of immunotherapy that prevents the immune response from slowing down, allowing the immune cells to continue fighting cancer. Single immunotherapy drugs or a combination of two immune checkpoint inhibitors are approved for cancer that has the molecular alterations known as microsatellite instability-high (MSI-H), deficient mismatch repair (dMMR) or tumor mutational burden-high (TMB-H).

Radiation Therapy

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 (chemo-radiation).

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 offer access to new therapies not yet widely available. Ask your doctor if a clinical trial may be an option for you.

 

 
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 11/6/20

Additional Sources of Information