Colorectal Cancer

Types of Treatment

Colon cancer begins in the lining of the colon or the rectum, which are parts of the large intestine. The colon is about 6 feet long, and the rectum and anal canal make up the last 6 to 12 inches of the large intestine.

Colorectal cancer is classified into one of five stages (0 to IV), which are then further divided into groups of tumors that have a similar prognosis (see staging illustrations). This grouping allows doctors to more accurately determine the best treatment options for your specific diagnosis. Ongoing research is also leading to personalized treatments for some patients.

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 colon or the rectum 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 and 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 who have microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) colorectal tumors as tested by a pathologist if the cancer progressed after previous treatment. Immune checkpoint inhibitors are a type of immunotherapy that works by blocking specific proteins and receptors that can trigger an immune system slowdown.

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, and is frequently given with chemotherapy (chemoradiation).

Other Treatments

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.

 

 
Commonly Used Medications
Chemotherapy
capecitabine (Xeloda)
fluorouracil – also known as 5-FU
irinotecan (Camptosar)
oxaliplatin (Eloxatin)
trifluridine/tipiracil (Lonsurf)
Immunotherapy
ipilimumab (Yervoy)
nivolumab (Opdivo)
pembrolizumab (Keytruda)
Targeted Therapy
bevacizumab (Avastin)
bevacizumab-awwb (Mvasi)
bevacizumab-bvzr (Zirabev)
cetuximab (Erbitux)
entrectinib (Rozlytrek)
larotrectinib sulfate (Vitrakvi)
panitumumab (Vectibix)
ramucirumab (Cyramza)
regorafenib (Stivarga)
ziv-aflibercept (Zaltrap)
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 5/7/20

Additional Sources of Information

 



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