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The treatment depends on the staging of the cancer. When colorectal cancer is caught at early stages (with little spread) it can be curable. However when it is detected at later stages (when distant metastases are present) it is less likely to be curable.
Surgery remains the primary treatment while chemotherapy and/or radiotherapy may be recommended depending on the individual patient's staging and other medical factors.
Surgery
Surgeries can be categorised into curative, palliative, bypass, fecal diversion, or open-and-close.
Curative Surgical treatment can be offered if the tumor is localized.
* Very early cancer that develops within a polyp can often be cured by removing the polyp (i.e., polypectomy) at the time of colonoscopy.
* In colon cancer, a more advanced tumor typically requires surgical removal of the section of colon containing the tumor with sufficient margins, and radical en-bloc resection of mesentery and lymph nodes to reduce local recurrence (i.e., colectomy). If possible, the remaining parts of colon are anastomosed together to create a functioning colon. In cases when anastomosis is not possible, a stoma (artificial orifice) is created.
* Curative surgery on rectal cancer includes total mesorectal excision (anterior resection) or abdominoperineal excision.
In case of multiple mestatasis, palliative resection of the primary tumour is still offered in order to reduce further morbidity caused by tumor bleeding, invasion, and its catabolic effect. Surgical removal of isolated liver metastases is, however, common; improved chemotherapy has increased the number of patients who are offered surgical removal of isolated liver metastases.
If the tumor invaded into adjacent vital structures which makes excision technically difficult, the surgeons may prefer to bypass the tumor (ileotransverse bypass) or to do a proximal fecal diversion through a stoma.
The worst case would be an open-and-close surgery, when surgeons find the tumor unresectable and the small bowel involved; any more procedures would do more harm than good to the patient.
Laparoscopic-assisted colectomy is a minimally-invasive technique that can reduce the size of the incision, minimize the risk of infection, and reduce post-operative pain.
As with any surgical procedure, colorectal surgery may result in complications including
* wound infection
* anastomosis breakdown, leading to abscess or fistula formation, and/or peritonitis
* bleeding with or without hematoma formation
* adhesions resulting in bowel obstruction (especially small bowel)
* blind loop syndrome as in bypass surgery.
* adjacent organ injury; most commonly to the small intestine, ureters, spleen, or bladder
Chemotherapy
Chemotherapy is used to reduce the likelihood of metastasis developing, shrink tumor size, or slow tumor growth. Chemotherapy is often applied after surgery (adjuvant), before surgery (neo-adjuvant), or as the primary therapy if surgery is not indicated (palliative). The treatments listed here have been shown in clinical trials to improve survival and/or reduce mortality rate and have been approved for use by the US Food and Drug Administration.
* Adjuvant (after surgery) chemotherapy. One regimen involves the combination of infusional 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX)
o 5-fluorouracil (5-FU) or Capecitabine (Xeloda®)
o Leucovorin (LV, Folinic Acid)
o Oxaliplatin (Eloxatin®)
* Chemotherapy for metastatic disease. Commonly used first line chemotherapy regimens involve the combination of infusional 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) with bevacizumab or infusional 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI) with bevacizumab
o 5-fluorouracil (5-FU) or Capecitabine
o Leucovorin (LV, Folinic Acid)
o Irinotecan (Camptosar®)
o Oxaliplatin (Eloxatin®)
o Bevacizumab (Avastin®)
o Cetuximab (Erbitux®)
o Panitumumab (Vectibix)
* In clinical trials for treated/untreated metastatic disease.
o Bortezomib (Velcade®)
o Oblimersen (Genasense®, G3139)
o Gefitinib and Erlotinib (Tarceva®)
o Topotecan (Hycamtin®)
[edit] Radiation therapy
Radiotherapy is not used routinely in colorectal cancer, as it could lead to radiation enteritis, and is difficult to target specific portions of the colon. Indications included:
* Colon cancer
o pain relief and palliation - targeted at metastatic tumor deposits if they compress vital structures and/or cause pain.
* Rectal cancer
o neoadjuvant - downgrade the tumor to increase resectability
o adjuvant - where a tumor perforates the colon as judged by the surgeon or the pathologist (Dukes C tumour), guided by surgical clips
o palliative - kill tumor tissue when surgery is not indicated
Sometimes chemotherapy agents are used to increase the effectiveness of radiation by sensitizing tumor cells if present.
Immunotherapy
Bacillus Calmette-Gue'rin (BCG) is being investigated as an adjuvant mixed with autologous tumor cells in immunotherapy for colorectal cancer.
Vaccine
In November 2006, it was announced that a vaccine had been developed and tested with very promising results.(See ) The new vaccine, called TroVax, works in a totally different way to existing treatments by harnessing the patient's own immune system to fight the disease. Experts say this suggests that gene therapy vaccines could prove an effective treatment for a whole range of cancers. Oxford BioMedica is the company behind the vaccine; it's a British company established as a spin-out from Oxford University and specialises in the development of gene-based treatments. Further vaccine trials are underway.
Support therapies
Cancer diagnosis very often results in an enormous change in the patient's psychological wellbeing. Various support resources are available from hospitals and other agencies which provide counseling, social service support, cancer support groups, and other services. These services help to mitigate some of the difficulties of integrating a patient's medical complications into other parts of their life.
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Important notice:
The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other
qualified health provider with any questions you may have regarding a medical condition.
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