What are the treatment options and their side effects? What treatment is best for me? Which methods have proven most effective?
These and many more questions are likely running through your head when you’ve been diagnosed with cancer.
Here you can find answers to your questions, learn what to expect during and after treatment, and find information to discuss with your physician. Ultimately you and your doctor will make the decision on what treatment is best for you.
Setting the Stage for TreatmentIn the first step of cancer diagnosis, your doctor will conduct tests and tissue biopsies to determine your cancer stage. Cancer staging is the process of classifying how far a cancer has progressed. The most commonly used system for staging colorectal cancers, developed by the American Joint Committee on Cancer (AJCC), is known as TNM (Tumor, Nodes, Metastasis). This method takes into account the tumor size, lymph node involvement and whether the cancer has spread—or metastasized—to other organs.
Once the stage is determined, the course of treatment may include more than one therapy together or in sequence. In deciding what treatment is best, it is important to ask questions and seek a second opinion.
TreatmentsThe three primary forms of colon and rectal cancer therapy are:
In deciding with your doctor which therapy or combination of therapies are best, you will want to discuss side effects and complications of each treatment strategy.
For surgery to treat colon cancer, usually the cancer and a length of normal colon 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. Surgery for colon cancer can sometimes be done with a new approach called laparoscopic or keyhole surgery. In this method, a lighted tube and special instruments are placed inside the body through a few small incisions, rather than one large one. Keyhole surgery for colon cancer has been clinically proven to work as well as the standard approach when performed by a surgeon experienced in this type of surgery. Also, patients usually recover faster than they do after the usual operation! 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.
Surgery is also usually the main treatment for rectal cancer, although radiation and chemotherapy will often be given before surgery. There are several types of surgery for rectal cancer. Some operations (polypectomy, local excision, and local transanal resection) can be done with instruments placed into the anus, without having to cut through the skin. One of these methods might be used to remove some stage I cancers that are fairly small and not too far from the anus.
For some stage I and most stage II or III rectal cancers, other types of surgery may be done. A low anterior resection is used for cancers near the upper part of the rectum, close to where it connects with the colon.
For cancers in the lower part of the rectum, close to its outer connection to the anus, an abdominoperineal resection is done. After this surgery, a colostomy is usually needed. A colostomy is an opening of the colon in the front of the abdomen, and may be temporary or permanent. It is used for the elimination of solid body waste (feces or stool).
If the rectal cancer is growing into nearby organs, more extensive surgery is needed. In a pelvic exenteration the surgeon removes the rectum as well as nearby organs such as the bladder, prostate, or uterus if the cancer has spread to these organs. A colostomy is needed after this.
When injected by IV, drugs enter the bloodstream and spread throughout the body, making the treatment useful for cancers that have spread to distant organs. Some chemotherapy drugs are delivered orally by taking pills, and others are delivered directly to the tumor via internal pumps or microspheres. In some cases, chemotherapy drugs can be injected into an artery leading to the part of the body with the tumor. This approach is called regional chemotherapy. Since the drugs go straight to the cancer cells, there may be fewer side effects.
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.
The main use for radiation therapy in people with colorectal cancer is when the cancer has attached to an internal organ or the lining of the abdomen. If this happens, the doctor cannot be sure that all the cancer has been removed, and radiation therapy is used to kill the cancer cells left behind after surgery. For rectal cancer, radiation is also given to prevent the cancer from coming back in the place where it started and to treat local recurrences that are causing symptoms such as pain.
External radiation is most often used for people with colon or rectal cancer. Treatments are given 5 days a week for several weeks. Each treatment lasts only a few minutes and is something like having an x-ray for a broken bone. A different approach may be used for some cases of rectal cancer. The radiation can be aimed through the anus and reaches the rectum without passing through the skin of the abdomen.
A different approach may be used for some cases of rectal cancer. The radiation can be aimed through the anus and reaches the rectum without passing through the skin of the abdomen.
For internal radiation therapy, small pellets of radioactive material are placed next to or directly into the cancer. This method is sometimes used in treating people with rectal cancer, particularly sick or older people who would not be able to withstand surgery.
Personalize Your Treatment Options
The American Cancer Society provides a helpful online tool offering personalized treatment option information specific to your cancer diagnosis. Here, you’ll get treatment and side-effect information, find questions to help you ask your doctor the right questions, and get personalized reports based on the latest published medical research—all information to help you make more informed treatment decisions alongside your doctor. Click below to access the tool.
Colorectal Cancer Profiler Tool
*This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.
The treatment information shared on this Web site is not official policy of Olympus America Inc. or the American Cancer Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.
Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.
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