Colorectal Cancer Treatment

  • Treatment

    Call your doctor if you experience rectal bleeding or a change in bowel habits that lasts longer than three weeks. Seek immediate medical attention if you are unable to pass stool.

    Your doctor is the best source of information on the drug treatment choices available to you.

    Your doctor may wish to administer radiation before surgery to shrink your tumor or after surgery to kill any lingering cancer cells. If you have rectal cancer, radiation could be the primary treatment. Radiation therapy uses high-energy rays to destroy cancer cells. It is used most frequently for rectal cancer; sometimes as the main therapy. When given before surgery, it can reduce the size of the tumor and make it easier to remove. Post-surgery, it can destroy cancer cells that may have been missed. It can also ease the pain, bleeding, and intestinal blockages that occur with advanced cancers.

    Radiation from an outside source is the most common way to deliver the therapy, which is typically given five days a week for many weeks. Each treatment lasts for a few minutes, and is a lot like having an x-ray. Some doctors are experimenting with implanting radioactive seeds directly into and around a tumor. Internal radiation is not often used for people with colorectal cancer. If you have a colon tumor that cannot be removed, your doctor may wish to try this approach. The side effects of radiation—fatigue, skin irritation, loss of appetite, nausea, and diarrhea—are usually temporary.

    Therapies that boost the patient's immune system are currently being explored. Immunotherapy uses the body's natural defenses to fight cancer. A variety of clinical trials involving different immune-enhancing therapies for colorectal cancer are underway. Some are looking at whether boosting the immune system overall with certain drugs might help. Others are exploring vaccines that stimulate the immune system to recognize and destroy abnormal cellular changes that occur with colorectal cancer. These are still in the experimental phases, and none have yet been shown to be effective in a clinical trial.

    If you have colon cancer, your doctor will recommend surgery to remove it. Very early colon cancers (i.e., stage 0 and 1) can be removed through a colonoscope, obviating the need to cut into the abdomen. Laparoscopic surgery for colon cancer is controversial. This minimally invasive procedure involves making very small incisions in the abdomen and using special instruments to remove the cancerous parts of the colon and nearby lymph nodes. Laparoscopic procedures are considerably less traumatic, and have a shorter recovery period than standard surgical procedures, but the risk of cancer recurrence is higher. Some experts think the laparoscopy should be reserved for very old patients in whom easier recovery outweighs risk of recurrence in terms of importance.

    The majority of patients with colon cancer undergo segmental resection. For this procedure, the cancerous part of the colon plus some of the healthy tissue surrounding it and nearby lymph nodes are removed, and the healthy sections are rejoined. The amount taken depends on the size and location of the tumor. A surgical resection can cure you. If your cancer has spread or is incurable, the procedure may prolong your life or make you more comfortable.

    Before a bowel resection, you will be asked to follow a special diet and fast the preceding night. The surgery will be performed under general anesthesia, and may take several hours depending on the extent of your cancer. If cancer has spread to other areas, such as the liver or lungs, it may be removed at this time.

    If your cancer is located so close to the anus that your doctor is unable to rejoin the remaining healthy sections, you will need a colostomy. For a colostomy, your colon will be brought outside your body through your abdominal wall, and stitched to your skin. A bag will be attached to collect intestinal wastes. A temporary colostomy may be needed in the event of an emergency resection. Permanent colostomies are needed in about 15% of cases.

    Hospital recovery typically takes 3 to 10 days. During this time, you will have a catheter inserted in your bladder, and you will need to be fed through an intravenous line or a tube in your stomach or bowel. The doctor will frequently ask if you have had gas or a bowel movement, a good sign that your bowel is starting to function normally again. At this point, you can resume regular eating. Once out of the hospital, you should be able to do light activities in as little as a week, but should avoid heavy exertion and lifting for 4 to 6 weeks.

    If you have rectal cancer, your doctor will probably recommend surgery to remove it. Surgery is usually the main treatment for rectal cancer, though some cases may be managed with radiation alone. Local excision can remove superficial lesions from the inner layers of the rectum. But in some cases, a resection is necessary. Early cancers can be removed with instruments inserted through the anus without an abdominal operation. More extensive procedures are needed for advanced cancers. If the tumor is in the upper part of the rectum, the remaining healthy segments can be re-attached and stool eliminated normally. If the rectal tumor grows too close to the anus, a colostomy will be needed.

    Shark cartilage has been touted as a cancer remedy, but evidence for the claim is slim. Assuming that sharks don't get cancer, some researchers began studying various substances from these fish and found that shark cartilage (the elastic material that makes up a shark's frame as bone makes up a human frame) blocks blood vessel formation. Because tumors need blood and oxygen to grow, scientists hypothesized that shark cartilage might help fight cancer. Other cancer-fighting properties in shark cartilage have been reported, and some animal studies have shown promise for the supplement. But human studies of shark cartilage for cancer have failed to show any real benefit, and it cannot be recommended until positive results are reported.

    Your long-term outlook depends on which stage your cancer was in when it was discovered and how well you responded to your treatments. If your cancer was caught early, your chance of cure is high. In general, the five-year survival rate for those whose colorectal cancer is limited to in the intestinal lining is 90%. When cancer penetrates intestinal muscle, the rate is 70-80%. When cancer invades the lymph nodes, the rate drops to 40-50%.

    If you have had colorectal cancer, you will need to see your doctor on a regular basis. If your treatments were successful, your doctor will want to see you annually to make sure your cancer has not returned. Follow-up visits generally include physical and rectal examinations, colonoscopy, an abdominal CT scan, and blood tests that reveal tumor markers or anemia. If any of these tests is suspicious, your doctor may request imaging studies such as x-rays, CT scans, and MRIs. If no cancer is found after 3 years, you may only need to see your doctor once every 3 years for colonoscopy. This is because new cancers can develop in the colons of people after resection.

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