Colorectal Cancer - Treatment Overview

Treatment Overview

The first step in treating colorectal cancer is usually an operation to remove the tumor. Sometimes a fairly simple operation can be done during a colonoscopy or sigmoidoscopy to remove small polyps and a small amount of tissue surrounding them. However, in most cases a major operation, in which the cancer and part of the colon or rectum around it are removed, is needed. If cancer has spread to another part of your body, such as the liver, you may need more far-reaching surgery.

After the cancer has been examined under a microscope, it will be staged. Staging is a way for your doctor to tell how far, if at all, your cancer has spread. It also helps your doctor decide what your treatment should be.

There are several different types of staging systems, so it's important to ask your doctor to explain carefully what stage your cancer is in and what that means.

In general, the most common staging system describes colorectal cancer this way:

• Stage I: Your cancer has not spread beyond the inside of your colon or rectum.
• Stage II: Your cancer has spread into the muscle layer of your colon or rectum.
• Stage III: Your cancer has spread to one or more lymph nodes in the area.
• Stage IV: Your cancer has spread to other parts of your body, such as the liver, lung, or bones.

Cancers that have not spread beyond the colon or rectum may require only surgery. If the cancer has spread, you may need radiation therapy, chemotherapy, or both.

Initial treatment

You and your doctor will work together to decide what your treatment should be. You will consider your own preferences and your general health, but the stage of your cancer is the most important tool for choosing your treatment.

Surgery is almost always used to remove colon cancer. If the cancer is found early, you may need only a simple procedure, called a polypectomy, in which a doctor removes small polyps found in the colon or rectum during a colonoscopy or sigmoidoscopy.

For a larger cancer, more extensive surgery is needed to remove the cancer and part of the colon or rectum around it. This is called a bowel resection. During this operation, your doctor will also remove some of your lymph nodes for testing. The healthy ends of the colon or rectum are then sewn back together.

Sometimes it isn't possible to rejoin the ends, and a colostomy is needed. This creates an opening on the outside of your abdomen where waste can pass through into a colostomy bag. The colostomy may be temporary until your colon heals, or it may be permanent if the entire lower colon or rectum was removed. Very few people who have colorectal cancer need a permanent colostomy.

Radiation therapy, which uses X-rays to destroy cancer cells, is standard treatment for some types of cancer in the rectum. Radiation therapy is often combined with surgery or chemotherapy. Compared to surgery alone, radiation therapy given before surgery for rectal cancer may reduce the risk that the cancer will return and may help you live longer.⁹

Chemotherapy uses drugs—given either as pills or through a needle—to destroy cancer cells throughout the body. Chemotherapy is used for some stages of colon cancer.

Your doctor may prescribe medicines to control nausea and vomiting caused by chemotherapy. There are also things you can do at home to manage these and other side effects. See the Home Treatment section of this topic for more information.

For more information about specific treatments, see the following topics:

• Colon Cancer – Health Professional Information [NCI PDQ]
• Colon Cancer – Patient Information [NCI PDQ]
• Rectal Cancer – Health Professional Information [NCI PDQ]
• Rectal Cancer – Patient Information [NCI PDQ]

Dealing with your emotions

If you have just been told you have colorectal cancer, you may have many different feelings. Most people feel some denial, anger, and grief. Others have few emotions. There is no normal or right way to react.

There are many things you can do to help with your emotional reaction to colorectal cancer. You may find that talking with family and friends helps. Some people find that spending time alone is what they need.

If your feelings get in the way of your ability to make decisions, it is important to talk with your doctor. Your cancer treatment center may offer psychological services. Your local American Cancer Society chapter can help you find a support group. Talking with other people who have had similar feelings can be very helpful.

Ongoing treatment

After your treatment, you will need regular checkups by a family doctor, general practitioner, medical oncologist, radiation oncologist, or surgeon, depending on your case. During your follow-up visits you may have one or more of these tests:

• Physical exams. How often you have these depends on your general health and the type of colorectal cancer you have. In general, you will see your doctor several times a year for 3 to 5 years and then return to once-a-year checkups.
• Colonoscopy to inspect the inner surface of your colon and rectum for new problems.
• Carcinoembryonic antigen (CEA) and other blood tests to check the success of your treatment and find out whether the cancer has returned.
• CT scan, PET scan, or MRI to see if the cancer has spread to other organs.

Treatment if the condition gets worse

Colorectal cancer comes back after surgery in about half of people who have surgery to remove the cancer.⁹ The cancer may be more likely to come back after surgery if it was not discovered in an early stage. Cancer that has spread or comes back is harder to treat. A cure is less likely, but treatment can help you feel better and live longer. For more information, see the topic Colorectal Cancer, Metastatic and Recurrent.

What To Think About

After you have had colorectal cancer, your chances of having it again go up. It's important to continue to see your doctor and be tested regularly to help find any returning cancer or new polyps early.

Clinical trials are designed to find better ways to treat people with cancer and are based on the most current information. Some people who meet the criteria for participation choose to enroll in such clinical trials.