Colorectal Cancer Treatment

It’s helpful to understand the possible treatments for colorectal cancer. The following are overviews of the most common treatments. These should help you know what to expect, what the potential side effects are, and what the advantages are to each.

  • Surgical treatments
  • Colorectal resection
  • Chemotherapy
  • Radiation therapy
  • Biologic therapy

Surgery for Colorectal Cancer

The most common colorectal cancer treatment involves removing the tumor and surrounding lymph nodes. Annual bloodwork may be recommended as colorectal surgeries can have an effect on metabolism. These lab values can check to make sure you are getting all the essential nutrients and electrolytes your body needs. Common surgical procedures for colorectal cancer include:

Prophylactic Colectomy

Some people have a strong family history of cancer or other bowel-related diseases like intractable irritable inflammatory bowel disease (IBS). These people may choose to have their colon removed before any problems develop. This procedure may be done laparoscopically. This is associated with smaller incisions and a shorter recovery time.

Local Excision

A local excision is done when cancer is found at an early stage. A resection is performed through the anal canal to locally remove the tumor.

Partial Colectomy

If the cancer is larger, it’s necessary to remove both the tumor and a small amount of healthy tissue and nearby lymph nodes. This colorectal cancer treatment is called a colectomy. The healthy portions of the colon and rectum are reconnected. This reconnection procedure is called anastomosis.

Hopefully your surgeon can preserve anal function (and avoid the need for a permanent colostomy).

Partial Resection or Total Colectomy and Colostomy

If it is not possible to reconnect the colon, you will need to have a colostomy. This procedure creates a surgical opening called a stoma. The colon goes through the wall of the abdomen onto the skin. This creates a path for waste material (feces) to leave the body. If you have a colostomy, you will need to wear a special bag to collect this waste. This may be temporary or permanent.

Colorectal Resection

Colon resection surgery removes a section of the large intestine. This is done in order to remove diseased parts of the colon. This procedure is not just used for colorectal cancer. It is used in a variety of other diseases like Crohn’s disease, colitis, and diverticulitis, to name a few.

How does colorectal resection treat colorectal cancer?

When you have colorectal cancer, a colon resection is done to remove all visually detectable cancer.

How to prepare for a colorectal resection

The doctor may ask you to stop taking some medicines up to one week before colon resection surgery. Usually these are drugs that can lead to excess bleeding, like aspirin or blood thinners.

You should also prepare by drinking eight 8-ounce glasses of fluid every day. You may require a special diet for several days before surgery. The colon must be cleaned out before the surgery. Your doctor may ask you to take an enema or laxatives. You may have to drink a large container of solution. This preparation may start several days before the procedure. It’s not a fun process, but also not painful.

It’s important to arrange for a ride to and from the hospital. You’ll also probably need help at home for the first few days after the procedure.

What to expect during the procedure

You will be given general anesthesia so you will be asleep during the procedure. The colon resection surgery will be done with either a traditional surgery or with a laparoscope. With laparoscopy, recovery will be shorter.

During the procedure, the diseased section of the intestine is removed. The two loose ends of intestine are then sewn together. The surgeon may leave some soft tubes in the abdomen. These let any fluids drain.

If the doctor thinks the intestines need time to rest and heal, he or she may perform a colostomy. In this procedure, the surgeon brings the colon onto the abdomen wall. This opening is called a stoma. One or both ends of the intestine are attached to the stoma. Waste material (feces) leave the intestine through the stoma and collect in a pouch called an ostomy bag.

The doctor may leave the colostomy in place for several months as the intestines heal. When that healing has happened, the ends of the intestine will be joined together. Sometimes, a permanent colostomy is necessary if most of the large intestine has been removed.

A colon resection takes between one and four hours. You will probably be in the hospital between five and seven days.

What to expect after the procedure

The doctor may prescribe antibiotics. You may also need medicine for nausea and pain. Some patients require a nasogastric (NG) tube for a few days. This tube enters through the nose and goes to the stomach. This helps decompress the bowel.

The intestine will need some time to heal before it can function properly again. At first you will receive fluid through an IV (needle in a vein, such as in the hand). You will need to be on liquid and soft diets as you get better. Eventually you will work your way back to a regular diet.

If you had a colostomy there will be a pouch attached on the outside of the body. Waste material (feces) will collect in it. You will have special instructions about diet and activity. For the first few days after colon resection surgery, you’ll be restricted from eating. If you have had a colostomy, you’ll need to take it easy for a few months.

It is normal to take some time to adjust to a colostomy. Your doctor can help you find a support group in your area as well as arrange home health care.

What is Ostomy?

Ostomy is the general name for a surgical operation to create an opening (stoma) from an area inside the body to outside the body to get rid of waste such as urine or stool. The waste is collected in a receptacle, usually a special plastic bag called an ostomy bag. These bags can be emptied, cleaned, and replaced as needed.

Ostomies are common colorectal cancer treatments and are also used to treat anal cancer and bladder cancer, especially when parts of these organs have to be removed. Ostomies can be temporary or permanent depending on the extent of the surgery.

The care of ostomies requires special supplies and appliances. You will be extensively trained and educated on how to care for it by your healthcare team.

Types of ostomies include:

  • Colostomy: A colostomy creates an opening from the colon or large intestine to outside the body.  Colostomies rid the body of waste and mucus.
  • Ileostomy: An ileostomy creates an opening from the small intestine to outside the body. Ileostomies rid the body of waste and mucus.
  • Urostomy: A urostomy creates an opening that allows urine to leave the body from the kidney instead of the bladder.

Once you become comfortable with cleaning and changing your ostomy bag and have healed from surgery, you will be able to resume most of your daily activities. Talk to your healthcare team to learn how to properly care for an ostomy.

What should I ask my healthcare team?

Here are some questions you may want to ask your healthcare team about living with an ostomy:

  • What kind of ostomy will I have?
  • Will my ostomy be temporary or permanent?
  • How long will it take me to heal?
  • How do I need to limit my physical activity and for how long?
  • When can I return to work?
  • Who will show me how to clean and change my ostomy bag?
  • What are the signs of infection or other serious medical issues?
  • Where can I buy ostomy supplies, and will my insurance cover them?
  • Where can I find an ostomy support group?
  • Do I need to change my diet?

What resources are available for cancer patients with ostomies?

United Ostomy Associations of America, Inc. (www.ostomy.org) provides information on living with an ostomy, a support group locator, and online discussion boards.

Osto Group (www.ostogroup.org) provides discounted and free ostomy products to uninsured ostomy users.

Chemotherapy

Although colorectal cancer treatment often involves surgery alone, chemotherapy may also be used. Chemotherapy treatment (often called “chemo”) doesn’t refer to one specific medicine but a group of many different medicines. Chemo medicines prevent cancer cells from growing and spreading. Chemo medicines do this by destroying cancer cells altogether or preventing them from dividing. Chemo affects the whole body because it goes through the bloodstream.

When is chemotherapy used?

Chemotherapy may be given either alone or along with radiation therapy. When given alone, it is given in a higher dose designed to destroy cancer cells. When given along with radiation therapy, it is delivered at a lower dose. This is designed to make the cancer more sensitive to the radiation.

Newer agents designed to inhibit tumor blood vessel growth are also being used for patients with advanced stage and metastatic colon cancer. A doctor can determine which agents are most appropriate for the treatment.

Chemotherapy is usually given through the vein, but some forms can be given by mouth. The medical oncologist will decide how many cycles or courses of chemotherapy are best.

The number of cycles of chemotherapy needed vary

Typically, after surgery, if you get chemo alone for colon cancer, you will receive between 6 and 12 cycles. When you receive chemo along with radiation, you may get 2 cycles alone and then 2 more with radiation. Then you may get another 4-8 after the radiation is done.

Different oncologists use different schedules. The type of chemo drug being used is another factor. If you are considering chemotherapy for colorectal cancer treatment, you may also want to ask your doctor about clinical research trials for new chemotherapy drugs and combinations.

What can I expect from chemotherapy?

Chemotherapy not only weakens and destroys cancer cells at the site of the tumor, but throughout the body as well. Unfortunately, this means that chemo can unintentionally harm the development of normal cells like hair, nails, mouth, and digestive tract.

The side effects chemo causes depend on the type of chemotherapy and how many cycles received. The most common side effects of chemo are:

  • Nausea and vomiting
  • Fatigue or tiredness
  • Confusion, forgetfulness (“chemo brain”)
  • Decreased blood counts, sometimes with bruising, bleeding, or infection
  • Sores inside the mouth
  • Numbness in the hands and feet
  • Diarrhea, loose stool
  • Increased urgency to have a bowel movement or urinate

When chemotherapy is given at a lower dose, these side effects are less common. This sometimes happens when radiation is necessary too. However, patients often feel very tired. Irritation of the colon and anus can be a side effect, especially if there is a history of colitis, Crohn’s disease, or gastrointestinal problems. Make sure to tell the doctor if you have these conditions before starting chemo. There may be drugs available that can help with these side effects.

If you experience side effects, call your physician right away. It is better to address side effects as soon as possible, and there are numerous drugs available to help manage side effects.  Many side effects can also be managed by changing what and how you eat.

Chemotherapy can also cause infertility. Talk to your doctor as soon as possible. There may be ways to preserve your fertility, but they usually need to be done before starting chemotherapy.

How is chemo given?

Chemo medicines come in different forms and can be given in different ways:

  • Intravenously (IV): As an infusion, the medicine comes through a thin needle (IV) in a vein in the hand or lower arm. An oncology nurse will insert the needle before each infusion and take it out afterwards.
  • Injection: As a single shot into a muscle in the leg, arm, hip, or under the skin in the fatty part of the stomach, leg or arm.
  • By mouth: As a pill or capsule, taken at home or at the doctor’s office.
  • Through a port: This is inserted in the chest during a short outpatient surgery. It is about the size of a quarter and sits right under the skin. A port is a small disc made of plastic or metal. A catheter (soft thin tube) connects the port to a large vein. The chemo medicines are delivered through a thin needle right into the port. Blood can also be drawn through the port. Once chemo is finished, the port is removed in a brief outpatient procedure.
  • Through a catheter in the chest or arm. This is a soft thin tube that is inserted into a large vein. This is done in a short outpatient surgery. The other end of the catheter stays outside the body. This is similar to having a port.

If you have a catheter or port, your medical team will tell you to be sure to watch for signs of infection.

What’s the advantage of a port or catheter?

Many doctors recommend getting a catheter or port. It makes chemotherapy easier and more comfortable, as patients don’t have to be restuck each time, like with an IV or injection. Some colorectal cancer patients have a portable pump attached to the port or catheter. This controls how much and how fast the chemotherapy medicine goes in. The pump can either be internal (implanted under the skin during a short outpatient procedure) or external (carried by the patient). Once chemo is done, the pump is taken out.

How often will I have to have chemo?

Your oncologist will set your colorectal cancer treatment regimen. Every chemo regimen is made up of cycles. This means a period of treatment followed by a period of recovery. For example, you may get chemo one day and then have a few weeks of recovery with no treatment. That would be one cycle. Or you may get chemo for several days in a row and then have a recovery period. Several cycles make up a complete chemotherapy regimen.

The number of cycles in a regimen and the length of each regimen vary from patient to patient. A lot depends on the medicines used.

You can get chemotherapy in a variety of settings: at a hospital, in a doctor’s office, or in a clinic. You may even get chemo at home if you are taking chemo in a pill form or you have a portable pump.

If you take chemo in a clinic, hospital, or doctor’s office, you usually go home between treatments. In some cases, you may stay in the hospital to be monitored. This is especially true if your immune system isn’t working as well as it should be. Your doctor will explain where you’ll be getting your treatment.

What should I bring to my chemo appointment?

A chemotherapy treatment at a hospital or clinic can take anywhere from one to several hours. Although many chemo treatment areas have televisions and magazines, you may want to bring something to help pass the time. Ideas include:

  • A laptop
  • Knitting, needlepoint, or crochet
  • A thick novel
  • Crossword or other puzzle book
  • Sketchbook and pencils
  • Cards or board games (if you have someone to play with)
  • MP3 player or portable CD player to listen to music
  • Paper and pens to keep a journal or write letters

Is there anything I should be thinking about before I start chemotherapy?

Chemotherapy treatment can drain most of your energy. This is a major process the body is going through. There are some things you should take care of before you start chemo:

  • Get your teeth cleaned and get a dental check-up. Chemo weakens the immune system, so you may be more vulnerable to infections caused by bacteria that are dislodged during teeth cleaning.
  • Get any heart tests (like an EKG) that the doctor recommends.
  • If you’re a woman, get a Pap smear if you’re overdue. Chemo can alter the results of Pap smears, so it’s best to get one beforehand.
  • Find someone to help around the house. Chemo causes extreme fatigue. Line up someone to help with chores such as cleaning, grocery shopping, carpooling, and cooking. Don’t be too afraid to ask for help.
  • Join a support group if that sounds helpful.
  • Find out ahead of time what you should and shouldn’t eat or drink on treatment days.

Tell your doctor all the vitamins, supplements, over-the-counter, and prescription medicines you take.

  • Talk to your doctor about hair loss. Most chemo medicines cause some amount of hair loss. If you plan on wearing a wig, you might want to go ahead and get it so you can match it to your hair color and style.

Radiation Therapy

Radiation therapy is also called radiotherapy or radiation. This is a very effective colorectal cancer treatment, as it destroys cancer cells that may remain after the colorectal surgery.

Your doctor may recommend radiation in combination with chemotherapy and surgery. Radiation can pinpoint the cancer cells very well. In addition, radiation therapy is relatively easy to tolerate because its side effects are limited to the treated area.

A radiation oncologist will oversee your radiation treatments. There are three major types of radiation used for colorectal cancer:

External beam radiation therapy

This is the most common type of radiation used. Short bursts of X-ray beams are fired from the machine at the cancer. This type of radiation is designed to treat the cancer but affect as little normal tissue as possible.

Intensity modulated radiotherapy (IMRT)

This less common form of radiation uses many thin beams to focus the highest dose of radiation on the tumor.

High dose brachytherapy

This form of radiation uses catheters and tubes to direct an extra dose of radiation to the tumor. This form of radiation is occasionally used to boost the radiation delivered to a rectal tumor.

In advanced stages of rectal cancer, another treatment option is to combine radiation therapy with hyperthermia and possibly chemotherapy. Hyperthermia uses heat to damage tumors. This makes the cancer cells more sensitive to the effects of radiation.

What to expect during radiation

The goal of radiation is to destroy as much cancer as possible while preserving normal tissue. The radiation oncologist will determine how many treatments you will receive. Sometimes treatments are given once a day and sometimes twice a day. A treatment usually only takes a few minutes. The total treatment time can take between 5 and 8 weeks, depending on the total dose required.

The most common side effects of radiation are burns and irritation to the skin. Radiation to the rectum can often be painful and include changes in bowel function such as diarrhea, cramping, and irritation. Fatigue is also a common side effect of radiation. If you experience any side effects, let your healthcare team know.

Biologic Therapy

Biological therapy is a colorectal cancer treatment that works with the immune system. All the parts of the immune system help protect you from getting diseases and infection. The immune system includes the:

  • Spleen
  • Lymph nodes
  • Tonsils
  • Bone marrow
  • White blood cells

White blood cells are particularly important to the immune system. Here are some terms you might hear:

  • Monocytes and lymphocytes are types of white blood cells.
  • B cells, T cells, and Natural killer cells are types of lymphocytes.

The immune system is able to tell the difference between good cells that keep you healthy and bad cells that make you sick.

Biological therapy can serve two purposes. First, it can help fight colorectal cancer by:

  • Stopping or slowing the growth of cancer cells.
  • Making it easier for the immune system to destroy cancer cells.
  • Keeping cancer from spreading to other parts of the body.

Biological therapy can also help control side effects from other colorectal cancer treatments like chemotherapy. Cancer vaccines are one form of biological therapy. Other vaccines are given before you get sick, but cancer vaccines are given once you have cancer. These vaccines help the body fight the cancer and keep it from returning.

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