If you or someone you know was recently diagnosed with colon or rectal cancer, there are a lot of questions and several appointments leading up to determining the best treatment plan. The right treatments and the timing of them vary from patient to patient. Let’s take a look at the treatments available today and the timing of them so you can ask your oncologist questions about what’s right for you.
Who Treats Colon and Rectal Cancers?
A medical oncologist, a doctor who specializes in the treatment of cancer using systemic therapies, will lead the treatment planning and coordinate with other physicians and caregivers. They also oversee the medical treatments given to the patient, such as chemotherapy, targeted therapy, and other systemic treatments for colorectal cancer.
Depending on the type of treatments you need, the medical oncologist will work with the following to develop a personalized treatment plan:
- A colorectal surgeon, also known as a gastrointestinal (GI) surgeon, performs surgery to remove the cancer and will remove lymph nodes to have them tested for signs of cancer. If needed, the surgeon will also perform an ileostomy or colostomy procedure, allowing waste to be removed from the body while the colon heals.
- A radiation oncologist, if radiation therapy is determined to be a part of the treatment plan. Radiation is not always a part of the treatment plan, especially for late-stage patients.
You might also have other experts on your cancer care team, such as physician assistants, nurse practitioners, infusion nurses, radiation technicians, psychologists, nutritionists, and social workers. They all work together to give you the best care possible.
How Is Your Colorectal Cancer Treatment Plan Determined?
After a colorectal cancer diagnosis, the medical oncologist will determine the stage of the cancer by analyzing the size of the tumor and if cancer cells have spread to lymph nodes and other parts of the body. This information will play an important role in which treatments are needed and when they should be given.
To gather this information, you may need another colonoscopy, CT scans, an MRI, and/or a PET scan to determine the extent of the cancer. Very early cancer growth is considered stage 0 and is often treated fully by removing the polyp that was cancerous. Typically, colorectal cancer is staged between I (one) and IV (four), with various treatments available at each stage.
Other important factors considered when choosing the correct treatment plan include:
- Your age and overall health. Older patients or those whose health is not stable may not be able to go through some of the treatments.
- The type of colorectal cancer you have
- The size and location of the tumor, determining whether surgery is possible
The team of oncologists and surgeons will review each colorectal cancer patient's individual situation and recommend the best next steps.
When a treatment plan is presented, feel free to ask questions. You need to be sure the goal of each treatment is clear, as well as what you can expect for side effects and recovery time.
What Are the Options for Treating Colorectal Cancer?
As a general rule, the stage of your cancer will determine your treatment options. Many patients receive more than one type of treatment for colon or rectal cancer.
Surgery for Colorectal Cancer
Surgery is the most common way to treat colorectal cancer, especially early-stage cancers. Here are some surgical options to treat colorectal cancer:
Polypectomy: A gastroenterologist will remove cancerous polyps in your colon or rectum during a colonoscopy. This method is best for the early stages of colorectal cancer.
Colectomy: During a colectomy, your surgeon will remove the cancerous portion of the colon, as well as some healthy tissue on either end. In some cases, your colorectal cancer surgeon may need to remove the entire colon.
Laparoscopic-assisted colectomy is the technique used today. The surgeon will make several small cuts in your abdomen to insert a thin tube, including a camera and surgical tools. This method allows patients to recover and return home more quickly.
Depending on how much of your colon has been removed, you may need a colostomy. A colostomy is a hole made during surgery, called a stoma, that connects the colon to the outside of the belly. This helps waste leave the body through a small pouch. You may only need the colostomy for a short time to let the colon or rectum heal after resection. Sometimes, it can be permanent.
Chemotherapy for Colorectal Cancer
Chemotherapy uses medications to kill cancer cells. FOLFOX is an abbreviation for a combination chemotherapy treatment that includes three medicines:
- Folinic acid
- Fluorouracil
- Oxaliplatin
Medical oncologists usually use FOLFOX along with other therapies to treat colorectal cancer, especially if it’s reached the lymph nodes. Research has shown that combination chemotherapy treatment works better to destroy the malignant cancer cells that cause colorectal cancer than individual chemotherapy drugs alone.
Chemotherapy can be used
- Before surgery to shrink the tumor
- After surgery to be sure any remaining cancer cells are destroyed
- As the primary treatment if surgery is not possible.
- To destroy cancer cells that may have spread microscopically to other areas of the body are also destroyed before they can develop into a tumor.
Radiation Therapy for Colorectal Cancer
Radiation therapy uses high-energy rays which destroy cancer cells. The most common type of radiation therapy for colorectal cancer is external beam. The patient lies down in the same position under a machine called a linear accelerator so that the radiation beams can be pointed exactly where the cancer is (or was) to treat that precise area. This is repeated five days a week for 2-8 weeks. Your cancer care team will determine the number of treatments needed.
Radiation therapy is used in a few different ways, depending on the stage of cancer, including:
- Before surgery, to reduce the size of a colon or rectal tumor, making it easier to remove.
- After surgery, targeting the surgery site and possibly the lymph nodes to ensure any remaining cancer cells are destroyed.
- When surgery isn't possible, radiation therapy can help ease symptoms, such as bleeding or pain.
Targeted Therapy for Colorectal Cancer
Targeted therapies block cancer growth by targeting specific gene mutations identified in the patient. Currently, this category of treatment is available to patients with late-stage or recurrent colorectal cancer. Some of the most common types of targeted therapy work against the VEGF, EGFR, and BRAF gene mutations.
Both the VEGF and EGFR genes help cancer cells grow. The targeted therapies for these genes block blood vessel formation to prevent the cancer cells from multiplying.
Another example of targeted therapy for colorectal cancer focuses on the BRAF gene mutation. If this mutation is present, your oncologist may include BRAF inhibitor drugs that target the abnormal BRAF protein on the cell to shrink or slow down the growth of the malignant tumor.
Immunotherapy for Colorectal Cancer
Immunotherapy can be a treatment option for both early-stage and advanced colorectal cancers. Cancer cells can hide from the body’s immune system, making it hard for the body to destroy them. Immunotherapy works by allowing the body to identify the cancer cells and then attack them.
Clinical Trials for Colorectal Cancer
Clinical trials for colorectal cancer aim to find new treatment options that are safe and effective. These trials may involve new drugs, cancer vaccines, or even existing drugs that can be used in a new way. Thanks to clinical research trials, targeted therapies are now available to personalize treatment based on specific gene mutations.
The doctors at New York Oncology Hematology participate in clinical research trials, opening new therapy options to patients at various stages of colorectal cancer.
After the Treatment is Over, Remission is the Goal
Remission happens when your treatments are complete and your oncologist does not find any more cancer in your body. Sometimes, this is also called having "no evidence of disease.” Be sure you attend your follow-up appointments for scans and bloodwork. These tests make it possible to find recurrent cancer as early as possible. If the cancer returns, you may also start to experience symptoms. Report these to your oncologist as soon as possible. Don’t wait for a follow-up appointment.
Remission from colorectal cancer can be temporary or permanent. The earlier it’s found, the more likely complete remission is possible. If the cancer does come back, you will meet with the oncologist for additional testing, and a new treatment plan will be created. There may be treatment options available to you now that were not an approved option during the initial treatment process.
Colorectal Cancer Care in New York’s Capital District
NYOH offers the latest in colorectal cancer treatment in the Capital District, including clinical research, genetic testing, patient education, and support. We also have expertise in survivorship care for cancer, which can help you manage the physical and emotional changes that may occur during and after your cancer treatment.
If you have received a colorectal cancer diagnosis, request a consultation with one of our colorectal cancer specialists at any of our convenient locations in Albany, Troy, Schenectady, Saratoga County, or Hudson, New York. We will review your options and create a specialized colorectal cancer treatment plan for you.
