Treatment & Management

of Colon Cancer

In general treatment for colon cancer may require surgery, radiation, and/or systemic therapy with chemotherapy, immunotherapy or precision cancer medicines. The specific treatment for each person is individualized and is based on the stage of the cancer and its genomic profile.

Surgery

For patients with potentially curable colon cancer, a properly performed surgical operation to remove the cancer and regional lymph nodes is essential for optimal results.  There are several different types of surgical procedures used in the treatment and management of colon cancer. The size and spread of the cancer helps determine the appropriate procedure to use.

Polypectomy: A polypectomy is the removal of a single polyp in the colon and is typically performed during a colonoscopy, which uses a long flexible tube with an attached camera.

Conventional surgery (open colectomy): Conventional surgery for colon cancer requires surgeons to create a large opening in the abdomen in order to reach the cancer. After the removal of the cancer and lymph nodes, the two cut ends of the colon are sewn together. In some instances, a temporary colostomy is created and the two ends of the colon are reconnected at a later time. A colostomy is an opening where the large intestine is attached to the abdominal wall and allows passage of stool into a replaceable bag outside of the patient’s body.

Laparoscopic surgery: Laparoscopic surgery, also called minimally invasive surgery, allows surgeons to do procedures by making only a few small incisions in the abdomen. A small tube that holds a video camera is inserted into the abdomen, creating a live picture of the inside of the patient’s body. This picture is displayed on a television screen so that physicians perform the entire surgery by watching the screen. The cancer is removed through another, slightly larger incision.

Laparoscopic surgery appears to be about as likely to be curative as the standard approach for earlier-stage cancers.1 Some potential advantages of the procedure include less pain, a shorter hospital stay, and a quicker recovery. However, there is still limited information from randomized trials about the approach. In addition, laparoscopic surgery requires special expertise and patients need to be treated by a skilled surgeon who has done many of these operations.2

Learn more about surgery here.

Radiation

Radiation therapy uses high-powered energy beams, such as X-rays or protons, to kill cancer cells. Radiation therapy is not a common way to treat colon cancer, though it may be used in certain circumstances. Radiation therapy, often with chemotherapy, is frequently used in the adjuvant or neoadjuvant setting for the treatment of rectal cancers, whereas chemotherapy alone is more common for the adjuvant and neoadjuvant treatment of colon cancers.

Learn more about radiation here.

Systemic Therapy: Precision Cancer Medicine, Chemotherapy

Systemic therapy is any treatment directed at destroying cancer cells throughout the body. Many patients with colon cancer already have small amounts of cancer that have spread outside the colon that cannot be treated with surgery. These cancer cells cannot be detected with any of the currently available tests and are referred to as micrometastases. The presence of micrometastases causes a recurrence following local treatment with surgery. An effective systemic treatment is needed to cleanse the body of micrometastases in order to improve a patient’s duration of survival and potential for cure.

Systemic therapies commonly used in the treatment of colon cancer include:

Precision Cancer Medicines

The purpose of precision cancer medicine is to define the genomic alterations in the cancers DNA that are driving that specific cancer. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack the cancer cells with specific abnormalities, leaving normal cells largely unharmed. Precision medicines are being developed for the treatment of colon cancer and patients should ask their doctor about whether testing is appropriate.

Learn more about precision cancer medicines here.

Chemotherapy

Chemotherapy uses medications that can be taken orally as a pain or are injected into a vein to kill cancer cells. In some situations chemotherapy is combined with immunotherapy or other precision cancer medicines to achieve the best results.

The delivery of cancer treatment following local treatment with surgery is referred to as “adjuvant” therapy and may include chemotherapy, immunotherapy, or use of precision cancer medicines. Adjuvant chemotherapy is offered to most patients with Stage II and all patients with stage III, or IV colon cancer for the purpose of reducing the risk of cancer recurrence.

Treatment by Colon Cancer Stage

Stage I: Cancer is confined to the lining of the colon.

Stage II: Cancer may penetrate the wall of the colon into the abdominal cavity or other adjacent organs but does not invade any local lymph nodes.

Stage III: Cancer invades one or more of the local lymph nodes but has not spread to other distant organs.

Stage IV: Cancer has spread to distant locations in the body, which may include the liver, lungs, bones or other sites.

Recurrent/Relapsed: Colon cancer has progressed or returned (recurred/relapsed) following initial treatment.

Next: Surgery for Colon Cancer

Next: Precision Cancer Medicine for Colon Cancer

Next: Radiation Therapy for Colon Cancer

References

1 Jayne DG, Thorpe HC, Copeland J et al. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. British Journal of Surgery. 2010;97:1638-45.

2 Alsina J, Choti MA. Liver-directed therapies in colorectal cancer. Seminars in Oncology. 2011;38:651-567.