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Treatment of Colon Cancer

Surgery, Chemotherapy, Radiation and You

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Updated December 22, 2011

Early detection and treatment of colon cancer may improve your prognosis (treatment outcome) and quality of life. When detected and treated early, people diagnosed with colon cancer have a 93 percent survival rate for five years following treatment. However, before you get immersed in statistics, take a moment to learn about what each treatment entails.

There are two main categories of treatments for colon cancer. Local treatments target one specific area, such as surgery or radiation. Systemic, or body-wide, treatments have a much wider net and include chemotherapy or targeted biologic therapies.

Depending on your physical health, stage of the cancer, and personal choice, you may elect one treatment or a combination of therapies, including surgery, chemotherapy, radiation, and targeted therapies.

Surgical Options

Surgical removal is the first treatment of choice for most stage 0 colon cancers. Colon cancer surgeries may involve a simple procedure to remove an isolated cancerous polyp, or a major operation called a colectomy, which removes a portion (or portions) of the intestine. The surgeon may remove or destroy cancerous tissues from other organs, such as the liver or lungs, if the cancer has spread.

Depending on the size and location of your colon cancer, the doctor may offer a laparoscopic colectomy versus an open colectomy. A laparoscopic procedure requires a much smaller incision than the open colectomy, which can result in a six to eight inch scar following the surgery.

If you have a history of lung or heart problems, your doctor may collaborate with specialists, such as pulmonary or cardiology doctors, to decide if surgery is the best option for you.

Non-surgical procedures may be used to destroy or shrink metastases in conjunction with surgery -- or standalone if you cannot tolerate surgery.

  • Cryosurgery kills the cancerous cells by freezing them.
  • Radiofrequency ablation uses energy waves to destroy (burn) cancer cells that have metastasized to other organs, such as the liver or lungs.
  • Ethanol ablation destroys the cancer cells with an injection of alcohol.

Chemotherapy

Most chemotherapy drugs work by killing cells that divide rapidly. In a person with cancer, the fastest proliferating cells are the cancer cells; however, side effects can occur in other tissues that are dividing somewhat rapidly. There are a few different ways to receive chemotherapy drugs. Your treatment may include taking them by mouth in pill form, intravenously, or through an injection directly into the artery closest to the tumor.

Chemotherapy is administered before or after surgical treatment and is most frequently used to treat stage II, III and IV cancers. Drugs given prior to surgery are used to shrink the tumors before physical removal. Chemotherapy is sometimes used to shrink tumors throughout the body when systemic metastasis has occurred (stage IV). Your doctor may advise you to take chemotherapy after surgery to kill any remaining cancer cells and decrease the chances of recurrence.

Agents Specific to Colon Cancer

Chemotherapy agents that are most often used in colon cancers include:

  • 5-FU (fluorouracil)
  • Eloxatin (oxaliplatin)
  • Xeloda (capecitabine)
  • Camptosar (irinotecan)

There are many different combinations of these agents, which are usually administered during two to four week cycles (rounds) of chemotherapy, followed by a period of rest and recovery. Capecitabine is a pill, whereas the others are given by an intravenous infusion.

Common side effects of chemotherapy for colon cancer are multitudinous, but most can be eased with medications. You may experience:

  • Nausea, vomiting and loss of appetite
  • Hair loss
  • Mouth sores
  • Peeling skin
  • Sunlight sensitivity
  • Diarrhea
  • Low blood counts (neutropenia)
  • Numbness or tingling of the hands or feet

You may also feel very tired and get sick easily. This usually occurs in conjunction with a drop in your blood count. You will need to get plenty of rest and practice good hygiene measures (like hand washing) to avoid unnecessary strain on your immune system with an illness, like the common cold.

Radiation

Radiation therapy uses a specific type of x-ray to kill cancer cells and can be used in conjunction with chemotherapy and surgery for colon cancer. A radiation oncologist will provide targeted radiation treatments to reduce any painful symptoms of the cancer, kill any remaining cancer cells suspected after surgery or from recurrence, or as a form of treatment if you cannot tolerate surgery.

Radiation therapy is either administered externally (like an x-ray) or implanted internally (inside your body).

External radiation therapy sessions usually occur five days per week for several weeks and are painless procedures. You may have skin irritation (think sunburn) at the radiation site, nausea, or vomiting at some point during treatment.

Internal radiation therapy, also called brachytherapy, requires small radioactive pellets placed adjacent to or in the cancerous tissues. Brachytherapy is usually completed in one visit.

Targeted Therapy

Targeted treatments for colon cancer are given concurrently with chemotherapy, typically intravenously, once every one to three weeks.

These drugs usually recognize the protein growth factors that cover cancerous cells, such as the vascular endothelial growth factor or the epidermal growth factor receptor. Since these drugs are antibodies, which specifically attack the proteins they bind, they only kill cells covered in these factors and they have the potential for fewer side effects than chemotherapy agents. Examples of targeted therapy drugs include:

  • Erbitux (cetuximab)
  • Avastin (bevacizumab)
  • Vectibix (panitumumab)

Side Effects and Risks

All treatments present a risk of side effects. The benefits of your treatment should outweigh the risks. Your doctor will work with you closely and tailor your treatment program to your needs.

Gone are the days when one kindly doctor tends to all of your healthcare needs. Your treatment plan will involve a team of medical professionals, including specialized doctors -- such as oncologists and radiologists -- nurses, and dietitians, to help guide you toward the best prognosis possible. Start a journal and keep a phone list of your medical professionals so you will know whom to contact for what.

Sources:

American Cancer Society. (2008). Colorectal Cancer. What You Need to Know - NOW. Atlanta: American Cancer Society Health Promotions.

American Cancer Society. (n.d.) Colorectal Cancer. Chemotherapy. Accessed: November 5, 2011.

National Comprehensive Cancer Network. (n.d.) NCCN Treatment Summaries. Colorectal Cancer Stages 0, I, II, and III. Accessed: November 4, 2011.

U.S. National Library of Medicine. (n.d.) Large Bowel Resection. Accessed November 4, 2011.

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