Yi-Jen Chen, MD, PhD, Radiation Oncologist, City of Hope | Duarte
This page was updated on June 1, 2023.
Treatment for colorectal cancer may include surgery, chemotherapy, immunotherapy and a number of other options. Which would be appropriate for you depends on several factors, including the stage and extent of your disease. The process of treating colorectal cancer often involves the input and expertise of a multidisciplinary care team—a group of doctors who specialize in various fields of medicine related to treating cancer of the colon or rectum. These doctors work together to establish a treatment plan suited to you. As colorectal cancer may be treated using a combination of approaches, different doctors may guide you through these treatments according to their specialty.
The types of doctors involved in your care will depend on your treatment plan, but may include:
Gastroenterologist who specializes in diagnosing and treating problems in the digestive tract
Medical oncologist who specializes in using chemotherapy, targeted therapy or other drugs to treat cancer
In addition to these doctors, you may encounter or meet with other medical professionals, including nurses, pharmacists, psychologists, oncology dietitians and social workers as part of your care team.
Your cancer care team may consider a variety of factors before developing a treatment plan. Your input and preferences are critical in this decision, and you should ask questions about all of your options. Questions to consider include treatment goals and the potential side effects and benefits of each option.
Factors that play a role in determining your treatment plan may include your:
Medical history
Overall health
Social support network
Decisions concerning the side effects of each treatment option
Surgery is the most common colorectal cancer treatment. Surgery for colorectal cancer may involve removing tumors, removing the affected section of the colon, reattaching healthy ends of the intestines and removing nearby lymph nodes. In rare cases, the entire colon may need to be removed. Patients may receive chemotherapy and/or radiation therapy before and/or after surgery for colorectal cancer. These adjuvant therapies are intended to target cancer cells that may remain after surgery and may help shrink tumors before they are surgically removed.
All surgeries have potential complications. Pain and tenderness at the surgical site are common side effects. Some surgeries for colorectal cancer may cause temporary constipation or diarrhea.
Questions to ask your doctor before colorectal cancer surgery
What is the goal of surgery?
How can I prepare for surgery?
What should I expect on the day of surgery?
What should I expect after surgery?
What are the potential complications of surgery?
How long will it take me to recover?
Common types of surgery to treat colorectal cancer
Local excision: Ideal for early-stage colon or rectal cancers, local excision involves inserting a tube into the rectum and using surgical tools to cut out the cancer.
Resection: Resection involves removing the tumor and a portion of healthy tissue nearby to minimize the chances of further spread. For rectal cancer, this procedure is done if the cancer has spread into the rectal wall. For colon cancer, this procedure is often called partial colectomy, and may be used to treat stage 1, 2 or 3 patients. Doctors remove the segment of the colon that contains cancer and some surrounding healthy tissue and connect the remaining tissue.
Radiofrequency ablation (RFA) and cryosurgery: With the aim of killing cancer cells, radiofrequency ablation uses tiny electrodes and cryosurgery uses freezing cold temperatures. These procedures may be used to treat colorectal cancer patients who aren’t able to have surgery, or for cancers that have spread to the liver.
Pelvic exenteration: This procedure is used for more advanced rectal cancer that has spread. It involves removing the rectum, bladder and lower portion of the colon. Women may also need to have the vagina, uterus and ovaries removed, while men may have their prostate removed. To allow for stool and urine to exit the body without these organs, an opening in the abdomen (stoma) is created, and excretions are collected in a bag outside of the body.
Colostomy: Sometimes, when colon cancer is treated with resection, the surgeon is unable to reattach the two remaining ends of the colon together, and a stoma is created so that stool can still be excreted. The stool is collected in a bag outside of the body. The colon may be reattached later on, or the stoma may be permanent.
Drugs known as checkpoint inhibitors may be used to treat advanced colorectal cancer that have specific genomic features. The U.S. Food and Drug Administration (FDA) has approved certain checkpoint inhibitors to treat patients with inoperable metastatic tumors with microsatellite instability-high (MSI-H) or mismatch repair deficiency (dMMR) genetic features, regardless of where the tumor is located. MSI-H is often found in colorectal tumors, especially in patients with Lynch syndrome, a genetic condition that elevates the risk of colorectal cancer.
Checkpoint inhibitors work by blocking specific checkpoint receptors, which are immune cells that distinguish good cells from bad ones. Immunotherapy is not recommended for all patients, and responses to the treatment vary. Immunotherapy may also be used in combination with other treatments, such as surgery or chemotherapy.
Questions to ask your doctor before undergoing immunotherapy treatment for colorectal cancer
What is the goal of this treatment?
What side effects should I expect?
What can be done to reduce these potential side effects?
How long will this treatment and the potential side effects last?
Chemotherapy
Chemotherapy drugs are designed to destroy cancer cells or impede their ability to grow and reproduce. Chemotherapy may not be necessary for patients with stage 1 or stage 2 colorectal cancer, but it is a common treatment option for patients with stage 3 or stage 4 disease. Chemotherapy for colorectal cancer may be given intravenously or in pill form.
Neoadjuvant chemotherapy is given prior to colorectal cancer surgery. An oncologist may recommend a combination of chemotherapy and radiation therapy to help reduce the size of a tumor before surgery. This treatment is more common for rectal cancer.
Adjuvant chemotherapy is given after surgery. This treatment may help destroy colorectal cancer cells that remain after cancer removal surgeries and may help lower the risk of recurrent cancer. Adjuvant chemotherapy may help prevent colorectal cancer from spreading to other parts of the body.
Questions to ask your doctor before undergoing radiation therapy for colorectal cancer
What are the goals of radiation therapy?
What kind of side effects should I expect and can anything be done to reduce them?
What are the chances that radiation therapy will affect my sexuality and fertility?
Targeted therapy
Monoclonal antibody therapy is a type of targeted therapy used to treat colorectal cancer. Monoclonal antibodies are bio-engineered proteins that may help leverage the body’s natural immune response to recognize, attack and destroy colorectal cancer cells. Monoclonal antibodies may be used alone or in combination with other treatments, such as chemotherapy.
The potential side effects of targeted therapy may vary depending on the type of drug used. Some targeted therapy drugs may present complications such as rashes, headache, fatigue, fever and diarrhea. Others may cause high blood pressure, bleeding, a high risk of infections, mouth sores and poor appetite. More serious complications may also occur.
It’s important to ask your care team about the potential side effects and complications of targeted therapy before undergoing treatment.
Questions to ask your doctor about targeted therapy for colorectal cancer
What is the goal of treatment with targeted therapy?
Which targeted therapy drug will be used and why?
What are the potential side effects and complications of treatment with targeted therapy?
Colorectal cancer clinical trials
City of Hopemay offer clinical trials to qualifying colorectal cancer patients as part of our commitment to offering new and innovative treatment options. Clinical trials are a critical testing ground for determining the effectiveness and safety of new and developing cancer drugs and other treatments. Qualifying colorectal patients may be eligible to participate in a clinical trial at any stage of their disease and/or treatment. Talk to your doctor about whether a clinical trial is an option for you and ask about the risks and requirements involved.
Colorectal cancer treatments by stage
Treatment plans for colorectal cancer depend largely on the cancer’s stage. Surgery is a common treatment option used for earlier-stage colorectal cancers (stage 0, 1, 2 and 3). Additionally, your doctor may choose to combine surgery with a systemic treatment such as chemotherapy and/or radiation therapy for a better result.
Common treatment options for colon cancer, depending on its stage
Stage 0: Endoscopic surgery to remove a polyp (polypectomy)
Stage 1: Surgical resection to remove the tumor and nearby lymph nodes
Stage 2: Surgery to remove the tumor and nearby lymph nodes, which may be followed by chemotherapy
Stage 3: Surgery to remove the tumor, followed by chemotherapy
Stage 4: A combination of surgery, radiation therapy, chemotherapy and other options may be considered, as well as clinical trials and palliative care (to help relieve symptoms)
Common treatment options for rectal cancer, depending on its stage
Stage 0: Endoscopic surgery to remove a polyp (polypectomy)
Stage 1: Surgical resection to remove the tumor and nearby lymph nodes
Stage 2: Surgery to remove the tumor and nearby lymph nodes, which may be followed by chemotherapy
Stage 3: Upfront chemotherapy and radiation therapy, followed by surgery to remove the tumor and nearby lymph nodes
Stage 4: A combination of surgery, radiation therapy, chemotherapy and other options may be considered, as well as clinical trials and palliative care (to help relieve symptoms)
Recurrent colorectal cancer
Sometimes, cancer returns after scans show no sign of disease. This is called recurrent cancer. Cancer may come back in the same place it started or in another part of the body.
If cancer recurs, you’ll undergo testing again to figure out the cancer’s location and whether it has spread. Then, a treatment plan can be made accordingly.
What to ask when developing a treatment plan
After you’ve been diagnosed with colorectal cancer, the process of deciding on a treatment plan can be confusing and scary. It’s important to communicate openly with your care team about your preferences and concerns.
When your doctor presents you with a treatment plan, you may want to do some research on the options presented. That way, you can come back with questions and make sure that you understand all of your options.
Some questions you may want to consider asking include:
What are the goals of each treatment option?
What can I do to prepare for treatment?
What side effects should I expect and how long might they last?
What are the potential complications of each treatment option?
Is there a clinical trial I could enroll in?
What are the chances this treatment plan will completely get rid of the cancer?
How will I know whether the treatment is working?
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