Surgery
Surgical removal is the treatment of choice for most early-stage colon cancers, but the type of surgery depends on factors like how far the cancer has spread and wherein the colon it is located.
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Polypectomy
Many early colon cancers (stage 0 and some early stage 1 tumors) and most polyps can be removed during a colonoscopy. During a polypectomy, the cancerous polyp is cut at the stalk using a wire loop instrument that is passed through the colonoscope, which is a long, flexible tube with a camera and light at its tip.
Colectomy
This form of colon cancer surgery involves a specialist, called a colorectal surgeon, removing a portion (or portions) of the intestine. Rarely, a total colectomy, in which the entire colon is removed, is needed to treat colon cancer. A total colectomy may be used to treat those with hundreds of polyps (like people with familial adenomatous polyposis) or those with severe inflammatory bowel disease.
There are two ways a colectomy can be performed—laparoscopically or open—and the option your surgeon chooses depends on factors like the size and location of the colon cancer, as well as the surgeon’s experience.
During a colectomy, the diseased section of the colon is removed, along with an adjacent part of the healthy colon and lymph nodes. Then, the two healthy ends of the bowel are reattached. The surgeon’s goal will be for the patient to return to the most normal bowel function possible. This means that the surgeon will take out as little of the colon as possible.
Some of the tissue removed from the lymph nodes is taken to a pathology lab and examined under a microscope by a pathologist. The pathologist will look for signs of cancer in the lymph tissue. Lymph nodes conduct a fluid called lymph to cells in the body. Cancer cells tend to gather in the lymph nodes, so they are a good indicator for determining how far cancer has spread. The removal of lymph nodes also reduces the risk of cancer reoccurring.
In some cases, like if surgery needs to be done urgently because a tumor is blocking the colon, a reconnection of the healthy bowel (called an anastomosis) may not be possible. In these cases, a colostomy may be necessary.
Colostomy Surgery
A colostomy is created when part of the large intestine is inserted through an opening in the abdominal wall. The part of the colon that is on the outside of the body is called a stoma (Greek for “mouth”). The stoma is pink, like gum tissue, and does not feel pain. An external bag worn on the abdomen is then necessary to collect waste. The bag is emptied several times a day and changed on a regular basis.
During a second surgery, the healthy ends of the colon are reattached together and the stoma is closed up. Rarely, a permanent colostomy is needed.
Preparation and Recovery
Every medical procedure carries risks and benefits. Make sure you talk with your healthcare provider about them and ask questions so you feel confident about your treatment decision.
Prior to any surgery on the colon, it must be squeaky clean on the inside. This is accomplished through a complete bowel preparation, similar to the one you may have had for your colonoscopy.
BleedingInfectionBlood clots in the legsLeaking anastomosisIncision dehiscence (opening of the abdominal incision)Scarring and adhesions
You will be required to stay in the hospital for at least a few days following bowel resection. The time in the hospital will allow any surgical incisions to begin healing, while nurses and other healthcare providers monitor hydration, nutrition, and other needs after surgery, like pain control.
Depending on the surgery, drains may be placed. These drains allow excess fluids, such as blood, to leave the abdomen. The drains may be removed before discharge from the hospital. If you had a colostomy inserted during the surgery, the nursing staff will teach you how to care for your colostomy bag and stoma before you go home.
Local Therapy
In certain cases, radiation therapy may be used in the treatment of colon cancer. 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 cancer, kill any remaining cancer cells suspected after surgery or from recurrence, or as a form of treatment if a person cannot tolerate surgery.
FeverIncreasing painRedness, drainage or tenderness around incision sitesNon-healing areas of incisionNausea, vomitingBlood in the stool or colostomy bagA cough that does not go awayYellow eyes or skin
Radiation therapy sessions usually occur five days per week and are painless procedures, although a person may experience skin irritation (like a sunburn) at the radiation site, as well as nausea or vomiting at some point during treatment.
Systemic Therapy
Unlike radiation, these options affect the entire body, instead of zeroing in on a specific area.
Chemotherapy
Chemotherapy drugs travel throughout the body and kill cells that are dividing (growing or duplicating) rapidly. Though the treatment doesn’t distinguish between cancerous cells and healthy, fast-dividing cells (like those in hair or nails), the latter will be replaced upon completion of chemotherapy.
The majority of people with stage 0 or stage 1 colon cancer will not require chemotherapy. For those with later stage colon cancer, chemotherapy may be given prior to surgery to shrink the tumors before physical removal. Chemotherapy is also sometimes used to shrink tumors throughout the body when systemic metastasis has occurred (in stage 4 cancer).
Chemotherapy may be administered in conjunction with other colon cancer treatments (for example, surgery or radiation) or by itself. A medical oncologist (the cancer specialist who orders the chemotherapy) will take several factors into consideration when choosing the best chemotherapy options, including the stage and grade of cancer and your physical health.
Drugs and treatment regimens: Intravenous chemotherapy drugs are given by injection through a vein, whereas oral chemotherapy drugs are given by mouth with a pill.
Most intravenous chemotherapy drugs are given in cycles, which are followed by a period of rest. Your healthcare provider will take your health, your cancer’s stage and grade, the chemotherapy drugs used, and the treatment goals into consideration while deciding how many treatments are right for you.
After chemotherapy is started, your healthcare provider will have a better idea of how long you will need the treatment based on your body’s response to the medications.
Some of the chemotherapy drugs used to treat colon cancer include:
5-FU (fluorouracil)Eloxatin (oxaliplatin)Xeloda (capecitabine)Camptosar (irinotecan, irinotecan hydrochloride)Trifluridine and tipiracil (Lonsurf), a combination drug
Targeted Therapy
Nausea, vomiting, and loss of appetiteHair lossMouth soresDiarrheaLow blood counts, which can make you more prone to bruising, bleeding, and infectionHand-foot syndrome, which is a red rash on the hands and feet that may peel and blister (may occur with capecitabine or 5-FU)Numbness or tingling of the hands or feet (may occur with oxaliplatin)Allergic or sensitivity reaction (may happen to occur with oxaliplatin)
Targeted treatments for colon cancer can be used either along with chemotherapy or by themselves if chemotherapy is no longer working.
These drugs usually recognize the protein growth factors that cover cancerous cells, such as the vascular endothelial growth factor (VEGF) or the epidermal growth factor receptor (EGFR), or proteins located inside the cell. Some of these drugs are antibodies administered intravenously, which specifically attack the proteins they bind to. They only kill cells covered in these factors and have the potential for fewer side effects than chemotherapy agents.
Some of these agents are given concurrently with chemotherapy once every one to three weeks, including:
Avastin (bevacizumab)Erbitux (cetuximab)Vectibix (panitumumab)Zaltrap, Eylea (aflibercept)
Others Cyramza (ramucirumab) may be administered alone. Tyrosine kinase inhibitors, such as Stivarga (regorafenib), are administered orally.
That said, the most common side effect of the drugs that target EGFR are an acne-like rash on the face and chest during treatment. Other potential side effects include headache, fatigue, fever, and diarrhea. For the drugs that target VEGF, the most common side effects include:
High blood pressureExtreme tiredness (fatigue)BleedingIncreased risk of infectionHeadachesMouth soresLoss of appetiteDiarrhea
Immunotherapy
For people with advanced colon cancer or cancer that is still growing despite chemotherapy, immunotherapy may be a treatment option. The purpose of immunotherapy is to use a person’s own immune system to attack the cancer. Types of immunotherapy drugs include:
Keytruda (pembrolizumab)Opdivo (nivolumab)Trasztuzmab and pertuzumab or laptinib (for tumors that are Her2 amplified tumors and RAS and BRAF wild type)Encorafenib and cetuximab or panitumumab (for tumors that are BRAF mutation positive)Larotrectinib or entrectinib (for tumors NTRK fusion positive)
Some potential side effects of these drugs include:
FatigueFeverCoughFeeling short of breathItching and rash Nausea, diarrhea, loss of appetite, or constipationMuscle and/or joint pain
Specialist-Driven Procedures
If the colon cancer has spread to other organs, like to the liver or lung (called metastatic colon cancer), surgery may be performed to remove one or more of those spots. Many factors go into the decision of how to best treat metastatic colon cancer, including the number of metastatic lesions, where they are located, and a patient’s goals of care.
Non-surgical procedures may also be used to destroy or shrink metastatic lesions.
These non-surgical procedures include:
Cryosurgery, which kills the cancerous cells by freezing them Radiofrequency ablation, which uses energy waves to destroy (burn) cancer cells that have metastasized to other organs, such as the liver or lungs Ethanol ablation, which destroys the cancer cells with an injection of alcohol
Palliative Care
Palliative treatment, also known as symptom management or comfort care, is focused on subduing uncomfortable symptoms from a chronic or terminal disease. In colon cancer, palliative treatment can help you cope physically, emotionally, and spiritually during your fight.
Some common symptoms and sources of discomfort that a palliative care provider will focus on include:
Anxiety, depression, and confusionShortness of breath and fatigueLoss of appetite and weight lossConstipation, diarrhea, and bowel obstructionLymphedemaNausea and vomiting
Furthermore, pain management is a top priority in palliative care. You can receive pain management from your healthcare provider, oncologist, or even a pain management specialist. Interventions to alleviate or control your cancer pain may include:
Pain medicines (prescription, over-the-counter drugs, and complementary medicines)Tricyclic antidepressants or anticonvulsants (for nerve-based pain)Interventional procedures (epidurals, nerve blocks)Physical or occupational therapyCounseling and biofeedback
Complementary Medicine (CAM)
Research suggests that combining chemotherapy with Chinese herbal therapies and other vitamins and supplements (for example, antioxidants) can improve survival rates in colon cancer when compared to chemotherapy alone.
While incorporating complementary medicine into your colon cancer care is a reasonable idea, be sure to only do this under the guidance of your oncologist. This will help prevent any unwanted side effects or interactions.
If the cancer is localized (has not spread), the five-year survival rate is around 90%. If it has spread to nearby organs and/or lymph nodes, the five-year survival rate is 72%. Colon cancer that has metastasized to the lungs, liver, or other distant organs, the five-year survival rate is 14%.
