Colon Cancer (Colorectal Cancer)

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Treatment

Surgery is the treatment of choice for colorectal cancer. Treatment depends on the stage of the disease and the overall health of the patient. Chemotherapy and radiation therapy may be used as adjuvant treatment (i.e., in addition to surgery).

Surgery
Radical bowel resection, also called partial colectomy and hemicolectomy, is used to treat 80-90% of colorectal cancer patients. This procedure may be performed through a large incision in the abdomen (called open surgery) or through several small incisions (called laparoscopic surgery).

In this procedure, the tumor is located using a no-touch technique (i.e., the surgeon locates the tumor without manipulating the colon to avoid releasing cancer cells into the bloodstream). The segment of the colon that contains the tumor and the nearby lymph nodes are removed and healthy segments of the colon are reconnected, if possible (called end-to-end anastomosis). Removal of the lymph nodes is called lymphadenectomy.

If the colon cannot be reconnected, a temporary or permanent colostomy is performed. Approximately 15% of patients require a permanent colostomy.

Radical bowel resection is performed under general anesthesia. Several days before surgery, antibiotics are prescribed and the patient's diet is restricted to ensure that the entire colon is empty. These measures help reduce the risk for postoperative infection.

Recovery varies depending on the patient's age and overall health, and the extent of the surgery. After surgery, patients may experience pain, weakness, fatigue, and loss of appetite. Dietary modifications may be necessary until the digestive tract heals. Complications include the following:

• Allergic reaction to anesthesia
• Formation of a blockage of the intestine
• Formation of blood clots (e.g., pulmonary embolism)
• Infection
• Leakage at the reconnection site

Laparoscopic surgery (e.g., right or left hemicolectomy, partial colectomy) may result in a shorter hospital stay and a faster recovery time. Complications include injury to the colon or ureter (tube that carries urine from the kidney to the bladder), excess carbon dioxide in the blood (hypercapnia), and development of a hernia at the incision site.

Colorectal cancer that invades adjacent tissues or organs (e.g., stomach, liver, kidneys, small intestine, ovaries, abdominal wall) usually is treated by removal of the entire tumor, including part of the adjacent tissue or organ.

Surgical procedures used to treat metastatic colorectal cancer may include partial hepatectomy (removal of part of the liver) and oophorectomy (removal of the ovaries).

Chemotherapy
Chemotherapy is a systemic treatment (travels throughout the body via the bloodstream) that often uses a combination of drugs to slow tumor growth and destroy cancer cells. Drugs may be administered orally or intravenously (through a needle in a vein). In some cases, chemotherapy drugs can cause an allergic or hypersensitivity reaction. These reactions, which may be severe and are triggered by an immune system response, can occur immediately or within hours or days of treatment.

Chemotherapy is often used as a first-line treatment for metastatic colorectal cancer to destroy cancer cells that have metastasized (spread). It also may be used prior to surgery (called neoadjuvant therapy) to shrink the tumor, may be administered following surgery (called adjuvant therapy), and may be combined with biological therapy (also called immunotherapy) and radiation therapy.

Newer combinations of chemotherapy drugs, such as FOLFOX (5-fluorouracil [5-FU], leucovorin, and oxaliplatin [Eloxatin®]) and FOFIRI (5-fluorouracil [5-FU], leucovorin, and irinotecan [Camptosar®]) may be used to prevent recurrence following surgery or to shrink the tumor prior to surgery.

A combination of chemotherapy drugs (5-fluorouracil [5-FU], leucovorin, and irinotecan [CPT11]), administered intravenously, is standard treatment for metastatic colorectal cancer. Side effects include diarrhea, mouth irritation (mucositis), low white blood cell count (e.g., neutropenia), and hair loss (alopecia).

Colorectal cancer with liver metastasis also may be treated using floxuridine (FUDR®) administered intra-arterially (i.e., through an artery). Side effects include nausea, vomiting, diarrhea, and inflammation of the intestine (enteritis).

In addition to chemotherapy drugs, blocking agents (e.g., cetuximab [Erbitux®]) may also be used to treat metastatic colorectal cancer. These drugs prevent cancer cell receptors from receiving factors (e.g., epidermal growth factor) that cause cell growth, cell division, and additional metastasis. Blocking agents target specific cells so they usually do not cause systemic side effects. Side effects of these drugs include allergic reactions (e.g., difficulty breathing, hives, low blood pressure, rash).

Bevacizumab (Avastin®) may also be used to treat advanced colorectal cancer. This medication prevents new blood vessels, which are necessary for tumor growth, from forming. It does not affect normal tissues that already have an established blood supply. Side effects include blood clots and high blood pressure, which can be controlled with medication.

Panitumumab (Vectibix™) is the first entirely human monoclonal antibody approved by the Food and Drug Administration (FDA) to treat patients with metastatic colorectal cancer following chemotherapy. This medication is administered intravenously once every 2 weeks.

Immunotherapy
Immunotherapy, or biological therapy, attempts to stimulate the immune system to fight disease and protect the body from side effects of chemotherapy. Immunotherapy agents that may be used to treat colorectal cancer include bacilli Calmette-Guerin (BCG) and levamisole (Ergamisol®).

Immunotherapy may cause flu-like side effects such as the following:

• Chills
• Diarrhea
• Fever
• Loss of appetite
• Muscle aches and weakness
• Nausea and vomiting

Radiation Therapy
Radiation therapy uses high energy x-rays to destroy cancer cells and shrink tumors. External beam radiation (i.e., radiation from a machine outside the body) may be used in addition to surgery to treat colorectal cancer (called adjuvant therapy). It also may be used to relieve symptoms (called palliative treatment) in patients with metastatic colorectal cancer.

Side effects include fatigue, hair loss, reddened skin, and swelling (edema). Medicines and other treatments can reduce the intensity of the side effects. As with other cancer treatments, the incidence of side effects varies with patient health and the exact nature of the treatment.

Follow-up Treatment
Follow-up care is recommended for colorectal cancer patients to ensure that recurrent or metastatic disease is detected as soon as possible. Patients should undergo regular physical examinations, fecal occult blood tests, colonoscopies, CT scans, and chest x-rays.

Prognosis
Prognosis depends on the stage of the disease and the overall health of the patient. Overall, colorectal cancer patients have a 5-year survival rate of about 61%. The 5-year survival rate is about 92% when the disease is treated before it has spread (metastasized); 64% when the cancer has spread to nearby organs or lymph nodes; and 7% when it has spread to other parts of the body (e.g., liver, lungs).

Prevention
Early detection and removal of intestinal polyps may help prevent colorectal cancer. Studies are being conducted to determine if reducing risk factors (e.g., smoking, daily alcohol consumption), eating a low-fat, high-fiber diet, and increasing physical activity can help prevent the disease.

Colon Cancer (Colorectal Cancer), Treatment reprinted with permission from oncologychannel.com
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