Treating Colorectal Cancer

How is colorectal cancer treated?

Colorectal cancer treatment is tailored to your needs, the type of cancer you have and how advanced the cancer is. The best choice for you depend on:

• The cancer stage
• Genes or proteins the cancer may have
• Whether the colon is blocked or has a hole in it
• Your age and general health
• Whether the cancer is new or has come back
• How you feel about different treatment options and their side effects

Treatment options include:

Active surveillance

For rectal cancer, your health care provider may test regularly to see if the cancer has changed. If it’s not growing, you may not need other treatment.

Endoscopic removal

Sometimes, a gastroenterologist can remove polyps and shallow tumors during a colonoscopy, and you don’t need any other treatment.

Surgery

For deeper tumors, surgery is typically required.  Surgery involves removing the cancer and the associated lymph nodes so that they can be tested. Surgery can often cure early-stage cancers and relieve symptoms in advanced cases.

• Colon cancer: In a partial colectomy or colon resection surgery, a section of your colon is removed through surgery and the two ends are reconnected. This can often be performed laparoscopically or robotically through small incisions.   
• Rectal cancer: Surgery for treatment of rectal cancer also removes the tumor and the associated lymph nodes. These can also often be performed through small incisions to improve recovery. Ostomy bags (a pouch used to collect urine or stool) are not always required for treatment. 

Surgery can have side effects. Your provider can discuss the pros and cons with you so you can make an informed decision.

Chemotherapy

Medications given by mouth or through a vein (intravenously) can kill cancer cells or keep them from growing. Chemotherapy is often used along with other treatments. 

It might be used before surgery to shrink a tumor, after surgery to kill any remaining cancer cells or to control cancers that have spread. 

Chemotherapy is usually given in cycles, so your body can recover between treatments. Your oncologist will work with you to determine the optimal duration.

Side effects of chemo include:

• Fatigue
• Nausea and vomiting
• Hair loss
• Nerve issues (neuropathy)
• Diarrhea 

Your health care team can help you treat any side effects.

Blood vessel blockers

Some cancers create a lot of new blood vessels, which is called angiogenesis. Drugs called angiogenesis inhibitors can block this process and cut off the blood flow to the cancer. This treatment is usually used along with chemotherapy.

Targeted therapy 

Targeted therapy is tailored to particular mutations in the cancer cells. It directly targets those mutations to improve the effects of chemotherapy.

Side effects depend on what kind of drug you take. You may have high blood pressure, low blood counts or heart or liver problems. Most of these side effects can be treated.

Immunotherapy

Immunotherapy stimulates your own immune system to improve its ability to attack the cancer cells.  Based on the mutations in a tumor, an individual may benefit from immunotherapy. 

Like with targeted therapy, side effects depend on which drug is used. You may feel tired, have a rash or have more serious side effects like damage to the liver, intestines or thyroid glands. Most side effects can be treated.

Radiation therapy

Radiation therapy is often part of the treatment plan for rectal cancers. It can target and destroy cancer cells with high-energy rays. Your provider may recommend radiation therapy before surgery to shrink tumors or after surgery to get rid of any remaining cancer cells. In some cases, radiation can help avoid surgery or permanent ostomy bags. 

For rectal cancer, external beam radiation is usually used, where radiation is aimed at the cancer from outside of the body. This type is used most often.

Side effects of radiation include:

• Skin changes at the radiation site
• An upset stomach
• Diarrhea or pain with bowel movements.
• Frequent urination
• Fatigue 

Your health care provider can help you manage side effects, and most of them clear up after treatment ends.

After colorectal cancer

After treatment for colon cancer or rectal cancer, you'll have follow-up visits regularly for exams, blood tests and possibly other tests to check to see if the cancer has come back. Over time, the visits will be less frequent.

You may feel anxious or worried after cancer treatment. You may have new priorities and you may worry that cancer will come back. Relaxation exercises, mindfulness, meditation and yoga may help. You may also want to join a support group or speak with a counselor or therapist.

Support and care for colorectal cancer

Colorectal cancer diagnosis and treatment can be challenging. It can help to:

• Lean on family, friends and support groups for emotional support and practical assistance, like taking care of children, pets and household responsibilities.
• Connect with resources like counseling services (which can help you cope with the emotional toll of cancer) and financial assistance programs (which can provide support with treatment costs).
• Get regular follow-up care to monitor recovery, manage side effects and spot any new signs of cancer.
• Learn how to cope with common side effects such as fatigue, nausea and changes in bowel function.
• Maintain your quality of life with good nutrition, exercise and mental health care during and after treatment.

Banner MD Anderson’s team of colorectal cancer experts is here to help you with your diagnosis. We take time to understand your needs and focus on providing you with effective, personalized treatment. 

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