Your Treatment Plan

There are four types of treatments for colorectal cancer: surgery, radiation, chemotherapy and immune therapy. Often, a combination of these methods is used.

Surgery

The main treatment for colon cancer is surgery. You may need to have the entire colon or only a portion of it removed. If cancer is confined to the polyp, then only the polyp is removed, and the colon is left completely intact. If a segment of colon containing the tumor is removed, a margin of colon on either side of the tumor is removed as well. In most cases, the two ends of the remaining colon are reconnected (anastomosis). In cancers of the rectum and some cases of colon cancer, one end of the colon is surgically attached to a carefully constructed opening called a "colostomy," which is used to expel fecal matter instead of the anus. Depending on the kind of surgery, the colostomy is either temporary or permanent. The colostomy is more likely to be permanent if the tumor is located in the distal rectum. However, there are procedures that preserve rectal function.

Radiation therapy

Radiation treatment uses a directed beam of high-energy X-rays to destroy cancer cells mainly in the pelvis (rectal). The goal is to destroy only the cancer cells without harming surrounding normal tissue. External beam radiation uses a machine (like a CT scanner) to direct a beam of energy below the skin surface to target the tumor a few centimeters below. Internal radiation therapy (brachytherapy), used in early stage rectal cancer, delivers the radiation directly by inserting thin plastic tubes through the anus.

Chemotherapy

Chemotherapy is the use of anti-cancer drugs to eliminate cancer cells from the body. This is called a "systemic" form of cancer therapy, because medication is delivered either intravenously or taken by mouth as a pill or capsule. Chemotherapy is used in colon cancer as adjuvant therapy, usually for Stage III (lymph node positive) cancer, but also sometimes in high-risk Stage II colon cancers or cancer that has spread outside of its site of origin to other parts of the body (metastasized).

Immunotherapy

Immunotherapy is a treatment that uses parts of the immune system to fight disease. Monoclonal antibody therapy is a passive immunotherapy that helps to fight the cancer. Monoclonal antibody therapy works against the VEGF (vascular epithelial growth factor) protein using bevacizumab, or against the EGFR (epidermal growth factor), using cetuximab along with chemotherapy. Bevacizumab blocks blood vessel formation and growth and works in part by "cutting off" the blood supply to tumors. When used in combination with chemotherapy, it has had a significantly higher response rate and a prolonged disease-free survival than chemotherapy alone for metastatic colon cancer.

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This article was reviewed and updated June 2007.