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One word: Surgery. The sooner the better. In fact, most, if not all, colon cancers begin as benign (harmless) "polyps" that subsequently turn malignant (cancerous). These polyps can be removed very easily during endoscopy (colonoscopy). Once it has been determined that you have a tendency to form polyps, you should have endoscopy at least once a year.
If a cancer is found and it has not spread to distant sites, surgery to remove all of it is the best choice in nearly all cases. The doctor also looks for possible spread and will take small samples of other tissues that might contain cancer cells. Even if the cancer has spread, there may be a chance for removing it all under special circumstances. For instance, removing a single satellite cancer (called a metastasis) - or up to five, depending on the size and location - from the liver has been successful enough in prolonging life that it is a recommended treatment for selected cases. Removing metastases if only found in the liver or the lung may enable a cure rate of 25 percent to 30 percent.
Colostomy
Even if the cancer cannot be cured, the surgeon may need to deal with complications such as bowel obstruction. In such cases, the surgeon does as little as necessary to relieve the immediate problem. Often this involves bypassing an obstruction by creating a colostomy -- an opening in the abdominal wall (called a stoma) where the large bowel is connected, and a bag is then attached to catch the stool. Caring for a colostomy is not as easy as having natural bowel movements, but many people lead normal lives. Often a colostomy can be trained to move once a day so that only a bandage need be worn over it.
A colostomy may also result from curative surgery if the cancer is too close to the anus. The surgeon will try to reconnect healthy bowel above and below the cancerous section that has been removed, but if the lower piece is too short, a colostomy may be the only solution. In some cases, a colostomy is only temporary and can be taken down after you have healed from the rest of your surgery.
Radiation
Radiation is used before or after surgery for rectal or pelvic colorectal cases, or both, in selected cases, usually when there is little chance of curing the disease. Radiation does not cure colon cancer, but it can shrink it and slow its growth. Colon cancers in certain areas, particularly low in the pelvis near the anus, often receive radiation treatment before or after surgery because they are so likely to have spread locally. Radiotherapy is used primarily for rectal cancer and will decrease the risk of local recurrence. Radiotherapy with chemotherapy can improve chances for disease-free survival in rectal cancer.
Chemotherapy
Many different combinations of cancer-killing chemicals (chemotherapy) are used in colorectal cancer. Adjuvant chemotherapy when lymph nodes are positive (Stage III) decreases the risk of recurrence and death. In the past few years, combination chemotherapy using 5FU-leucovorin, irinotecan (Camptosar®) and oxaliplatin (Eloxatin®) have been shown to improve survival and have been approved by the FDA for the treatment of colorectal cancer. Should you face this possibility, you will need to have a thorough discussion with your doctor of the latest studies and recommendations.
Immunotherapy
Biological treatment, sometimes called biological response modifier (BRM) therapy or immunotherapy, attempts to mobilize the body to fight cancer. These new, experimental procedures use materials made by the body or made in a laboratory to boost, direct or restore the body's natural defenses against disease. Biological agents that have shown success in triggering an immune response against some cancers include interferons, interleukins, colony-stimulating factors, T cells, tumor vaccines, tumor necrosis factors and gene therapy. For example, clinical trials are underway using patient's own cancer cells or with the patient's white blood cells mixed with tumor proteins, to produce immunity against further cancer growth. Such "colon cancer vaccines" may offer hope in extending patients' lives. Clinical studies are in progress using monoclonal antibodies such as MOAB17-1A. Cetuximab (Erbitux), a monoclonal antibody directed against EGFR (epidermal growth factor receptor), and bevacizumab, a monoclonal antibody directed against VEGF (vascular endothelial growth factor), have shown to be efficacious when combined with chemotherapy. For example, a phase III trial that compared bevacizumab with IFL chemotherapy (irinotecan/5-FU/leucovorin) produced a significant improvement in survival of nearly five months compared with IFL chemotherapy alone. Both bevacizumab and cetuximab have been approved by the FDA for the treatment of metastatic colorectal cancer.
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External Sources
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Dollinger M, Rosenbaum, EH, Tempero M., et al. Everyone's Guide to Cancer Therapy, Fourth Edition, Kansas City, Missouri: Andrews McMeel Publishing, 2002
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National Cancer Institute
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This article was reviewed and updated June 2007.
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