Treatment & Management of Colon Cancer

Specific treatment for colon cancer is based on the stage and genomic profile of each persons unique colon cancer.

Treatment & Management of Colon Cancer

Medically reviewed by Dr. C.H. Weaver M.D. updated 8/2018

In general treatment for colon cancer may require surgery, radiation, and/or systemic therapy with chemotherapy, immunotherapy or precision cancer medicines. The specific treatment for each person is individualized and is based on the stage of the cancer and its genomic profile.

Surgery

For patients with potentially curable colon cancer, a properly performed surgical operation to remove the cancer and regional lymph nodes is essential for optimal results. There are several different types of surgical procedures used in the treatment and management of colon cancer. The size and spread of the cancer helps determine the appropriate procedure to use.

Polypectomy: A polypectomy is the removal of a single polyp in the colon and is typically performed during a colonoscopy, which uses a long flexible tube with an attached camera.

Conventional surgery (open colectomy): Conventional surgery for colon cancer requires surgeons to create a large opening in the abdomen in order to reach the cancer. After the removal of the cancer and lymph nodes, the two cut ends of the colon are sewn together. In some instances, a temporary colostomy is created and the two ends of the colon are reconnected at a later time. A colostomy is an opening where the large intestine is attached to the abdominal wall and allows passage of stool into a replaceable bag outside of the patient’s body.

Laparoscopic surgery: Laparoscopic surgery, also called minimally invasive surgery, allows surgeons to do procedures by making only a few small incisions in the abdomen. A small tube that holds a video camera is inserted into the abdomen, creating a live picture of the inside of the patient’s body. This picture is displayed on a television screen so that physicians perform the entire surgery by watching the screen. The cancer is removed through another, slightly larger incision.

Laparoscopic surgery appears to be about as likely to be curative as the standard approach for earlier-stage cancers.[1] Some potential advantages of the procedure include less pain, a shorter hospital stay, and a quicker recovery. However, there is still limited information from randomized trials about the approach. In addition, laparoscopic surgery requires special expertise and patients need to be treated by a skilled surgeon who has done many of these operations.[1],[2]

Systemic Therapy for Colon Cancer

Precision Cancer Medicines: The purpose of precision cancer medicine is to define the genomic alterations in the cancers DNA that are driving that specific cancer. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack the cancer cells with specific abnormalities, leaving normal cells largely unharmed. Precision medicines are being developed for the treatment of colon cancer and patients should ask their doctor about whether testing is appropriate.

Chemotherapy: Chemotherapy uses medications that can be taken orally as a pill or are injected into a vein to kill cancer cells. In some situations chemotherapy is combined with immunotherapy or other precision cancer medicines to achieve the best results.

The delivery of cancer treatment following local treatment with surgery is referred to as “adjuvant” therapy and may include chemotherapy, immunotherapy, or use of precision cancer medicines. Adjuvant chemotherapy is offered to most patients with stage II and all patients with stage III, or IV colon cancer for the purpose of reducing the risk of cancer recurrence.

Radiation Therapy for Colon Cancer

Radiation therapy uses high-powered energy beams, such as X-rays or protons, to kill cancer cells. Radiation therapy is not a common way to treat colon cancer, though it may be used in certain circumstances. Radiation therapy, often with chemotherapy, is frequently used in the adjuvant or neoadjuvant setting for the treatment of rectal cancers, whereas chemotherapy alone is more common for the adjuvant and neoadjuvant treatment of colon cancers.

Treatment by Colon Cancer Stage

Stage I: Cancer is confined to the lining of the colon.

Stage II: Cancer may penetrate the wall of the colon into the abdominal cavity or other adjacent organs but does not invade any local lymph nodes.

Stage III: Cancer invades one or more of the local lymph nodes but has not spread to other distant organs.

Stage IV: Cancer has spread to distant locations in the body, which may include the liver, lungs, bones or other sites.

Recurrent/Relapsed: Colon cancer has progressed or returned (recurred/relapsed) following initial treatment.

References

[1] Jayne DG, Thorpe HC, Copeland J et al. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. British Journal of Surgery. 2010;97:1638-45.

[2] Alsina J, Choti MA. Liver-directed therapies in colorectal cancer. Seminars in Oncology. 2011;38:651-567.

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