A shared treatment decision-making approach to your cancer care will ensure that you play a key role in your cancer treatment. Talk to your doctors. Ask questions. If you have been diagnosed with stage III or stage IV colorectal cancer, check out Your Guide in the Fight.Download Your Guide in the Fight
Factors That Can Affect Your Treatment Plan
- Stage of cancer
- Your overall health
- Whether or not the cancer has blocked the colon or made a hole in the colon wall
- Whether or not surgery completely removed the tumor and all metastatic tumors
- Specific tumor type, defined by laboratory tests known as biomarkers
- Your personal preferences
- Primary treatment: main treatment for cancer
- Neoadjuvant treatment: given before surgery
- Adjuvant treatment follows primary treatment
- First-line treatment: first treatment given to patients with metastatic CRC
- Second-line treatment: given if the first treatment fails
Types of Colorectal Cancer Treatment
There are a variety of possible treatments for colorectal cancer. And it’s important to discuss all of your options with your doctor before you begin treatment. Check out our breakdown of colorectal cancer treatment by stage to see the suggested treatments for your cancer stage.
- Targeted Therapies
- Radiation Therapy
- Clinical Trials
- Complementary Alternative Medicine and Integrative Care
Colon Cancer: your first treatment may be surgery to remove the primary tumor.
Rectal Cancer: you may be treated with radiation and chemotherapy prior to surgery.
What to Expect Before Surgery
- Your blood counts will be measured
- Your blood chemistry and CEA levels will be evaluated
- You will have a CT scan of the chest, abdomen and pelvis, or a PET scan, to determine exactly where the cancer is located
These tests are often done after surgery to compare results.
Common Surgery Types
Colectomy — Removes the cancerous part of the colon and nearby lymph nodes.
- Open colectomy — An incision is made in the abdomen, surgery performed through the opening, and the incision closed with sutures and/or staples.
- Laparoscopic colectomy — Three small incisions are made to insert a lighted instrument and specially designed surgical instruments that can be manipulated within the abdomen. Sometimes an incision is made just long enough for the surgeon’s hand to assist during laparoscopy.
After the cancerous part of the colon is removed (called a resection), the two ends of the remaining colon are reattached to eliminate waste through the rectum.
Colostomy (Ostomy) — Creates a way for stool to be removed from the body when part of the colon is removed. In this procedure, a stoma (opening) is made to the outside of the body and an ostomy pouch is placed around the stoma to collect and remove waste. An ostomy refers to the opening in the body for waste; while the stoma is the actual end of the intestine seen peeking through the abdominal wall. A colostomy can be temporary and reversed, or be permanent.
Temporary Ostomy and Reversal Surgery — This is possible if the colon can heal after the initial resection surgery (could take months to years). A reverse colostomy surgery (colostomy take-down) is performed so the stoma will no longer be necessary.
Low Anterior Resection (LAR): LAR is common in rectal cancer. The tumor and part of the rectum is removed without affecting the anus. The colon is then attached to the remaining part of the rectum so that after the surgery, your bowels can be used in the usual way.
Abdominoperineal Resection (APR) with Ostomy: APR is common in rectal cancer. One incision is made in the abdomen and another in the perineal area to remove the anus and the tissues surrounding it, including the sphincter muscle. This is a more invasive surgery than LAR because the anus is removed. With an APR you will need a permanent colostomy.
Chemotherapy is used to stop or limit the growth of rapidly dividing cancer cells. It can be taken:
- By mouth (oral chemotherapy)
- Injected into a vein (intravenous chemotherapy)
- Placed directly into the abdomen (regional chemotherapy)
Oral Chemotherapy, offered orally as a tablet or capsule, can be swallowed at home. It is equally as strong as other forms of chemotherapy and works just as well, as long as it’s taken on schedule, as described by your doctor.
Oral chemotherapy, such as capecitabine (Xeloda®) or oral targeted therapy, such as Stivarga®, can cause the same side effects as other forms of chemotherapy.
If you are prescribed an oral chemotherapy or an oral targeted therapy, you will work with a specialty pharmacist to fulfill your prescription. For tips on working with your specialty pharmacy, download Your Guide in the Fight. For more information, review our oral chemotherapy webinar.
Targeted therapies are drugs that block the growth of cancer by interfering with the molecules involved in tumor growth and spread. They have been shown to be helpful in patients with stage IV colorectal cancer patients, but not in patients with stage III colorectal cancer.
For more information about Targeted Therapies, visit the National Cancer Institute.
Common Targeted Therapies
- Bevacizumab (Avastin®) a monoclonal antibody used to block the growth and development of blood vessels
- Bevacizumab-awwb (Mvasi®) is a biosimilar of bevacizumab that received FDA approval in 2017
- Ziv-aflibercept (Zaltrap®) a recombinant fusion protein used to block blood vessel development
- Cetuximab (Erbitux®) a monoclonal antibody to inhibits cell growth for patients without a KRAS or NRAS mutation
- Panitumumab (Vectibix®) a monoclonal antibody to inhibit cell growth for patients without a KRAS or NRAS mutation and wild-type RAS metastatic colorectal cancer (mCRC)
- Regorafenib (Stivarga®) a small molecule drug to inhibit cell growth by interfering with the internal workings of the cell.
- Ramucirumab (Cyramza®) a monoclonal antibody used to block the growth and development of blood vessels
Radiation therapy is not often used to treat colon cancer unless it is in the treatment of tumors that have grown next to or into other organs. Radiation therapy may sometimes be used to relieve symptoms and improve your quality of life.
Types of Radiation Therapy
External Beam Radiotherapy (EBRT) — Uses a machine outside of the body to direct radiation toward the cancer. This is the approach most commonly used.
Internal Radiotherapy — Uses a radioactive substance sealed in needles, seeds, wires, or catheters and placed directly into or near the cancer.
Intensity-Modulated Radiotherapy (IMRT) — A form of external beam radiation therapy, using small beams of varying intensity.
Selective Internal Radiation (SIR – Speres, Microspheres or Theraspheres) — Tiny beads covered with radioactive material, and are injected into your liver to target liver metastases. Learn more about Liver Metastases and SIR-Spheres.
Intraoperative-Radiotherapy (IORT) — Another radiation option, given during surgery, for late-stage or recurrent cancer.
Radiofrequency Ablation & Cryosurgery — Radiofrequency ablation (using high-intensity heat to destroy a tumor) or cryosurgery (the use of extreme cold to destroy a tumor) for patients whose tumors can’t be removed by surgery.
Radio Surgery — Delivers a single high dose fraction of radiation, stereotactically directed to the liver.
Clinical trials for colorectal cancer test new treatment options include drug therapy, surgery, radiation, and combination procedures. There are also clinical trials that test new ways to stop cancer from recurring or reduce treatment side effects.
Immunotherapy is a type of treatment that uses certain parts of a person’s immune system to fight diseases such as cancer. The goal of immunotherapy is to boost a patient’s immune reaction to the cancer cells, allowing them to fight the disease more effectively. Immunotherapy has only been shown to be effective in a small subset of colorectal cancer patients. Specifically, patients with certain biomarkers (microsatellite-instability or mismatch repair deficiency) have recently been approved for the treatment pembrolizumab. Watch our video to learn more about immunotherapy and colorectal cancer.
- Pembrolizumab (Keytruda ®)
- Nivolumab (Opdivo ®)
Complementary Alternative Medicine (CAM) and Integrative Care
If you are considering complementary or alternative approaches to help you feel better, talk to your doctor.
No alternative method has been proven safe or effective by conclusive scientific evidence to treat colon or rectal cancer. Some CAM approaches may be harmful to patients undergoing standard treatment for cancer, while others may interfere with the benefits of chemotherapy or drugs used to treat side effects.
Complementary Medicine is used together with conventional medicine. For example, using aromatherapy to decrease patient discomfort after surgery.
Alternative Medicine is used in place of conventional medicine. For example, using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a conventional doctor.
Integrative Medicine combines treatments from conventional medicine and CAM for which there is some high-quality scientific evidence of safety and effectiveness.
If you are considering family planning for your future and have been diagnosed with CRC, talk with your care team about preserving your fertility before treatment begins.
If you’d like to learn more about the topic of fertility, visit:
- American Cancer Society – Options
- National Cancer Institute – Fertility
- American Society of Clinical Oncology – Coping – Fertility and Cancer Treatment
- Fertile Hope
A biosimilar is a type of drug that is similar to an existing biologic (type of large molecule drug/monoclonal antibody). For a biosimilar to be FDA approved, the biosimilar has to show equal effectiveness and no worsening of toxicity compared to the original FDA biologic drug. (Meaning, there are no clinically significant differences but they are slightly different because biologic drugs are derived from living organisms versus chemicals.)
Part of the aim of the development of biosimilars is to reduce the costs of medicine and make more, cost effective treatment options available to patients.Get Biosimilars Mini Magazine
A biomarker is a biological molecule found in blood, other body fluids or tissues. They also appear in tumors. Biomarkers play a key role in developing individualized treatment plans, or “personalized medicine.” Make sure your doctor tests for biomarkers at diagnosis so you can “know your tumor type.”
Some biomarkers to look for in colorectal cancer include:
- KRAS & NRAS
- Carcinoembryonic Antigen (CEA)
- Microsatellite Instability High (MSI-H)
- Tumor Sidedness (Right vs Left)
Learn more about biomarkers and the guidelines for biomarker tests by downloading test here.
* All colorectal cancer patients should know their MSI/MMR status*, especially patients with metastatic CRC because they now have a new treatment option, pembrolizumab. If you don’t know your MSI/MMR status, talk with your doctor.