If you’ve recently received a colorectal cancer diagnosis, you’re likely in a bit of shock. After all, there are frequently few signs of this disease, especially in its early stages. The good news: Treatment and medication options are plentiful, and together with your medical team, you’ll be able to come up with a plan that puts you back on the road to good health.
We went to some of the nation's top experts in colorectal cancer to bring you the most up-to-date information possible.
Leonid Cherkassky, M.D.Assistant Professor of Oncology
Gautam Mankaney, M.D.Gastroenterologist
Eduardo Vilar-Sanchez, M.D., Ph.D.Associate Professor of Clinical Cancer Prevention
What's the Deal With Colorectal Cancer?
Colorectal cancer, often referred to as just colon cancer, is a disease that starts in either your colon or rectum, which together make up your large intestine.
Typically, colorectal cancer begins as a cluster of small, noncancerous cells known as a polyp inside your intestine. Because your intestine is constantly shedding and rebuilding its lining, its cells multiply rapidly, and if there is an error in the process, some cells can become cancerous, eventually leading to colon cancer.
Although in its early stages, colon cancer is highly treatable, many cases are not diagnosed until the cancer is more advanced, which is why the disease kills more people than breast or prostate cancer every year. In fact, it’s the second most common cause of cancer deaths among men and women combined in the United States, after lung cancer.
Age is the primary risk factor for colorectal cancer—90% of cases are diagnosed in people over age 50. Obesity, family history, and genetic disposition are other risk factors. The good news: With treatments and medications available today, odds of beating the disease are better than ever.
It’s the kind of success story that you’d think would be better-known: Since 1970, the mortality rate for colon and rectal cancer—a.k.a. colorectal cancer—has dropped by more than half.
Part of that is because more people are doing the right thing and getting screened (more screening means more cancers are diagnosed at earlier, more treatable stages). But part of that drop is because of improvements in treatment.
For instance, there used to be just one chemotherapy drug available; now there are multiple. In addition, researchers have developed whole new categories of medications that fight colon cancer in different ways: Some precisely target the cancer, while others spur the immune system to fight tumor growth.
Medication isn’t the only area of improvement. Today, surgery is an option for people whose cancer is so advanced that it once seemed untreatable.
All the recent progress in treatment and medication for colorectal cancer means it’s more important than ever to work with a multidisciplinary team, including surgeons and medical oncologists, to plot your path to wellness if you’ve been diagnosed with the disease. This 360-degree perspective will give you the best odds of benefitting from the rapidly evolving treatment options out there.
Figuring out which treatment is right for you depends on a host of factors, including the stage of your disease, and things like your overall health. Here are a few options your doctor will likely talk with you about.
Surgery for Colon Cancer
This is the most common kind of treatment for colon cancer, and if the cancer is discovered early (Stage I or II), it’s generally all that’s needed.
In fact, if the cancer is found at Stage 0, which means that the cancer or cluster of abnormal cells hasn’t spread beyond the innermost layer of the intestinal lining, you may not even need a trip to the operating room—your doctor may be able to remove it in using implements attached to a colonoscope.
If the cancer is larger or has spread deeper into the lining of the colon, a section of the colon may need to be removed, generally along with nearby lymph nodes.
Even in later stages where the cancer has spread to other parts of the body, surgery can be a key part of treatment: Removing all visible signs of disease in nearby organs like the liver, plus chemotherapy, gives people with advanced colon cancer a good chance of long-term survival.
Should You Get Chemotherapy?
Once cancer has spread beyond the colon to lymph nodes or other organs (Stage III and Stage IV), surgery alone isn’t enough—you need whole-body treatment like chemotherapy, too. In chemotherapy, meds administered by intravenously (or sometimes orally) attack fast-growing cells in your body that look to be cancerous.
Chemo for colon cancer has made giant advances in the past couple of decades. Until about 2000, there was just one chemo medication for advanced colon cancer, a drug called 5-FU (5-fluorouracil), and patients had few options if 5-FU stopped working. Now, doctors have multiple drugs that can be used on their own or combined in different ways. These medications include:
Chemotherapy can be used at various stages of treatment. You might get it after surgery to treat any cancer cells that were left behind, or before surgery to shrink a large tumor and make it easier to remove. Chemotherapy is also sometimes used to shrink tumors that can’t be removed in order to ease symptoms and make you feel better.
Radiofrequency Ablation for Colorectal Cancer
In about 50% of people with later-stage colon cancer, the disease spreads to the liver as well. In this case, your doctor may suggest using radiofrequency waves to heat the tumor and destroy—or ablate—it.
To perform this procedure, a thin probe is inserted through the skin and into the tumor; then an electrical current is run through the probe, generating radio waves that heat and kill cancer cells.
Cryosurgical Ablation for Colorectal Cancer
Like radiofrequency ablation, cryosurgical ablation—or freezing the cancer cells—is used when colon cancer has spread to the liver. In this case, a needle-like probe is guided into the tumor, and a very cold gas is run through the probe in order to freeze the tumor.
Will You Need Radiation Therapy?
In this kind of treatment, X-rays are used to kill cancer cells or keep them from growing. Radiation therapy is a common treatment for rectal cancer, but it can also be used for colon cancer that can’t be completely removed surgically.
Colon Cancer and Targeted Therapy
This treatment uses a drug to attack specific cancer cells. If traditional chemotherapy is a sledgehammer (destroying cancer cells and healthy cells alike), targeted therapy is more of a chisel (aiming straight for the bad guys).
The “target” for these drugs can vary, and not all colon cancer tumors have the same targets. Your doctor will likely test your tumor for specific mutations if targeted therapy is being considered.
These are several types of targeted therapies for colon cancer, usually given intravenously.
Anti-angiogenesis therapy: This targeted therapy stops the development of new blood vessels feeding the cancer. Anti-angiogenesis drugs include Avastin (bevacizumab), Cyramza (ramucirumab), Stivarga (regorafenib), and Zaltrap (Ziv-aflibercept).
Epidermal growth factor receptor (EGRF) inhibitors: This therapy blocks production of a protein that spurs the growth of cancer cells. EGRF inhibitors include Erbitux (cetuximab) and Vectibix (panitumumab).
Immunotherapy Can Treat Colorectal Cancer
This treatment approach fires up your immune system to fight colon cancer more effectively. For example, immune checkpoint inhibitors, a type of immunotherapy, work by removing “caution” signals (a.k.a. checkpoints) to cancer-killing T-cells in your body, allowing them to go full speed ahead to attack cancer cells. Keytruda (pembrolizumab) is an example of an immune checkpoint inhibitor.
Other checkpoint inhibitors include Opdivo (nivolumab) and Yervoy (nivolumab plus ipilimumab).
All of these choices may feel a bit overwhelming if you’re coming to terms with your colorectal cancer diagnosis. The most important thing is that you have options. Treatment and medication for colon cancer have come a long way in recent years, and with all the possibilities available, you and your doctor are sure to settle on one (or several) that will put you on the path to managing your condition successfully.
Frequently Asked QuestionsColorectal Cancer Treatment
Can advanced colon cancer be treated?
Yes, more than ever, in large part because surgeons have become better at removing tumors that have spread to the liver and other organs. Chemotherapy plus surgery allows many patients with advanced colon cancer to live more than 10 years after diagnosis.
Does targeted therapy have side effects?
If chemotherapy is like a sledgehammer, targeted therapy is more of a chisel—but even so, these treatments can have side effects. Some can cause high blood pressure and fatigue, among other problems; others can cause acne-like rashes and headaches (all of which are preferable to cancer!).
Who can get immunotherapy?
Immunotherapy is used only for people with advanced colorectal cancer. Even then, it’s effective only for a subset of people with cancer that shows specific genetic changes. Special tests are needed to figure out if a patient might be helped by specific kinds of immunotherapy.
How often do I need a colonoscopy after treatment?
You’ll likely be scheduled for the exam every five years, according to recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer. If you had more advanced cancer, your doctor may set a different schedule for follow-up testing.
Colon Cancer and Liver Cancer:Cellular and Molecular Gastroenterology and Hepatology. (2017). “Colorectal Cancer Liver Metastasis: Evolving Paradigms and Future Directions.” ncbi.nlm.nih.gov/pmc/articles/PMC5331831/