Colon Cancer Treatment- Cancer/Oncology, Colorectal Medicine, Gastroenterology

Colon cancer (or colorectal cancer) is a type of cancer that arises in the large intestines. It is the third most common cancer worldwide and the second leading cause of cancer deaths.

Treating colon cancer can be a challenging journey that requires a multidisciplinary team of medical and paramedical professionals, as well as a proper support system. If you’ve been diagnosed with colorectal cancer, your treating physician will discuss the available treatment options with you depending on the disease stage, comorbidities, and multiple other factors.

You should ask questions and leave no concern unanswered. Together, you can choose a proper treatment plan after carefully weighing the benefits of each treatment against its risks and side effects.

Colon cancer treatment options include surgery, chemotherapy, radiotherapy, immunotherapy, and palliative treatment.

Colonoscopy

Colonoscopy plays an integral part in diagnosing colorectal cancer and it can have a role in treatment in the early stages. Colonoscopy is done using a scope, which is a flexible cord with a camera at its tip. Your doctor inserts the scope through your anus and advances it to see the inside of your colon on the connected screen. Various tools can be used during colonoscopy to excise suspicious lesions:

• Endoscopic polypectomy: If a small polyp is identified, it can be removed using special tools inserted through the colonoscope and sent to the lab for analysis. If the polyp is later found to have cancer cells that are completely contained within it, no further resection is done.
• Endoscopic mucosal resection: This technique is used to remove larger polyps and part of the large intestine wall to ensure no cancer cells are left behind.

Surgery

Surgical treatment of colon cancer includes removing all or part of the large intestines, surrounding lymph nodes, and diverting stool if needed. The name of the surgery done to remove colon cancer is “colectomy”, and there are two types:

• Partial colectomy: Also called segmental colectomy or hemicolectomy. This is when the surgeon decides to remove only part of the colon and not all of it. After identifying the tumor, the surgeon cuts the segment of the colon that has it and then tries to reconnect the two limbs together.
• Total colectomy: This is when the surgeon decides to remove the whole colon. Total colectomy is not commonly done to treat colorectal cancer, and it is usually done in special cases where other parts of the colon might also be diseased.

Partial and total colectomy can be done by one of two methods:

• Open surgery: This is the traditional surgical method in which the surgeon cuts a large incision on your abdomen and performs the surgery by hand.
• Laparoscopic surgery: The surgery is done through 3-4 small incisions. The surgeon inserts a camera with light through one incision, and special “laparoscopic” instruments in the others. The surgeon uses the camera to see the inside of your abdomen on a large screen and then utilizes the laparoscopic tools to cut out the intended part of the colon.

Regardless of whether partial colectomy or segmental colectomy is performed, and regardless of the method (laparoscopic or open), your surgeon will try and remove as many lymph nodes as he/she can. These are sent to the pathology lab to check for cancer cells. If cancer cells are found, you might need further treatment.

In certain cases, during colectomy, your doctor might decide to not directly reconnect the colon together and to perform a colostomy instead. A colostomy is when the surgeon makes an opening in the skin of your abdomen (called a stoma) and connects your intestines to it. The stool then exists your body through the stoma instead of the anus, and a special bag that sticks around it is used to collect waste. A colostomy can be either permanent or temporary, where another operation can be later done to reconnect the colon and close the stoma (colostomy closure).

In people who have advanced colorectal cancer, surgery is no longer curative. Your doctor might, however, perform palliative surgery. Palliative surgery does not aim to cure the cancer, but instead, it aims to only improve your symptoms and relieve obstruction or pain.

Chemotherapy

Chemotherapy is the use of special drugs to kill cancer cells. It’s usually used in combination with surgery to treat colon cancer:

• Before surgery: You might receive chemotherapy before surgery to shrink the tumor and make it easier to resect.
• After surgery: If your cancer has spread to the lymph nodes or is large enough, your doctor might recommend chemotherapy after surgery.

Even if your tumor cannot be treated by surgery, you might still be eligible to receive chemotherapy along with radiation therapy to improve your symptoms.

Radiation therapy

Radiation therapy is the use of light energy to burn cancer cells. Your doctor might recommend radiation therapy before surgery to shrink the tumor, after surgery to kill off any remaining cancer cells, or as a combination with chemotherapy if surgery is not an option.

During radiation therapy sessions, a beam of high energy light is directed at the area where the tumor is to destroy the cancerous cells.

Targeted drug therapy

Targeted therapy is the use of drugs that are highly precise in targeting cancer cells and destroying them. This is in contrast to traditional chemotherapeutic drugs, where these are usually toxic to both cancer and normal cells alike.

 Both targeted therapy and traditional chemotherapy are often given in combination in people with advanced colorectal cancer.

Immunotherapy

In advanced colorectal cancer, special tests may be done to see if your cancer is sensitive to immunotherapy.

Immunotherapy is the use of drugs that alter how our body’s immune system works and allows the recruitment of immune cells to fight off and kill the abnormal cancer cells.

Colorectal cancer can be a challenge to treat, however, day by day medicine is advancing and newer and more effective treatments are being developed. If you’ve been recently diagnosed with colon cancer, you should discuss the benefits and risks of every treatment option with your physician, try to involve close family members in the discussion, and make sure to bring out all your concerns during visits.

Sources:

• https://www.cancer.org/cancer/colon-rectal-cancer/treating/colon-surgery.html
• https://www.uptodate.com/contents/colorectal-cancer-epidemiology-risk-factors-and-protective-factors
• https://www.uptodate.com/contents/overview-of-the-management-of-primary-colon-cancer
• https://www.uptodate.com/contents/systemic-chemotherapy-for-nonoperable-metastatic-colorectal-cancer-treatment-recommendations
• https://www.uptodate.com/contents/surgical-resection-of-primary-colon-cancer

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