Colon Cancer; Treatment
Surgery is often required to treat colorectal cancer. The surgical procedure used depends on where the cancer is located.
Occasionally, early cancerous changes may be limited to a portion of an otherwise non-cancerous polyp. It is sometimes possible to remove some very early colon cancers during a colonoscopy. If the cancerous polyp is in the rectum, occasionally this polyp can be removed through the anus by a simple procedure so the surgeon doesn’t have to cut into the abdomen.
In right-sided cancer, the right side of the colon is removed. In left-sided cancers, the left side of the colon is removed. If a cancer is in the middle transverse colon, either the right or the left colon is removed along with the transverse colon. In rectal cancer, the rectum is removed.
If the cancer is found early, surgically removing the tumor can result in a five-year survival rate of approximately 72 to 93 percent of cases depending on the stage of the cancer.
If the cancer invades the muscles that help you control your bowels, those muscles have to be removed and a permanent colostomy created. A colostomy (stoma) is where a piece of the bowel is brought to the abdominal wall and a bag is kept over this piece to collect the stool. Occasionally, temporary stomas are created until the bowel has a chance to heal. The post-surgical use of colostomy bags is declining, however. Today, stomas do not restrict daily activities in any way.
The National Comprehensive Cancer Network (NCCN) guidelines recommend that people with rectal cancer be referred to an enterostomal therapist (a health care professional, often a nurse, trained to help people with their colostomies) as part of their initial work-up. The enterostomal therapist can address concerns about how a colostomy might affect your daily activities.
If the cancer is not detected until a later stage after it has spread to other tissue, you may receive chemotherapy first. Intravenous 5-fluorouracil (5-FU) in combination with leucovorin is the chemotherapy regimen most often used to treat colorectal cancer.
There are also newer options that may be more convenient than standard intravenous treatment, including capecitabine (Xeloda). For cancer that has spread to distant sites such as the liver or lung, other chemotherapeutic agents in addition to 5-FU are given.
In addition to chemotherapy, radiation therapy is recommended if the cancer has become attached to an internal organ or the lining of the abdomen. In fact, you may be treated with a combination of chemotherapy and radiotherapy prior to surgery for rectal cancer. This combination helps shrink the tumor, allowing the sphincter muscles (which control the rectum) to be saved.
Two drugs, bevacizumab (Avastin) and cetuximab (Erbitux), stop cancerous tumors from growing. Bevacizumab (Avastin) is used in combination with 5-FU chemotherapy and stops cancerous tumors from developing new blood vessels, eventually shrinking or killing the tumor. The drug cetuximab (Erbitux) blocks the growth factor that tells cancer cells to divide and has been approved for metastatic colon cancer. It can be given along with other chemotherapy drugs or alone if you can’t tolerate other chemotherapy drugs. Cetuximab (Erbitux) is also effective in shrinking tumors and delaying tumor growth. It has also been approved for the treatment of head and neck cancers. Erbitux carries a “black-box warning” because of the risk of severe infusion reactions. Discuss this risk with your health care professional if he or she suggests Erbitux.
For those whose colorectal cancer has metastasized to a few areas in the liver, lungs or elsewhere in the abdomen, surgically removing or destroying these metastases can increase the lifespan. Liver metastases may be destroyed by cryosurgery (freezing) or radio frequency ablation (heating the tumors with microwaves).
If the cancer comes back in only one part of the body, you may need surgery again. If it has spread to several parts of the body, you may receive chemotherapy or radiation therapy.
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Keywords: colostomy, stomas, colostomy bag, enterostomal therapist, polyp, chemotherapy, radiation
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