Colon & Rectal Treatment Options

If you were recently diagnosed with colon or rectal cancer, the Virginia Oncology Associates team is here to help. Just as every patient is unique, so is the specific treatment plan for each patient with colon or rectal (colorectal) cancer.

We will discuss a recommended treatment plan with you, including the goal of the treatments and the side effects you will likely experience. We do all of this because it’s important you understand and agree with the path forward on your cancer journey.

Learn more about the treatment types below:

• Surgery for Colorectal Cancer
• Radiation Therapy for Colorectal Cancer
• Chemotherapy for Colorectal Cancer
• Targeted Therapy for Colorectal Cancer
• Immunotherapy for Colorectal Cancer

How is a Colorectal Cancer Treatment Plan Created?

At Virginia Oncology Associates, you are treated by a multidisciplinary team. This means a group of physicians work together to create a personalized treatment plan. For colorectal cancer, the team typically consists of a medical oncologist, surgeon, radiation oncologist, and gastroenterologist. They will discuss many aspects of your situation, including:

• The stage of colorectal cancer. Understanding the stage directs the care team toward treatments most likely to work.
• The goal of treatment. Is it curative or palliative?
• Is surgery possible? 
  • If it is, will other treatments come before, after, or both? 
  • If surgery is not possible, what other treatments are available? 
• Is there a genetic mutation that can be treated with a targeted therapy? Biomarker test results will indicate whether some treatments are more effective. 

A treatment plan is created based on the answers to these and other questions. The medical oncologist will typically present the plan and answer questions. You may still need to set up a consultation with the surgeon and any other physicians who will be a part of your care.

Surgery for Colorectal Cancer

Surgery is the most common treatment for early-stage colorectal cancer. The type of surgery used depends on where the cancer is located in the colon or rectum and whether it has grown outside of these areas. 

Colon Cancer Surgeries

Early-stage colorectal cancers are sometimes entirely removed during a colonoscopy — a procedure that examines the bowels using a colonoscope or a thin, flexible tube with a light and camera. The gastroenterologist will remove the tumor if they’re sure it can be done without cutting through the abdominal wall using one of these procedures:

• Local excision. This procedure involves inserting a tube with a cutting tool through the rectum into the colon to cut out the cancer and a small amount of surrounding tissue on the wall of the rectum. 
• Polypectomy. This procedure involves the removal of polyps (small bulging areas of tissue) in the colon.

Learn more about colon polyps.

For more advanced colon cancer, other types of surgery may be used, such as: 

• Colectomy. This is a surgery to remove all or part of the colon. It is typically performed either laparoscopically or with open surgery. If only part of the colon is removed, it's called a hemicolectomy, partial colectomy, or segmental resection. If all of the colon is removed, it's called a total colectomy. Lymph nodes will also likely be removed to check for signs of cancer.
  For partial colectomies (removing the cancer and a small amount of healthy tissue around it), the surgeon will reconnect the healthy parts of the colon. This is called anastomosis.  
  If the colon is blocked, the surgeon may need to make an opening for waste to leave the body. This surgical opening connected to a pouch provides a pathway for waste to exit the body. 

Curative surgery can be performed even if the cancer has spread to other areas, such as the liver or lungs, in selective patients when it is limited to one area. Other local therapies are also possible, including a radiofrequency, microwave, or cryotherapy ablation to destroy cancer cells. 

• Radiofrequency ablation. A procedure uses a special probe with tiny electrodes that kill cancer cells. Sometimes, the probe is inserted directly through the skin, and only local anesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen. This is done in the hospital under general anesthesia.
• Microwave ablation. Electromagnetic microwaves are sent through a probe directed at the liver, where colon cancer has developed. This creates high temperatures that quickly kill tumors up to 6mm across.
• Cryosurgery. This treatment uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy.

Rectal Cancer Surgery

If cancer found in the rectum can’t be removed during a colonoscopy or through local excision, other procedures can be used, such as:

• Transanal excision (TAE). An operation in which the surgeon cuts through all layers of the rectal wall to take out the cancer as well as some surrounding normal rectal tissue. The hole in the rectal wall is then closed.
• Proctectomy. This procedure is performed to remove all or part of the rectum. The surgeon may create a pouch in the colon to replace the rectum and then attach the colon to the anus.

Radiation Therapy for Colorectal Cancer

Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. There are two main types of radiation therapy used for colorectal cancer:

• External radiation therapy uses a machine outside the body to precisely send radiation to the area of the body where cancer is found. Treatments are painless and require only a short visit. Most patients receive external beam radiation therapy five days a week for several weeks. 
• Brachytherapy is internal radiation therapy for rectal cancer. It uses a radioactive substance sealed in needles, seeds, wires, or catheters placed directly into or near the cancer. The substance is usually left in place for a short period of time. The process may be repeated over several days.

Radiation therapy is usually given before surgery to shrink a tumor to make it easier to remove. It can be given after surgery to ensure any unseen cancer cells left behind are destroyed. It can also be given during surgery, which is called intraoperative radiation therapy (IORT).

The way radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is also used to relieve pain from cancer that has spread to other areas of the body. 

Medical Oncology Therapies

Your colorectal cancer treatment plan may include systemic treatments to destroy cancer cells throughout the body. There are several categories, although they may not be right for all patients.

Chemotherapy for Colorectal Cancer

A combination of chemotherapy drugs called FOLFOX and FOLFIRI are commonly given to colorectal cancer patients. Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. This chemotherapy infusion is usually a 48-hour infusion the patient takes home. Instructions are provided to the patient and caregiver.

You may be treated in an outpatient part of the hospital, at the doctor’s office, or at home. A hospital stay is rarely needed.

Targeted Therapy for Colorectal Cancer

Targeted therapy is a category of cancer treatment focused on a specific genetic change to stop the growth of cancer cells. Before a targeted therapy is included in the treatment plan, biomarker tests are run on the tissue removed during the biopsy or surgery. The test looks for certain genetic changes that occurred over the patient’s lifetime and are known to lead to colon cancer development.

Drugs are now available to block the production of cancer cells due to certain genetic mutations. If the biomarker tests show certain mutations in any of the following genes, a targeted therapy may be added to the treatment plan:

• EGFR
• BRAF
• NTRK
• HER2
• RET
• KRAS

Side effects of targeted therapy are less intense for most patients compared to chemotherapy. This is largely because the drugs target and destroy cancer cells, leaving healthy cells alone. 

Currently, targeted therapies are used primarily for Stage 4 or recurrent colon cancer but talk to your VOA oncologist about your options.

Immunotherapy for Colorectal Cancer

Immunotherapy uses your body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells. A group of drugs called checkpoint inhibitors is now a cornerstone treatment for colorectal cancer patients of all stages whose tumor shows dMMR (deficient mismatch repair) or MSI-H (microsatellite instability-high). Your body’s immune system uses “checkpoints” to see if a cell should be turned off and blocked from reproducing. Cancer cells can trick these checkpoints into thinking the cell is healthy. By using checkpoint inhibitors, the body can identify and destroy cancer cells.

Clinical Trials for Colon and Rectal Cancer

Clinical trials have already brought many new drugs to patients with colon and rectal cancers. Virginia Oncology Associates is proud to have participated in the research that has led to these revolutionary therapies, which are now available to all patients. We continue to offer clinical research trials to our patients. If one is appropriate, your oncologist will discuss it with you. Participation is always voluntary. To learn more about clinical trials for colorectal cancer, visit our Colorectal Cancer Clinical Research page. 

Find a Colorectal Cancer Specialist Near You

Virginia Oncology Associates offers a comprehensive approach to providing patients with the best possible care during their colorectal cancer journey. With multiple offices conveniently located throughout Hampton Roads and Eastern North Carolina, you can receive the latest colorectal cancer treatment in a caring and comfortable environment close to home. We are ready to help provide a personalized treatment plan or a second opinion before starting treatment.