Colectomy (colon resection)

Your surgeon will make an incision in your abdomen and remove the cancer and a normal section of colon on either side of it, along with nearby lymph nodes. Your surgeon will then reattach the two healthy sides. Most people with colon cancer do not need a colostomy, but some may need a temporary colostomy after this surgery until the colon fully heals. This surgical procedure can also be done with minimally invasive techniques such as laparoscopy or robotic surgery.

Proctectomy (rectal resection)

Your doctor will make an incision in your abdomen and remove the cancerous section of your rectum, along with some nearby tissue and lymph nodes. Depending on the location of the tumor, you may need a colostomy or an ileostomy. For cancers in the upper part of the rectum, your surgeon can usually reattach the rectum so waste can leave the body normally. For tumors in the lowermost part of the rectum, your surgeon may need to remove the anus, so you may need a colostomy. Similar to colon surgery, this surgical procedure can be performed with minimally invasive techniques.

Pelvic exenteration

It is extremely rare to do a radical procedure called a pelvic exenteration to treat someone with metastatic disease. In this procedure the rectum, urinary bladder, prostate in males, and uterus and ovaries and part or all of the vaginal wall in females are removed. At times not all the pelvic organs need to be removed but only those where the tumor has attached or has grown into. This procedure is occasionally used, especially if the metastatic disease can be approached with the intention to cure or when the procedure is done to relieve symptoms. In most cases this procedure will require a colostomy. If your surgeon removes your bladder, a similar procedure called a urostomy is needed to allow urine to leave your body.

Colostomy

Normally, after a colectomy or proctectomy, the surgeon will reattach the healthy parts of your colon or rectum, allowing you to digest food and pass stools in the usual fashion with few complications. In some cases, your surgeon may not be able to reattach the two parts and may need to make an opening in your abdominal wall and attach the end of your intestine to it in order to allow waste to leave the body (stoma). This procedure is called a colostomy if the colon is utilized to bring out the abdominal wall or an ileostomy if the ileum (part of the distal small bowel) is utilized. For most people, stomas are temporary; however, some people with cancer in the lower rectum may need a permanent stoma. A colostomy is the most commonly used procedure for palliation in someone with metastatic disease when the patient presents with acute blockage.

Partial hepatectomy (liver resection)

Your doctor may recommend a partial hepatectomy if your cancer has metastasized to your liver. The operation removes only the cancerous area of the liver, leaving the remaining part of the liver. In order to have a partial hepatectomy, the patient must have enough healthy liver to function on its own. Patients with cirrhosis often cannot undergo the procedure because the damage to their livers is too great. A partial hepatectomy is considered the best treatment option available for patients with localized resectable cancer that has spread to the liver.

Your doctor may recommend chemoembolization to the heptic artery. Chemoembolization is a treatment where the injected chemotherapeutic drugs are delivered through a catheter into the hepatic artery, the major blood vessel of the liver. This procedure can slow or stop tumor growth.

Lung resection

Your doctor may recommend surgery to remove colorectal cancer that has metastasized to the lungs. Your doctor may remove the tumor and a wedge-shaped piece of healthy lung around it (wedge resection), the entire lobe where the tumor is located (lobectomy), or part of the lobe where the tumor is located (segmentectomy). Rarely, the entire lung where the cancer is located (pneumonectomy), or part of the bronchus where the cancer is located (sleeve resection) are removed in patients with metastatic disease.

Radiofrequency ablation (RFA)

Your doctor inserts a long, thin probe into the tumor and passes an electric current through the probe to kill the tumor with heat. This is most commonly performed in the liver for some tumors that cannot be technically removed.

Chemotherapy

Chemotherapy is the use of drugs to target rapidly growing cells in an effort to destroy cancer cells. Chemotherapy medications may be given by mouth (orally), through the vein (intravenously) and/or occasionally through an artery (intraarterially). There are situations where the chemotherapy is delivered into the abdomen. Doctors may give chemotherapy to shrink the tumor before surgery and may use it to destroy any traces of cancer left after surgery. In stage IV disease in which the cancer has spread and the patient is not a candidate for surgery, chemotherapy may be considered if your blood work and energy level are reasonable. It may be the best treatment option to prolong your overall survival and relieve symptoms. For stage IV patients that are not surgical candidates, the duration of chemotherapy is indefinite.

Radiation therapy

Radiation therapy uses waves of high-energy rays to target and kill cancer cells. Doctors give radiation therapy to shrink the tumor before surgery and eliminate any traces of cancer left after surgery. In external beam radiation, a large machine delivers radiation to your tumor from outside the body. In certain situations, radiation can be delivered via pellets in the blood stream. This is known as transarterial radioembolization (TACE), radioactive pellets are delivered via an artery most commonly to the liver.

Chemoradiation

Chemoradiation is a combination of chemotherapy and radiation therapy. Combining these two treatments makes both more effective. Doctors give chemoradiation to shrink the tumor before surgery and destroy any traces of cancer left after surgery.

Targeted or biologic therapy

Some cases of colorectal cancer contain cells that may benefit from specific non-chemotherapy agents which are more selective against the tumor and are focused on a specific pathway in cancer growth. Targeted therapy tries to specifically target these cells, preventing the proteins from fueling cell growth.

Immunotherapy

Some patients with a new diagnosis of colorectal cancer benefit from immunotherapy. These are drugs which help the immune system recognize the cancer and fight the cancer cells. In general, the side effects of immunotherapy are very tolerable for most patients.

Clinical Trials

A clinical trial allows patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.

Palliative Treatments

Doctors also use surgery and radiation to relieve symptoms caused by the cancer, particularly in advanced stages. Colostomy is the most commonly used procedure for palliation in someone with metastatic disease who presents a large bowel blockage or in patients with suspected impending bowel blockage to avoid a blockage during treatment.