Polypectomy

Early-stage colon cancer may still be only within a polyp. The doctor can remove the malignant polyp during a colonoscopy. When the doctor removes polyps during a colonoscopy, it is called a polypectomy.

Transanal resection

Small rectal tumors that are found near the anus and have not grown into the wall of the rectum can sometimes be removed without having to make any incisions. The surgeon passes tools through the anus to remove the tumor.

Laparoscopy

The surgeon makes three or four small incisions in the abdomen and guides a thin, lighted tube called a laparoscope to where the cancer is. The surgeon then passes other surgical tools through the incisions and removes the tumor and a healthy part of the colon in order to make sure that there is no tumor being left behind. The doctor will also remove lymph nodes and check nearby organs for cancer spread.

Colectomy (Colon resection)

The surgeon makes an incision in the abdomen and removes the cancer and a normal part of colon on either side of it, along with nearby lymph nodes. The surgeon then reattaches 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.

Proctectomy (rectal resection)

The doctor makes an incision in the abdomen and removes the cancerous section of your rectum, along with some nearby tissue and lymph nodes. Depending on where the tumor is, you may need a colostomy. For cancers in the upper part of the rectum, your surgeon can usually reattach either side so waste can leave the body normally. For tumors in the lower part of the rectum, your surgeon may need to remove the anus, so you may need a colostomy.

Pelvic exenteration

If rectal cancer grows into nearby organs such as the bladder, prostate, or uterus, your surgeon will need to remove these organs as well. This procedure requires a colostomy. If the surgeon removes the bladder, a similar procedure called a urostomy is needed to allow urine to leave the body.

After surgery, some patients may be given chemotherapy and radiation to kill any cancer cells that may remain. Your doctor may recommend radiofrequency ablation and or cryosurgery to lower the risk of the cancer coming back

Chemotherapy

Chemotherapy is the use of drugs to target rapidly growing cells in an effort to destroy cancer cells. Chemotherapy medications may be given through the vein (intravenously) or by mouth (orally). Doctors give chemotherapy to shrink the tumor before surgery and destroy any traces of cancer left after surgery. In more advanced stages in which the cancer has spread, chemotherapy may be the best treatment option to relieve symptoms in order to treat areas of tumor that cannot be treated as effectively by surgery or radiation.

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. For rectal cancer, your doctor may also be able to administer external radiation using a small device placed in the anus. This allows the radiation to kill the cancer without affecting the skin and nearby tissue, causing fewer side effects. In internal radiation therapy for colorectal cancer, the doctor places radioactive pellets inside the body near the tumor. Doctors commonly use internal radiation as a primary treatment for older patients with rectal cancer, who would not be able to go through with surgery.

Proton beam radiation therapy

Proton therapy is an advanced type of radiation therapy that uses “protons” rather than X-ray “photons” to deliver radiation to the tumor. In conventional radiotherapy, the photon beams can deposit radiation and damage healthy cells as they pass through the body. Proton therapy deposits most of the radiation directly at the tumor site, possibly resulting in less damage to healthy tissue and fewer side-effects.

• Please see Understanding Proton Therapy to learn more.

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 Therapy

Some cases of colorectal cancer contain cells that overexpress the mutated proteins important in growth and spread of the tumor cells. These mutated proteins may be different in different patients with colorectal cancer, and treatments are tailored accordingly in a targeted fashion to “turn them off.” These cause the cancer to grow more aggressively. Targeted therapy may potentially “target” these cells by stopping or slowing the growth of colorectal cancer.

Immunotherapy

Fewer than 5% of patients with metastatic colorectal cancer have tumors that shrink by agents which increase the body's immune system to recognize tumor cells and kill them by immune attack. It is important to ask your oncologist if "microsatellite instability", a marker for benefit of these drugs, has been tested once a diagnosis of stage IV colorectal cancer has been made, since this type of treatment works better than chemotherapy for patients with metastatic colorectal cancer that features microsatellite instability.
Some patients with newly diagnosed rectal cancers (even if not stage IV) may have tumors with microsatelllite instability status. If this is detected, it is important to ask your doctor if you may benefit from immunotherapy as an alternative method to treat your rectal cancer.

Clinical Trials

Clinical trials allow 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 show promise but has not yet been FDA approved to treat the disease. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.