Treatment of colorectal cancer

Cancer treatment is given by cancer specialists (oncologists). Some specialize in surgery, some in radiation therapy and others in chemotherapy (drugs). These doctors work with the person with cancer to decide on a treatment plan.

Treatment plans are designed to meet the unique needs of each person with cancer. Treatment decisions for colorectal cancer are based on:

• stage
• type of cancer (colon or rectal)
• location of the tumour
• whether the cancer has recurred or spread
• the person's overall health

Treatment options for colon cancer

• surgery
  • removal of a polyp (polypectomy)
    • A polyp is not a cancer, but there may be cancer cells within a polyp. If polyps are found during colonoscopy or sigmoidoscopy, they are surgically removed and checked for cancer cells.
  • removal of tumours in the mucosa layer of the colon (local excision or endoscopic mucosal resection)
  • removal of part of the colon (hemicolectomy, partial bowel resection)
  • removal of all of the colon (colectomy, total bowel resection)
  • removal of all of the colon, rectum and pelvic organs (pelvic exenteration)
  • removal of colon cancer that has spread to the liver or lung (metastases)
• chemotherapy
  • Chemotherapy for colon cancer may include:
    • 5-fluorouracil (Adrucil, 5-FU))
    • folinic acid (leucovorin)
    • oxaliplatin (Eloxatin)
    • capecitabine (Xeloda)
    • irinotecan (Camptosar, CPT-11)
    • raltitrexed (Tomudex)
  • Chemotherapy is sometimes injected directly into the hepatic artery in the liver to treat liver metastases (hepatic artery infusion). This approach is not a common practice in Canada.
• targeted therapy
  • It may be given alone or combined with chemotherapy for treatment of advanced disease.
  • Targeted therapy for colon cancer may include:
    • bevacizumab (Avastin)
    • cetuximab (Erbitux)
    • panitumumab (Vectibix)
• radiation
  • may include external beam radiation therapy given to relieve symptoms of advanced disease
• radiofrequency ablation
  • sometimes used to treat liver metastases
• follow-up after treatment is finished
  • It is important to have regular follow-up visits, especially in the first 2–3 years after treatment.

Treatment options for rectal cancer

• surgery
  • removal of a polyp (polypectomy)
    • A polyp is not a cancer, but cancer cells may be found within a polyp. If polyps are found during colonoscopy or sigmoidoscopy, they are surgically removed and checked for cancer cells.
  • removal of tumours in the mucosa layer of the rectum (local excision or endoscopic mucosal resection)
  • removal of the rectum and mesorectum (total mesorectal excision)
  • removal of part of the descending colon, the sigmoid colon, all or part of the rectum and its associated mesorectum (low anterior resection)
  • removal of all or part of the sigmoid colon and the entire rectum (proctectomy)
  • removal of part of the sigmoid colon, rectum, anus, mesorectum and anal muscles (abdominal perineal resection)
  • removal of all of the colon, rectum and pelvic organs (pelvic exenteration)
  • removal of rectal cancer that has spread to the liver or lung (metastases)
• radiation
  • may be given before or after surgery
  • when given after surgery, it is often combined with chemotherapy
  • may be given to relieve symptoms of advanced disease
  • external beam radiation is the most common type of radiation used to treat people with rectal cancer, but endocavitary radiation (radiation given through a device placed in the rectum) or brachytherapy may also be used
• chemotherapy
  • It may be given before or after surgery and is often combined with radiation.
  • Chemotherapy for rectal cancer may include:
    • 5-fluorouracil combined with folinic acid
    • oxaliplatin
    • capecitabine
    • irinotecan
    • raltitrexed
  • Chemotherapy is sometimes injected directly into the hepatic artery in the liver to treat liver metastases (hepatic artery infusion). This approach is not a common practice in Canada.
• targeted therapy
  • It may be given alone or combined with chemotherapy for treatment of advanced disease.
  • Targeted therapy for rectal cancer may include:
    • bevacizumab
    • cetuximab
    • panitumumab
• radiofrequency ablation
  • sometimes used to treat liver metastases
• follow-up after treatment
  • It is important to have regular follow-up visits, especially in the first 2–3 years after treatment.

Clinical trials

Clinical trials investigate better ways to prevent, detect and treat cancer. There are many clinical trials in Canada that are open to people with colorectal cancer. For more information, go to clinical trials.

See a list of questions to ask your doctor about treatment.