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Treatment Options for Colorectal Cancer

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					Treatment Options for Colorectal Cancer
The treatment depends on the staging of the cancer. When colorectal
cancer is
caught at early stages (with little spread) it can be curable. However
when it is
detected at later stages (when distant [[metastasi s|metastases]] are
present) it is
less likely to be curable.
Surgery remains the primary treatment while chemotherapy and/or
radiotherapy
may be recommended depending on the individual patient's staging and
other
medical factors.
Surgery
Surgical treatment is by far the most likely to result in a cure of colon
cancer if the
tumor is localized. Very early cancer that develops within a polyp can
often be cured
by removing the polyp at the time of colonoscopy. More advanced cancers
typically
require surgical removal of the section of colon containing the tumor
leaving
sufficient margins to reduce likelihood of re-growth. If possible, the
remaining parts
of colon are anastomosed together to create a functioning colon. In cases
when
anastomosis is not possible, a stoma (artificial orifice) is created.
While surgery is
not usually offered if significant metastasis is present, surgical
removal of isolated
liver metastases is common. Improved chemotherapy has increased the
number of
patients who are offered surgical removal of isolated liver metastases.
Laparoscopic assist resection of the colon for tumour can reduce the size
of painful
incision and minimize the risk of infection.
As with any surgical procedure, colorectal surgery can in rare cases
result in
complications. These may include infection, abscess, fistula or bowel
obstruction.
Chemotherapy
Chemotherapy is used to reduce the likelihood of metastasis developing,
shrink
tumour size, or slow tumor growth. Chemotherapy is of ten applied after
surgery
(adjuvant), before surgery (neo-adjuvant), or as the primary therapy if
surgery is not
indicated (palliative). The treatments listed here have been shown in
clinical trials to
improve survival and/or reduce mortality and hav e been approved for use
by the US
Food and Drug Administration.
Adjuvant (after surgery) chemotherapy. One regimen involves the
combination of
infusional 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX)
5-fluorouracil (5-FU)
Leucovorin (LV)
Oxaliplatin (Eloxatin®)
Capecitabine (Xeloda®)
Chemotherapy for metastatic disease. Commonly used first line regimens
involve
the combination of infusional 5-fluorouracil, leucovorin, and oxaliplatin
(FOLFOX)
with bevacizumab or infusional 5-fluorouracil, leucovorin, and irinotecan
(FOLFIRI)
with bevacizumab
5-fluorouracil (5-FU)
Leucovorin
Irinotecan
Oxaliplatin
Bevacizumab
Cetuximab
Radiation Therapy
Radiation therapy is used to kill tumor tissue before or after surgery or
when
surgery is not indicated. Sometimes chemotherapy agents are used to
increase the
effectiveness of radiation by sensitizing tumor cells if present.
Radiotherapy is not
used routinely in colorectal cancer, as it could lead to radiation
enteritis, and is
difficult to target specific portions of the colon, but may be used on
metastatic
tumor deposits if they compress vital structures and/or cause pain. There
may be a
role for post-operative adjuvant radiation in the case where a tumor
perforates the
colon as judged by the surgeon or the pathologist. However, as the area
of the prior
tumor site can be difficult (if not impossible) to ascertain by imaging,
surgical clips
need to be left in the colon to direct the radiotherapist to the area of
risk.
Immunotherapy
Bacillus Calmette-Guérin (BCG) is gaining prominence as a complementary
theraputic agent in the treatment of colorectal cancer. A review of
results from
recent clinical trials is given in Mosolits et al.
Support Therapies
Cancer diagnosis very often results in an enormous change in the
patient's
psychological wellbeing. Various support resources are available from,
hospitals and
other agencies which provide counseling, social service support, cancer
support
groups, and other services. These services help to mitigate some of the
difficulties
of integrating a patient's medical complications into other parts of
their life.
William Ransom provides information of Colon cancer screening, diagnosis
and treatment at http://colon-answers.com