In general treatment for colon cancer requires surgery and/or systemic therapy with chemotherapy, immunotherapy or precision cancer medicines. The specific treatment for each person is individualized and is based on the stage of the cancer, its genomic profile and the age, condition and preferences of the patient. In certain instances radiation or liver directed therapies may also be used.1,2,3,4,5,6,7
For patients with potentially curable colon cancer, a properly performed surgical operation to remove the cancer and regional lymph nodes is essential for optimal results. There are several different types of surgical procedures used in the treatment and management of colon cancer. The size and spread of the cancer determines the most appropriate surgery to use.
Polypectomy: A polypectomy is the removal of a single polyp in the colon and is typically performed during a colonoscopy, which uses a long flexible tube with an attached camera.
Conventional surgery (open colectomy): Conventional surgery for colon cancer requires surgeons to create a large opening in the abdomen in order to reach the cancer. After the removal of the cancer and lymph nodes, the two cut ends of the colon are sewn together. In some instances, a temporary colostomy is created, and the two ends of the colon are reconnected at a later time. A colostomy is an opening where the large intestine is attached to the abdominal wall and allows passage of stool into a replaceable bag outside of the patient’s body.
Laparoscopic surgery: Laparoscopic surgery, also called minimally invasive surgery, allows surgeons to do procedures by making only a few small incisions in the abdomen. A small tube that holds a video camera is inserted into the abdomen, creating a live picture of the inside of the patient’s body. This picture is displayed on a television screen so that physicians perform the entire surgery by watching the screen. The cancer is removed through another, slightly larger incision.
Laparoscopic surgery appears to be about as likely to be curative as the standard approach for earlier-stage cancers. Some potential advantages of the procedure include less pain, a shorter hospital stay, and a quicker recovery. However, there is still limited information from randomized trials about the approach. In addition, laparoscopic surgery requires special expertise and patients need to be treated by a skilled surgeon who has done many of these operations.2,3,4,5
Systemic Therapy for Colon Cancer
Systemic treatment is any substance that travels through the bloodstream, reaching and affecting cells all over the body. Traditionally systemic treatment was mainly chemotherapy but increasingly consists of precision cancer medicines and immunotherapy administered alone or in combinations to target specific cancer driving genetic mutations.
Systemic treatment is the standard of care for individuals with advanced stage or recurrent colon cancer. The delivery of systemic cancer treatment following surgery is referred to as “adjuvant” therapy and is offered to most patients with stage II and all patients with stage III colon cancer for the purpose of reducing the risk of cancer recurrence.3
Chemotherapy: Chemotherapy uses medications that can be taken orally as a pill or are injected into a vein to kill cancer cells. Chemotherapy can be combined with immunotherapy or other precision cancer medicines to achieve the best results.
Precision Cancer Medicines: Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack colon cancer cells with specific genetic abnormalities, leaving normal cells largely unharmed. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be selected to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. ALL newly diagnosed patients should have genomic-biomarker testing performed on their cancer.3
Radiation Therapy for Colon Cancer
Radiation therapy uses high-powered energy beams, such as X-rays or protons, to kill cancer cells. Radiation therapy is not a common way to treat colon cancer, though it may be used in certain circumstances. Radiation therapy, often with chemotherapy, is frequently used in the adjuvant or neoadjuvant setting for the treatment of rectal cancers, whereas chemotherapy alone is more common for the adjuvant and neoadjuvant treatment of colon cancers.
Treatment by Colon Cancer Stage
1 National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Colon Cancer. V.3.2008. © National Comprehensive Cancer Network, Inc. 2008. NCCN® and NATIONAL COMPREHENSIVE CANCER NETWORK® are registered trademarks of National Comprehensive Cancer Network, Inc.
2 Jayne DG, Thorpe HC, Copeland J et al. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. British Journal of Surgery. 2010;97:1638-45.
3 Alsina J, Choti MA. Liver-directed therapies in colorectal cancer. Seminars in Oncology. 2011;38:651-567.
4 Nelson H, Sargent D, Wie H, et al. A Comparison of Laparoscopically Assisted and Open Colectomy for Colon Cancer. The New England Journal of Medicine. 2004;350:2050-2059.
5 Zheng Z, Jemal A, Lin CC, Hu CY, Chang GJ. Comparative Effectiveness of Laparoscopy Vs Open Colectomy Among Nonmetastatic Colon Cancer Patients: an Analysis Using the National Cancer Data Base. Journal of the National Cancer Institute. 2015 Feb 6;107(3). pii: dju491. doi: 10.1093/jnci/dju491.
6 Jayne DG, Thorpe HC, Copeland J et al. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. British Journal of Surgery. 2010;97:1638-45.
7 Alsina J, Choti MA. Liver-directed therapies in colorectal cancer. Seminars in Oncology. 2011;38:651-567.
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