Surgery
Surgery is the most common treatment for colorectal cancer. It is a type of local therapy. It treats the cancer in the colon or rectum and the area close to the tumor.
A small malignant polyp may be removed from the colon or upper rectum with a colonoscope. Some small tumors in the lower rectum can be removed through the anus without a colonoscope.
For a larger cancer, the surgeon makes an incision into the abdomen to remove the tumor and part of the healthy colon or rectum. Some nearby lymph nodes also may be removed. The surgeon checks the rest of the intestine and the liver to see if the cancer has spread.
When a section of the colon or rectum is removed, the surgeon can usually reconnect the healthy parts. However, sometimes reconnection is not possible. In this case, the surgeon creates a new path for waste to leave the body. The surgeon makes an opening (a stoma) in the wall of the abdomen, connects the upper end of the intestine to the stoma, and closes the other end. The operation to create the stoma is called a colostomy. A flat bag fits over the stoma to collect waste, and a special adhesive holds it in place.
For most people who have a colostomy, it is temporary. It is needed only until the colon or rectum heals from surgery. After healing takes place, the surgeon reconnects the parts of the intestine and closes the stoma. Some people, especially those with a tumor in the lower rectum, need a permanent colostomy. The sections on "Side Effects of Treatment" and "Rehabilitation" have more information about colostomy.
People may want to ask the doctor these questions before having surgery:
- What kind of operation do you recommend for me?
- Do I need any lymph nodes removed? Will other tissues be removed? Why?
- What are the risks of surgery? Will I have any lasting side effects?
- Will I need a colostomy? If so, will it be permanent?
- How will I feel after the operation?
- If I have pain, how will it be controlled?
- How long will I be in the hospital?
- When can I get back to my normal activities?
Chemotherapy
Chemotherapy uses anticancer drugs to kill cancer cells. It is called systemic therapy because it enters the bloodstream and can affect cancer cells throughout the body.
The patient may have chemotherapy alone or combined with surgery, radiation therapy, or both. Chemotherapy given before surgery is called neoadjuvant therapy. Chemotherapy before surgery may shrink a large tumor.
Chemotherapy after surgery is called adjuvant therapy. Adjuvant therapy is used to destroy any remaining cancer cells and prevent the cancer from coming back in the colon or rectum, or elsewhere.
Chemotherapy is also used to treat people with advanced disease.
Anticancer drugs are usually given through a vein, but some also may be given by mouth. The patient may be treated in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a hospital stay may be needed.
People may want to ask the doctor these questions before having chemotherapy:
- Why do I need this treatment?
- Which drug or drugs will I have?
- How do the drugs work?
- What are the expected benefits of the treatment?
- What are the risks and possible side effects of treatment? What can I do about them?
- When will treatment start? When will it end?
- How will treatment affect my normal activities?
