Register
Login
×

Colorectal Cancer Treatment By Stages [ I to IV]

The colorectal cancer treatment mainly depends on the stage, location of the tumor, performance status of the patient, presence of certain genetic abnormalities, along with other factors.

Following are the preferred treatment approaches for different stages of colon cancer, but the final decision is taken after clinical assessment of the patient by an oncologist.

Colon Cancer - Treatment (Non-Metastatic Disease) - Infographic
Colon Cancer - Treatment (Non-Metastatic Disease)
Colorectal Cancer - Treatment (Metastatic Resectable Disease) - Infographic
Colorectal Cancer - Treatment (Metastatic Resectable Disease)
Colorectal Cancer - Treatment (Metastatic Unresectable Disease) - Infographic
Colorectal Cancer - Treatment (Metastatic Unresectable Disease)

Treatment: Colon Cancer

STAGE TNM TREATMENT
0 Tis N0 M0 Local excision or simple polypectomy with clear margins is considered preferred treatment approach.
I T1-2 N0 M0 Wide surgical resection of the part of colon depending on the involvement and site of disease.
II T3-T4b N0 M0 Wide surgical resection of the part of colon depending on the involvement and site of disease. Chemotherapy may be employed after surgery depending upon the presence of high risk factors as assessed by oncologist.
III T1-4b N1-2b M0 (Node-positive disease) Wide surgical resection of the part of colon depending on the involvement and site of disease followed by chemotherapy is considered as the standard treatment approach.
IV Any T Any N M1
(Metastatic disease)
Resectable disease: Wide surgical resection of the part of rectum depending on the involvement and site of disease along with the surgical resection/ablation/embolization of the metastases in the liver and/or surgical resection of lung metastases, as per surgeon’s discretion. Chemotherapy may be added thereafter.
Unresectable disease: Chemotherapy, targeted therapy, and/or immunotherapy is the mainstay of treatment in case the disease has spread to distant body parts/organs and considered unresectable. If the disease becomes resectable as per surgeon’s discretion, it may be managed as per resectable disease mentioned above.

Other treatment options like surgery, radiation therapy or bone-directed therapy may be considered for palliation or relief of symptoms.

Join our COLORECTAL CANCER COMMUNITY to connect with fighters and survivors across the globe.

Following is the brief description of various treatment types employed for COLON CANCER:

  1. Surgery: Surgery is the treatment of choice for early stage and some advanced stage colon cancers that have not spread to distant body parts and can be completely removed.

    In certain cases of advanced stage disease with distant metastases to liver and/or lungs, surgical resection of primary and metastasis may be done upfront or after chemotherapy, if the disease can be removed completely without affecting organ function, and as per physician discretion and patient’s condition.
  2. Chemotherapy: Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly growing cancer cells. It is considered to be the mainstay of treatment for advanced stage disease that has spread to distant body parts.

    Depending on the physician’s preference and patient’s condition, it may also be combined with other treatment options to accelerate the benefit achievement. It may be associated with side effects due to its effect on normal body cells apart from cancerous cells.
  3. Ablation: Ablation is a technique in which tumor is destroyed without actual removal from the body. This technique is mainly used for destroying liver metastasis, if patient is a suitable candidate for the same.

    High-energy radio waves are utilized in radiofrequency ablation (RFA), microwaves are used in microwave ablation (MWA) technique, while very cold gases are used in cryoablation to destroy tumors. Sometimes, an ethanol injection given directly into the tumor tissue can be used to kill tumor cells. Imaging techniques are utilized along with these ablation techniques to accurately locate the target tumors.
  4. Embolization: Embolization is a technique in which tumor is destroyed by blocking the blood supply to the tumor cells with tiny particles injected directly in the artery supplying blood to tumor cells.

    In arterial embolization, inert particles are used, whereas, particles are loaded with drugs in chemoembolization, and with radioactive substances in radioembolization). This technique is mainly used for destroying liver metastasis, if patient is a suitable candidate for the same.
  5. Targeted Therapy: Targeted drugs are designed to target a specific gene or protein characteristic of colon cancer cells. With advancements in diagnostic techniques, a number of genetic abnormalities for colon cancer have been identified that can be targeted with the help of targeted drugs.

    Molecular testing to confirm the genetic abnormality is the pre-requisite for starting a targeted therapy. They work differently than chemotherapy drugs that they target a specific gene or protein characteristic of the cancer cells. For example, Cetuximab targets epidermal growth factor receptor (EGFR) protein, Bevacizumab targets vascular endothelial growth factor (VEGF) receptor. They are generally used alone or in combination with chemotherapy for the treatment of higher stage disease.
  6. Immunotherapy: Cancer cells utilize certain mechanisms to escape from the immune system of the patient from attacking these cells. Immunotherapeutic agents activate the immune system to recognize and kill cancer cells.

    Pembrolizumab targets PD-1, a protein on T-cells that normally helps keep these cells from attacking cancer cells. This activates the immune system to kill the PD-L1 expressing cancer cells.
  7. Palliative Treatment: These treatments help in improving the overall quality of life by providing relief from the symptoms and reducing the suffering caused by the disease.

    It includes but not limited to placing stent in the colon for obstructive symptoms, using drugs to reduce pain, bleeding, and other symptoms such as diarrhea, external-beam radiation therapy or surgery to reduce tumor load.

It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes patient’s choice and health condition are also important to make a treatment choice.

Following are ultimate goals of treating stomach cancer:

  • Prolongation of life.
  • Reduction of symptoms
  • Improvement overall quality of life of the patient

Watch the video below to understand the TREATMENT OF LOCALISED AND LOCALLY ADVANCED COLON CANCER.

And the below video explains the TREATMENT OF METASTATIC COLON CANCER in detail.

Treatment: Rectal Cancer

The treatment of rectal cancer mainly depends on the stage, location of the tumor, distance from the anal sphincter, performance status of the patient, presence of certain genetic abnormalities, along with other factors.

Following are the preferred treatment approaches for different stages of rectal cancer, but the final decision is taken after clinical assessment of the patient by an oncologist.

STAGE TNM DESCRIPTION
0 Tis N0 M0 Local excision or simple polypectomy with clear margins is considered preferred treatment approach.
I T1-2 N0 M0 Wide surgical resection of the part of rectum (transluminal excision, abdominoperineal resection or low anterior resection [LAR]) depending on the involvement and site of cancer.
II and III T3-4b N0 M0
T1-4b N1-2b M0
Wide surgical resection of the part of rectum depending on the involvement and site of cancer. Chemotherapy and/or radiotherapy is generally employed before and/or after surgery based on oncologist’s discretion.
IV Any T Any N M1
(Metastatic disease)
Resectable disease: Wide surgical resection of the part of rectum depending on the involvement and site of disease along with the surgical resection/ablation/embolization of the metastases in the liver and/or surgical resection of lung metastases, as per surgeon’s discretion. Chemotherapy may be added thereafter.
Unresectable disease: Chemotherapy, targeted therapy, and/or immunotherapy is the mainstay of treatment in case the disease has spread to distant body parts/organs and considered unresectable. If the disease becomes resectable as per surgeon’s discretion, it may be managed as per resectable disease mentioned above.

Other treatment options like surgery, radiation therapy or bone-directed therapy may be considered for palliation or relief of symptoms.

Following is the brief description of various treatment types employed for RECTAL CANCER:

  1. Surgery: Surgery is the treatment of choice for early stage and some advanced stage rectal cancers that have not spread to distant body parts and can be completely removed. In certain cases of advanced stage disease with distant metastases to liver and/or lungs, surgical resection of primary and metastasis may be done upfront or after chemotherapy, if the disease can be removed completely without affecting organ function, and as per physician discretion and patient’s condition. Surgery for rectal cancer may be transluminal excision, abdominoperineal resection, low anterior resection, etc, depending upon the location of the tumor from the anal sphincter.
  2. Radiation Therapy: Radiation therapy (or radiotherapy) uses high-energy radiation directed to the affected area to kill cancerous cells. It can be employed either by using an external radiation source (external beam radiation therapy) or by directly placing the source of radiation near the cancer tissue (brachytherapy). It is commonly combined with other treatment options such as surgery and chemotherapy. Sometimes, it is used as palliative therapy to relieve pain, bleeding, and obstructive problems associated with the advanced stage disease.
  3. For the description of chemotherapy, ablation, embolization, Immunotherapy, and targeted therapy, please see treatment for colon cancer.
  4. Palliative Treatment: These treatments help in improving the overall quality of life by providing relief from the symptoms and reducing the suffering caused by the disease. It includes but not limited to placing stent in the rectum for obstructive symptoms, using drugs to reduce pain, bleeding, and other symptoms such as diarrhea, external-beam radiation therapy or surgery to reduce tumor load.

It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes patient’s choice and health condition are also important to make a treatment choice.

Following are ultimate goals of treating colon cancer:

  • Prolongation of life.
  • Reduction of symptoms
  • Improvement overall quality of life of the patient

Join our COLORECTAL CANCER COMMUNITY and share your experiences with others.

Join our community of fighters and survivors, motivate and uplift each other to fight cancer together.