Tons of questions fill the minds of patients with colorectal cancer. Many questions focus on treatment. How does it work?
“Chemotherapy, radiation therapy and surgery are most common parts of cancer care,” Heidi McKean, MD, Avera Medical Group medical oncologist and Avera Gastrointestinal (GI) Oncology Medical Director. Yet the approach continues to evolve. “Today, we have many cases where more intense upfront treatment can help patients avoid surgery.”
How Colorectal Cancer Treatment Is Evolving
When colorectal cancer patients meet with their medical oncologist, they’ll learn their options, based on the location of the tumor and stage of the cancer. Clinical trials might also be an option.
“Just a few years ago, almost all patients had surgery,” said Jesse Guardado, MD, surgeon and director of Avera's participation in the national accreditation program for rectal cancer at Avera Cancer Institute in Sioux Falls. “Like technology, cancer care changes rapidly. We bring those advancements to the treatment of every patient.”
Now, the use of chemotherapy and radiation, sooner, can lead to some cases where surgery is not required. This is known as total neoadjuvant therapy (TNT.) “If we can shrink the tumor enough, we can then monitor a patient instead of putting them through surgery,” he said.
Types of Treatment for Colon and Rectal Cancers
Since no two patients are the same, treatment always varies. Even individual cancer tumors have their own DNA mutations, but some common steps are part of treatment for all patients.
Put simply, cancer treatment can include:
- Chemotherapy: Use of drugs, either oral or injected, that are specialized to fight cancer.
- Radiation: Use of precise beams of energy to kill cancer cells and shrink or even eliminate the tumor.
- Surgery: Incisions are made to extract the tumor; part of the bowel may need to be removed to ensure clear margins. Minimally invasive procedures, with smaller incisions and less complications, are the norm.
- Immunotherapy: The use of medications that allow a patient’s immune system to help fight the cancer.
Avera Cancer Institute includes immunotherapy treatments, including those still in the clinical trial phases. Patients have more options than ever before, yet patients must fit the eligibility profile to qualify for these treatments.
How Your Stage of Cancer Affects Your Treatment
A key factor in treatment approach is the stage of colorectal cancer. The stages of cancer, shown in Roman numerals I through IV, (or 1 to 4) refer to several factors, most notably, if the cancer has spread:
- Stage 0: Cancer has not grown beyond the inner layers of the colon or rectum
- Stage I: Cancer is beyond the most inner layers.
- Stage II: Cancer has grown into the outermost layers, yet not spread to lymph nodes.
- Stage III: Cancer has spread to nearby lymph nodes, but not yet to distant organs.
- Stage IV: Cancer has reached distant organs, such as the lungs or liver.
“There are additional sub-stages in each colorectal cancer stage,” Guardado said. While sooner is always better for treatment to start, even patients with stage 4 colorectal cancer can be treated and sometimes cured.
“Rectal cancers are especially manageable,” he added. Treatment options – including surgery – can lead to outcomes that treat and beat the cancer.
“A minority of patients with stage IV colorectal cancer will have curable colorectal cancer,” McKean said. “If there are spots in liver or lung due to spread, the normal treatment is strong chemotherapy with targeted agents. Ablation or surgery is used to treat what’s left. Most stage IV treatment is chemotherapy to shrink and control the tumor/spread,” she added.
Tumors can be DNA sequenced, giving vital information on what drugs would best work to stop the cancer growth. “These mutation studies are quite new,” McKean said. “We’re also excited about clinical trials that give patients additional options.”
Learn More
When to consider a clinical trial if you have colorectal cancer
Will I have to travel for colorectal cancer treatment
How Avera’s cancer care program helps patients
