Treatment for Colorectal Cancer

Digestive Diseases

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Surgery, chemotherapy and molecularly targeted drugs, and radiation therapy are generally used in certain combinations to treat colorectal cancer. Which treatments are chosen depends on the stage of the cancer – how advanced it is.

NewYork-Presbyterian physicians are in the forefront of developing and using new, minimally invasive surgical techniques to reduce recovery time, and new targeted drugs together with chemotherapies to improve both tolerability and outcomes.

Surgery for Colorectal Cancer

The most commonly performed colon surgery is a segmental resection, which is often performed laparoscopically. In this procedure, surgeons remove the cancer, a section of normal colon on either side of the cancer, and nearby lymph nodes, and then reattach the sections of the remaining colon. Sometimes a temporary colostomy may be needed for recovery. With colostomy, the end of the colon is brought through an opening in the abdomen, and a pouch attached to collect waste. Less commonly, a permanent colostomy is needed. (Overall, our gastrointestinal surgeons treat about 90% of colorectal cancers laparoscopically.)

For rectal cancer, chemotherapy and radiation therapy may be performed before surgery and surgery is sometimes followed by chemotherapy.

Metastases in the liver may be surgically removed, or destroyed by freezing them (cryoablation) or heating them using microwave energy (ablation). This is done after injecting material into large blood vessels in the liver to block blood flow (embolization) to the liver.

Radiation, Chemotherapy, and Targeted Therapy for Colorectal Cancer

Chemotherapy, radiation, and targeted therapy may be used on their own, in combination, or in combination with surgery to treat colorectal cancer.

Prior to surgery, chemotherapy and radiation may be used to shrink the size of a tumor and reduce the risk of removing it. This is especially important if the tumor is near a critical area such as an artery, or in or near an internal organ.

Following surgery, chemotherapy, radiation, or, increasingly, targeted therapy, may be used to destroy any remaining cancer cells. They also may be used for patients with advanced cancer or when surgery is not possible, to minimize the effects of the cancer and the symptoms the patients may experience. Brachytherapy, a type of radiation therapy, which uses small pellets of radioactive material placed in or near the cancer, is sometimes used to treat rectal cancer.

For those unfamiliar with the term, targeted therapy refers to an emerging class of drugs that destroy cancerous cells, leaving healthy cells unharmed, and do so without the use and unwanted side effects of chemotherapy and radiation – nausea, hair loss, and weakness and fatigue.

Targeted therapies include bevacizumab (Avastin) for advanced metastatic colorectal cancer. Bevacizumab is an antiangiogenic antibody that hinders the production of vascular endothelial growth factor, or VEGF, a protein which tumors use to develop blood vessels (angiogenesis). Essentially, the drug "starves" a tumor by cutting off the blood supply that feeds it.