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Weill Cornell Cancer Center

Treatment

Some colorectal cancer may only require surgery as treatment; however; some patients may need a combination of surgery and chemotherapy.

Surgery

Many patients who need colorectal cancer surgery ask, “Will I need to wear a colostomy bag?” The good news is that while a temporary colostomy may be needed during the healing period after surgery, only about 10 percent of patients require a permanent colostomy after surgery and need to wear a bag to collect wastes. Enterostomal therapy nurses with advanced specialized training in the management of stomas are available via scheduled appointments to assist all patients at Weill Cornell [link to http://monahancenter.org/]

Weill Cornell surgeons are leaders in minimally invasive laparoscopic surgery for colon cancer, a technically complex procedure. Our gastrointestinal surgeons treat about 90 percent of colorectal cancers laparoscopically. Preliminary clinical studies indicate that the results are as good as, or better than, the traditional open surgical approach for colon cancer. Our surgeons are also at the forefront of new techniques to preserve colorectal structure and function, including the creation of a bowel “anastomosis” (a method for joining the intestines together, allowing stool to pass through normally).

Our colorectal surgeons are employing innovative approaches to removing large colorectal polyps and colorectal gastrointestinal stromal tumors (a type of sarcoma) that are too large to be removed using colonoscopy. Rather than surgically removing a large part of the colon or rectum, a combined endoscopic/laparoscopic procedure is performed which results in minimal side effects and allows for optimal preservation of colon and rectum tissue.

Patients with rectal cancer whose sphincter nerves or muscles have been compromised benefit from novel techniques to preserve fecal continence. Examples include nerve stimulation, implantation of an artificial sphincter mechanism, and biofeedback techniques that help patients sense the presence of stools and strengthen the anal muscles. Surgeons can also perform many rectal cancer surgeries laparoscopically to create a new rectum from healthy intestinal tissue.

Chemotherapy

Chemotherapy may be used before surgery, to shrink a tumor and make it easier to remove, or after surgery to destroy any remaining cancer cells. Anticancer drugs such as 5-fluorouracil, leucovorin, irinotecan, capecitabine, and oxaliplatin have been considered a mainstay of colorectal cancer treatment.

In recent years, several targeted anticancer drugs have become part of the arsenal of medications that doctors can use to treat patients whose cancer requires more than surgery. These include cetuximab, bevacizumab, and panitumumab, which slow or halt cancer growth by interfering with the molecular signals that colorectal cancer cells need to grow and multiply.

Weill Cornell investigators have participated in clinical trials leading to the approval of several of the drugs commonly used to treat colorectal cancer today, as well as ongoing clinical trials of novel treatment approaches for all stages of the disease. Weill Cornell medical oncologists have developed a screening protocol to follow patients diagnosed with stage II colon cancer to determine if and when chemotherapy is needed. Our researchers also initiated a multicenter phase II study showing that the combination of cetuximab, bevacizumab, and conventional chemotherapy resulted in increased tumor shrinkage and slowed tumor progression.

Interventional Radiology

Interventional radiologists use non-surgical, catheter-directed techniques which may improve the quality of life of patients with colorectal cancer and increase their survival. They have extensive expertise in combination therapies that deliver therapy directly to tumor tissues. One study showed that appropriately selected colon cancer patients who had these procedures lived twice as long as those who received conventional intravenous chemotherapy alone.

Radiation Therapy

Some patients with rectal or anal cancer benefit from radiation therapy. At Weill Cornell, radiation oncologists use new targeted techniques such as intensity-modulated radiation therapy (IMRT) or intraoperative brachytherapy to treat rectal cancer. IMRT is a type of three-dimensional radiation therapy that uses sophisticated computer software and medical imaging to deliver targeted high-intensity radiation directly to tumors with greater precision than conventional radiation therapy. Intraoperative brachytherapy, another targeted form of treatment, involves the placement of radioactive substances directly on tumor tissue during surgery to kill cancer cells.

Learn more about radiation therapy for colorectal cancer.

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