Colorectal Cancer Treatment Options

Treatment options for young-onset colorectal cancer depends on the stage and location of the disease, as well as your overall health.

Is colorectal cancer curable?

Colorectal cancer is a highly treatable and often curable disease.  This usually depends on where the cancer has spread and the response to treatment.

Colon cancer

Surgery

The most common treatment for colorectal cancer is surgery. Procedures may involve the removal of tumors, the area of the colon where the tumor was found, surrounding healthy tissue and nearby lymph nodes.

Early-stage colon cancer

If the cancer is very small and contained to a polyp, your doctor may be able to remove it completely during a colonoscopy. For polyps that are too large to remove during a colonoscopy, a surgeon may perform laparoscopic colon surgery.

Washington University colon and rectal surgeons are experts in minimally invasive laparoscopic and robotic surgery, which involves smaller incisions than traditional open surgery. It usually leads to fewer complications, a shorter hospital stay and a faster recovery.

Advanced colon cancer

If your cancer has spread into or through your colon, your surgeon may recommend more invasive surgical approaches. These may include partial colectomy, colostomy or lymph node removal.

For more advanced colon cancer, your surgeon may recommend an operation to relieve a blockage in your colon. The goal of this procedure is not to cure cancer, but rather to alleviate symptoms and improve your quality of life.

Radiation therapy

While radiation therapy is not commonly used to treat colon cancer, it may be used in certain cases, such as:

  • Before surgery to help shrink the tumor, making it easier to remove.
  • During or after surgery to kill any cancer cells that have been left behind.
  • In conjunction with chemotherapy for patients who aren’t healthy enough for surgery.
  • To ease symptoms in patients with more advanced cancers.
  • To help treat cancer that has spread to other areas of the body.
Will this therapy make me radioactive?

No, radiation therapy doesn’t cause you to become radioactive. The radiation is produced by our machine and there is no radioactivity inside of your body once the beam is turned off.

What are the side effects of radiation therapy?

Following radiation therapy, some patients may experience:

  • Fatigue
  • Diarrhea or constipation
  • Skin problems
  • Hair loss (in the treatment area)

Speak to your care team about any side effects you may be experiencing. There are steps they can take to help you feel better.

Rectal cancer

Surgery

The most common treatment for all stages of rectal cancer is surgery. If the tumor does not directly involve the anal sphincter muscle or pelvic floor, surgeons at Siteman are often able to remove it while leaving these structures intact, allowing patients to avoid a permanent colostomy and maintain normal bowel function.

Early cancers can also be amenable to transanal endoscopic microsurgery (TEM). This advanced, minimally invasive procedure is used to remove tumors high inside the rectum.

What is an ostomy? Will I need one?

An ostomy is a mechanism that allows for the drainage of waste if the colon is unable to function. Surgeons will create an opening (stoma) from the colon to the outside of the body. A bag covers the opening and collects stool as it drains. In most cases, ostomies are temporary measures that allow the colon to heal after surgery. This is rarely a long-term solution for colon cancer patients.

I'm self-conscious about having an ostomy bag. Will it be visible through clothing?

Ostomy bags are designed to be slim and to block any smell from escaping, which can make them practically undetectable underneath clothes. There are ways to conceal your bag in almost any situation. There are articles of clothing (including swimwear and underwear) specially designed to help conceal your bag. You can also get decorative sleeves and pouches designed for ostomy bags for everyday use.

Can you swim with an ostomy bag?

You can still swim with an ostomy bag! They are specially designed to be water-resistant. Some adjustments (like ensuring a good seal before and after swimming, and protecting your stoma in situations where it may be bumped or irritated) are unavoidable, but such adjustments do not mean you have to abandon your favorite activities.

Radiation therapy

This type of therapy uses high-energy beams to kill cancer cells. It may be used alone or in conjunction with chemotherapy and/or surgery to treat rectal cancer. This treatment can help shrink tumors prior to surgery or may be used during surgery to kill any remaining cancer cells.

While the standard of care for rectal cancer has historically involved surgical resection, Washington University physician investigators at Siteman Cancer Center are pioneering short-course radiation therapy followed by chemotherapy for nonoperative management of rectal cancer. Many patients may experience a complete response to therapy without surgery. This may permit less time away from work and daily life activities and possibly improved rectal function.

Radiation therapy may be particularly beneficial for patients whose cancer has spread to the lymph nodes or beyond the wall of the rectum. It is also recommended for patients with locally recurrent rectal cancer.

Will this therapy make me radioactive?

No, radiation therapy doesn’t cause you to become radioactive. The radiation is produced by our machine and isn’t active after treatment.

What are the side effects of radiation therapy?

Following radiation therapy, some patients may experience:

  • Fatigue
  • Diarrhea or constipation
  • Skin problems
  • Hair loss
  • Loss of appetite
  • Fertility issues
  • Decreased libido or ability to enjoy sex
  • Low blood counts
  • Difficulty controlling bladder
  • Nausea and vomiting

Speak to your care team about any side effects you may be experiencing. There are steps they can take to help you feel better.

“Watch and wait” (nonoperative management)

Nonoperative management can allow some rectal cancer patients to avoid surgery altogether. For patients with locally advanced cancers, the standard of care is chemotherapy and radiation given prior to surgery (neoadjuvant chemoradiotherapy). If the tumor disappears, our rectal cancer specialists will “watch and wait” to make sure the tumor doesn’t come back (complete clinical response). If the tumor does come back, surgery may be considered.

Patients who achieve a complete clinical response after being treated with nonoperative management will need to come in for regular screenings. However, “watch and wait” helps reduce the risk of surgical complications, problems with incontinence or sexual health, and the need for a permanent ostomy.

Colon and rectal cancers

Chemotherapy

This type of therapy uses drugs to kill cancer cells. These drugs may be administered by mouth or by injection into a vein. For both colon and rectal cancers, chemo is often given prior to surgery in conjunction with radiation therapy to shrink tumors and make them easier to remove. It may also be given after surgery to kill any remaining cancer cells and to reduce the risk of recurrence.

Will chemotherapy make me lose my hair?

Fortunately, the chemotherapy drugs that treat colon cancer usually don’t cause hair loss. Your treatment team will work proactively to manage and alleviate other common side effects, such as nausea and neuropathy. Your doctor can prescribe anti-emetic drugs to treat nausea and, ideally, prevent it before it starts.

What is neuropathy?

Neuropathy is a side effect of chemotherapy that causes tingling and numbness in the hands and feet. Let your care team know about any symptoms you may have, as there are ongoing clinical trials at Siteman investigating new methods and solutions for this condition. If your neuropathy can’t be controlled, you may need to stop chemotherapy. The good news is that neuropathy resolves over time for most patients.