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Colon Cancer Treatment Options

The treatment choice for colon cancer depends mainly on the location of the tumor and the stage of the disease. Treatment may include one or more of the following:1 colonoscopy, chemotherapy, biological therapy, radiation therapy or surgery - the most common treatment for colon cancer.

Your doctor can discuss treatment options in detail, expected side effects and results. You and your doctor can work together to develop a treatment plan that meets your needs.

Colonoscopy/Polypectomy

A colonoscopy is an effective way to exam the full lining of the colon and rectum to screen for early signs of cancer, but during your colonscopy, small potentially cancerous polyp can also be removed (polypectomy).

Your doctor will give you important instructions on how to cleanse your bowels prior to the colonoscopy. The day of the procedure, patients are given a light sedative although deeper sedation may be required in some cases. The doctor inserts a colonoscope (long, flexible tube with a small camera attached) into the anus and slowly guides it through the rectum and colon. Once the scope reaches the opening to the small intestine, it is slowly withdrawn and the lining of the large intestine is examined again. The procedure typically lasts thirty to sixty minutes. Cramping or bloating may occur the first hour afterwards. Colonoscopy is an out-patient procedure full recovery is expected the next day.

Chemotherapy

Chemotherapy uses anticancer drugs to kill cancer cells. The drugs enter the bloodstream and can affect cancer cells all over the body. Anticancer drugs are usually given through a vein, but some may be given by mouth. You may be treated in as an out-patient, in the doctor's office, or at home. Rarely, a hospital stay may be needed.

The side effects of chemotherapy depend mainly on the specific drugs and the dose. Side effects can include: infection, bruising or bleeding easily, fatigue, hair loss, poor appetite, nausea and vomiting, diarrhea or mouth sores. Your health care team can suggest ways to control many of these side effects. Most side effects usually go away after treatment ends.

Biological Therapy

Some people with colon cancer that has spread receive a monoclonal antibody - a type of biological therapy. The monoclonal antibodies bind to colon cancer cells. They interfere with cancer cell growth and the spread of cancer. People receive monoclonal antibodies through a vein at the doctor's office, hospital, or clinic. Some people receive chemotherapy at the same time.

Side effects depend mainly on the monoclonal antibody used. Side effects may include rash, fever, abdominal pain, vomiting, diarrhea, blood pressure changes, bleeding, or breathing problems. Side effects usually become milder after the first treatment.

Radiation

Radiation therapy (also called radiotherapy) uses high energy x-rays to kill cancer cells. It affects cancer cells only in the treated area. Doctors use different types of radiation therapy to treat cancer. Sometimes people receive two types:

External radiation:

This type of radiation comes from a machine. Treatment is given at a hospital or clinic five days a week for several weeks.

Internal radiation (implant radiation or brachytherapy):

The radiation comes from radioactive material placed in thin tubes put directly into or near the tumor. The patient stays in the hospital, and the implants generally remain in place for several days. Usually they are removed before the patient goes home. Intraoperative radiation therapy (IORT) is a type of radiation given during surgery.

Side effects depend mainly on the amount of radiation given and the part of your body that is treated. Radiation therapy to your abdomen and pelvis may cause nausea, vomiting, diarrhea, bloody stools, or urgent bowel movements. It may also cause urinary problems, such as being unable to stop the flow of urine; and your skin in the treated area may become red, dry, and tender.

You are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can. Although the side effects of radiation can be distressing, your doctor can usually treat or control them. Also, side effects usually go away after treatment ends.

Surgery

Surgery is the most common treatment for colon cancer. Colon cancer surgery to remove part of the colon is known as a colectomy, colon resection or hemicolectomy.

Whether your surgery is open or laparoscopic, the goal is the same: to remove the cancer, part of the healthy colon, and nearby lymph nodes. Your surgeon will also check the rest of your intestine and your liver to see if the cancer has spread. Surgery on your right colon (ascending) is called a right colectomy; surgery on your left colon (descending) is a left colectomy; and surgery on the sigmoid colon (lower left colon just before the rectum) is called a sigmoid colectomy. After the cancerous part of the colon is removed, the remaining sections of the bowel are joined together. This reconnection of the colon is known as an anastomosis.

The reconnection is not always possible. In this case, the surgeon creates a new path for waste to leave your body. The surgeon makes an opening (stoma) in the wall of the abdomen, connects the upper end of the intestine to the stoma, and closes the other end. The operation to create the stoma is called a colostomy. A flat bag fits over the stoma to collect waste, and a special adhesive holds it in place. For most patients, the stoma and colostomy bag are temporary and needed only until the colon heals from surgery. After healing, the surgeon reconnects the healthy parts of the intestine and closes the stoma.

Potential side effects of surgery depend on several things, including the extent of the operation and a person’s general health before surgery. Your health care team will monitor you for signs of bleeding, infection, or other problems requiring immediate treatment.

Your options for surgery include:^1,4

Open Colectomy:

The surgeon makes a large cut into your abdomen to access the colon and surrounding areas. Traditional open surgery is very invasive and typically involves more trauma to the body and a long recovery.

Laparoscopic Colectomy:

Early colon cancer may be removed laparoscopically – minimally invasively. Your surgeon uses a thin, lighted tube with a small camera attached (laparoscope) to perform the operation. Small incisions are made in your abdomen to access the colon and surrounding areas. Laparoscopic surgery requires the use of long-handled, rigid instruments which can present limitations during complex and delicate operations that require a greater degree of dexterity.

da Vinci® Surgery for Colon Cancer

If your doctor recommends surgery to treat colon cancer (right, left or sigmoid colectomy), you may be a candidate for minimally invasive da Vinci Surgery. Using the most advanced technology available, the da Vinci SurgicalSystem enables your doctor to perform this delicate operation through a few tiny incisions with breakthrough vision, precision and control. da Vinci Surgery offers colon cancer patients such potential benefits as:

• Low blood loss⁷
• Quick return to bowel function⁸
• Quick return to diet⁸
• Short hospital stay⁸

The da Vinci System is a state-of-the-art surgical platform with 3D, high-definition vision and patented surgical instruments that takes surgery beyond the limits of the human hand. By overcoming the challenges of traditional open and laparoscopic surgery, da Vinci is changing the experience of surgery for people around the world.

• The da Vinci Surgical System
• FAQs
• Am I A Candidate?
• Important Safety Information

As with any surgery, these benefits cannot be guaranteed since surgery is specific to each patient, condition and procedure. It is important to talk to your doctor about all treatment options, including the risks and benefits. This information can help you make the best decision for your situation.