Colorectal cancer treatment
Treatment of colorectal cancer can involve surgery, chemotherapy, radiation, immunotherapy, targeted therapy or a combination of multiple therapies. Your doctor will talk to you about the best options that fit your situation.
Colon cancer treatment
The main treatment for colon cancer is surgical removal of the tumor by removing a section of the colon that includes the tumor and healthy bowel on either side.
In the past, many operations involved the formation of a colostomy, which meant wearing a bag on the abdominal wall to collect bowel movements. Fortunately, surgery has progressed significantly in recent decades, and now only rarely involves creation of a colostomy.
Most operations are now performed minimally invasively using laparoscopy or a surgical robot. These approaches use small incisions in the abdomen to introduce a camera and surgical instruments to conduct the operation without the need for a large incision. Minimally invasive techniques have been shown to help patients recover more quickly and with less pain.
Chemotherapy or radiation therapy may be recommended before surgery to shrink the tumor. After surgery, the need for chemotherapy, targeted therapy or immunotherapy is decided primarily on the basis of whether the cancer has spread to the lymph nodes.
Rectal cancer treatment
Non-operative management
Patients with locally advanced rectal cancer are recommended to proceed with total neoadjuvant therapy (TNT). This means patients receive both chemotherapy and radiation prior to surgery in an effort to shrink the tumor and, in some cases, treat the tumor completely.
By giving patients chemotherapy and radiation before surgery, the multidisciplinary team at Hollings has seen a complete clinical response rate (no evidence of cancer) in up to 40% of patients. This group of patients who have a complete clinical response following TNT may not require surgery at all.
However, patients who show a complete clinical response do require monitoring with MRI and sigmoidoscopy every three months for three years to ensure there are no signs of the disease returning. This non-operative “watch and wait” approach depends on close adherence to the surveillance regimen to detect tumor regrowth early, if it occurs. With early detection, patients can still be treated with curative intent surgery.
Surgical procedures
In cases in which the tumor is still present after TNT, the next step will depend on the stage of the cancer and tumor location within the rectum.
Local excision: For small stage I rectal cancers that are less than 3 centimeters in size, removal of the tumor through the anal canal with preservation of the rectum may be considered.
Low anterior resection with anastomosis involves removing the portion of the rectum where the tumor is located, including the fatty tissue that surrounds the rectum (mesorectum) and houses the lymph nodes. A new connection is made between the colon and lower rectum. This may require a temporary diverting ostomy to allow the new connection to heal completely.
Abdominoperineal resection is generally reserved for tumors invading the anal sphincter muscles. This procedure requires removal of the anal canal and sphincter muscles in addition to the rectum with creation of a permanent colostomy. This may be considered in patients with advanced tumors involving the sphincter muscle or patients with pre-existing incontinence that may prefer a colostomy.
Minimally invasive approaches
At Hollings, the surgical procedures above are most commonly performed minimally invasively (i.e., with small incisions), which permits a faster recovery and improved quality of life. These approaches include:
- Robotic surgery: Uses advanced surgical instruments through small incisions with 3D imaging and wristed instruments to allow for delicate maneuvers in small spaces. The robotic platform is particularly well adapted to surgery within the confines of the pelvis.
- Laparoscopy: Uses small incisions to deploy multiple instruments to accomplish all the goals of traditional large incision surgery with a faster patient recovery and equivalent oncological outcomes.
- Transanal Minimally Invasive Surgery (TAMIS): Laparoscopic surgery through the anal canal, avoiding any abdominal incisions, to remove the tumor but keep the rectum in place. This approach frequently allows patients to go home on the same day as their surgery. TAMIS may be appropriate for selected small, early cancers that historically may have required removal of the rectum.
- Transanal Total Mesolectal Excision (TaTME): A hybrid minimally invasive surgery using a combined transanal and transabdominal approach for low rectal tumors in an attempt to preserve the anal sphincter muscles and prevent a permanent ostomy.
Maximizing quality of life
In all therapies, the goal of the Hollings team is to treat the cancer and also to avoid post-surgical complications, avoid the need for a colostomy, and maximize your quality of life.
It is important to remember that treatment for rectal cancer is individualized and must consider both the stage and location of the tumor. The team also considers your values and goals as the patient, taking into consideration your current bowel function, social support and network.
Establishing an individualized treatment plan is a dialogue between you and the surgeon in which the surgeon helps to explain the rationale for each treatment and the potential outcomes to allow you to make an informed decision and take ownership over your cancer care.
Make an appointment
To make an appointment with a colorectal cancer care provider, please call 843-792-9300.
Refer a colorectal cancer patient
Physicians: to refer a colorectal cancer patient to Hollings, please call patient referral coordinator Tosha Lockett at 843-876-4098.
Nurse navigator support
Our gastrointestinal cancer nurse navigator Sara Sneed, BSN, RN, will help you understand what to expect during treatment and answer questions you may have.
