The fundamentals of colon cancer treatment

Colon cancer treatment depends upon the stage and spread of the disease. Read the article to learn what are the different treatment protocols for each stage of the disease, and how metastasis of colon cancer is managed.

1.Treatment According to Stage:

Cancer that is present in different stages responds variably to cancer therapy. Those in the earlier stages have the best prognosis. For this reason, treatment options for colon cancer in the various stages of the disease vary widely. These are the common treatment modalities for each stage:

Stage 1

At this stage, colon cancer cells can be removed completely using surgical interventions. This stage has low chances of recurrence and commonly, no further treatment is necessary.

Stage 2 

Patients who suffer from stage 2 colon cancer can also be treated using surgical interventions. However, recurrence is high. In effect, chemotherapy may be needed to prevent recurrence.

Stage 3
Compared with stage 2 colon cancer, there may be a greater risk that cancer will recur following the surgery. At this stage, chemotherapy is commonly recommended. Monoclonal antibodies are also being studied in clinical trials along with chemotherapy to reduce chances of recurrence.

Stage 4

At this stage, colon cancer has metastasized to distant sites. If cancer has spread to areas near the bowel, it is called local spread, and if it has spread to other areas of the body i.e. the lungs and liver, it is called metastatic cancer or secondary cancer. Stage 4 cancer is almost impossible to cure. Common treatment options are directed to control cancer and to reduce associated symptoms of colon cancer such as pain. Some of the treatment options considered for stage 4 colon cancer includes:

Chemotherapy – given via IV injection or IV drip or may be taken as capsules or tablets.

Surgery – may be required to remove cancer growth that has blocked the lumen of the colon.

Radiotherapy – may be done before surgery to make the tumor size smaller and more amenable to surgical removal.

Monoclonal Antibodies – drugs such Bevacizumab (Avastin®), Cetuximab (Erbitux®) and Panitumumab (Vectibix®) may also be given to control the rate of colon cancer growth.

2.Pros and Cons of Treatment

Without a doubt, having colon cancer is a frightful condition. However, seeking treatment may be an equally stressful situation, especially due to the well-known side effects associated with the treatment options for colon cancer. Although the side effects are uncontrollable, medicines are available to make side effects more bearable.

Treatment may vary for different reasons, and the potential benefits or disadvantages will vary individually or on a case-to-case basis. It would be best to consult, the physician or the members of the healthcare team for the pros and cons of each type of treatment.

3.Treatment for Metastatic Colon Cancer

Metastatic colon cancer is commonly treated with systemic therapy (i.e. Chemotherapy, biological therapy, hormonal therapy and targeted therapy), local therapy (i.e. Radiotherapy and surgery), or the combination of two. The type of treatment will depend on the nature of primary cancer; the location, size, number of tumors that metastasized, patient’s age as well as the patient’s overall health condition and even the past treatments employed by the patient.

Surgery – Surgery is unlikely used during metastatic cancer, especially if cancer has spread to multiple locations in the body. The removal of the primary tumor is less likely cure the colon cancer. Surgery is often conducted to reduce symptoms, prolong and improve the quality of life of the patient. Chemotherapy may also be initiated before the surgery is started to reduce the tumor size.

Chemotherapy– Chemotherapy is a standard treatment option for metastatic colon cancer and may be used before or after surgery. The primary objective in chemotherapy is the reduction of tumor size, control of growth and prevention of the spread of cancer. Common drugs used for chemotherapy include 5-FU, Irinotecan, Capecitabine, Leucovorin, Bevacizumab and Cetuximab, among others.

4.Factors that Affect Treatment

With the advancement of medical technology in the treatment of colon cancer, multiple methods of treatment have been developing and careful consideration of different factors are evaluated to determine the appropriate treatment, depending on the case.

Factors that may affect the choice of therapy, as well as the chance of recovery, may vary in every case. The same treatment modalities for colon cancer may work differently for different individuals due to variations in:
Cancer stage, commonly, 90% of patients with stage I colorectal cancer will survive for five years, only 87% of those in stage II, 50% of those in stage III and only about 10% can survive for five years for those with widespread disease.

Presence of obstruction or perforation

Completeness or quality of surgical removal of cancer cells

Levels of carcinoembryonic antigen (CEA)

Presence of cancer recurrence

Patient’s overall health

Dr. Adem Gunes
Dr. Abdullah El-Hossami