Once you have received a diagnosis of colorectal cancer, you and your medical team will discuss treatment, which depends on the stage of your cancer, that is, how far it has spread, said Joseph Ruggiero, MD, a medical oncologist and professor emeritus of clinical medicine.
Doctors stage colon cancer and rectal cancer differently. Staging rectal cancer requires CAT scanning and an MRI of the pelvis to assess a tumor’s size and whether it has infiltrated lymph nodes. Staging cancer above the rectum also involves a CAT scan, as well as analysis of the tumor and regional lymph nodes excised during surgery, Dr. Ruggiero explained.
After staging, your doctors will design a course of treatment, which is often multidisciplinary. “Overall, the highest cure rates with the least toxicity occur with multiple treatment types,” Dr. Ruggiero said. Although most patients with colon cancer require surgery, surgery alone may not produce the best outcome, he said. “Patients may require preoperative chemotherapy and radiation to shrink their tumor and prevent spread before the surgeon even operates, which has led to marked improvements in outcomes with reduced toxicity,” he said.
If the 5-6-week chemotherapy/radiation regimen is too inconvenient, then you may opt for a one-week course of radiation, which would allow you to complete your treatment sooner, said radiation oncologist, Encouse Golden, MD, Ph.D. “It's a lot more convenient, and patients who select one versus the other have similar outcomes,” Dr. Golden said.
Weill Cornell Medicine uses a state-of-the-art MRI-guided radiation therapy machine, called a MRIdian, for shorter course regimens, which allows doctors to target a tumor with limited side effects. “This precision ensures that we're sparing the normal organs while focusing the radiation on our target, including at-risk areas of disease within the pelvis, and the primary tumor,” Dr. Golden said.
Today, much colorectal cancer surgery is minimally invasive, laparoscopic, or robotic, explained Heather Yeo, MD, MHS, Associate Professor of Surgery. “If patients are able to have minimally invasive surgery, depending on their cancer, usually their recovery is a little bit quicker,” Dr. Yeo said. “If they have standard open surgery, they recover just as well but may be in the hospital a little bit longer,” she added. The average length of stay for colorectal surgery in the United States is five days.
Of course, most treatments for colorectal cancer have side effects. “Patients often have fatigue, appetite changes, and changes in bowel habits, depending on the type of procedure they’ve undergone,” Dr. Yeo said. Patients who have standard colon surgery typically regain normal GI and bowel function. Those who have a colostomy--when the colon is brought up through the abdominal wall--or an ileostomy—when the small bowel is brought up through abdominal wall--may have lifetime side effects. Yet, patients can still work, play, exercise and have an active sexual life. “Their quality of life long-term is very high,” she said.
For the first two years after surgery, your doctors will monitor you closely. They also may ask you to consider preventative chemotherapy. “Preventative chemotherapies after colonic surgery have dramatically improved the cure rates,” Dr. Ruggiero noted.
Overall, improvements in medical technology have dramatically improved colorectal cancer treatment and survival. Said Dr. Golden, “Patients in the next five to 10 years, will be able to benefit from recent advances, so, there's a lot to look forward to.”