08/09/2018

Understanding colon cancer treatment options

There are several ways to treat colon cancer depending on stage and type. Learn more about treatment options:

Surgery
Chemotherapy
Radiation
Colon Cancer Screening

You just found out you or a loved one has colon cancer. Now it’s time to consider your treatment options. The first thing you should know is that at the Nancy N. and J.C. Lewis Cancer & Research Pavilion, we take a multi-disciplinary team approach to your cancer and that you will be well cared for.

The Gastrointestinal (GI) Cancer Team meets weekly to discuss cases of patients with colon, stomach, esophageal, liver and other cancers of the GI tract. The team is comprised of gastroenterologists, surgeons, medical oncologists, radiation oncologists, nurse navigators and others.

Dr. Travis Wiggins
Dr. Travis Wiggins, gastroenterologist with Gastroenterology Consultants of Savannah and St. Joseph’s/Candler GI department chairman

Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, excluding skin cancers. The American Cancer Society estimates in 2018 97,220 new cases of colon cancer and 43,030 new cases of rectal cancer will be diagnosed.

Additionally, colorectal cancer is the third leading cause of cancer-related deaths in men and women in the U.S. It’s expected to cause about 50,603 deaths in 2018, according to the American Cancer Society.

The good news is that the death rate from colorectal cancer has been dropping in both men and women for several decades. One reason for this is screening colonoscopies. Colonoscopy allows physicians to find polyps – a small clump of cells on the lining of the colon and rectum – and removing them before they develop into cancers and/or cancer being detected earlier when it is easier to treat.

“Colon cancer is unique among other cancers in that it is potentially preventable,” says Dr. Travis Wiggins, gastroenterologist with Gastroenterology Consultants of Savannah and St. Joseph’s/Candler GI department chairman. “The way that is achieved is by removing pre-cancerous polyps at the time of colonoscopy before they turn into cancer. More often than I would like, I diagnose individuals with cancer in their 50s and 60s who have never had a colonoscopy, and I can’t help but think to myself, ‘If only they had undergone screening earlier.’”

Related Article: Don’t fear the colonoscopy

A colorectal cancer treatment plan is determined by the location, size and stage of the tumor. While each case is individualized, it’s important for patients to understand their options.

Surgery

For most colon cancers, surgery is the primary treatment. In most cases, the section of the colon containing cancer is removed. Occasionally the entire colon needs to be removed in patients with more than one area of cancer or in those with hereditary cancer syndromes, says Dr. Wiggins.

The majority of colon cancer surgeries are minimally-invasive procedures. Very rarely does this cancer require open resection. Jeffrey Mandel, M.D., F.A.C.S., surgeon with SouthCoast Health – Surgery and member of the LCRP GI cancer multi-disciplinary team, approaches most colon cancer surgeries laparoscopically, a minimally-invasive procedure that uses slender tools through small incisions in the body.

Another minimally-invasive surgical option is robotic surgery with the da Vinci Surgical System. Using instruments controlled by the surgeon at the da Vinci console, it also requires only small incisions in the body.

Dr. Mandel says that prior to undergoing surgery, patients will have a CT scan of their chest, abdomen and pelvis, and blood work also will be required. The day before surgery, patients will have to undergo a bowel prep, just as one does prior to a colonoscopy.

Dr. Mandel
Dr. Jeffrey Mandel, surgeon with SouthCoast Health – Surgery and member of the LCRP GI cancer multi-disciplinary team

Following surgery, patients can expect to be in the hospital anywhere from two to five days. Patients will be given IV fluids until they are able to eat again. Once a patient passes gas, they can begin real food and go home.

The long-term side effects of colon cancer surgery are minimal. As with any surgery, Dr. Mandel says most patients experience short-term discomfort. Some patients may experience one or two more bowel movements daily; however, patients can continue to eat normal foods. Only in rare circumstances do patients require an ostomy, and many times for those who do this is temporary.

“Most people do pretty well and are back on their feet doing what they would normally do two to three weeks after surgery,” says Dr. Mandel.

Early stage cancers can often be treated with surgery alone. Higher stage cancers and those at risk of recurrence may require chemotherapy and/or radiation therapy in addition to their surgery.

Chemotherapy                                                 

“Basically, at stage 3 and above, meaning there is lymph node involvement, you are going to get chemo,” Dr. Mandel says. “There are a few cases, if you are young, for example, where someone may get chemo for stage 2, but usually it’s just patients who are stage 3 and 4.”

Chemotherapy typically begins about two to three weeks following surgery so the patient has time to heal. Chemo cycles vary in length, depending on which chemotherapy agents are used, says Sheila M. Lowe, RN, CWOCN, oncology patient navigator at the LCRP.

One regiment involves the use of a pump, which is worn 24 hours a day. The pump is refilled every week. Another option, if insurance approves it, is an oral chemo agent. The most common treatment is intravenous chemotherapy, which typically is given every three weeks for 12 cycles lasting about six months.

Occasionally patients with rectal cancer may require neoadjuvant chemo and radiation, which is therapy prior to surgery. Neoadjuvant chemo and radiation can decrease the chances of local recurrence of the cancer. Also, patients with stage 4 metastatic cancer – meaning the cancer has spread elsewhere – may get chemo prior to surgery.

Given together before surgery, chemo and radiation can shrink the tumor, says Lowe. Typically, patients can expect roughly two months of treatment, and then have surgery six to eight weeks later. Patients should be aware that chemotherapy may still be needed after surgery.

Radiation

Most colon cancer patients do not require radiation treatments. Usually the cancer can be destroyed through surgery and/or chemo. The decision for the need for radiation treatments is based on the location of the tumor (usually reserved for rectal cancers), stage of the tumor, lymph node involvement and whether or not the cancer has spread, Lowe says.

Radiation treatment can be given before or after surgery. Typically, radiation therapy is given in 25 to 28 treatments, which is approximately five and a half weeks because treatments are Monday through Friday, Lowe says. At this time, colorectal patients are treated on the TrueBeam machine, which delivers a radiation beam that targets the cancer and keeps exposure to healthy cells to a minimum.

Follow-up

Follow-up is extremely important for all cancer survivors. Colon cancer patients can expect appointments with members of their medical team every three months for the first two years and then every six months for the next three years, Dr. Mandel says. At five years, they are considered cured.

However, patients with colon cancer that has been removed and cured remain at elevated risk for developing cancer again in another part of the colon, Dr. Wiggins says. It is important for them to have ongoing follow-up colonoscopy evaluations, he says.

“Also, having a diagnosis of colon cancer means that individual’s first-degree relatives are at an elevated risk of colon cancer,” adds Dr. Wiggins. “Those relatives should initiate colon cancer screening via colonoscopy at the age of 40, or 10 years earlier than the age of diagnosis of the affected relative, whichever comes first.”

Screening

Both Dr. Wiggins and Dr. Mandel stress the importance of routine colonoscopies. Most only need a colonoscopy every 10 years. It’s a safe and well-tolerated procedure, Dr. Wiggins says.

The recommendation of when to begin screening has recently changed due to a disturbing trend in the age of diagnosis of colon cancers.

“Over the past 10 years, an increasing number of patients are being diagnosed in their 30s and 40s. We do not have a clear explanation as to why this is occurring,” Dr. Wiggins says. “As a result, however, the American Cancer Society has changed the recommendation to begin colon cancer screening at the age of 45 years instead of 50 years.”

Related Article: A disturbing new trend: Studies have revealed a rise in colorectal cancer rates among younger adults

Patients may want to check with their insurance companies to see at what age a colonoscopy is covered.

“Colon cancer rates have been coming down since people have been screening, but it’s still a fairly high number that don’t get their routine screening,” Dr. Mandel says. “It breaks your heart when someone comes in at 55, 60 or 65 and has never had a colonoscopy and has cancer that has spread.”

 

Also In This Series:
 

  • St. Joseph's Hospital Campus: 11705 Mercy Blvd., Savannah, GA 31419, (p) 912-819-4100
  • Candler Hospital Campus: 5353 Reynolds St., Savannah, GA 31405, (p) 912-819-6000
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St.Joseph's Hospital Campus: 912-819-4100

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