Treatment of Ca. Colon
Management of colon cancer relies primarily on surgical removal of the tumor and some of the surrounding tissues. The need for further treatment with chemotherapy or radiation therapy is determined upon evaluation of the resected cancer. Surgery is the oldest method of treating this cancer with the idea being complete removal of the cancer from the body. Cure is possible in cases where the cancer is limited to the bowel, with no spread to the other tissues. Surgery is done in the hospital and under general anesthesia. Patients may stay in the hospital for 7-10 days after surgery. Chemotherapy may be needed, as indicated by the stage of the illness, and patient's overall condition.
In the laboratory, the pathologist will examine the margins the removed piece of bowel. He will also determine the depth of penetration of the cancer as well as any lymph node involvement. This is referred to as Pathological Staging. The need for further treatment is dependent on the full staging of the cancer.
Treatment Guidelines
Stage 1 or Duke A: Surgery alone can cure a great majority of patients in this stage. There is no need for any future treatments.
Stage 2 or Duke B: Surgery plus Adjuvant Chemotherapy for selected patients, i.e. when cancer has involved the fatty tissues outside of bowel.
Stage 3 or Duke C: Surgery followed by adjuvant chemotherapy in all patients who can tolerate chemotherapy. After completion of chemotherapy.
Adjuvant Chemotherapy: This treatment refers to usage of chemotherapy drugs to reduce the risk of recurrence of the cancer. Adjuvant Chemotherapy should be offered to all patients with stages 2 and 3 (Duke B and C). This is the duty of the surgeon and the medical oncologist to inform each and every patient of the stage of their disease as well as potential treatment options. Adjuvant treatment is given for total of six months. Patients undergoing this treatment should have a Port-A-Cath. Common drugs that are used in this situation are:5-FU (Flurouracil), Leucovorin and Oxaliplatin in a combination known as FOLFOX regimen.
Stage 4 or Duke D: Surgery followed by chemotherapy in all patients who can tolerate chemotherapy. This is a rather difficult condition to treat. Unfortunately, cure is not possible and the goal of treatment is to prolong the survival of the patients and help them with complications of the illness. Chemotherapy should be offered to all patients with stages 4 (Duke D). This is the duty of the surgeon and the medical oncologist to inform each and every patient of the stage of their disease, prognosis as well as potential treatment options. Patients undergoing treatment should have a Port-A-Cath.
Common regimen that are used in this situation are:
5-FU (Flurouracil), Leucovorin and Oxaliplatin in a combination known as FOLFOX regimen,
5-FU (Flurouracil), Leucovorin and Irinotecan in combination
Avastin and Erbitux are two of the newer drugs for treatment of colorectal cancer and are used in conjunction with above two combinations.
Patients who have metastatic disease to liver only, should be considered for surgical removal of the involved section of their liver.
Chemotherapy complications
Chemotherapy is normally well tolerated, however one has to be aware of potential complications and side effects. When the side effects become excessive and severe, chemotherapy should be reduced or discontinues until the side effects resolve. Following is a list of most important side effects:
- Soreness in the mouth
- Abdominal pain
- Diarrhea, with Irinotecan
- Nerve damage from Oxaliplatin
- Sun sensitivity
- Increased tear formation
- Lowering of white blood count
- Anemia
Radiation is reserved for patients who develop metastatic disease to brain, bone or spine.
Follow Up:
After completion of chemotherapy, all patients with Duke B and C disease should be followed carefully with frequent:
Physical examination
Blood tests, CEA
Hemeoccult test
Annual Colonoscopy
