Treatment Options for Colon and Rectal Cancer


There are different types of treatment for patients with bowel cancer.
 
Some treatments are standard (the currently used treatment), and some are being tested in clinical trials.
 
Treatment for bowel cancer is decided by: 
  • Where the cancer is in your bowel
  • How big the tumour is
  • The number, size and position of any tumours outside the bowel (including lymph nodes)
  • The type of cancer cells – their cell type and genetic makeup
  • Your general health and fitness
  • Your wishes as the patient
It will also be determined by:
  • Medical guidelines for best practice in treating bowel cancer
  • The availability of different treatment options within your local hospital
  • The access to clinical trials available within your local hospital
  • How well you respond to the treatments
  • The impact of any side-effects you may experience as a result of treatment
There is a combination of treatments given to treat bowel cancer, depending on where the cancer is within your body.  
 
Download Bowel Cancer Australia's Treatment Options Matrix and Bowel Cancer Australia's Bowel Cancer Treatment Flowchart which provide a summary of what your options might be, according to your own individual diagnosis.
 
Once your specialist team have received the results of your tests and fully understand the extent of the cancer, they will be able to discuss your diagnosis and what your treatment options might be.

Colon Cancer
 
There are different types of treatment for patients with colon cancer.
 
Six types of standard treatment are used:

Surgery Removing the cancer during an operation is the most common treatment for all stages of colon cancer. 

Radiofrequency ablation Radiofrequency ablation is the use of a special probe with tiny electrodes that kill cancer cells.  Sometimes the probe is inserted directly through the skin and only local anesthesia is needed.  In other cases, the probe is inserted through an incision in the abdomen.  This is done in the hospital with general anesthesia.

Cryosurgery Cryosurgery is a treatment that uses an instrument to freeze and destroy abnormal tissue.  This type of treatment is also called cryotherapy. 

Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. 

Radiation Therapy Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.  This type of treatment is also called radiotherapy.

Targeted Therapies Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.  Types of targeted therapies used in the treatment of colon cancer include monoclonal antibodies and angiogenesis inhibitors.

 
Depending on the stage and location of your cancer, you may be recommended either one or a combination of these treatments.  
 
For some patients, taking part in a clinical trial may be the best treatment choice.  Clinical trials are taking place in many parts of Australia and around the world, visit Bowel Cancer Australia's Clinical and Treatment Trials webpage for more information. 
 
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working.  Decisions about whether to continue, change or stop treatment may be based on the results of these tests.  This is sometimes called re-staging.
 
Some of the tests will continue to be done from time to time after treatment has ended.  The results of these tests can show if your condition has changed or it the cancer has recurred (come back).  These tests are sometimes called follow-up tests or check-ups.

Treatment Options for Colon Cancer
 
Stage 0
(Carcinoma in Situ)

Treatment of stage 0 (carcinoma in situ) may include the following types of surgery:

  • Local excision or simple polypectomy 
  • Resection and anastomosis.  This is done when the tumour is too large to remove by local resection.
 
Stage I Colon Cancer 

Treatment of stage I colon cancer usually includes the following:

  • resection and anastomosis
 
Stage II Colon Cancer 
Treatment of stage II colon cancer may include the following:

  • Resection and anastomosis which may be followed by chemotherapy
  • Clinical trials of new chemotherapy regimens after surgery
 

Stage III Colon Cancer 
Treatment of stage III colon cancer may include the following:

  • Resection and anastomsis which may be followed by chemotherapy
  • Clinical trials of new chemotherapy regimes after surgery
 

Stage IV and Recurrent Colon Cancer 
Treatment of stage IV and recurrent colon cancer may include the following:

  • Local excision for tumours that have recurred
  • Resection with or without anastomosis
  • Surgery to remove parts of other organs, such as the liver, lungs, and ovaries, where the cancer may have recurred or spread


Treatment of cancer that has spread to the liver may also include the following:

  • Chemotherapy given before surgery to shrink the tumour, after surgery, or both before and after
  • Radiofrequency ablation or cryosurgery, for patients who cannot have surgery
  • Chemoembolisation of the hepatic artery
  • Radiation therapy or chemotherapy may be offered to some patients as palliative therapy to relieve symptoms and improve quality of life
  • Chemotherapy and/or targeted therapy with a monoclonal antibody or an angiogenesis inhibitor
  • Clinical trial of chemotherapy and/or targeted therapy
 
Treatment for areas of cancer that has spread the lung or ovaries is surgery.
 

  
Rectal Cancer 
 
There are different types of treatment for patients with rectal cancer.
 
Four types of standard treatment are used:

Surgery Surgery is the most common type of treatment for all stages of rectal cancer.

Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. 

Radiation Therapy Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.  This type of treatment is also called radiotherapy.

Targeted Therapies Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.  Types of targeted therapies used in the treatment of colon cancer include monoclonal antibodies and angiogenesis inhibitors.

 
Depending on the stage and location of your cancer, you may be recommended either one or a combination of these treatments.  
 
For some patients, taking part in a clinical trial may be the best treatment choice.  Clinical trials are taking place in many parts of Australia and around the world, visit Bowel Cancer Australia's Clinical and Treatment Trials webpage for more information. 
 
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working.  Decisions about whether to continue, change or stop treatment may be based on the results of these tests.  This is sometimes called re-staging.
 
Some of the tests will continue to be done from time to time after treatment has ended.  The results of these tests can show if your condition has changed or it the cancer has recurred (come back).  These tests are sometimes called follow-up tests or check-ups.
 
After treatment for rectal cancer, a blood test to measure amounts of carcinoembryonic antigen (a substance in the blood that may be increased when cancer is present) may be done to see if the cancer has come back.
 

Treatment Options for Rectal Cancer
 
Stage 0
(Carcinoma in Situ)

Treatment of stage 0 (carcinoma in situ) may include the following types of surgery:

  • Simple polypectomy
  • Local excision
  • Resection (when the tumour is too large to remove by local excision)
  • Internal or external radiation therapy
   
Stage I
Rectal Cancer 

Treatment of stage I rectal cancer usually includes the following:

  • Local excision
  • Resection
  • Resection with radiation therapy and chemotherapy before and after surgery
 
Stage II
Rectal Cancer
Treatment of stage II rectal cancer may include the following:
 
  • Resection plus a combination or chemotherapy and radiation therapy before or after surgery
  • Resection with or without chemotherapy after surgery
  • A clinical trial of a new treatment
 

Stage III
Rectal Cancer
Treatment of stage III rectal cancer may include the following:
 
  • Resection plus a combination of chemotherapy and radiation therapy before or after surgery
  • Resection with or without chemotherapy after surgery
  • A clinical trial of a new treatment
 

Stage IV and Recurrent Rectal Cancer
Treatment of stage IV and recurrent rectal cancer may include the following:
 
  • Resection with or without a combination of radiation therapy and chemotherapy before surgery
  • Resection or pelvic exenteration, as palliative therapy to relieve symptoms and improve the quality of life
  • Radiation therapy, chemotherapy, or a combination of both, as palliative therapy to relieve symptoms and improve the quality of life
  • Chemotherapy to control the growth or the tumour
  • Placement of a stent to help keep the rectum open if it is partly blocked by the tumour, as palliative therapy to relieve symptoms and improve the quality of life
  • Systemic chemotherapy with or without monoclonal antibody therapy, such as Avastin (bevacizumab)
  • A clinical trial of a new anticancer drug
     

Treatment of rectal cancer that has spread to other organs depends on which organ the cancer has spread to.
 

Treatment for areas of cancer that have spread to the liver includes the following:

  • Cryosurgery or radiofrequency ablation
  • Chemoembolisation or systemic chemotherapy
  • Internal radiation therapy
  • Surgery to remove the tumour.  Chemotherapy may be given before surgery to shrink the tumour.
  • A clinical trial of chemoembolisation combined with radiation therapy to the tumours in the liver
 
Treatment areas of cancer that has spread to the lung or ovaries is surgery.


 
Treatment Options for Anal Cancer
 
Anal cancer is a very rare form of bowel cancer and the treatment for this is quite specialised.  
 
Please see our Bowel Cancer Australia's Anal Cancer webpage for more information. 
 
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