What are the treatment options for colorectal cancer?

Treatment options that may be considered include surgery, chemotherapy and radiotherapy. The treatment advised for each case depends on various factors such as the stage of the cancer (how large the cancer is and whether it has spread), and your general health.

You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side effects, and other details about the various possible treatment options for your type of cancer.

You should also discuss with your specialist the aims of treatment. For example:

• Treatment may aim to cure the cancer. Some colorectal cancers can be cured, particularly if they are treated in the early stages of the disease. (Doctors tend to use the word 'remission' rather than the word 'cured'. Remission means there is no evidence of cancer following treatment. If you are 'in remission', you may be cured. However, in some cases a cancer returns months or years later. This is why some doctors are reluctant to use the word cured.)
• Treatment may aim to control the cancer. If a cure is not realistic, with treatment it is often possible limit the growth or spread of the cancer so that it progresses less rapidly. This may keep you free of symptoms for some time.
• Treatment may aim to ease symptom. If a cure is not possible, treatments may be used to reduce the size of a cancer which may ease symptoms such as pain. If a cancer is advanced then you may require treatments such as nutritional supplements, painkillers, or other techniques to help keep you free of pain or other symptoms.

Surgery
It is often possible to surgically remove the primary tumour. Removing the tumour may be curative if the cancer is in an early stage. The common operation is to cut through the intestine above and below the tumour. The affected section is then removed and, if possible, the two cut ends of intestine are sewn together.

• Sometimes a temporary colostomy is done to allow the joined ends to heal without faeces passing through. The colostomy is often reversed in a second operation a few months later when the joined ends of the intestine are well healed.
• If the tumour is low down in the rectum, then the rectum and anus need to be removed. You would then need a permanent colostomy.

A colostomy is where an opening (hole) is made through the wall of the abdomen. A section of colon is then cut and the edges are attached to the opening in the abdominal wall. This is called a stoma and it allows faeces to pass out from the colon into a disposable bag which is stuck over the stoma.

Even if the cancer is advanced and a cure is not possible, surgery may still have a place to ease symptoms. For example, a stent can be inserted to ease a blocked colon. A stent is a thin metal tube which is placed through a narrowed or blocked section of colon. It can then be opened wide and remains in the colon to prevent a further blockage.

Chemotherapy and radiotherapy
One or other of these treatments may be advised depending on the site and stage of the cancer.

• Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells, or stops them from multiplying. See separate leaflet called chemotherapy for more details.
• Radiotherapy is a treatment which uses high energy beams of radiation which are focussed on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. It is most commonly used for colorectal cancer when the tumour is in the rectum. See separate leaflet called radiotherapy for more details.

When chemotherapy or radiotherapy are used in addition to surgery it is known as 'adjuvent chemotherapy' or 'adjuvent radiotherapy'. For example, following surgery you may be given a course of chemotherapy or radiotherapy. This aims to kill any cancer cells which may have spread away from the primary tumour site. Sometimes, adjuvant chemotherapy or radiotherapy is given before surgery to shrink a large tumour so that the operation to remove the tumour is easier for a surgeon to do, and is more likely to be successful.

What is the prognosis (outlook)?

Without treatment, a colorectal cancer is likely get larger, and spread to other parts of the body. However, in many cases it grows slowly and may remain confined to the lining of the colon or rectum for some months before growing through the wall of the colon or rectum, or spreading. You have a good chance of a cure if if you are diagnosed and treated when the cancer is in an early stage.

If the cancer is diagnosed when it has grown through the wall of the colon or rectum, or spread to other parts of the body, there is less chance of a cure. However, treatment can often slow down the progression of the cancer.

The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.

Screening for colorectal cancer

A screening test aims to detect a disease before it has caused symptoms and when treatment is likely to be curative. Potential screening tests for colorectal cancer include a faecal occult blood test, a colonoscopy, or a sigmoidoscopy. Newer tests such as a DNA test of cells in faeces are being developed. The test used, and how often it should be done, depends on various factors. Whatever test is used, the aim is to detect bowel polyps or early cancer in 'high risk' people because:

• If a polyp is found it can usually be removed easily during a colonoscopy.
• The outlook is good if colorectal cancer is detected and treated in an early stage.

People who may be offered routine screening for colorectal cancer include:

• Close relatives of people who developed colorectal cancer before the age of 45-50, or members of families where colorectal cancer is common in the family.
• Close relatives of people with hereditary conditions which may lead to colorectal cancer.
• People who have already had a previous colorectal cancer (which has been treated).
• Older people. Research studies have concluded all older people should be screened. In the UK a national 'Bowel Cancer Screening Programme' will be phased in from April 2006. Men and women aged 60-69 will be invited to take part in screening every two years. The screening test used will be a faecal occult blood test (described above).

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