Colorectal cancer Microchapters |
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Colorectal cancer medical therapy On the Web |
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To view the medical therapy of familial adenomatous polyposis (FAP), click here
To view the medical therapy of hereditary nonpolyposis colorectal cancer (HNPCC), click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[3]; Saarah T. Alkhairy, M.D.; Elliot B. Tapper, M.D.
Chemotherapy is used to reduce the likelihood of metastasis developing, shrink tumor size, and slow tumor growth. Chemotherapy is often applied after surgery (adjuvant), before surgery (neo-adjuvant), or as primary therapy if surgery is not indicated (palliative). Other therapies include radiation and support therapies.
The mainstay of treatment for colorectal cancer is surgical resection; however, chemotherapy and radiotherapy have proven to also play an important role in treatment depending on the stage at diagnosis.[1]
Neoadjuvant chemotherapy or chemoradiotherapy is recommended among patients with advanced rectal cancer.[1]
Neoadjuvant chemoradiotherapy may be used to treat locally advanced colon cancer patients; however, studies have yet to prove the effectiveness of this regimen due to:[2]
Adjuvant chemotherapy is recommended for patients with advanced, node-positive, colon cancer.
Postoperative radiotherapy is not routinely recommended for colon cancer since it could lead to radiation enteritis.
It's use among patients with rectal cancer is advised for patients with transmural invasion or local invasion to lymph nodes.
It may also be used to target metastatic tumor deposits if they compress vital structures and/or cause pain.
Radiotherapy plays a role in palliative care of colorectal cancer patients as it decreases the tumor burden in order to relieve or prevent symptoms.
The following table indicates which treatment should be performed for each stage of colorectal cancer.[3][4][5][6]
Stage | Treatment |
0 (Carcinoma in situ) | Local excision or simple polypectomy; resection + anastomosis (when the tumor is too large to remove by local excision) |
1 | Resection + anastomosis |
2 | Resection + anastomosis +/- adjuvant chemotherapy |
3 | Resection + anastomosis +/- adjuvant chemotherapy; clinical trials of new chemotherapy regimens after surgery |
4 (and recurrent colon cancer) | Local excision for tumors that have recurred; resection with or without anastomosis; surgery to remove parts of other organs where the cancer may have recurred or spread (chemotherapy can be given to shrink the tumor, radiofrequency ablation or cryosurgery for patients who can not have surgery, chemoembolization of the hepatic artery); radiation therapy or chemotherapy may be offered as palliative therapy, chemotherapy and/or targeted therapy with a monoclonal antibody or an angiogenesis inhibitor; clinical trials of chemotherapy and/or targeted therapy |
Chemotherapy is used to reduce the likelihood of metastasis developing, shrink tumor size, and slow tumor growth.
The treatments listed here have been shown in clinical trials to improve survival and/or reduce mortality rate and have been approved for use by the US Food and Drug Administration:[7]
Resection without the use of chemotherapy is recommended for these stages.
The main options for adjuvant chemotherapy for this stage include:
The main options for adjuvant chemotherapy for this stage include:
The most commonly used regimens include the following:
Cancer diagnosis very often results in an enormous change in the patient's psychological well-being.
Various support resources are available from hospitals and other agencies which provide counseling, social service support, cancer support groups, and other services.
These services help to mitigate some of the difficulties of integrating a patient's medical complications into other parts of their life.[8]