Colorectal cancer medical therapy

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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.

## Overview[edit | edit source]

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.

## Medical Therapy[edit | edit source]

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[edit | edit source]

Neoadjuvant chemotherapy or chemoradiotherapy is recommended among patients with advanced rectal cancer.[1]

* Preoperative chemoradiotherapy is recommended for patients with clinical T3N0 or T4N0 tumors.
* T1 or T2 rectal cancer patients, with a suspicion of lymph node involvement on MRI, may also benefit from neoadjuvant chemoradiotherapy.

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]

* Increased chemotherapy related toxicity
* Difficulty of targeting specific portions of the colon via radiation (the rectum does not move as much as the colon and is easier to target)

### Adjuvant chemotherapy[edit | edit source]

Adjuvant chemotherapy is recommended for patients with advanced, node-positive, colon cancer.

### Postoperative radiotherapy[edit | edit source]

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.

### Stage specific therapy[edit | edit source]

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

### Chemotherapeutic agents[edit | edit source]

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]

#### Stage 0 & 1[edit | edit source]

Resection without the use of chemotherapy is recommended for these stages.

#### Stage 2[edit | edit source]

The main options for adjuvant chemotherapy for this stage include:

* 5-FU \+ leucovorin
* capecitabine (alone)

#### Stage 3[edit | edit source]

The main options for adjuvant chemotherapy for this stage include:

* 5-FU\+ leucovorin \+ oxaliplatin
* capecitabine \+ oxaliplatin

#### Stage 4[edit | edit source]

The most commonly used regimens include the following:

* Leucovorin \+ 5-FU \+ oxaliplatin
* Leucovorin \+ 5-FU \+ irinotecan
* Capecitabine \+ oxaliplatin
* Any of the above combinations plus either bevacizumab or cetuximab (but not both)
* 5-FU \+ leucovorin
* With or without bevacizumab
* Capecitabine
* With or without bevacizumab
* Leucovorin \+ 5-FU \+ oxaliplatin \+ irinotecan
* Irinotecan
* With or without cetuximab
* Cetuximab
* Alone
* Panitumumab
* Alone
* Regorafenib
* Alone

### Support therapies[edit | edit source]

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]

## References[edit | edit source]

1. ↑ 1.0 1.1 Ma B, Gao P, Wang H, Xu Q, Song Y, Huang X; et al. (2017). "What has preoperative radio(chemo)therapy brought to localized rectal cancer patients in terms of perioperative and long-term outcomes over the past decades? A systematic review and meta-analysis based on 41,121 patients". Int J Cancer. 141 (5): 1052–1065. doi:10.1002/ijc.30805. PMID 28560805.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
2. ↑ Cukier M, Smith AJ, Milot L, Chu W, Chung H, Fenech D; et al. (2012). "Neoadjuvant chemoradiotherapy and multivisceral resection for primary locally advanced adherent colon cancer: a single institution experience". Eur J Surg Oncol. 38 (8): 677–82. doi:10.1016/j.ejso.2012.05.001. PMID 22632848.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
3. ↑ Yasmine Samir Galal, Tarek Tawfik Amin, Abdulelah Khalid Alarfaj, Abdulaziz Abdullah Almulhim, Abdullah Abdulmohsen Aljughaiman, Abdulrhaman Khaled Almulla & Rehab Ahmed Abdelhai (2016). "Colon Cancer among Older Saudis: Awareness of Risk Factors and Early Signs, and Perceived Barriers to Screening". Asian Pacific journal of cancer prevention : APJCP. 17 (4): 1837–1846. PMID 27221862.CS1 maint: Multiple names: authors list (link)
4. ↑ Samir Pathak, Sanjay Pandanaboyana, Ian Daniels, Neil Smart & K. R. Prasad (2016). "Obesity and colorectal liver metastases: Mechanisms and management". Surgical oncology. 25 (3): 246–251. doi:10.1016/j.suronc.2016.05.021. PMID 27566030.CS1 maint: Multiple names: authors list (link)
5. ↑ Masato Watanabe, Masanori Tada, Takafumi Satomi, Daichi Chikazu, Masashi Mizumoto & Hideyuki Sakurai (2016). "Metastatic rectal adenocarcinoma in the mandibular gingiva: a case report". World journal of surgical oncology. 14 (1): 199. doi:10.1186/s12957-016-0958-6. PMID 27473859.CS1 maint: Multiple names: authors list (link)
6. ↑ Vivek Subbiah & Howard Jack West (2016). "Jaundice (Hyperbilirubinemia) in Cancer". JAMA oncology. 2 (8): 1103. doi:10.1001/jamaoncol.2016.1236. PMID 27416009.
7. ↑ [1]
8. ↑ Woźniak K, Iżycki D (2014). "Cancer: a family at risk". Prz Menopauzalny. 13 (4): 253–61. doi:10.5114/pm.2014.45002. PMC 4520372. PMID 26327863.

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