Treatment Overview

The first step in treating colorectal cancer is usually an operation to remove the tumor. Sometimes a simple operation can be done during a colonoscopy or sigmoidoscopy to remove small polyps and a small amount of tissue surrounding them. But in most cases a major operation, in which the cancer and part of the colon or rectum around it are removed, is needed. If cancer has spread to another part of your body, such as the liver, you may need more far-reaching surgery.

After the cancer has been examined under a microscope, it will be staged. Staging is a way for your doctor to tell how far, if at all, your cancer has spread. It also helps your doctor decide what your treatment should be.

There are several different types of staging systems, so it's important to ask your doctor to explain carefully what stage your cancer is in and what that means.

Cancers that have not spread beyond the colon or rectum may require only surgery. If the cancer has spread, you may need radiation therapy, chemotherapy, or both.

Initial treatment

You and your doctor will work together to decide what your treatment should be. You will consider your own preferences and your general health, but the stage of your cancer is the most important tool for choosing your treatment.

Surgery is almost always used to remove colorectal cancer. Your doctor may use one of the following types of surgery:

• Local incision. When the cancer is still just in a polyp, it will be removed during colonoscopy or sigmoidoscopy.
• Resection. If your cancer is larger, your doctor will remove the cancer and a small amount of healthy tissue. The healthy ends of the colon or rectum are then sewn back together. During this operation, your doctor will also remove some of your lymph nodes for testing.
• Resection and colostomy. Sometimes it isn't possible to rejoin the ends of the colon or rectum after the cancer is removed. Your doctor will do a colostomy and make an opening on the outside of your abdomen where waste can pass through into a colostomy bag. The colostomy may be temporary until your colon heals. Or it may be permanent if the entire lower colon or rectum was removed.

Sometimes it is possible to have laparoscopic surgery to remove the cancer. This is surgery where very small incisions are made in the belly. A tiny camera and special instruments are used to remove the cancer. For the best results, it is important to have an experienced surgeon and to have this surgery at a hospital where many of these surgeries are done.³