Treatment for colon and rectal cancers depend on the size and location of the tumor as well as other factors. A team of Johns Hopkins experts evaluate each patient to develop an individualized treatment plan based on the specific characteristics of the tumor. These doctors may order x-rays, ultrasound, a CT scan, and blood tests to determine the extent of the disease. This evaluation is an important step in helping the medical team design the best and most effective treatment regimen. Treatment plans may include a single therapy or combination of therapies including surgery, chemotherapy and radiation therapy.
When colon cancer is detected in an early stage, it is most commonly treated with a surgical procedure called a colectomy. The surgeon removes the part of the colon that contains the cancer as well as a small portion of surrounding normal tissue. In all but the rarest cases, the surgeon is able to reconnect the healthy sections of the colon and rectum, and bowel function soon returns to normal. If the cancer is completely removed during surgery, and pathologists determine that it was an early stage cancer, no further treatment is needed.
If surrounding tissue is found to contain any cancer cells, the doctors will likely recommend adjuvant chemotherapy. treatment with anticancer drugs. The drugs are given intravenously and/or orally and travel through the bloodstream to destroy tumor cells that may have broken away from original tumor and could begin to grow again elsewhere in the body. Sometimes chemotherapy is given prior to surgery to shrink a tumor and reduce the extent of surgery. This is called neo-adjuvant therapy. Chemotherapy is also given when the cancer has spread beyond the scope of surgery.
Surgeons at Johns Hopkins have refined surgical techniques for rectal cancer that often allow nerves and sphincter muscles to remain intact, preserving continence and sexual function, and many times eliminating the need for external waste collection pouches known as ostomies. These innovative procedures have not only saved lives but greatly enhanced the quality of life for rectal cancer patients.
Some rectal cancer patients receive radiation therapy to the pelvis and/or chemotherapy following surgery to prevent the cancer from coming back or from spreading to other surrounding tissue and organs. Chemotherapy and radiation therapy is sometimes recommended prior to surgery to decrease the size of the tumor and further decrease the need for colostomy. Hopkins doctors now use transrectal ultrasound, which allows them to evaluate the size and depth of the tumor without surgery, making it possible to determine which patients would benefit from pre-surgical treatment.
Some patients, particularly those whose tumor is very low in the rectum, may require a colostomy. A colostomy is performed when the rectal cancer invades too close to the anal sphincter muscles requiring removal of the anus. To allow solid waste to leave the body, the surgeon creates an opening in the abdomen, called a stoma. The waste is collected in a special bag that covers the stoma. After a brief adjustment, most patients return to their normal lifestyle. To help with this transition, nurses and experts known as enterostomal therapists work closely with patients to teach them how to care for their colostomy and guide and support them in returning quickly to their normal activities.
Advanced Colon and Rectal Cancer
Experts at Johns Hopkins continue to refine standard therapies and develop new ones to offer viable treatment options for all colon and rectum cancer patients. In patients with advanced colon and rectum cancer, the disease frequently has spread beyond the colon and rectum to the liver. If there are a small number of tumors in the liver, the doctor can often remove them surgically. Recent advances at Johns Hopkins in surgical techniques, anesthesia support, and intraoperative ultrasonography have significantly improved outcomes for patients undergoing liver surgery. If surgical removal is not an option, doctors may use a technique known as cryotherapy. During this surgery, a probe containing liquid nitrogen is placed on the tumors to destroy them by freezing.
Johns Hopkins researchers are studying a number of drugs with known or potential activity in the treatment of colon and rectum cancer. The researchers also participate in large national studies of new treatment approaches. These innovative therapies are available to patients who cannot be treated with surgery. For some patients, outpatient treatment with an infusion pump to provide a continuous intravenous flow of anticancer drugs is an option. Others may benefit from a chemotherapy pump surgically implanted at the tumor site to deliver anticancer drugs directly to the tumor.