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Rectal Cancer: Treatments

Treatment for 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.

Chemotherapy for Localized Rectal Cancer

Chemotherapy for rectal cancer patients is usually provided as part of a larger treatment plan that involves surgery and radiation treatments. For some rectal cancer patients, chemotherapy is used along with radiation therapy before surgery to shrink a tumor, so that surgeons do not have to remove too much of the tissue, blood vessels, and nerves that surround the tumor. Sparing these tissues can help patients recover faster and maintain their ability to pass fecal matter.

Chemotherapy may also be given to patients after surgery, for up to six months, to kill off any cancer cells that may have been left behind after surgery. This type of chemotherapy is sometimes called adjuvant chemotherapy. According to Nilofer Azad, M.D., an associate professor of oncology at Johns Hopkins and a medical oncologist specializing in gastrointestinal cancers, researchers continue to study whether adjuvant chemotherapy is needed for all patients. She suggests that rectal cancer patients discuss this treatment with their physicians so that they can decide together on the best course of therapy.

Some of the main chemotherapy drugs, used alone or in combination, for treating rectal cancer include:

  • fluorouracil (5-FU)
  • leucovorin
  • oxaliplatin
  • capecitabine (Xeloda)

Chemotherapy and Immunotherapy for Metastatic Rectal Cancer Patients

Patients with metastatic, or stage IV rectal cancer, are also likely to receive chemotherapy for their primary and metastatic cancers, before and after surgery. These patients receive many of the same treatments as patients with metastatic colon cancer. They may also be eligible for clinical trials at Johns Hopkins that are primarily focused on colon cancer patients.

A recent clinical trial by Johns Hopkins researchers has suggested that an immunotherapy drug called pembrolizumab (Keytruda) may be very effective for metastatic advanced colorectal cancer in patients that have the genetic biomarker of high microsatellite instability.

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.

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