Colon-cancer.org

DO NOT USE COLON HYDROTHERAPY FOR TREATING COLON CANCER UNLESS SPECIFICALLY INSTRUCTED TO DO SO BY A LICENSED PHYSICIAN

SURGERY

Surgical removal of the involved anatomic segment of colon (colectomy) along with its blood supply and regional lymph nodes is the primary therapy for colon cancer. Usually, on the basis of the blood supply, the partial colectomies are separated into right, left, transverse, or sigmoid. The removal of the blood supply at its origin along with the regional lymph nodes that accompany it assures an adequate margin of normal colon on either side of the primary tumor. When the cancer lies in a position such that the blood supply and lymph drainage lies between two of the major vessels, both vessels are taken to assure complete radical resection, or removal (extended radical right or left colectomy). If the primary tumor penetrates through the bowel wall, any tissue adjacent to the tumor extension is also taken if feasible.
Surgery is used as primary therapy for stages I through III colon cancer unless there are signs that local invasion will not permit complete removal of the tumor, as may occur in advanced stage III tumors. However, this circumstance is very rare, and occurs in less than 2% of all colon cancer cases.
After the resection is completed, the ends of the remaining colon are reconstructed; the hook-up is called an anastomosis. Once healing has occurred, there may be a slight increase in the frequency of bowel movements. This effect usually lasts only for several weeks. Most patients go on to develop completely normal bowel function.

Occasionally, the anastomosis would be risky and cannot be performed. (Most commonly, this occurs when the bowel could not be adequately evacuated in an emergency circumstance due to bowel obstruction.) When the anastomosis cannot be performed, a colostomy is performed instead. A colostomy is performed by bringing the end of the colon through the abdominal wall and sewing it to the skin. The patient will have to wear an appliance (a bag) to manage the stool. The colostomy may be temporary and the patient may undergo a hookup at a later, safer date, or the colostomy may be permanent. In most cases, emergent colostomies are not reversed and are permanent.

RADIATION

Radiation therapy is used as an adjunct to surgery if there is concern about potential for local recurrence post-operatively and the area of concern will tolerate the radiation. For instance, if the tumor invaded muscle of the abdominal wall but was not completely removed, this area would be considered for radiation. Radiation has significant dose limits when residual bowel is exposed to it because the small and large intestine do not tolerate radiation well.
Radiation is also used in the treatment of patients who present with or progress to having metastatic disease. It is particularly useful in shrinking metastatic colon cancer to the brain.

CHEMOTHERAPY

Chemotherapy is useful for patients who have had all identifiable tumor removed and are at risk for recurrence (adjuvant chemotherapy). Chemotherapy may also be used when the cancer is stage IV and is beyond the scope of regional therapy, but this use is rare.
Adjuvant therapy is considered in stage II disease with deep penetration or in stage III patients. Standard therapy is treatment with fluorouracil, (5FU) combined with leucovorin for a period of 6 to 12 months. 5FU is an antimetabolite and leukovorin improves the response rate. (A response is a temporary regression of the cancer in response to the chemotherapy.) Another agent, levamisole, (which seems to stimulate the immune system), may be substituted for leucovorin. These protocols reduce rate of recurrence by about 15% and reduce mortality by about 10%. The regimens do have some toxicity but usually are tolerated fairly well.

Similar chemotherapy may be administered for stage IV disease or if a patient progresses and develops metastases. Results show response rates of about 20%. Unfortunately, these patients eventually succumb to the disease, and this chemotherapy may not prolong survival or improve quality of life in Stage IV patients. Clinical trials have now shown that the results can be improved with the addition of another agent to this regimen. Irinotecan does not seem to increase toxicity but it improved response rates to 39%, added 2-3 months to disease-free survival, and prolonged overall survival by a little over two months.

Prognosis

Prognosis is the long-term outlook or survival after therapy. Overall, about 50% of patients treated for colon cancer survive the disease. As expected, the survival rates are dependent upon the stage of the cancer at the time of diagnosis, making early detection a very worthwhile endeavor.
About 15% of patients present with stage I disease and 85-90% survive. Stage II represents 20-30% of cases and 65-75% survive. 30-40% comprise the stage III presentation of which 55% survive. The remaining 20-25% present with stage IV disease and are very rarely cured.

Alternative and complementary therapies
Alternative therapies have not been studied in a large-scale, scientific way. Large doses of vitamins, fiber, and green tea are among therapies tried. Avoiding cigarettes and alcohol may be helpful. Before initiating any alternative therapies, the patient is wise to consult his/her physician to be sure that these therapies do not complicate or interfere with the established therapy.

Coping with cancer treatment

For those with familial syndromes causing colon cancer, genetic counseling may be appropriate. Psychological counseling may be appropriate for anyone having trouble coping with a potentially fatal disease. Local cancer support groups may be helpful and are often identified by contacting local hospitals or the American Cancer Society.
The Colon Cancer Alliance offers internet online support at the following web page: <http://www.ccalliance.org/connect/support.html>.

Clinical trials

Clinical trials are scientific studies in which new therapies are compared to current standards in an effort to identify therapies that give better results.
Agents being tested for efficacy in patients with advanced disease include oxaliplatin and CPT-11. Please see reference below for current information available from the National Cancer Institute regarding these clinical trials.

DO NOT USE COLON HYDROTHERAPY FOR TREATING COLON CANCER UNLESS SPECIFICALLY INSTRUCTED TO DO SO BY A LICENSED PHYSICIAN

Colon Cancer Prevention

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