Colorectal Cancer Treatment

Strategies for the treatment of colorectal cancer vary, depending on the tumor’s development. Small tumors that are caught early on may be removed using minimally invasive techniques, while more advanced cancers may require extensive surgical procedures in combination with other forms of therapy.

At Moffitt Cancer Center, the cancer experts within our Gastrointestinal Oncology Program come together as a multispecialty collaborative team to assess each patient’s condition and devise a highly individualized treatment plan. This team – consisting of surgeons, medical oncologists, radiation oncologists, interventional radiologists, endoscopy specialists, supportive care specialists, and other medical professionals – meets weekly as a tumor board to monitor each patient’s progress, ensuring that every person under our care receives the most comprehensive treatment available.

Table of Contents

• Surgery
• Chemotherapy
• Radiation Therapy
• Immunotherapy
• Clinical Trials
• Side Effects
• FAQs

Colorectal Cancer Outcomes More than Double the National Average

Moffitt's goal is to attain the best possible outcomes, ensuring the highest quality of life for our patients. On average, Moffitt’s colorectal cancer treatment survival rates are nearly 2.5 times than the national average.

Outcomes

Surgery for Colorectal Cancer

Surgery is a common and often crucial treatment option for colorectal cancer. The primary goal is to remove all or as much of the tumor as possible and prevent the cancer from spreading to other parts of the body. To achieve heightened effectiveness, surgery is often combined with other treatments, such as radiation therapy and chemotherapy.

At Moffitt Cancer Center, the board-certified, fellowship-trained surgeons in the Gastrointestinal Oncology Program are skilled in performing the latest surgical techniques, including laparoscopic colon resections, anal sphincter-preserving surgeries, and HIPEC (Hyperthermic Intraperitoneal Chemotherapy).

Our multispecialty team thoroughly reviews each patient's case, carefully evaluating the location and stage of the tumor along with other unique factors to develop a truly individualized treatment plan. This comprehensive, collaborative approach ensures the best possible outcomes for our patients.

Minimally Invasive and Localized Procedures

Whenever possible, our surgeons utilize techniques that minimize the size of incisions, reduce recovery time, and preserve healthy bowel function. These procedures are typically reserved for small or early-stage tumors that have not penetrated deeply into the bowel wall or spread beyond the original site. This approach ensures the highest chance of cure with the least impact on the patient's immediate quality of life.

Transanal endoscopic microsurgery (TEM)

TEM is a minimally invasive surgical technique that can be used to remove certain rectal polyps and small, early-stage rectal tumors. During the procedure, a surgeon will insert a specialized operating scope through the anus and guide it into the rectum. The scope will provide a magnified, high-definition view of the rectal wall, allowing the surgeon to precisely remove the polyp or tumor and a slim margin of surrounding healthy tissue.

Transanal endoscopic microsurgery offers several advantages over traditional open colorectal cancer surgery, including a lower risk of surgical complications, shorter hospital stay and faster recovery.

Colectomy and Resection Procedures

These are the most common surgical procedures for colorectal cancer, involving the removal of the specific segment of the colon where the tumor is located. Our goal is always to safely remove the cancer along with a surrounding margin of healthy tissue and nearby lymph nodes, and then successfully rejoin the remaining bowel segments through a procedure called anastomosis. We frequently perform these using laparoscopic or robotic techniques.

Partial colectomy

Typically performed using minimally invasive surgical techniques, such as laparoscopy and robotic surgery, a partial colectomy involves making several small incisions in the abdomen. The surgeon will then remove the cancerous portion of the colon along with a slim margin of surrounding healthy tissue.

To restore bowel function after a partial colectomy, the surgeon may perform an anastomosis to reconnect the remaining ends of the colon. Alternatively, if anastomosis is not possible, the surgeon may perform a colostomy to create an opening (stoma) in the abdomen to allow waste to pass out of the body.

Ileocolectomy

Also known as a right colectomy, an ileocolectomy involves surgically removing part of the last segment of the small intestine (ileum) and part of the adjacent first segment of the colon (cecum). If possible, the surgeon may perform the procedure using minimally invasive surgical techniques. An ileocolectomy may be followed by an anastomosis or colostomy.

Proctosigmoidectomy (Sigmoidectomy)

A proctosigmoidectomy involves surgically removing the cancerous portion of the last segment of the colon (sigmoid colon) and the upper part of the rectum. If possible, the surgeon may perform the procedure using minimally invasive surgical techniques. A proctosigmoidectomy may be followed by an anastomosis or colostomy.

Total Removal Procedures

In cases involving widespread disease across the entire colon, certain inflammatory bowel diseases, or genetic syndromes that carry a high cancer risk, the removal of the entire large bowel may be necessary. These procedures are extensive but offer a curative option for complex conditions. Our team utilizes advanced planning to ensure the best possible post-operative quality of life, which often includes careful planning for long-term bowel management.

Total abdominal colectomy

The surgeon will remove the entire colon, including the cecum and rectum. If possible, the surgeon may perform the procedure using minimally invasive surgical techniques. A total abdominal colectomy may be followed by an anastomosis or colostomy.

Total proctocolectomy

The surgeon will remove the entire colon, rectum and possibly the anus. If possible, the surgeon may perform the procedure using minimally invasive surgical techniques. A total proctocolectomy may be followed by a permanent colostomy.

Advanced and Specialized Procedures

For patients with cancer that has advanced or spread to the lining of the abdominal cavity (peritoneum), specialized and complex treatments may be required to aggressively manage the disease. These procedures often combine the expertise of surgical oncology with advanced chemotherapy delivery methods, ensuring the highest concentration of treatment is delivered directly to the affected area.

Hyperthermic (heated) intraperitoneal chemotherapy (HIPEC)

HIPEC is a two-step procedure that may be a treatment option for colorectal cancer that has spread to the peritoneal cavity, a space in the abdomen that contains vital organs, including the stomach, liver and intestines. After removing any visible tumors, a surgical oncologist will place a heated chemotherapy solution inside the abdomen, where it will circulate for approximately 90 minutes. By helping the chemo drugs penetrate the targeted tissues, the heat can heighten the effectiveness of the treatment. Once the HIPEC procedure is complete, the surgeon will drain the chemotherapy solution from the abdomen and close the incision.

A highly specialized procedure, hyperthermic (heated) intraperitoneal chemotherapy is typically performed by a team of experienced surgeons, oncologists and other medical specialists at a high-volume cancer center.

Rectal-Specific and Complex Procedures

Surgery for cancer in the rectum is particularly sensitive due to the organ's location near the anal sphincter, which controls continence. These procedures are specifically designed to provide the best chance for cure while addressing the significant challenge of preserving natural bowel function whenever medically possible. The type of surgery used depends heavily on how close the tumor is to the anus.

Abdominoperineal resection

The surgeon will remove the sigmoid colon, rectum and anus. If possible, the surgeon may perform the procedure using minimally invasive surgical techniques. An abdominoperineal resection may be followed by a permanent colostomy.

Does colorectal cancer surgery mean I will need a colostomy bag?

Not necessarily. The need for a colostomy bag after colorectal cancer surgery depends on several factors, including the location and extent of the tumor, the type of surgery performed and the patient’s overall health. In some cases, a surgeon can remove the tumor and reconnect the remaining portions of the colon and rectum without the need for a colostomy. However, in other cases, especially if the tumor is situated low in the rectum or if there are complications during surgery, a colostomy may be necessary to divert stool temporarily or permanently.

If a colostomy is performed, waste will be collected in a small pouch connected to the colon via a stoma. A specially trained nurse (ostomy nurse) can provide detailed instructions on how to care for the stoma and colostomy bag. In some cases, a colostomy can be reversed if the ends of the intestines can be surgically reattached after healing.

If a colostomy was not performed, most patients gradually regain their normal bowel function and have a normal bowel movement within 4-5 days. During recovery, some patients experience:

• More urgent bowel movements
• More frequent bowel movements
• Bowel incontinence
• Diarrhea or constipation
• Fragmented stool (stool passed in small, intermittent episodes)
• Bowel or rectal pain

Most of these side effects are temporary and usually resolve within a few weeks.

Colorectal Cancer Chemotherapy

Many patients with colorectal cancer receive chemotherapy as part of their treatment plan. Chemotherapy works by destroying cells that multiply more rapidly than normal. This can help to shrink or eliminate colorectal tumors. However, chemotherapy is often paired with one or more other treatments, such as surgery or radiation therapy, to increase a patient’s chance of achieving remission.

Colorectal cancer chemotherapy is provided by a medical oncologist. After considering factors such as the patient’s age and the cell type of the tumor, a medical oncologist will decide:

• Which chemotherapy drugs to use (there are more than two dozen medications that can be used for the treatment of colorectal cancer, and many patients receive a custom combination of two or more medications)
• What doses of the drugs to use, and how long the chemotherapy regimen should last (most colorectal cancer chemotherapy cycles are two to four weeks in duration and repeated four to eight times)
• Whether chemotherapy should be given before surgery, after surgery, as the only form of treatment or in conjunction with other therapies (this decision is made as part of a collaborative discussion with a patient’s surgeons and radiation oncologists)

Personalized Colorectal Chemotherapy from Expert Medical Oncologists

At Moffitt Cancer Center, our medical oncologists tailor each patient’s chemotherapy plan to meet his or her unique needs. And, by working hand in hand with a patient’s other oncologists, our medical oncologists are able to design a comprehensive plan that is not only intended to eliminate as many cancerous cells as possible, but also to give the patient the best possible quality of life during treatment. Because we understand the side effects that can occur during chemotherapy, we offer supportive therapies to help manage any pain, nausea, fatigue, and other complications. For our patients’ convenience, all of our colorectal cancer treatment and supportive care options are provided in a single location.

Radiation Therapy for Colorectal Cancer

Radiation therapy can be used for colorectal cancer treatment. While it is a fairly common treatment for cancers of the rectum, it is used more sparingly for the treatment of colon cancer. Radiation therapy can be used before or after surgery and is often combined with chemotherapy. Both treatments can be given at the same time, or one right after the other.

Radiation therapy works by using highly targeted energy to destroy cancerous cells. There are several different ways that this energy can be delivered:

• During external beam radiation therapy (EBRT), radioactive beams are aimed at a tumor from a source outside the body. The most common source is a machine known as a linear accelerator. Patients typically undergo several EBRT sessions a week for a period of several weeks.
• During internal radiation therapy (also known as brachytherapy), radioactive implants are inserted into (or near) the tumor. These implants may be designed to dissolve after they have finished treating the tumor, or they can be removed after treatment is complete.
• During systemic radiation therapy, radioactive medications are swallowed or injected into a patient’s body, where they can travel through the bloodstream to destroy cancerous cells.

The Expert Team Behind Your Personalized Radiation Treatment

At Moffitt Cancer Center, each patient’s radiation therapy plan is tailored to his or her specific needs by a multispecialty team of oncologists. This team includes radiation oncologists, who design the treatment plan; radiation therapists, who operate the machinery used to deliver the radiation therapy; dosimetrists, who program this machinery; and a number of other physicists, nurses and supportive care specialists who ensure treatment is properly planned and carried out. It is not only the technological advancements that we offer, but the experience and skill of this team, that enables us to produce the best possible outcomes and improve each patient’s quality of life during treatment.

Immunotherapy for Colorectal Cancer

Immunotherapy is sometimes used for treating advanced colorectal cancer. This innovative treatment involves using medication that boosts the patient’s immune system, helping it to more effectively find and destroy cancer cells. Immunotherapy may be implemented when chemotherapy does not stop a tumor’s growth or if a tumor can’t be successfully removed with surgery. It may also be a treatment option when cancer recurs or metastasizes (spreads to other areas).

Immune checkpoint inhibitors for colorectal cancer patients

There are several types of immunotherapy that help the immune system fight cancer in different ways, and one with FDA-approved options for colorectal cancer is known as immune checkpoint inhibitors. The immune system depends on “checkpoint” proteins to distinguish harmful cells from healthy ones, using them to trigger an immune response when needed. However, cancer cells can manipulate these checkpoints, effectively switching them off to avoid being detected and attacked. Checkpoint inhibitors work by blocking this interference, turning the checkpoints back on so the immune system can properly recognize and target cancer cells.

There are two immune checkpoint inhibitors that may be used for colorectal cancer: nivolumab (Opdivo®) and pembrolizumab (Keytruda®). These immunotherapies are PD-1 inhibitors, meaning that they target the PD-1 protein on the immune system’s T cells. By blocking this protein, the immune system is able to find and attack cancer cells in the body. Another immunotherapy that is sometimes used for colorectal cancer is ipilimumab (Yervoy®), which targets a different protein on T cells: CTLA-4.

Potential side effects of colorectal cancer immunotherapy

The use of checkpoint inhibitors can cause side effects such as:

• Fatigue
• Joint pain
• Coughing
• Nausea
• Itching or skin rashes
• Decreased appetite
• Constipation or diarrhea

In some cases, the immune system may begin attacking noncancerous cells in other parts of the body, resulting in other side effects of the lungs, liver, kidneys, intestines or other organs. The side effects in these cases can sometimes be serious, so it’s important to always inform your physicians of any changes in your side effects.

Clinical Trials and Breakthrough Colorectal Cancer Research

At Moffitt Cancer Center, our commitment to research means we are continually finding better ways to fight colorectal cancer. Our robust clinical trials offer access to advanced therapies, including promising new targeted drugs, immunotherapies, and innovative treatment combinations specifically for colorectal cancer that are often unavailable anywhere else. Considering a clinical trial is a vital part of exploring every available option, as these studies are critical for improving patient outcomes and setting new standards in the field.

Managing the Side Effects of Colorectal Cancer Treatment

As with any intensive therapy, it is common to experience side effects during and after colorectal cancer treatment. We want you to know that managing these effects is an essential and expected part of your recovery, not just something to endure. By working closely with your care team and utilizing effective management strategies, you can maintain your quality of life throughout the process. Below are five common side effects and proven ways to help manage them.

• Change in bowel function – Eating smaller, more frequent meals and drinking plenty of fluids can help with constipation. For diarrhea, certain foods, such as bananas, mashed potatoes and marshmallows may help.
• Nausea/vomiting – It may help to start with bland foods and avoid caffeine and alcohol until these side effects subside.
• Loss of appetite – Similar to the recommendations above, smaller and more frequent meals that include mostly bland foods may be easier to tolerate if you have lost your appetite.
• Tiredness/fatigue – It is important to take it slow during your recovery and plan to take frequent breaks as needed until you have regained some strength.
• Numbness/tingling – Also called peripheral neuropathy, tingling in the extremities or an inability to handle heat or cold can occur following colorectal cancer treatment. Eating foods and drinking fluids at room temperature may be helpful.

Are there medications that can help with my side effects?

In many cases, your physician can prescribe a medication that can help with a specific side effect. Therefore, it is important to communicate fully with your physician about any side effects you are experiencing following your treatment. This can also help your physician identify possible signs of complications earlier in the recovery.

Answers to Your Colorectal Cancer Treatment Questions

Starting colorectal cancer treatment brings many questions. To help you feel informed and prepared, we've gathered answers to some of the most frequently asked questions about treatment goals, planning, specific therapies, and long-term follow-up care.

• What is the primary goal of colorectal cancer treatment?
  
  • The main goal is typically to remove the cancer completely, prevent its spread (recurrence), and preserve as much normal bowel function as possible, ultimately aiming for a cure or long-term disease control.
• What factors determine the best treatment plan for me?
  
  • Treatment is highly individualized and depends on the stage of the cancer (how far it has spread), the cancer's location (colon or rectum), the patient's overall health, and any relevant genetic or molecular markers of the tumor.
• What are the main types of treatment for colorectal cancer?
  
  • The main treatment types are surgery, chemotherapy, radiation therapy (especially for rectal cancer), and targeted therapy or immunotherapy. These are often used in combination.
• What is involved in post-treatment follow-up care?
  • Follow-up care typically includes regular visits, blood tests (like the CEA marker), colonoscopies, and CT scans to monitor for recurrence. The schedule is intense initially and gradually lessens over five years.
• What is the typical long-term prognosis for colorectal cancer?
  • Prognosis is highly dependent on the stage at diagnosis. Cancers caught in the early stages often have excellent long-term survival rates. Advances in chemotherapy, targeted therapy, and surgical techniques continue to improve outcomes across all stages.
• Are there any dietary or lifestyle changes I should make after treatment?
  • Yes, maintaining a healthy weight, regular physical activity, and a diet rich in fruits, vegetables, and whole grains are generally recommended to promote overall health and may help reduce the risk of recurrence. Specific dietary needs can be addressed with an oncology dietitian.

Connect with Moffitt's Colorectal Cancer Experts Today

Moffitt Cancer Center is nationally recognized for our commitment to research and delivering highly personalized treatment for colorectal cancer. Our dedicated Gastrointestinal Oncology Program brings together specialists in surgery, medical oncology, and radiation to design targeted plans that focus on curing the disease, managing side effects, and preserving long-term quality of life.

We do not require a referral to consult our colorectal cancer treatment team. Contact Moffitt Cancer Center by calling 1-888-663-3488 or filling out our new patient registration form.

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